Hyaluronic acid dermal fillers are becoming a very popular choice for patients wanting to undergo non-invasive facial rejuvenation. It's known to be a relatively safe procedure. Delayed inflammatory reactions to hyaluronic acid fillers are uncommon with frequent spontaneous resolution. These reactions can be triggered by many situations like infections or vaccination. We report a case of delayed inflammatory reaction to hyaluronic acid dermal fillers post SARS COV 2 vaccination.
The food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy, often underdiagnosed despite an increasing prevalence. This study aims to assess the impact of FPIES on the quality of life and identify risk factors for psychosocial distress. We collected data from a cohort of 48 pediatric patients with FPIES, recruited by private and hospital allergists through telephone interviews with families. Quality of life, assessed through QUALIN and Peds QL questionnaires, is generally preserved, but psychopathological aspects and sociability are affected. Parental concerns are significant, with 61% experiencing anxiety during the food diversification period. Regarding emotional well-being, 85% of parents express concerns, while FPIES induces stress in 75% of them. Family activity limitations affect 62% of families. FPIES impacts the social life of children (54%) and has a significant financial impact on 57% of families. Negative influences on quality of life include a history of hospitalization, the number of emergency room visits for FPIES, cow's milk as a triggering food, and FPIES to multiple foods. These results emphasize the importance of considering psychosocial dimensions in the overall management of FPIES.
The Food Protein-Induced Enterocolitis Syndrome (FPIES) is a non-IgE-mediated food allergy, primarily manifesting in young children through vomiting. There are numerous differences regarding the implicated foods depending on the country and population studied. The study focused on a regional cohort of 48 children with FPIES in France, aiming to identify the most common triggers and provide appropriate dietary advice to families. Data were collected through telephone interviews with the families of FPIES patients. The results revealed that cow's milk was the most frequent trigger (67%), followed by egg (21%), beef, and fish (10% each). A correlation between reactions to beef and cow's milk was observed. The most commonly reported symptoms were vomiting, followed by abdominal pain, pallor, and diarrhea. IgE sensitization was present in 19% of tested children, with no statistically significant influence on FPIES recovery. In conclusion, this study emphasizes the significance of regional peculiarities in FPIES trigger foods and suggests that dietary recommendations should be adjusted accordingly.
The prevalence of food allergies has been on the rise recently, manifesting in various systemic symptoms. This report presents a rare case of acute pancreatitis in an adult triggered by cow's milk allergy. Although few reports exist linking different food allergens to pancreatitis, this case underscores the importance of considering food allergies in the differential diagnosis of gastrointestinal disorders, beyond typical symptoms like urticaria, pruritus, vomiting, and diarrhea. Allergy patients presenting with only gastrointestinal symptoms may be misdiagnosed as having food intolerances such as lactose intolerance.
The European Baseline Series (EBS) of patch tests is the essential tool for allergological exploration of patients suspected of allergic contact dermatitis. The main objective of our study was to define the epidemiological, clinical characteristics, and sensitization profile to contact allergens of the EBS among all patients who underwent contact allergological exploration in an allergology clinic in Algeria over a 15-year period (from 2007 to 2022). Our aim was to generate a map of allergic contact dermatitis in Eastern Algeria to support prevention efforts on a national scale.
Our study was a retrospective descriptive monocentric study conducted in an allergology and contact allergen exploration medical office in Constantine, Algeria. It included all EBS performed between March 2007 and February 2022 on patients who were either first-time visitors or referred for patch testing.
A total of 202 patients suspected of contact dermatitis were tested, with ages ranging from 3 to 75 years. Among them, 125 were female (61.9%) and 77 were male (38.1%). Of these, 138 patients (68.8%) (45 males, 93 females) tested positive for one or more allergens. Fifty-eight patients (42%) had a positive reaction to more than two contact allergens. The most common positive reactions were observed with nickel (30.2%), cobalt (28.2%), potassium dichromate (27.2%), myroxylon pereirae (9.9%), and fragrance mix I (8.4%). Sensitivity to nickel was more frequent among females (P < 0.0001), while sensitivity to potassium dichromate was more frequent among males (P = 0.01).
The distribution of different causes of contact allergy identified through EBS was similar to what is observed in Europe. It allowed us to define, based on the sensitization profile of the patients included in our study, the most frequent causes of allergic contact dermatitis within our population. However, the emergence of new contact allergens can only be identified if Algeria establishes an allergo-vigilance network, similar to that in Europe, enabling both the evolution of patch test compositions and the detection of new allergic risks within the population.
The objective of this study was to apprehend information practices of patients receiving allergy care.
We conducted a prospective monocentric study administering a questionnaire to 200 patients consulting for any type of allergy in a French university hospital center. Respondents provided answers on their socio-demographic characteristics, personal practices for seeking information on allergies, understanding of the information shared by allergists, and doctor's attitude.
In all, 68% of patients declared informing themselves on allergies. Healthcare professionals were their main sources of information (allergist 66%, family doctor 57%, other specialists 5%), followed by the Internet (22%), leaflets from pharmaceutical laboratories (16%), and traditional media (television 11%, press 6%, radio, 2%). Patients expressed the need for information and explanations from the allergist, regarding the diagnosed allergy, adverse effects, and duration of treatment. Thirty-one percent of them encountered difficulty in understanding the information shared by the doctor during the consultation, especially in patients suffering from respiratory allergies, with a short clinical history, an educational level below high school diploma and among those who do not seek information on allergies besides medical consultation.
The study led to identify first outlines on information practices of allergy patients. The work will be continued by a qualitative study.
