The journal of allergy and clinical immunology. Global最新文献_第2页

Outcomes of pediatric patients with suspected allergies to COVID-19 vaccines

The journal of allergy and clinical immunology. Global

Pub Date : 2025-02-01 DOI: 10.1016/j.jacig.2024.100387

Qin Ying Lim MBBS , Tsun Ming Lau BSc , Sophie H.Y. Lai MBBS , Gilbert T. Chua MBBS , Kaiyue Zhang MPH , Jennifer H.Y. Lam BSc (Hon) , Wilfred H.S. Wong PhD , Yu Lung Lau MD (Hon) , Jaime S. Rosa Duque MD

Background

Adverse effects following immunizations (AEFIs) can contribute to vaccine hesitancy.

Objective

We evaluated clinical outcomes of AEFIs subsequent to administration of the coronavirus disease 2019 (COVID-19) vaccine at 2 pediatric allergy centers.

Methods

Data on pediatric patients referred for COVID-19 AEFI concerns between March 2021 and October 2022 were reviewed. The collected data included patient demographics, clinical characteristics, outcomes of prior COVID-19 vaccination, recommendations after consultation, and outcomes of revaccination.

Results

The 163 patients were separated into 2 groups based on the absence (n = 89 [54.6%]) or presence (n = 74 [45.4%]) of prior COVID-19–related AEFIs. The most common reason for referral without a prior AEFI was another suspected drug allergy (n = 58 [35.6%]). All patients in this group were recommended for COVID-19 vaccination. Of the 163 patients, 82 (92.1%) proceeded with vaccination, with 77 of them (93.9%) tolerating vaccination. Most of those with a prior COVID-19–related AEFI had a delayed cutaneous reaction (n = 60 [37.0%]); 1 patient (0.6%) had suspected anaphylaxis. In this group, 6 (8.1%) were advised to postpone COVID-19 vaccination until their debilitating skin conditions had improved in response to further treatment, whereas 45 (77.6%) tolerated subsequent vaccination to the same or an alternate COVID-19 vaccine type. The most common AEFI on revaccination was urticaria (in 8 of 11 patients [72.7%]). AEFI on revaccination was significantly associated with a history of spontaneous urticaria or angioedema (relative risk = 3.6 [95% CI = 1.30-9.99]; P = .020) and urticaria following COVID-19 vaccination previously (relative risk = 4.12 [95% CI = 1.22-13.87]; P = .017).

Conclusions

Children with a history of urticaria or angioedema related or unrelated to prior COVID-19 vaccination were at higher risk of a COVID-19–related AEFI on revaccination, although most were able to complete the vaccination series under the management of our immunology/allergy service.

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引用次数: 0

ChatGPT as a source of information on asthma

The journal of allergy and clinical immunology. Global

Pub Date : 2025-02-01 DOI: 10.1016/j.jacig.2024.100390

Amnuay Kleebayoon PhD , Viroj Wiwanitkit MD

引用次数: 0

Biologic therapies targeting type 2 cytokines are effective at improving asthma symptoms and control—a systematic review and meta-analysis

The journal of allergy and clinical immunology. Global

Pub Date : 2025-02-01 DOI: 10.1016/j.jacig.2024.100374

Rebecca E. Bignold PhD, Hannah Busby BSc, Jenny Holloway BSc, Aaishah Kasu BSc, Sonia Sian BSc, Jill R. Johnson PhD

Background

Allergic asthma is a highly prevalent chronic inflammatory disease driven by aeroallergen exposure. In severe asthma, the current standard of care does not fully control disease symptoms, indicating an unmet clinical need. Biologic therapies targeting cytokines IL-4, IL-5, and IL-13 have been shown to provide benefits to asthmatic patients over currently existing asthma treatments.

Objective

We sought to review the effects of recently developed biologic therapies for asthma treatment.

Methods

In this meta-analysis, the impact of IL-5 and IL-4/IL-13 biologic inhibitors was critically appraised considering overall lung function, symptom control, and oral corticosteroid use in asthmatic patients. Trials were identified using PubMed, Web of Science, Scopus, and clinicaltrials.gov. Clinical trials assessing severe asthmatic participants older than 12 years were included.

