European annals of allergy and clinical immunology最新文献

Summary: Background. It has been observed that diseases such as rhinitis and asthma not only affect the physical health of individuals but can also significantly impact their psychological well-being. The aim of this study is to analyze the relationship between allergic rhinitis (AR), non-allergic rhinitis (NAR), and asthma with symptoms of depression in adults. Methods. Comparative cross-sectional study. Adult subjects diagnosed with AR, NAR or asthma were selected and a fourth group of apparently healthy individuals (control group) was recruited. Study subjects were included consecutively. Multivariate binary logistic regression models were used to investigate the association of the diseases in this study (AR, NAR or asthma) with the 21 symptoms of depression from the Beck Depression Inventory-II. The adjusted odds ratio (aOR) was used as the test statistic. Results. A total of 257 participants (60% women; mean age 33.2 years) were included and compared cross-sectionally in four groups: AR (n=59), NAR (n=42), asthma (n=80), and a control group (n=76). In women, asthma and allergic rhinitis were associated with loss of energy and tiredness or fatigue. On the contrary, among men, neither asthma nor allergic rhinitis showed an association with the variables analyzed. However, anxiety showed an association as a risk factor for symptoms of depression in both sexes. Conclusions. Our study reveals for the first time that although the spectrum of symptoms of depression is broad, rhinitis and asthma are only related to some of them.

Summary: Background. In patients whose chronic urticaria (CU) cannot be controlled with omalizumab 300 mg and antihistamines, the dose can be increased up to 600 mg. The study aimed to compare the clinical characteristics of patients receiving 300 mg versus higher doses of omalizumab, and to evaluate baseline predictors for updosing. Methods. A total of 159 patients who have been followed up at a tertiary care allergy center and received omalizumab for at least 12 months were included. The clinical characteristics of those who received the standard-dose omalizumab (Group 1) were compared to the ones who received therapy over the standard dose (Group 2).  Results. A total of 139 (87%) were in Group 1, and 20 (13%) were in Group 2. CU duration at baseline was shorter in Group 2. Chronic inducible urticaria was present in 2%, and 40% of the patients in Group 1 and 2, respectively. Elevated D-dimer level was associated with high-dose omalizumab use (p < 0.001). Area under the curve in the ROC analysis was 0.812 and the cutoff value of D-dimer level was 0.46 mg/dl (p = 0.001, sensitivity and specificity 67%, and 84%, respectively). The anti-TPO positivity was higher in patients with low IgE (31% vs 8%, p = 0.008). Conclusions. Nearly one in every ten patients required higher doses of omalizumab therapy. D-dimer level seems to be a predictor for omalizumab updosing and unresponsiveness to standard dose. IgG-anti-TPO positivity and low IgE do not predict the need for dose escalation; however, this result should be strengthened with a larger number of patients.

Summary: Background. Children with milk and egg allergies have outcomes in which, three-quarters are tolerant to baked forms of the allergenic food. Identifying predictors of tolerance to baked foods for IgE-mediated immediate-type reactions may guide the early introduction of baked allergens to diet and tolerance development. This study explores factors associated with early tolerance to baked foods. Methods. We retrospectively analysed patients with IgE-mediated immediate-type food allergy in infancy who either became tolerant to the baked form before two years or remained reactive after two years. Results. We examined 143 patients solely with IgE-mediated immediate-type egg and/or milk allergies excluding the ones having atopic dermatitis, 76 (42 egg-allergics; 34 milk-allergics) achieved tolerance, and 67 (38 egg-allergics; 29 milk-allergics) were reactive beyond the age of two. Independent markers favoring tolerance to baked forms at two years included the absence of anaphylaxis during the first reaction, applicable to milk and egg allergens. The absence of familial atopy and concomitant egg allergy were also independent predictors for milk-allergic subjects. Receiver operating characteristic analysis determined cut-off values for specific-Immunoglobulin E (sIgE) levels (kU/L) predicting mild phenotype at first admission: egg white-sIgE ≤ 7.39, milk-sIgE ≤ 5.99, and casein-sIgE ≤ 4.99, with AUC values of 0.703, 0.716, and 0.749, respectively. Conclusions. This study identifies key prognostic for tolerance of baked allergen for IgE-mediated immediate-type reactions, providing valuable insights to determine the patients who need more intensive care versus the ones who don't need baked allergen avoidance early in their life from their initial admission at infancy.

Summary: Background. Cholinergic urticaria (CholU) is characterized by itching and/or stinging, painful micro wheals due to systemic heating. There are two standardized protocols to diagnose CholU using an exercise bike with heart rate or warming passive. The objective is to provide an affordable, new, low-tech test to assist the diagnostic. Methods. Cross-sectional study with a convenience sample; 10 with a diagnostic or high suspicion of CholU and 20 participants without suspicion of CholU, recruited in a UCARE from a developing country. After the pre-participation assessment, the provocation test through movements of going up and down a flight of stairs and with a heart rate monitor, an increasing 15 bpm every 5 min until an increase of 90 bpm above the initial level, for 30 min and/or stopped immediately, upon visualization of wheals and with body temperature measured in 3 different locations every 5 min. Results. The group CholU comprised eight females and two males (29.6y), and the other group had eleven females and nine males (27.2y). Data analysis demonstrated that in a positive test in a body temperature measured above 37.05ºC and with a variation of 0.35ºC above the initial value, sensitivity of 80% and specificity of 100% in the forehead region and sensitivity of 80% and specificity of 90% in tympanic region. Conclusions. Thus, with the feasibility of reproducing the method, it is expected that this simple and accessible method for diagnosing CholU can be a tool for application, mainly in developing countries.

