atop-ics and patients with anaphylaxis. Our findings showed that atop-ics, healthy controls and patients with non- life- threatening allergic reactions had gene polymorphisms consistent with increased activity of angiotensin II. Patients with life- threatening anaphylaxis involving airway angioedema and cardiovascular collapse had gene polymorphisms for low AII activity that could encourage higher eNO activity and shock in anaphylaxis. Single gene analysis, bi- allelic and tri- allelic ensembles of these genes confirmed highly significant differences in gene frequency between these groups. This may offer further understanding of AII and eNO effects on microcirculation in anaphylaxis. life (relevant FAQLQ for specific population) (Penn State Worry Questionnaire) at baseline, 1- and 3- month post- intervention. A total of 129 participants ( n = 33 parents, n = 44 adults and n = 52 children) were recruited and randomized to the intervention or control groups, and 100 ( n = 26 parents, n = 40 adults and n = 34 children) were at the 1- month follow- up. Group CBT reduced impairment in FAQLQ in all populations and reduced levels of worry in the parent group. This study provides encouraging findings regarding the feasibility of brief, online, group CBT in terms of recruitment and retention and a preliminary short- term signal of efficacy on FA quality of life.
{"title":"Prize‐winning abstracts from BSACI/WAO 2022 meeting","authors":"M. Shamji, R. Boyle, G. Roberts","doi":"10.1111/cea.14184","DOIUrl":"https://doi.org/10.1111/cea.14184","url":null,"abstract":"atop-ics and patients with anaphylaxis. Our findings showed that atop-ics, healthy controls and patients with non- life- threatening allergic reactions had gene polymorphisms consistent with increased activity of angiotensin II. Patients with life- threatening anaphylaxis involving airway angioedema and cardiovascular collapse had gene polymorphisms for low AII activity that could encourage higher eNO activity and shock in anaphylaxis. Single gene analysis, bi- allelic and tri- allelic ensembles of these genes confirmed highly significant differences in gene frequency between these groups. This may offer further understanding of AII and eNO effects on microcirculation in anaphylaxis. life (relevant FAQLQ for specific population) (Penn State Worry Questionnaire) at baseline, 1- and 3- month post- intervention. A total of 129 participants ( n = 33 parents, n = 44 adults and n = 52 children) were recruited and randomized to the intervention or control groups, and 100 ( n = 26 parents, n = 40 adults and n = 34 children) were at the 1- month follow- up. Group CBT reduced impairment in FAQLQ in all populations and reduced levels of worry in the parent group. This study provides encouraging findings regarding the feasibility of brief, online, group CBT in terms of recruitment and retention and a preliminary short- term signal of efficacy on FA quality of life.","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81606692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hiroyuki Arai, H. Kouzaki, T. Murao, Keigo Nakamura, Kento Kawakita, Koji Matsumoto, H. Kikuoka, A. Yuta, Takeshi Shimizu
{"title":"Sublingual immunotherapy with Japanese cedar pollen extract induces apoptosis of memory CD4+ T cells","authors":"Hiroyuki Arai, H. Kouzaki, T. Murao, Keigo Nakamura, Kento Kawakita, Koji Matsumoto, H. Kikuoka, A. Yuta, Takeshi Shimizu","doi":"10.1111/cea.14183","DOIUrl":"https://doi.org/10.1111/cea.14183","url":null,"abstract":"","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82362047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Hakl, P. Kuklínek, Marta Sobotková, I. Krčmová, P. Kralickova, M. Vachová, J. Hanzlíková, Martina Nováčková, M. Svoboda, I. Kováčová, J. Litzman