Results

The meta-analysis included 6600 participants from 14 trials published in 2013 to 2020. For IL-5 inhibitors, improvements in FEV₁ (mean difference [MD], 0.11; 95% CI, 0.11 to 0.12), Asthma Control Questionnaire scores (MD, −0.4; 95% CI, −0.41 to −0.38), annual exacerbation rates (MD, −0.46; 95% CI, −0.48 to −0.45), and oral corticosteroid use (MD, −50; 95% CI, −52.58 to −47.42) favored biologic treatment. Significant improvements in FEV₁ (MD, 0.11; 95% CI, 0.10 to 0.11), Asthma Control Questionnaire scores (MD, −0.20; 95% CI, −0.22 to −0.18), and annual exacerbation rates (MD, −0.15; 95% CI, −0.16 to −0.14) were also seen with anti–IL-4/IL-13 biologic therapies. However, anti–IL-4/IL-13 inhibitors were associated with more adverse events than placebo (MD, 1.13; 95% CI, 0.97 to 1.3).

Conclusions

Biologic inhibitors targeting T_H2 cytokines are beneficial for improving overall asthma control.

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引用次数: 0

Three versions of an atopic dermatitis case report written by humans, artificial intelligence, or both: Identification of authorship and preferences 由人类、人工智能或两者共同撰写的特应性皮炎病例报告的三个版本：作者和偏好的识别。

The journal of allergy and clinical immunology. Global

Pub Date : 2025-02-01 DOI: 10.1016/j.jacig.2024.100373

Mara Giavina Bianchi MD, PhD , Andrew D’adario MSc , Pedro Giavina Bianchi MD, PhD , Birajara Soares Machado PhD

Background

The use of artificial intelligence (AI) in scientific writing is rapidly increasing, raising concerns about authorship identification, content quality, and writing efficiency.

Objectives

This study investigates the real-world impact of ChatGPT, a large language model, on those aspects in a simulated publication scenario.

Methods

Forty-eight individuals representing 3 medical expertise levels (medical students, residents, and experts in allergy or dermatology) evaluated 3 blinded versions of an atopic dermatitis case report: one each human written (HUM), AI generated (AI), and combined written (COM). The survey assessed authorship, ranked their preference, and graded 13 quality criteria for each text. Time taken to generate each manuscript was also recorded.

Results

Authorship identification accuracy mirrored the odds at 33%. Expert participants (50.9%) demonstrated significantly higher accuracy compared to residents (27.7%) and students (19.6%, P < .001). Participants favored AI-assisted versions (AI and COM) over HUM (P < .001), with COM receiving the highest quality scores. COM and AI achieved 83.8% and 84.3% reduction in writing time, respectively, compared to HUM, while showing 13.9% (P < .001) and 11.1% improvement in quality (P < .001), respectively. However, experts assigned the lowest score for the references of the AI manuscript, potentially hindering its publication.

Conclusion

AI can deceptively mimic human writing, particularly for less experienced readers. Although AI-assisted writing is appealing and offers significant time savings, human oversight remains crucial to ensure accuracy, ethical considerations, and optimal quality. These findings underscore the need for transparency in AI use and highlight the potential of human-AI collaboration in the future of scientific writing.

