Allergo Journal International最新文献

Summary

Background

As a vegan diet is per definition a plant-based diet, consumers rely on plant protein sources in order to substitute animal proteins. Plant protein sources commonly used in this context are the following: cereals, like wheat (Triticum aestivum, Triticum durum), oat flakes; pseudo cereals like quinoa; nuts and oil seeds like cashew (Anacardium occidentale), hazelnut (Corylus avellana), walnut (Juglans regia); seeds like psyllium seeds (Plantago ovata), sesame (Sesamum indicum), and chia seed (Salvia hispanica).

Methods

In order to assess the allergy risk posed by vegan diet, a literature search focusing on the composition of this particular diet and whether the respective foods are potentially allergenic was performed.

Results

At first glance, it is evident for allergologists that these protein sources are well-known allergen sources. Particularly nuts and legumes harbour storage proteins, oleosins, and lipid transfer proteins that as such are associated with severe allergic reactions to food. In addition, there is increasing evidence that the simultaneous consumption of several of these foods may produce a summation effect where many single allergens of high allergenic potential sum up, thereby inducing anaphylaxis. Furthermore, food processing—or the lack of it—puts patients with pollen-associated food allergy at risk to react to some of the plant foods used in vegan diets.

Conclusion

Therefore, individuals with a history of atopy should be educated regarding the allergy risk of a vegan diet.

Background

Cefalexin is a commonly prescribed oral antibiotic, with a similar side chain to amoxicillin. The objectives of this study were to (1) describe the frequency and nature of previously recorded cefalexin adverse reaction (AR) labels in the electronic medical record (EMR) in a medical inpatient cohort, (2) evaluate the accuracy of these labels and (3) examine the association between a cefalexin allergy label and the antibiotics prescribed during an inpatient admission.

Methods

Consecutive admissions under general medicine in a tertiary hospital over a 1-year period were included in this retrospective cohort study. Data regarding cefalexin adverse reaction (AR) history, and antibiotics prescribed during admission were collected from the EMR. Cefalexin allergy descriptions were reviewed using expert criteria to determine whether the described reaction was most consistent with allergy or intolerance.

Results

The number of admissions included in this study was 12,134. Of the 224 (1.9%) admissions with a recorded cefalexin AR, 196 (87.5%) had a label of allergy and 28 (12.5%) of intolerance. Following the application of expert criteria, 43 (21.9%) of cefalexin allergy labels were found to be consistent with intolerance. The presence of a low-risk cefalexin allergy was associated with an increased likelihood of receiving non-penicillin antibiotics including clindamycin and ciprofloxacin.

Conclusion

Cefalexin AR are common, and frequently incorrectly classified in the electronic medical record with consequences for in-hospital antibiotic prescribing and antimicrobial stewardship.

As a widespread disease, contact dermatitis affects all age groups with a high prevalence and incidence. In addition to a reduction in the quality of life, it causes considerable health and socioeconomic costs. Essentially, five subtypes can be distinguished, namely irritant contact dermatitis, phototoxic contact dermatitis, allergic contact dermatitis with its two special forms of hematogenous and aerogenous contact dermatitis, photoallergic contact dermatitis, and protein contact dermatitis. The diagnosis is based on a detailed history and clinical skin findings as well as the exposure-related performance of allergological in vivo and in vitro tests. Once the contact substance—irritant or allergen—has been identified, the key to therapeutic success lies in its strict avoidance. Symptomatic therapy of contact dermatitis should always be individualized and based on the stage of eczema. Topical glucocorticoids are considered first-line therapy for both irritant and allergic contact dermatitis. The always accompanying basic therapy with skin care products plays a central role for sustainable therapeutic success. Systemic therapy is considered when topical therapy is ineffective or not feasible. In this context, the short-term use of systemic glucocorticoids should be limited to extensive or clinically severe acute contact dermatitis and exacerbations of chronic contact dermatitis. The efficacy of the use of newer biologics and Janus kinase inhibitors in contact dermatitis is currently being evaluated in several clinical trials.

Purpose

Aeroallergens are airborne particles capable of triggering rhinitis and respiratory complications in sensitive individuals. Tree pollen is a major source of aeroallergens and can potentially induce allergic responses in a variety of ways. Thus, studying the allergenicity of urban green spaces is crucial to public health quality. Conocarpus trees have been vastly imported in recent years in Iran for reforestation projects and now have a wide distribution in southern parts of Iran, especially in Khuzestan province. Yet, these plants have not been studied adequately for their allergenic potential. This work aims to evaluate the IgE-mediated skin reactivity to Conocarpus pollen extract in patients suffering from asthma and allergic rhinitis living in southwest Iran.

Methods

Ninety consecutive patients diagnosed with asthma and allergic rhinitis were selected. Mild cases initially and moderate to severe cases after a period of treatment and follow-up underwent skin prick test (SPT) for Conocarpus pollen extract and several other aeroallergens.

Results

A skin prick test was performed for all 90 patients presenting asthma and allergic rhinitis symptoms and treated and followed in an outpatient setting. 17% had weakly positive test results for Conocarpus pollen extract. The maximum mean wheal diameter was 4 mm. For comparison, about 48% of the patient were sensitized to Russian thistle, with a maximum mean wheal size of 12 mm. Sensitization to grasses, some other trees, and indoor allergens were also measured.

Conclusion

Conocarpus trees have a low potential for inducing allergic responses in the studied population. There is no evidence that they have any role in triggering the thunderstorm asthma episodes.

Indications for epicutaneous patch testing include the detection or exclusion of allergic contact dermatitis of the skin, transitional mucosa or oral mucosa, suspected delayed-type immune reactions to ingredients of implants, and certain drug reactions (maculopapular exanthema, symmetrical drug-related intertriginous and flexural exanthema [SDRIFE], acute generalized exanthematous pustulosis [AGEP], and fixed drug eruption). When available, allergen preparations that have been pharmaceutically tested and that are approved or marketable as medicinal products should be used. Existing diagnostic gaps can be closed by testing the patient’s own materials in a suitable preparation. Interferences of ultraviolet (UV) light exposure or drugs with patch test reactions have to be considered. In addition to the reading after 48 h and 72 h, a further reading between day 7 (168 h) and day 10 (240 h) is useful, since about 15% of the positive test reactions remain undetected without this late reading. All positive patch test reactions considered allergic must be evaluated with regard to their clinical relevance based on existing exposures.