To the editor, Hereditary angioedema (HAE) is a rare condition which manifests as repeated episodes of localized subcutaneous or submucosal oedema.1 Oedemas involving the upper airways carry the risk of asphyxiation and death. The aim of this study was to present our clinical experience of icatibant and C1 inhibitor use for treating HAE1/2 laryngeal attacks (LA). To our knowledge, this is the first direct comparison of these treatment approaches for LA. A retrospective patient record analysis was performed. Data were collected from the Czech national registry of primary immunodeficiencies, where all known diagnosed HAE patients in Czechia are registered. Data collected between March 2012 and December 2019 were analysed. The attacks were recorded on paper diaries and reported by e-mail, then validated by attending doctors during patients' visits and entered electronically in the registry. Repeated dose/therapy was defined as using the same or another drug within 48 h after the first treatment. Generalized estimating equation (GEE) was used to evaluate differences between treatments with adjustment for potential dependencies among time courses of LA from one individual. Attacks that had missing data on the modelled time courses were excluded from the individual analysis. All analyses were conducted using R version 4.0.4 R Core Team (2021).2 Data from 180 HAE patients (153 HAE1; 26 HAE2; and 1 HAEnC1INH) were available. A total of 5690 attacks were recorded in 153 patients, of which 499 (8.8%) were laryngeal attacks, occurring in 66 patients (40 females and 26 males; 54 HAE1 and 12 HAE2). Another attack location was present in 217 LA, median age at LA was 43.2 (range 5.0– 74.7) years, and triggers were identified in 24.4% of LA (Table 1). Almost all LA (497, 99.6%) were actively treated. Drug use was not randomized but was influenced by patient preference and HAE centre experience. Most attacks, 345 (69.4%), were treated with icatibant (Firazyr®), 94 (18.9%) attacks with recombinant human C1INH (rhC1 INH, Ruconest®), 52 (10.5%) attacks with plasmaderived, pasteurized, nanofiltered C1INH (pnfC1INH, Berinert®) and 2 (0.4%) attacks with plasmaderived, nanofiltered C1INH (nfC1INH, Cynrize®). Because only 2 LA were treated with nfC1INH, the data were not analysed. Three attacks were treated with attenuated androgens and one with fresh frozen plasma, which were also excluded from analysis. In our study, fixed drug doses were used Firazyr® (30 mg), Ruconest® 2100 U 1– 2 vials (median dose 2100 U, range 2100– 4200 U) and Berinert® 500 IU 1– 2 vials (median dose 1000 IU, range 500– 1000 IU). Fortythree patients (65%) with a LA were on longterm prophylaxis (LTP) at the time of the attacks. Two hundred seven (41.6%) LA occurred despite LTP with C1INH (rhC1INH 34 attacks in 2 patients, pnfC1INH 31 attacks in 4 patients), attenuated androgens (119 attacks in 37 patients) and tranexamic acid (58 attacks in 37 patients). In 35 attacks, the patients had been using
{"title":"Registry‐based analysis of Icatibant and C1‐inhibitor use in treatment of laryngeal attacks of hereditary angioedema","authors":"R. Hakl, P. Kuklínek, Marta Sobotková, I. Krčmová, P. Kralickova, M. Vachová, J. Hanzlíková, Martina Nováčková, M. Svoboda, I. Kováčová, J. Litzman","doi":"10.1111/cea.14182","DOIUrl":"https://doi.org/10.1111/cea.14182","url":null,"abstract":"To the editor, Hereditary angioedema (HAE) is a rare condition which manifests as repeated episodes of localized subcutaneous or submucosal oedema.1 Oedemas involving the upper airways carry the risk of asphyxiation and death. The aim of this study was to present our clinical experience of icatibant and C1 inhibitor use for treating HAE1/2 laryngeal attacks (LA). To our knowledge, this is the first direct comparison of these treatment approaches for LA. A retrospective patient record analysis was performed. Data were collected from the Czech national registry of primary immunodeficiencies, where all known diagnosed HAE patients in Czechia are registered. Data collected between March 2012 and December 2019 were analysed. The attacks were recorded on paper diaries and reported by e-mail, then validated by attending doctors during patients' visits and entered electronically in the registry. Repeated dose/therapy was defined as using the same or another drug within 48 h after the first treatment. Generalized estimating equation (GEE) was used to evaluate differences between treatments with adjustment for potential dependencies among time courses of LA from one individual. Attacks that had missing