背景：人工智能（AI）在科学写作中的应用正在迅速增加，这引起了人们对作者身份识别、内容质量和写作效率的担忧。目的：本研究调查了ChatGPT（一个大型语言模型）在模拟出版场景中对这些方面的现实影响。方法：48名代表3种医学专业水平（医学生、住院医师和过敏或皮肤病学专家）的个体评估了一份特应性皮炎病例报告的3种盲法版本：人类书面（HUM）、人工智能生成（AI）和联合书面（COM）。该调查评估了作者身份，对他们的偏好进行了排序，并对每篇文章的质量标准进行了13次评分。生成每份手稿所花费的时间也被记录下来。结果：作者身份识别的准确率为33%。专家参与者（50.9%）比居民（27.7%）和学生（19.6%,P < .001）表现出更高的准确性。参与者更喜欢AI辅助版本（AI和COM）而不是HUM (P < 0.001)， COM获得最高的质量分数。与HUM相比，COM和AI的写入时间分别减少了83.8%和84.3%，而质量分别提高了13.9% （P < 0.001）和11.1% （P < 0.001）。然而，专家们给人工智能手稿的参考文献打分最低，这可能会阻碍其发表。结论：人工智能可以欺骗性地模仿人类写作，特别是对于经验不足的读者。尽管人工智能辅助写作很有吸引力，而且可以节省大量时间，但人类的监督仍然是确保准确性、道德考虑和最佳质量的关键。这些发现强调了人工智能使用透明度的必要性，并强调了人类与人工智能合作在未来科学写作中的潜力。

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引用次数: 0

Food allergy has no negative impact on children’s school performance: A Swedish sibling and co-twin control study

The journal of allergy and clinical immunology. Global

Pub Date : 2025-02-01 DOI: 10.1016/j.jacig.2024.100380

Cecilia Lundholm PhD , Hanna Karim MD , Awad I. Smew MD, PhD , Michael Silverman PhD , Tong Gong PhD , Bronwyn K. Brew PhD , Catarina Almqvist MD, PhD

Background

Food allergy has been shown to negatively impact children’s mental health and quality of life. However, its impact on school performance is unknown.

Objective

We aimed to investigate whether food allergy, severe and nonsevere, is associated with school performance when accounting for measured and unmeasured familial factors.

Methods

This was a register-based cohort study, with sibling controls, including all children born in Sweden 2001-5 (n = 456,164) with food allergy information based on hospital visits and prescriptions, grades, and national test results from all Swedish schools and confounders. Primary exposure was food allergy severity (none, nonsevere, or severe) in school years 7-9, and the primary outcome was total grades from year 9, with secondary exposures/outcomes also at younger ages. The primary outcome was analyzed by linear regression and, for sibling/twin control analyses, fixed effect linear regression. Results were replicated in a twin cohort (n = 31,609).

Results

In unadjusted and analyses adjusted for measured confounders, children with severe food allergy appeared to have better total grades than children without food allergy (β_unadjusted = 10.6 [95% confidence interval (CI), 8.6, 12.6] and β_adjusted = 5.5 [95% CI, 3.7, 7.4]). When also adjusting for unmeasured confounders shared by siblings, the difference was close to null and statistically nonsignificant (β_sibling = 1.6 [95% CI, −1.5, 4.7]; for nonsevere food allergy, β_sibling = −0.0 [95% CI, −2.2, 2.1]). The twin cohort results were similar.

Conclusions

We found no consistent evidence of a negative effect of food allergy, either severe or nonsevere, on school performance when adjusting for measured and unmeasured confounders shared by siblings.

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引用次数: 0

Anti–IL-4Ra therapy is superior to other biologic classes in treating allergic bronchopulmonary aspergillosis 抗il - 4ra治疗过敏性支气管肺曲霉病优于其他生物制剂。

The journal of allergy and clinical immunology. Global

Pub Date : 2025-02-01 DOI: 10.1016/j.jacig.2024.100369

Pedro A. Lamothe MD, PhD , Charles Lewis Humphrey Pruett MS , Natalia Smirnova MD , Aaron Shepherd MD , Martin C. Runnstrom MD , Jiwon Park BA , Rebecca H. Zhang MS , Leshan Zhao MS , Colin Swenson MD , F. Eun-Hyung Lee MD

Background

Allergic bronchopulmonary aspergillosis (ABPA) is a disease resulting from an overactive type 2 response to Aspergillus. Initial studies suggest that asthma biologics can effectively treat ABPA, but it is unclear which biologic class is superior.

Objective

We sought to compare the effectiveness of asthma biologics in the treatment of ABPA.