Immunotherapy is the gradual administration of increasing doses of allergens to reduce or eliminate the patient's adverse clinical response following exposure to these allergens. The goal of the current study was to evaluate the effectiveness of subcutaneous immunotherapy in patients with allergic diseases referred to the Bushehr Asthma and Allergy Clinic, Iran.
Patients with respiratory allergic diseases, who had positive skin prick test, randomly enrolled in this observational study and underwent immunotherapy for one year. To evaluate the efficacy of immunotherapy, two questionnaires were completed for all the patients before and one year after the start of immunotherapy, including the Total Nasal Symptom Score (TNSS) and Asthma Control Test (ACT).
A total of 878 patients with asthma or allergic rhinitis disorder [53.6% (n = 471) male and 46.4% (n = 407) female] with a median (IQR) age of 28.0 (12.0–35.0) years were randomly enrolled in this observational study. Five hundred forty-nine patients (64.8%) were over 18 years old and 298 patients (33.9%) were under 18 years old, the age of the other patients was not known. The median (IQR) duration of disease was 84.0 (36.0–138.0) months. Rinithis allergy had most frequent than asthma [39.9% (n = 350) vs. 22.2% (n = 195), respectively] and 218 patients (24.8%) have both of them. After the treatment, 234 patients (54.5%) completely stop and 26.3% patient (n = 113) used less than half of the drugs. The mean TNSS (n = 259) and ACT (n = 186) scores for patients had significant difference before and after immunotherapy [13.64 vs. 5.68, P < 0.001; 7.91 vs. 17.43, P < 0.001, respectively].
The mean TNSS and ACT score before and after the treatment significantly improved the patients’ symptoms. To conclude, standard immunotherapy can be effective in patients with moderate to severe allergic rhinitis and mild to moderate persistent allergic asthma to reduce clinical symptoms.
Capecitabine is an oral fluoropyrimidine carbamate, analog of 5-fluorouracil. It is widely used for many malignant tumors. Hand-foot syndrome is the most common dermatological toxicity associated with capecitabine and Stevens-Johnson syndrome is the rarest manifestation. We report a case of Stevens-Johnson syndrome induced by capicitabine.
A 49-year-old patient, hospitalized in oncology for the management of a mucinous colorectal adenocarcinoma with peritoneal metastases. He was treated with capecitabine 3500 mg per day. The patient presented diffuse pigmented lesions and an erosive scrotal lesion with dysphagia to solids and liquids, vomiting and non-bloody diarrhea, which occurred 5 days after the onset of the treatment. The clinical examination found an altered patient. The skin examination found a pigmented desquamative plaque on the face, diffuse atypical target lesions, a pigmented plaque on the palms of both hands, a scrotal erosion and cheilitis. The histology confirmed the diagnosis Stevens-Johnson syndrome. The pharmacovigilance declaration concluded that Stevens-Johnson syndrome was secondary to capecitabine according to chronological and bibliographic data. The patient died of respiratory distress.
Stevens-Johnson syndrome is a rare and serious complication that can occur, rarely, in patients treated with capecitabine. Our case is the 5th case of capecitabine-induced SJS that has been reported in the literature since 2008.
Idiopathic anaphylaxis (IA) is a rare life-threatening disorder that may present with severe symptoms similar to other forms of anaphylaxis. It is an exclusion diagnosis and requires careful consideration of all recognizable and rare causes of anaphylaxis. Psychiatric conditions, such as somatoform disorders, should be considered in the differential diagnosis when there is a paucity or absence of clinical signs. A 17-year-old female patient was admitted to the inpatient clinic for pediatric allergy due to recurrent anaphylaxis. In the last two years, the patient was administered intramuscular epinephrine more than 200 times and was admitted to the intensive care unit four times due to severe anaphylaxis. The attacks frequently appeared as flushing, itching, shortness of breath, and rarely hypotension, but without a defined trigger. The patient was diagnosed with IA and received oral steroids, omalizumab, and rituximab. However, none of her attacks were accompanied by elevated tryptase levels and the aforementioned pharmacotherapies did not prevent relapse. After psychiatric evaluation, somatoform disorders were suspected despite striking variations in the severity of the physical symptoms. The psychiatric diagnosis was also supported by a good response to fluoxetine and supportive individual psychotherapy. The patient is currently being followed up without any anaphylactic attacks. Somatoform disorders should be considered in the differential diagnosis of IA because of overlapping physical symptoms. In the clinical practice of diagnosing and managing IA, symptoms that are not only subjective but also objective and unresponsive to conventional treatments should alert physicians to the probability of the psychiatric condition and the requirement for psychiatric consultation.
Anaphylaxis is a life-threatening systemic allergic reaction. In this study, we evaluated the pedodontists’ knowledge, experience and preparedness for allergic reactions and anaphylaxis management.
A cross-sectional survey was designed and distributed through the web-based application.
One hundred and four pedodontists completed the survey. All of the participants questioned allergic diseases and drug allergies before the dental procedure. Of the participants, 81.7% were aware that the first choice in the treatment of anaphylaxis was adrenaline, and 71.2% of them were informed that the route of administration of adrenaline was intramuscular. However, 22.1% of the participants reported concern about not being able to recognize anaphylaxis and 59.6% of them were inaccurate about the dose of adrenaline that should be administered to treat anaphylaxis. The participants who were trained about anaphylaxis in the last 5 years responded more accurately to the adrenaline dose applied in the treatment of anaphylaxis (P = 0.001). There was no association between accurately knowing the dosage and route of adrenaline and the participants’ age, gender, duration of employment, or workplace (P > 0.05).
In this study, it was determined that the management of allergic diseases and anaphylaxis needs to be improved in pedodontic clinics.
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