data on the modelled time courses were excluded from the individual analysis. All analyses were conducted using R version 4.0.4 R Core Team (2021).2 Data from 180 HAE patients (153 HAE1; 26 HAE2; and 1 HAEnC1INH) were available. A total of 5690 attacks were recorded in 153 patients, of which 499 (8.8%) were laryngeal attacks, occurring in 66 patients (40 females and 26 males; 54 HAE1 and 12 HAE2). Another attack location was present in 217 LA, median age at LA was 43.2 (range 5.0– 74.7) years, and triggers were identified in 24.4% of LA (Table 1). Almost all LA (497, 99.6%) were actively treated. Drug use was not randomized but was influenced by patient preference and HAE centre experience. Most attacks, 345 (69.4%), were treated with icatibant (Firazyr®), 94 (18.9%) attacks with recombinant human C1INH (rhC1 INH, Ruconest®), 52 (10.5%) attacks with plasmaderived, pasteurized, nanofiltered C1INH (pnfC1INH, Berinert®) and 2 (0.4%) attacks with plasmaderived, nanofiltered C1INH (nfC1INH, Cynrize®). Because only 2 LA were treated with nfC1INH, the data were not analysed. Three attacks were treated with attenuated androgens and one with fresh frozen plasma, which were also excluded from analysis. In our study, fixed drug doses were used Firazyr® (30 mg), Ruconest® 2100 U 1– 2 vials (median dose 2100 U, range 2100– 4200 U) and Berinert® 500 IU 1– 2 vials (median dose 1000 IU, range 500– 1000 IU). Fortythree patients (65%) with a LA were on longterm prophylaxis (LTP) at the time of the attacks. Two hundred seven (41.6%) LA occurred despite LTP with C1INH (rhC1INH 34 attacks in 2 patients, pnfC1INH 31 attacks in 4 patients), attenuated androgens (119 attacks in 37 patients) and tranexamic acid (58 attacks in 37 patients). In 35 attacks, the patients had been using ","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78287771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
allergy is the most common food- related trigger of anaphy-lactic reactions in the United States and some other countires. 1 Probiotic and Peanut Oral Immunotherapy (PPOIT) was shown to be effective at inducing desensitization and promoting sustained unresponsiveness (SU), however, there is an apparent lack of data on the long- term effectiveness and safety. 2 Hsiao and colleagues aimed to evaluate the mechanism by which PPOIT altered peanut- specific humoral immunity and how these mechanisms relate to SU induction. 3– The study is a double- blinded placebo- controlled randomized trial that included 62 children with peanut allergy. Plasma levels of whole peanut and peanut components were measured, along with specific- IgE (sIgE) and specific- IgG4 (sIgG4) using ImmunoCAP, in addition to measuring salivary peanut- specific- IgA (sIgA) quantified by ELISA. sIgE levels were significantly reduced post treatment, while sIgG4 levels, like sIgA levels, were significantly increased by end- of- treatment, but were lowered to placebo levels once treatment stopped. This study was the first to evaluate the long- term immunologic effects of PPOIT and resulted in two main novel find-ings. The first being that peanut and peanut component sIgG4 levels were directly proportional to the amount of peanut ingested post-treatment; increased peanut sIgG4 levels being reflective of an ac-tive allergen exposure. The second observation was that peanut and peanut component sIgG4 levels were significantly lower in subjects with persistent SU compared to those without. The study also pro-vides evidence on the important role that allergen specific- IgE plays in the attainment and persistence of SU. The authors highlighted intrapulmonal cellular and humoral inflammatory pattern in patients with humoral immunodeficiency associated with lung function parameters. This is mirrored by gene regulation and secretion of proinflammatory secreted mediators IL- 1 β , IL- 6, CXCL- 8 and TNF- α , which were induced in lower airway cells along with local neutrophil counts. In addition, bronchiectasis- related airway dysfunction was associated with higher levels of proinflammatory cell load and increased levels of proinflammatory- secreted mediators IL- 1 β , IL- 6, CXCL- 8 and TNF- α .