Methods

We performed a retrospective analysis of patients with ABPA treated with asthma biologics, and measured outcomes of respiratory exacerbations, daily oral corticosteroids, and antifungals. We assessed these variables while individuals were treated with 1 of 3 biologic classes: anti-IgE, anti–IL-5/IL-5 receptor alpha (IL-5Ra), anti–IL-4 receptor alpha (IL-4Ra).

Results

A total of 21 patients were included in our analysis. Anti–IL-4Ra was associated with a significantly lower number of exacerbations and oral corticosteroid use compared with anti-IgE or anti–IL-5/IL-5Ra therapies. Anti–IL-4Ra also had significantly lower antifungal use than anti-IgE, and there was a trend toward lower antifungal use when compared with anti–IL-5/IL-5Ra. In a subgroup of 10 patients treated with 2 or more biologics sequentially, we found that 8 of them achieved clinical control on anti–IL-4Ra therapy after failing anti-IgE and/or anti–IL-5/IL-5Ra therapies.

Conclusions

Dupilumab blocks the IL-4Ra, resulting in the downstream inhibition of both IL-4 and IL-13 effector pathways. Dupilumab may benefit patients with ABPA by inhibiting the generation of airway mucus (IL-13), and by reducing local B-cell differentiation into IgE antibody–secreting cells (IL-4). On the basis of our findings and with the known molecular mechanisms of dupilumab, we believe that anti–IL-4Rα–targeted therapy may be more effective than anti-IgE or anti–IL-5/IL-5Rα therapies to treat ABPA.

背景：过敏性支气管肺曲霉病（ABPA）是一种由曲霉过度活跃的2型反应引起的疾病。初步研究表明哮喘生物制剂可有效治疗ABPA，但尚不清楚哪一类生物制剂更优。目的：比较哮喘生物制剂治疗ABPA的疗效。方法：我们对接受哮喘生物制剂治疗的ABPA患者进行了回顾性分析，并测量了呼吸恶化、每日口服皮质类固醇和抗真菌药物的结果。当个体接受抗ige、抗IL-5/IL-5受体α (IL-5Ra)、抗il -4受体α (IL-4Ra)三种生物分类中的一种治疗时，我们评估了这些变量。结果：共有21例患者纳入我们的分析。与抗ige或抗il -5/IL-5Ra治疗相比，抗il - 4ra与显著降低的恶化次数和口服皮质类固醇使用相关。与抗il -5/IL-5Ra相比，抗il - 4ra的抗真菌使用量明显低于抗ige，且有降低抗真菌使用量的趋势。在一个由10名患者组成的亚组中，我们发现其中8名患者在抗ige和/或抗il -5/IL-5Ra治疗失败后，抗il - 4ra治疗获得了临床控制。结论：Dupilumab阻断IL-4Ra，导致IL-4和IL-13效应通路的下游抑制。Dupilumab可能通过抑制气道粘液（IL-13）的产生和减少局部b细胞向IgE抗体分泌细胞（IL-4）分化而使ABPA患者受益。根据我们的研究结果和已知的dupilumab分子机制，我们认为抗il - 4r α靶向治疗可能比抗ige或抗il -5/IL-5Rα治疗更有效。

