European annals of allergy and clinical immunology最新文献

Summary: Background. Non-steroidal anti-inflammatory drugs (NSAID)/analgesics (paracetamol) are among the most common causes of drug hypersensitivity reactions in children, with a reported prevalence of around 0.3% in the pediatric population. Paracetamol and ibuprofen are the most commonly reported culprits in the pediatric population. Our objective was to describe the allergy workup to NSAID/paracetamol of a pediatric population monitored in an allergy outpatient clinic. Methods. Retrospective observational study by consulting the medical records of patients evaluated in a pediatric outpatient clinic with history of NSAID/paracetamol, between January 2016 to August 2022. Results. A total of 43 patients have been evaluated for NSAID/paracetamol suspected allergy: 53.5% females, mean age of 9.8 ± 5.1 years, 47.7% atopic. The drugs reported as culprits were: ibuprofen (75.6%), paracetamol (17.8%), metamizole (4.4%) and naproxen (2.2%) and clinical manifestations were mainly urticaria/angioedema and maculopapular exanthema. Skin tests were performed in 7 patients: paracetamol (n = 5) and metamizole (n = 2), which were all negative. Fourty-six drug provocation tests were performed: 28 with the culprit drug and 18 with an alternative one; only 2 were positive (ibuprofen - culprit NSAID group): one immediate periorbital angioedema and one delayed lip edema with oropharyngeal tightness. Conclusions. The investigation of allergy to NSAID/paracetamol in children remains a challenge. In our population, ibuprofen was the most common NSAID reported. There were only 2 (4.3%) mild reactions on DPT. We could allow the use of the culprit NSAID/analgesic in 11 patients and an alternative one in 9 patients. This study highlights the importance of DPT in children for a correct diagnosis of NSAID hypersensitivity and selection of an alternative drug.

Summary: Background. Beta-lactams (BLs) allergy is considered a major health issue, as BLs are the most frequently involved in drug allergic reactions. Amoxicillin (AX) is the main sensitizer among all BLs. AX is commercialized alone or combined with clavulanic acid (CLA) in order to increase the antibiotic spectrum. The growing prescriptions of AX-CLA formulations contributed to increase the role of CLA as an allergy inducer. At present, little is known about the clinical characteristics of hypersensitivity reactions to clavulanate. The aim of this study was to assess the difference in the prevalence of cutaneous vs systemic reactions in patients with a documented history of allergic reactions to amoxicillin- clavulanate and tested positive for clavulanate or penicillin/amoxicillin. Methods. Between January 2017 and March 2023, out of 88 outpatients with suspected BLs allergy we selected 59 patients with a reaction to AX-CLA. Hypersensitivity reactions were classified according to onset time as immediate or delayed and according to clinical presentation as mucocutaneous or systemic reactions (anaphylaxis). All patients underwent recommended test protocols for diagnosing BLs hypersensitivity to identify the culprit drug. Sensitization was assessed through serologic and skin tests. Results. Patients whit immediate and delayed mucocutaneous reactions to AX-CLA are more sensitized to CLA 12/41 (29%) than AX or BLs determinants 9/41 (22%); on the opposite patients with immediate systemic reactions are more sensitized to AX or BLs determinants 13/18 (72%) than CLA 2/18 (11%), p less than 0.00. There was no difference in immediate vs delayed reaction regarding CLA or AX and BLs determinants sensitization. Conclusions. Our study suggests that patients who presented only muco-cutaneous reactions were more often sensitized to CLA rather than AX.

Summary: Many food allergens not actually included in the European priority list of allergenic foods have the potential to cause severe allergic reactions and could escape correct identification and behave as "hidden allergens". Moreover, the adoption in recent years of novel diets based on plant products and new sustainable foods or the use of specific food additives have contributed to the onset of new emerging allergens of public health importance. The knowledge of hidden allergens is important both for physicians and for patients to improve the prevention, diagnosis and treatment of food allergies, in order to decrease eventual improper diagnosis of idiopathic anaphylaxis. In this review, the characteristics of the most frequent hidden allergens and their diagnostic tools are described. A detailed history with a careful review of the ingredient lists, an understanding of possible cross-reactions or contaminations with other foods, together with an allergological evaluation consisting of in vivo or in vitro tests and, where necessary, an oral food challenge, are recommended for the successful identification of the culprit allergen. In future, it will be very important to implement these diagnostic tools, especially in the field of molecular allergology, and reporting allergens on labels should become mandatory.

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.