{"title":"Biomarkers of airway inflammation and immunotherapy","authors":"M. Shamji, R. Boyle","doi":"10.1111/cea.14174","DOIUrl":"https://doi.org/10.1111/cea.14174","url":null,"abstract":"allergy is the most common food- related trigger of anaphy-lactic reactions in the United States and some other countires. 1 Probiotic and Peanut Oral Immunotherapy (PPOIT) was shown to be effective at inducing desensitization and promoting sustained unresponsiveness (SU), however, there is an apparent lack of data on the long- term effectiveness and safety. 2 Hsiao and colleagues aimed to evaluate the mechanism by which PPOIT altered peanut- specific humoral immunity and how these mechanisms relate to SU induction. 3– The study is a double- blinded placebo- controlled randomized trial that included 62 children with peanut allergy. Plasma levels of whole peanut and peanut components were measured, along with specific- IgE (sIgE) and specific- IgG4 (sIgG4) using ImmunoCAP, in addition to measuring salivary peanut- specific- IgA (sIgA) quantified by ELISA. sIgE levels were significantly reduced post treatment, while sIgG4 levels, like sIgA levels, were significantly increased by end- of- treatment, but were lowered to placebo levels once treatment stopped. This study was the first to evaluate the long- term immunologic effects of PPOIT and resulted in two main novel find-ings. The first being that peanut and peanut component sIgG4 levels were directly proportional to the amount of peanut ingested post-treatment; increased peanut sIgG4 levels being reflective of an ac-tive allergen exposure. The second observation was that peanut and peanut component sIgG4 levels were significantly lower in subjects with persistent SU compared to those without. The study also pro-vides evidence on the important role that allergen specific- IgE plays in the attainment and persistence of SU. The authors highlighted intrapulmonal cellular and humoral inflammatory pattern in patients with humoral immunodeficiency associated with lung function parameters. This is mirrored by gene regulation and secretion of proinflammatory secreted mediators IL- 1 β , IL- 6, CXCL- 8 and TNF- α , which were induced in lower airway cells along with local neutrophil counts. In addition, bronchiectasis- related airway dysfunction was associated with higher levels of proinflammatory cell load and increased levels of proinflammatory- secreted mediators IL- 1 β , IL- 6, CXCL- 8 and TNF- α .","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91353936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Mehta, H. Allen, D. Campbell, Karoline Fagerli Arntsen, M. Simpson, R. Boyle
Excessive use of specialized formula for cow's milk allergy was reported in England, but complete analysis has not been undertaken and trends in other countries are unknown. Some specialized formula products, especially amino‐acid formula (AAF), have high free sugars content. We evaluated specialized formula trends in countries with public databases documenting national prescription rates.
{"title":"Trends in use of specialized formula for managing cow's milk allergy in young children","authors":"S. Mehta, H. Allen, D. Campbell, Karoline Fagerli Arntsen, M. Simpson, R. Boyle","doi":"10.1111/cea.14180","DOIUrl":"https://doi.org/10.1111/cea.14180","url":null,"abstract":"Excessive use of specialized formula for cow's milk allergy was reported in England, but complete analysis has not been undertaken and trends in other countries are unknown. Some specialized formula products, especially amino‐acid formula (AAF), have high free sugars content. We evaluated specialized formula trends in countries with public databases documenting national prescription rates.","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"41 1","pages":"839 - 847"},"PeriodicalIF":0.0,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74587058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Allen, Ursula Pendower, M. Santer, M. Groetch, Mitchell Cohen, S. Murch, H. Williams, D. Munblit, Y. Katz, Neeraj Gupta, S. Adil, Justine Baines, E. D. Bont, M. Ridd, Victoria L. Sibson, A. McFadden, J. Koplin, Josephine Munene, M. Perkin, S. Sicherer, R. Boyle
There is significant overdiagnosis of milk allergy in young children in some countries, leading to unnecessary use of specialized formula. This guidance, developed by experts without commercial ties to the formula industry, aims to reduce milk allergy overdiagnosis and support carers of children with suspected milk allergy.