{"title":"Anti–IL-4Ra therapy is superior to other biologic classes in treating allergic bronchopulmonary aspergillosis","authors":"Pedro A. Lamothe MD, PhD , Charles Lewis Humphrey Pruett MS , Natalia Smirnova MD , Aaron Shepherd MD , Martin C. Runnstrom MD , Jiwon Park BA , Rebecca H. Zhang MS , Leshan Zhao MS , Colin Swenson MD , F. Eun-Hyung Lee MD","doi":"10.1016/j.jacig.2024.100369","DOIUrl":"10.1016/j.jacig.2024.100369","url":null,"abstract":"<div><h3>Background</h3><div>Allergic bronchopulmonary aspergillosis (ABPA) is a disease resulting from an overactive type 2 response to <em>Aspergillus</em>. Initial studies suggest that asthma biologics can effectively treat ABPA, but it is unclear which biologic class is superior.</div></div><div><h3>Objective</h3><div>We sought to compare the effectiveness of asthma biologics in the treatment of ABPA.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of patients with ABPA treated with asthma biologics, and measured outcomes of respiratory exacerbations, daily oral corticosteroids, and antifungals. We assessed these variables while individuals were treated with 1 of 3 biologic classes: anti-IgE, anti–IL-5/IL-5 receptor alpha (IL-5Ra), anti–IL-4 receptor alpha (IL-4Ra).</div></div><div><h3>Results</h3><div>A total of 21 patients were included in our analysis. Anti–IL-4Ra was associated with a significantly lower number of exacerbations and oral corticosteroid use compared with anti-IgE or anti–IL-5/IL-5Ra therapies. Anti–IL-4Ra also had significantly lower antifungal use than anti-IgE, and there was a trend toward lower antifungal use when compared with anti–IL-5/IL-5Ra. In a subgroup of 10 patients treated with 2 or more biologics sequentially, we found that 8 of them achieved clinical control on anti–IL-4Ra therapy after failing anti-IgE and/or anti–IL-5/IL-5Ra therapies.</div></div><div><h3>Conclusions</h3><div>Dupilumab blocks the IL-4Ra, resulting in the downstream inhibition of both IL-4 and IL-13 effector pathways. Dupilumab may benefit patients with ABPA by inhibiting the generation of airway mucus (IL-13), and by reducing local B-cell differentiation into IgE antibody–secreting cells (IL-4). On the basis of our findings and with the known molecular mechanisms of dupilumab, we believe that anti–IL-4Rα–targeted therapy may be more effective than anti-IgE or anti–IL-5/IL-5Rα therapies to treat ABPA.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 1","pages":"Article 100369"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Resolution of hypogammaglobulinemia-associated recurrent Campylobacter bacteraemia after hematopoietic cell transplantation (HCT) 造血细胞移植（HCT）后低γ球蛋白血症相关的复发弯曲杆菌菌血症的解决。

The journal of allergy and clinical immunology. Global

Pub Date : 2025-02-01 DOI: 10.1016/j.jacig.2024.100378

Emmanouil Karofylakis MD , Effrossyni Gkrania-Klotsas MD, MPH, FRCP, PhD , Benjamin Uttenthal MA, MBBS, PhD, MRCP, FRCPath , Dinakantha Kumararatne MBBS, FRCPath, DPhil

Primary or secondary hypogammaglobulinemia is associated with persistent norovirus and Campylobacter infections despite immunoglobulin replacement therapy. Allogeneic hematopoietic cell transplantation for hematologic indications can lead to immune reconstitution by correcting a previously undiagnosed concurrent primary immunodeficiency.

原发性或继发性低γ球蛋白血症与持续的诺如病毒和弯曲杆菌感染有关，尽管免疫球蛋白替代治疗。同种异体造血细胞移植用于血液学适应症可以通过纠正先前未确诊的并发原发性免疫缺陷导致免疫重建。

引用次数: 0

Stability of diluted chlorhexidine for skin testing in drug allergy evaluations 稀释后的洗必泰在药物过敏评估中用于皮肤测试的稳定性。

The journal of allergy and clinical immunology. Global

Pub Date : 2025-02-01 DOI: 10.1016/j.jacig.2024.100372

Divya Shah MD , Gabriel Cojuc-Konigsberg BS , Stacy D. Brown PhD , Sergio E. Chiarella MD , Gerald W. Volcheck MD , Hirohito Kita MD , Lene H. Garvey MD, PhD (Professor) , Alexei Gonzalez-Estrada MD

Background

Chlorhexidine gluconate (CHX), a common cause of perioperative anaphylaxis, is frequently used for skin testing in allergy evaluations. Although CHX’s maximal nonirritating concentrations are known, the stability of its dilutions for skin testing remains unexplored, particularly when sterile water for injection (SWFI) or normal saline (NS) are used as diluents.

Objective

Our aim was to evaluate the stability and precipitation of CHX when diluted with SWFI or NS for drug allergy skin testing.

