Journal of Investigational Allergology and Clinical Immunology最新文献

Background and objectives: Sunflower seed is one of the most common edible seeds. Its consumption is growing. Cases of sunflower seed allergy have been reported since the 1970s. However, there are few data on the prevalence and clinical manifestations of sunflower seed allergy. To improve our understanding of sunflower seed allergy.

Methods: We evaluated the clinical and immunological features of patients with sunflower seed allergy diagnosed in the allergy department of a tertiary hospital in Madrid over a 5-year period.

Results: Forty-seven patients reported adverse reactions after ingestion of sunflower seed and were sensitized specifically to sunflower seed, as determined by skin prick test (median, 8 mm) or specific IgE (median, 1.10 kUA/L). Most reactions were adult-onset and were preceded by a history of atopy and other food allergies, predominantly to peach, peanut, and nuts. The clinical presentation of sunflower seed allergy ranged from mild to severe, with many patients experiencing severe reactions, in which epinephrine was underused. Repeated exposures to sunflower seed in the same patient showed severity of symptoms to vary. Levels of sunflower seed IgE were strongly correlated with levels of IgE to nonspecific lipid transfer proteins, while the severity of the reactions did not differ significantly according to sensitization to the proteins.

Conclusion: Our findings reveal variability in the clinical presentations of sunflower seed allergy on repeated exposures and underuse of epinephrine in anaphylaxis. We highlight the importance of strict avoidance of sunflower seed and accurate prescription and administration of epinephrine in allergic patients.

Interest in finding efficient ways to remove penicillin allergy alerts has grown as a result of awareness of the considerable excess of falsenegative diagnoses in patients with penicillin allergy labels (90%-95%), the poorer course with non-ß-lactam antibiotics, the increase in bacterial resistance, and the fact that these problems can affect up to 20% of the population in some countries. The strategies proposed have generated many publications in countries where the number of allergists to conduct such studies is low. In many cases where delabeling is performed, the risk of ß-lactam allergy is low, and a single penicillin challenge is sufficient to delabel the alert. However, other less "ultrarapid" strategies can be used to administer a ß-lactam during an admission for infection and thus postpone delabeling until traditional drug allergy consultations. However, the definitive withdrawal of ß-lactam alerts is threatened by nonremoval of alerts in electronic health records and by the reactivation or nonsynchronization of alerts between electronic systems at different levels of care. Allergy departments need to reflect on how to implement practices that enable rapid and efficient delabeling of drug allergy alerts, especially in patients with major comorbidities.

Background: An environmental exposure chamber (EEC) is a health facility that enables allergic symptoms to be induced in a controlled manner in persons sensitized to a dispersed allergen. We performed a study at our institution to technically and clinically validate an EEC in patients allergic to grass pollen.

Methods: We developed a new EEC inside a clean room (ISO-8 class) measuring 15.6 m². During the technical validation, the patient's exposure conditions were simulated by ensuring homogeneous distribution of the allergen with a particle disperser and monitoring both particle and pollen grain concentrations. Temperature, pressure, and humidity were also registered. A total of 31 volunteers were exposed to Phleum pratense pollen in the EEC. Of these, 25 were allergic (cases), with symptoms of rhinoconjunctivitis with or without asthma, and 6 were not (controls). One control and 2 cases were exposed twice to check reproducibility, generating a total of 34 challenges. The test was stopped once the positivity criterion was reached or the patient completed 90 minutes in the EEC.

Results: Both the stability of particle concentrations and approximation to the pollen sample concentration were guaranteed. All challenges with controls were negative. Among the cases, 15% of challenges were negative and 85% were positive. No severe or late reactions were observed. Volunteers exposed twice to the same pollen had the same result in both challenges.

Conclusion: Our EEC proved to be a specific, safe, and reproducible tool for the diagnosis of grass pollen allergy.