{"title":"Detection and management of milk allergy: Delphi consensus study","authors":"H. Allen, Ursula Pendower, M. Santer, M. Groetch, Mitchell Cohen, S. Murch, H. Williams, D. Munblit, Y. Katz, Neeraj Gupta, S. Adil, Justine Baines, E. D. Bont, M. Ridd, Victoria L. Sibson, A. McFadden, J. Koplin, Josephine Munene, M. Perkin, S. Sicherer, R. Boyle","doi":"10.1111/cea.14179","DOIUrl":"https://doi.org/10.1111/cea.14179","url":null,"abstract":"There is significant overdiagnosis of milk allergy in young children in some countries, leading to unnecessary use of specialized formula. This guidance, developed by experts without commercial ties to the formula industry, aims to reduce milk allergy overdiagnosis and support carers of children with suspected milk allergy.","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"52 1","pages":"848 - 858"},"PeriodicalIF":0.0,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82683476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Kim, Dong Chan Kim, Young Woong Choi, Eun-So Lee, J. Choi
To the Editor, Chronic spontaneous urticaria (CSU) is a common skin disorder characterized by recurrent wheals and pruritus lasting more than 6 weeks; its prevalence tends to increase every year.1 Moreover, CSU can be a considerable social burden for patients and can substantially impair the quality of life, because of its longterm nature and unpredictable symptoms.1 Although various factors are associated with CSU occurrence, idiopathic cases account for approximately 80% of all CSU cases.2 General anaesthesia (GA) is associated with nonallergic disorders as well as various allergic disorders3; previous mastocytosis or chronic urticaria is a known risk factor for severe complications of GA.4 However, the longterm effects of GA exposure on these allergic disorders have not been evaluated, and the relationship between GA and CSU remains unclear. Thus, we conducted a retrospective cohort study to determine whether the risk of CSU increases after exposure to GA using Korean National Health Insurance Service national sample cohort data from 2002 to 2015.5 We included individuals exposed (n = 145,903) and unexposed (n = 291,806; control participants) to GA (1:2 ratio). Diagnosis of the sample cohort was based on the International Classification of Diseases, Tenth Revision (ICD10). We divided GA exposure into intravenous injection, endotracheal tube, and mask anaesthesia, and the total duration of GA was calculated. To reduce selection bias, we set the first 2 years (2002– 2003) as the washout period, and those with diagnostic codes of CSU (L501, L508, and L509) before the first recorded exposure to GA in the study period were excluded. For the GA participants, the observation began on the day of the first exposure (cohort entry date). In order to obtain a nonGA cohort, age group(within 5 years), sex, and income, cohort entry datematched controls that were unexposed to GA were randomly selected in a 1:2 ratio. We followed up both cohorts for 2 years from the cohort entry dates to the day when the diagnostic code of urticaria was first assigned during CSU treatment, or to death, emigration, or December 2015 (the date of the last followup of the sample cohort), whichever came first. Participants with subsequent CSU were defined as those who had (1) more than two ICD10 diagnostic codes of CSU, (2) more than 6 weeks of medical claims records for CSU, and (3) more than 6 weeks of a history of antihistamine prescription for treating CSU. Moreover, the CSUrelated treatment record of each patient was collected even after the end of the followup to investigate the differences in the clinical features of CSU such as disease duration and frequency of systemic treatment in both groups. The Kaplan– Meier method and a Cox proportionalhazard regression model were used to obtain survival curves and hazard ratios (HRs). The Cox proportionalhazards assumption of proportionality was also checked using Schoenfeld residuals. The results were considered statistically signif
同样，根据年龄分层的多变量Cox回归分析显示，GA暴露显著增加了老年人群CSU的风险。