Methods

CHX dilutions (5-0.002 mg/mL) were prepared using SWFI and NS. HPLC and UV-visible spectrophotometry were used to assess stability and precipitation over 48 hours. Turbidity was measured at various time points to monitor precipitation.

Results

HPLC analysis showed no significant differences in peak heights between CHX-SWFI and CHX-NS dilutions. However, visible precipitation and increased turbidity (>100 NTU) were observed in CHX-NS at higher concentrations (5 mg/mL) after 60 minutes. No precipitation occurred in CHX-SWFI at any concentration for 48 hours.

Conclusion

For CHX skin testing, SWFI is the preferred diluent at concentrations higher than 0.02 mg/mL to avoid precipitation. Using NS for the final dilution from 0.02 to 0.002 mg/mL is feasible and reduces injection pain. Except for CHX-NS at 5 mg/mL, reagents can be prepared up to 24 hours before testing.

背景：葡萄糖酸氯己定（CHX）是围手术期过敏性休克的常见原因，经常用于过敏评估中的皮试。虽然已知道 CHX 的最大无刺激浓度，但其稀释液在皮试中的稳定性仍有待探索，尤其是在使用注射用无菌水（SWFI）或生理盐水（NS）作为稀释剂时：我们的目的是评估 CHX 经 SWFI 或 NS 稀释后用于药物过敏皮肤试验时的稳定性和沉淀情况：方法：使用 SWFI 和 NS 制备 CHX 稀释液（5-0.002 mg/mL）。采用高效液相色谱法和紫外可见分光光度法评估 48 小时内的稳定性和沉淀情况。在不同的时间点测量浊度，以监测沉淀情况：高效液相色谱分析显示，CHX-SWFI 和 CHX-NS 稀释液的峰高无明显差异。然而，60 分钟后，在较高浓度（5 毫克/毫升）的 CHX-NS 中观察到明显的沉淀和浊度增加（>100 NTU）。任何浓度的 CHX-SWFI 在 48 小时内均未出现沉淀：结论：对于 CHX 皮肤测试，当浓度高于 0.02 毫克/毫升时，SWFI 是避免沉淀的首选稀释剂。使用 NS 进行 0.02 至 0.002 mg/mL 的最终稀释是可行的，并可减少注射疼痛。除 5 毫克/毫升的 CHX-NS 外，试剂可在检测前 24 小时内配制完成。

{"title":"Stability of diluted chlorhexidine for skin testing in drug allergy evaluations","authors":"Divya Shah MD , Gabriel Cojuc-Konigsberg BS , Stacy D. Brown PhD , Sergio E. Chiarella MD , Gerald W. Volcheck MD , Hirohito Kita MD , Lene H. Garvey MD, PhD (Professor) , Alexei Gonzalez-Estrada MD","doi":"10.1016/j.jacig.2024.100372","DOIUrl":"10.1016/j.jacig.2024.100372","url":null,"abstract":"<div><h3>Background</h3><div>Chlorhexidine gluconate (CHX), a common cause of perioperative anaphylaxis, is frequently used for skin testing in allergy evaluations. Although CHX’s maximal nonirritating concentrations are known, the stability of its dilutions for skin testing remains unexplored, particularly when sterile water for injection (SWFI) or normal saline (NS) are used as diluents.</div></div><div><h3>Objective</h3><div>Our aim was to evaluate the stability and precipitation of CHX when diluted with SWFI or NS for drug allergy skin testing.</div></div><div><h3>Methods</h3><div>CHX dilutions (5-0.002 mg/mL) were prepared using SWFI and NS. HPLC and UV-visible spectrophotometry were used to assess stability and precipitation over 48 hours. Turbidity was measured at various time points to monitor precipitation.</div></div><div><h3>Results</h3><div>HPLC analysis showed no significant differences in peak heights between CHX-SWFI and CHX-NS dilutions. However, visible precipitation and increased turbidity (>100 NTU) were observed in CHX-NS at higher concentrations (5 mg/mL) after 60 minutes. No precipitation occurred in CHX-SWFI at any concentration for 48 hours.</div></div><div><h3>Conclusion</h3><div>For CHX skin testing, SWFI is the preferred diluent at concentrations higher than 0.02 mg/mL to avoid precipitation. Using NS for the final dilution from 0.02 to 0.002 mg/mL is feasible and reduces injection pain. Except for CHX-NS at 5 mg/mL, reagents can be prepared up to 24 hours before testing.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 1","pages":"Article 100372"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Obstetric penicillin allergy evaluations 产科青霉素过敏评估。