Summary: Background. Guidelines highlight the pivotal role of adrenaline auto-injector (AAI) training. However, the standards of visual training platforms have not been determined. Our aim was to evaluate the reliability and quality of the AAI related videos on YouTube. Methods. After a search on YouTube about AAI, all videos were categorized into groups based on their origin and the aim of the content. The quality, reliability, understandibility, and actionability of the videos were evaluated using the Global Quality Scale (GQS), Patient Education Materials Assessment Tool Audovisiual (PEMAT-A/V), Quality Criteria for Consumer Health Information (DISCERN), and a modified DISCERN. In each video, the application steps of AAI were evaluated according to a scale of correct usage. Results. 107 YouTube videos in English were included. No significant difference in terms of views, likes, duration and uploading time was observed between the health and non-health groups whereas the GQS (p = 0.001), DISCERN total (p = 0.02) and modified DISCERN (p = 0.001) scores were higher in the health group. It was found that scores tended to be higher in educational videos. AAI use was mentioned in 85% videos. The median number of mentioned steps was 6. Conclusions. YouTube is an ef-fective platform for visual learning for the use of AAIs. Although the visibility of the videos is equal independent of the origin, the ones recorded by medical professionals seem to provide the most qualified and reliable information.

Summary: Background. Patients with severe allergic conditions often request support from the prehospital emergency services given the rapid, unexpected and po-tentially life-threatening nature of the reactions, such as anaphylaxis. Studies regarding prehospital incidents for allergic conditions are scarce. This study aimed to characterize prehospital medical requesting assistance due to suspected hypersensitivity reactions (HSR). Methods. Retrospective study of allergic-re-lated requesting assistances between 2017 and 2022 of a Portuguese emergency dispatch center ‒ Emergency and Resuscitation Medical Vehicle (VMER) ‒ in Coimbra University Hospital. Demographic and clinical variables were analyzed, including clinical manifestations, anaphylaxis severity grading, therapeutic interventions, and post-incident allergic work-up. Regarding anaphylactic events, three diagnosis timings were compared: on-site, hospital emergency department and investigator-diagnosis based on data reviewed. Results. Out of 12,689 VMER requesting assistances, 210 (1.7%) were classified as suspected HSR reactions. After on-site medical evaluation, 127 (60.5%) cases maintained the HSR classification (median age 53 years; 56% males) and the main diag-noses included HSR to Hymenoptera venom (29.9%), food allergy (29.1%), and pharmaceutical drugs (25.5%). Anaphylaxis was assumed on-site in 44 (34.7%) cases, in the hospital emergency department in 53 cases (41.7%) and by investigators in 76 (59.8%) cases. Regarding management, epinephrine was administered on-site in 50 cases (39.4%). Conclusions. The main reason for prehospital requesting assistance was HSR to Hymenoptera venom. A high proportion of incidents met the criteria for anaphylaxis and despite the inher-ent difficulties of the prehospital setting, many of the on-site diagnoses agreed with the criteria. Regarding management, epinephrine was underused in this setting. After pre-hospital events, a proper referral to a specialized consultation is crucial for a full diagnostic work-up and disease management.

Summary: Background. Evidence regarding drug provocation test (DPT) with chemo-therapeutic agents is scarce. The aim of our study is to describe the experience of DPT in patients with a history of hypersensitivity reactions (HSRs) to antineoplastic and biological agents. Methods. Eight-year retrospective, observational, descriptive study of patients with a history of HSRs to chemo-therapy who were submitted to DPT. Anamnesis, skin tests (ST) and DPT were analyzed. Patients with a negative DPT were submitted to at least one regular supervised administration (RSA). Patients with positive DPT or HSR during RSA were offered rapid drug desensitization (RDD). Results. A total of 54 patients were submitted to DPT. The most common suspected drugs were platins (n = 36), followed by taxanes (n = 11). Most of the initial reactions were classified as grade II (n = 39) according to Brown's grading system. ST with platinum (n = 35), taxanes (n = 10) and biological agents (n = 4) were negative, except for one intradermal test with paclitaxel, which was positive. A total of 64 DPTs were performed. Eleven percent of all DPTs were positive [platins (n = 6), doxorubicin (n = 1)]. Of the 57 RSA with the culprit drugs, 2 were positive (platins). The diagnosis of hypersensitivity was confirmed by DPT/RSA in 9 patients. All patients with positive DPT/RSA presented HSRs of equal or less severity than the initial one. Conclusions. DPT followed by RSA allowed to exclude HSRs in 45 patients (55 culprit drugs). DPT before desensitization prevents non-hypersensitivity patients from undergoing RDD. In our study DPT was safe, all reactions were managed by an allergist.