{"title":"Association of chronic spontaneous urticaria with the first exposure to general anaesthesia","authors":"J. Kim, Dong Chan Kim, Young Woong Choi, Eun-So Lee, J. Choi","doi":"10.1111/cea.14177","DOIUrl":"https://doi.org/10.1111/cea.14177","url":null,"abstract":"To the Editor, Chronic spontaneous urticaria (CSU) is a common skin disorder characterized by recurrent wheals and pruritus lasting more than 6 weeks; its prevalence tends to increase every year.1 Moreover, CSU can be a considerable social burden for patients and can substantially impair the quality of life, because of its longterm nature and unpredictable symptoms.1 Although various factors are associated with CSU occurrence, idiopathic cases account for approximately 80% of all CSU cases.2 General anaesthesia (GA) is associated with nonallergic disorders as well as various allergic disorders3; previous mastocytosis or chronic urticaria is a known risk factor for severe complications of GA.4 However, the longterm effects of GA exposure on these allergic disorders have not been evaluated, and the relationship between GA and CSU remains unclear. Thus, we conducted a retrospective cohort study to determine whether the risk of CSU increases after exposure to GA using Korean National Health Insurance Service national sample cohort data from 2002 to 2015.5 We included individuals exposed (n = 145,903) and unexposed (n = 291,806; control participants) to GA (1:2 ratio). Diagnosis of the sample cohort was based on the International Classification of Diseases, Tenth Revision (ICD10). We divided GA exposure into intravenous injection, endotracheal tube, and mask anaesthesia, and the total duration of GA was calculated. To reduce selection bias, we set the first 2 years (2002– 2003) as the washout period, and those with diagnostic codes of CSU (L501, L508, and L509) before the first recorded exposure to GA in the study period were excluded. For the GA participants, the observation began on the day of the first exposure (cohort entry date). In order to obtain a nonGA cohort, age group(within 5 years), sex, and income, cohort entry datematched controls that were unexposed to GA were randomly selected in a 1:2 ratio. We followed up both cohorts for 2 years from the cohort entry dates to the day when the diagnostic code of urticaria was first assigned during CSU treatment, or to death, emigration, or December 2015 (the date of the last followup of the sample cohort), whichever came first. Participants with subsequent CSU were defined as those who had (1) more than two ICD10 diagnostic codes of CSU, (2) more than 6 weeks of medical claims records for CSU, and (3) more than 6 weeks of a history of antihistamine prescription for treating CSU. Moreover, the CSUrelated treatment record of each patient was collected even after the end of the followup to investigate the differences in the clinical features of CSU such as disease duration and frequency of systemic treatment in both groups. The Kaplan– Meier method and a Cox proportionalhazard regression model were used to obtain survival curves and hazard ratios (HRs). The Cox proportionalhazards assumption of proportionality was also checked using Schoenfeld residuals. The results were considered statistically signif","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80292173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Bobrowska-Korzeniowska, P. Majak, A. Brzozowska, K. Polańska, D. Kaleta, K. Smejda, E. Mospinek, W. Stelmach, J. Jerzyńska
development of respiratory diseases in paediatric population. What is more, we confirmed that the specific VOC profile may reflects the activity of the epithelium and the ecosystem of local bacteria and identifies children vulnerable to the adverse effects of the urban environment.
{"title":"Cluster analysis of exhaled volatile organic compounds (VOCs)—link between environmental exposure and asthma in preschool children","authors":"M. Bobrowska-Korzeniowska, P. Majak, A. Brzozowska, K. Polańska, D. Kaleta, K. Smejda, E. Mospinek, W. Stelmach, J. Jerzyńska","doi":"10.1111/cea.14175","DOIUrl":"https://doi.org/10.1111/cea.14175","url":null,"abstract":"development of respiratory diseases in paediatric population. What is more, we confirmed that the specific VOC profile may reflects the activity of the epithelium and the ecosystem of local bacteria and identifies children vulnerable to the adverse effects of the urban environment.","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90992430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Stojanovic, C. Zubrinich, A. Sverrild, Janine Mahoney, E. Denton, Joy Lee, M. Hew
Inducible Laryngeal Obstruction (ILO), also known as Vocal cord dysfunction (VCD) ─ episodic, paradoxical glottic closure during respiration ─ can mimic or even coexist with asthma.1– 3 Common triggers include inhaled irritants, odours and exercise.4 Proposed mechanisms include sensory neural dysfunction resulting in accentuation of the glottic closure reflex, which may be both irritant and stress mediated.5 It is less widely known that VCD also presents to allergists, mimicking anaphylaxis in response to allergen exposure via inhalation, ingestion or injection, and posing a diagnostic dilemma. Definitive diagnosis requires laryngoscopy confirmation of paradoxical vocal fold movement and exclusion of laryngeal angioedema, but this is rarely available during an acute episode.