The journal of allergy and clinical immunology. Global

Pub Date : 2025-02-01 DOI: 10.1016/j.jacig.2024.100376

Lakshmi G. Nair MD , S. Shahzad Mustafa MD , Allison Ramsey MD

Background

Penicillin allergy is reported in 5% to 15% of the world population, with 3% to 10% of pregnant women reporting the same. However, more than 90% of these patients can tolerate penicillin after appropriate evaluation. Penicillin is indicated for various issues that arise in pregnancy, and a history of allergy can have negative individual and public health consequences.

Objective

Our aim was to prospectively evaluate the feasibility, safety, and select obstetric outcomes of obstetric penicillin allergy evaluations arranged through a direct referral phone line from obstetric practices to an employed allergy/immunology practice.

Methods

Patients were referred via direct phone line for evaluation during their antenatal visits between May 2019 and May 2022. Patients underwent skin prick testing, and those with a negative penicillin skin testing (PST) result were subjected to amoxicillin challenge. In select cases of patients with a low-risk history, direct oral challenge was performed. Data were analyzed using descriptive statistics.

Results

Of the 324 patients referred between May 2019 and May 2022, a total of 251 (77.5%) presented for in-office evaluations. Of those 251 patients, 239 (95.2%) underwent PST followed by oral challenge if the PST result was negative; 12 patients (4.8%) underwent direct challenge without skin testing, and all of them passed the challenge. Of the patients undergoing PST, 230 (97.2%) had a negative result and 229 tolerated subsequent oral amoxicillin doses, with 1 patient experiencing a delayed reaction to the amoxicillin. The group of patients who presented for evaluation included more people living in ZIP codes described as being of high socioeconomic status than in the no-show group (73.7% vs 63.3%).

Conclusion

To our knowledge, ours is the largest study to date to demonstrate the safety and feasibility of a phone line for obstetric penicillin allergy referrals. We demonstrate a better show rate than previous analyses, with most of the patients presenting for evaluation being successfully delabeled.

背景：青霉素过敏报告占世界人口的5%至15%，其中3%至10%的孕妇报告同样的情况。然而，经过适当的评估，90%以上的患者可以耐受青霉素。青霉素适用于妊娠期间出现的各种问题，过敏史可能对个人和公共健康产生负面影响。目的：我们的目的是前瞻性地评估产科青霉素过敏评估的可行性、安全性和选择产科结果，这些评估通过直接转诊电话从产科诊所安排到过敏/免疫学诊所。方法：于2019年5月至2022年5月期间，通过电话直接转介患者进行产前检查。患者进行皮肤点刺试验，青霉素皮肤试验（PST）阴性的患者进行阿莫西林刺激。在有低风险病史的患者中，直接进行口腔攻击。数据分析采用描述性统计。结果：在2019年5月至2022年5月期间转诊的324例患者中，共有251例（77.5%）进行了现场评估。在这251名患者中，239名（95.2%）接受了PST检查，如果PST结果为阴性，则再进行口腔穿刺；12例（4.8%）患者直接激射，未进行皮肤试验，均通过激射。在接受PST治疗的患者中，230例（97.2%）结果为阴性，229例后续口服阿莫西林耐受，1例患者出现阿莫西林延迟反应。与未就诊组相比，就诊组中居住在被描述为高社会经济地位的邮政编码地区的患者更多（73.7% vs 63.3%）。结论：据我们所知，我们的研究是迄今为止最大的研究，以证明产科青霉素过敏转诊电话线路的安全性和可行性。我们证明了一个更好的显示率比以前的分析，大多数患者提出评估被成功地去标签。

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引用次数: 0

Validating and utilizing dried blood spots for family screening: Screening Programme Providing Outreach for Testing Hereditary Angioedema (SPPOT-HAE) 验证和利用干血点进行家庭筛查：为遗传性血管性水肿（spot - hae）检测提供外展的筛查计划。

The journal of allergy and clinical immunology. Global

Pub Date : 2025-02-01 DOI: 10.1016/j.jacig.2024.100381

Jane C.Y. Wong MBBS , Dorothy L.Y. Lam MSc , Jackie S.H. Yim MSc , Elaine Lee MSc , Weihong Shi MMed , Valerie Chiang MBBS , Philip H. Li MD

Background

Hereditary angioedema (HAE) is a rare genetic disorder with potentially life-threatening consequences, traditionally diagnosed by conventional laboratory methods that can be resource intensive and inconvenient. Incorporating dried blood spot (DBS) tests may be a promising alternative for diagnosing HAE and family screening.

Objective

This study aimed to validate DBS with conventional laboratory assays among confirmed C1 esterase inhibitor (C1-INH) HAE patients and assess the utility of DBS in a Screening Programme Providing Outreach for Testing Hereditary Angioedema (SPPOT-HAE).

Methods

In part 1, 16 Chinese C1-INH-HAE patients from 7 families participated in the validation of DBS for detecting C4, C1-INH, and functional C1-INH (fC1-INH). The results were compared with conventional laboratory assays. In part 2, DBS was utilized in family screening for HAE in a large Chinese family with relatives previously refusing testing.

Results

The study found strong correlation between conventional assays and DBS in measuring C4 (r = 0.870, P < .0001), C1-INH (r = 0.978, P < .0001), and fC1-INH (r = 0.756, P < .0001). There were no false-negative results from the DBS for C4, C1-INH or fC1-INH. SPPOT-HAE successfully recruited 9 additional relatives for family screening, of whom 22% were confirmed to have HAE. The use of DBS in an outreach program overcame barriers of prior family screening initiatives.

Conclusion

This is the first study to validate measurement of fC1-INH using DBS in C1-INH-HAE with conventional assays. An outreach program using DBS is a promising strategy overcoming previous barriers of family screening. Further large-scale, multicenter studies are required to establish the role of DBS, compare cost-effectiveness with prior strategies, and maximize diagnosis in resource-constrained countries.

背景：遗传性血管性水肿（HAE）是一种罕见的遗传性疾病，具有潜在的危及生命的后果，传统上通过传统的实验室方法诊断，这可能是资源密集和不方便的。结合干血斑（DBS）试验可能是诊断HAE和家庭筛查的一种有希望的替代方法。目的：本研究旨在通过常规实验室检测在确诊的C1酯酶抑制剂（C1- inh） HAE患者中验证DBS，并评估DBS在遗传性血管性水肿（spot -HAE）筛查计划中的应用。方法：在第一部分中，来自7个家庭的16例中国C1-INH- hae患者参与了DBS检测C4、C1-INH和功能性C1-INH （fC1-INH）的验证。结果与常规实验室检测结果进行了比较。在第2部分中，DBS被用于一个亲属先前拒绝检测的中国大家庭的HAE家庭筛查。结果：常规方法测定C4 （r = 0.870, P < 0.0001）、C1-INH （r = 0.978, P < 0.0001）、fC1-INH （r = 0.756, P < 0.0001）与DBS有较强相关性。DBS检查C4、C1-INH或fC1-INH均无假阴性结果。spot -HAE成功招募了9名额外的亲属进行家庭筛查，其中22%被证实患有HAE。在推广项目中使用DBS克服了先前家庭筛查倡议的障碍。结论：这是第一个用DBS检测C1-INH-HAE患者fC1-INH的研究。使用DBS的外展计划是一种有希望的策略，克服了以前家庭筛查的障碍。需要进一步开展大规模、多中心的研究，以确定DBS的作用，比较与先前策略的成本效益，并在资源受限的国家最大限度地提高诊断。

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