{"title":"Laryngoscopy diagnosis of inducible laryngeal obstruction during supervised challenge for suspected anaphylaxis","authors":"S. Stojanovic, C. Zubrinich, A. Sverrild, Janine Mahoney, E. Denton, Joy Lee, M. Hew","doi":"10.1111/cea.14156","DOIUrl":"https://doi.org/10.1111/cea.14156","url":null,"abstract":"Inducible Laryngeal Obstruction (ILO), also known as Vocal cord dysfunction (VCD) ─ episodic, paradoxical glottic closure during respiration ─ can mimic or even coexist with asthma.1– 3 Common triggers include inhaled irritants, odours and exercise.4 Proposed mechanisms include sensory neural dysfunction resulting in accentuation of the glottic closure reflex, which may be both irritant and stress mediated.5 It is less widely known that VCD also presents to allergists, mimicking anaphylaxis in response to allergen exposure via inhalation, ingestion or injection, and posing a diagnostic dilemma. Definitive diagnosis requires laryngoscopy confirmation of paradoxical vocal fold movement and exclusion of laryngeal angioedema, but this is rarely available during an acute episode.","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"163 5 1","pages":"924 - 928"},"PeriodicalIF":0.0,"publicationDate":"2022-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86671748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Mori, Camilla Fazi, R. Pertile, G. Liccioli, L. Sarti, Erika Paladini, Tatiana Alicandro, M. Giovannini, S. Barni, Claudia Valleriani
To the Editor, Allergy to pine nut (seeds of genus Pinus trees) causes 3% of paediatric foodinduced anaphylaxis in Italy.1 In contrast to other nuts, where sensitization to crossreactive antigens is common,2 pine nut allergy is usually isolated.3 The main pine nut allergens are 2S albumins and vicilins, the latter triggering mainly local signs and symptoms.3 Diagnosis of pine nut allergy relies on clinical history, examination and specific testing using skin prick test, prickbyprick test (PbP), and/or serum specific IgE (sIgE) and, where necessary, oral food challenges (OFC).4 OFC is timeconsuming and can cause severe anaphylactic reactions.5 In this study, we evaluated the diagnostic test accuracy of pricktoprick skin test and sIgE to pine nuts in children. Charts from patients referred to the Allergy Unit of Meyer Children's University Hospital from December 2015 to March 2020 because of a suspected reaction to pine nuts or who had a positive PbP or sIgE to pine nuts as part of a tree nut allergy assessment were reviewed. All children who underwent an OFC to pine nuts were included in the study, and written informed consent was obtained from the children's parents for all procedures performed. Prickbyprick test to pine nut and other nuts (walnut, hazelnut, almond, cashew, peanut and pistachio) were performed with fresh nuts in all included patients.6 PbP was considered positive if the weal diameter was equal to or greater than 3 mm at 15 minreading. Histamine (10 mg/ml; Alk Abellò) and normal saline were used for positive and negative controls. sIgE was determined using a commercial assay (ImmunoCAP system, Thermo Fisher Scientific). Oral food challenges were open and not placebocontrolled, using 5 mg pine nut (0.7 mg of pine nut protein); then, the dose was doubled every 20 min until a reaction occurred or the total amount of about 20 pine nuts (about 588 mg of pine nut protein) was reached according to a modified protocol.7 As soon as any objective clinical manifestations were observed, the OFC was stopped, and the reaction was treated.4 OFC assessors were not blind to PbP and sIgE results. Epinephrine administration was used according to relevant guidelines.8 The median values of PbP and sIgE to pine nut were studied in the pine nut tolerant group and in the pine nut allergic group. Thus, we established the cutoff values for PbP and sIgE with the higher sensitivity, specificity, positive predictive values (PPV) and negative predictive value (NPV), as well as sensitivity, specificity, PPV and NPV of other potential cutoff values. Receiver operating characteristic (ROC) curve analyses were performed for PbP and sIgE. Correlation between sIgE and PbP to pine nut was assessed through linear regression and Spearman correlation index. Besides, we studied the role of sex, age, PbP or sIgE values in association with positive OFCs. Finally, we analysed the importance of clinical history in association with positive OFCs with pine nut when it was reco
{"title":"Pine nut allergy in children: A diagnostic test accuracy study","authors":"F. Mori, Camilla Fazi, R. Pertile, G. Liccioli, L. Sarti, Erika Paladini, Tatiana Alicandro, M. Giovannini, S. Barni, Claudia Valleriani","doi":"10.1111/cea.14173","DOIUrl":"https://doi.org/10.1111/cea.14173","url":null,"abstract":"To the Editor, Allergy to pine nut (seeds of genus Pinus trees) causes 3% of paediatric foodinduced anaphylaxis in Italy.1 In contrast to other nuts, where sensitization to crossreactive antigens is common,2 pine nut allergy is usually isolated.3 The main pine nut allergens are 2S albumins and vicilins, the latter triggering mainly local signs and symptoms.3 Diagnosis of pine nut allergy relies on clinical history, examination and specific testing using skin prick test, prickbyprick test (PbP), and/or serum specific IgE (sIgE) and, where necessary, oral food challenges (OFC).4 OFC is timeconsuming and can cause severe anaphylactic reactions.5 In this study, we evaluated the diagnostic test accuracy of pricktoprick skin test and sIgE to pine nuts in children. Charts from patients referred to the Allergy Unit of Meyer Children's University Hospital from December 2015 to March 2020 because of a suspected reaction to pine nuts or who had a positive PbP or sIgE to pine nuts as part of a tree nut allergy assessment were reviewed. All children who underwent an OFC to pine nuts were included in the study, and written informed consent was obtained from the children's parents for all procedures performed. Prickbyprick test to pine nut and other nuts (walnut, hazelnut, almond, cashew, peanut and pistachio) were performed with fresh nuts in all included patients.6 PbP was considered positive if the weal diameter was equal to or greater than 3 mm at 15 minreading. Histamine (10 mg/ml; Alk Abellò) and normal saline were used for positive and negative controls. sIgE was determined using a commercial assay (ImmunoCAP system, Thermo Fisher Scientific). Oral food challenges were open and not placebocontrolled, using 5 mg pine nut (0.7 mg of pine nut protein); then, the dose was doubled every 20 min until a reaction occurred or the total amount of about 20 pine nuts (about 588 mg of pine nut protein) was reached according to a modified protocol.7 As soon as any objective clinical manifestations were observed, the OFC was stopped, and the reaction was treated.4 OFC assessors were not blind to PbP and sIgE results. Epinephrine administration was used according to relevant guidelines.8 The median values of PbP and sIgE to pine nut were studied in the pine nut tolerant group and in the pine nut allergic group. Thus, we established the cutoff values for PbP and sIgE with the higher sensitivity, specificity, positive predictive values (PPV) and negative predictive value (NPV), as well as sensitivity, specificity, PPV and NPV of other potential cutoff values. Receiver operating characteristic (ROC) curve analyses were performed for PbP and sIgE. Correlation between sIgE and PbP to pine nut was assessed through linear regression and Spearman correlation index. Besides, we studied the role of sex, age, PbP or sIgE values in association with positive OFCs. Finally, we analysed the importance of clinical history in association with positive OFCs with pine nut when it was reco","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88545032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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