Allergy and asthma proceedings最新文献

We present a case of a 12-year-old healthy girl who presented with acute onset of dry, hyperpigmented, and raised pruritic rash. The lesions initially presented on her thighs then progressed to the trunk and arms hours after receiving the tetanus-diphtheria-pertussis (Tdap) and meningococcal vaccine. After a poor response to medium potency topical steroids, a biopsy specimen was taken, which led to our diagnosis. Current literature reports this condition occurring after Tdap; measles, mumps, and rubella; and COVID-19 vaccinations; but, to our knowledge, not after meningitis vaccines. The role that vaccines play in the pathophysiology remains unclear. This condition may get mistaken for an allergic reaction and lead to vaccine avoidance.

Background: Beta-lactam antibiotics are the most common cause of hypersensitivity reactions to medications, followed by nonsteroidal anti-inflammatory drugs (NSAID). Objective: The aim of this study was to classify children with hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAID-H) according to the latest updates. Methods: ENDA recommendations were used to evaluate all patients with suspected NSAID-H. Children were classified as either selective responders (SR) or cross-intolerant based on the results of the drug provocation test (DPT). Results: Sixty-seven patients with suspected NSAID-H were evaluated in this study. NSAID-H was confirmed in 20 patients (29.9%). Among the 20 patients diagnosed with NSAID-H, 15 were classified according to the 2018 EAACI/ENDA Position Paper. Twelve patients (80%) were classified as cross-intolerant and 3 (20%) as SRs. NSAID-H was confirmed in 4 of 37 patients (10.8%) ages <10 years and 16 of 30 patients (53.3%) ages >10 years (p < 0.001). Twelve patients ages >10 years were classified. Cross-intolerance was detected in nine patients (66.6%). In patients >10 years of age, NSAID-induced urticaria/angioedema (NIUA) (16.7%) was the most common type in the group with classifiable cross-intolerant. In addition, NSAID-exacerbated respiratory disease was detected in one patient. Conculsion: Ibuprofen is the most common NSAID-H drug used in children. NIUA is the most common reaction. In pediatric allergy, hypersensitivity to NSAIDs is a challenging diagnostic issue. Hypersensitivity to NSAIDs poses a challenging diagnostic issue in pediatric allergies. The oral challenge test is the main diagnostic tool; however, in clinical practice, performing multiple challenge tests is difficult.

Background: Half of U.S. households own a dog despite 10% of individuals being sensitized to dog. Assessment and treatment options for dog allergy include the use of commercial dog extracts which have inconsistent performance, making diagnosing and managing dog allergy challenging. Contamination of dog extracts with other allergens has previously been reported. Objective: We sought to determine whether commercial dog extracts contain other aeroallergens. Methods: An extract purity and quantification study on acetone precipitated dog hair and dander extract (AP dog) was performed, 6 aeroallergens; Alternaria (Alt a 1), Ragweed (Amb a 1), German Cockroach (Bla g 2), Dust Mite (Der p t), Cat (Fel d 1), and Rye Grass (Lol p 1). Following, conventional dog hair and dander extract (CV dog) and the new ultrafiltered dog hair and dander extract (UF dog) were also assessed based on the initial results of AP dog. SDS-PAGE was performed on all three dog extracts to compare allergen content. Lastly, serology results and aeroallergen immunotherapy prescriptions were compared. Results: The ELISA trays with Alt a 1, Amb a 1, Bla g 2, Der p 1, and Lol p 1 antibodies did not capture AP dog, while the ELISA tray with Fel d 1 antibody captured AP dog, CV dog, and UF dog. SDS-PAGE results of the 3 dog extracts did not reveal a band at the molecular weight for Fel d 1. Conculsion: Contamination of commercial dog extracts was not found. However, our findings are supportive of commercial dog extracts containing a Fel d 1-like dog allergen that is cross-reactive to Fel d 1. Cross-reactivity between commercial dog extracts and Fel d 1 could be responsible for double positivity to cat and dog in serology. Additional studies are needed to better illustrate this Fel d 1-like dog allergen.

Background: Although the gold standard for diagnosing beta-lactam antibiotic (BLA) allergy is the drug provocation test (DPT), there is no standardized protocol for children. Objective: We aimed to evaluate the clinical features and DPT results of children with a history of low-risk non-immediate reactions (NIR) to BLA who underwent initial direct single therapeutic dose challenge with a 5-day prolonged DPT. Methods: We retrospectively evaluated children ages 0-18 years with a history of low-risk NIRs to BLAs. On the first day of provocation, a single-dose DPT protocol without any skin test was administered at the clinic. The therapeutic dose was adjusted to not exceed the maximum single-unit dose (MSUD) for age and weight. The DPT protocol was administered with 100% of MSUD. To identify children with delayed reactions, the parents or caregivers were told to continue giving the medication at home for 5 days. Results: One hundred and nine children were included in this study. The median (interquartile range) age of the children was 62.5 months (26.5-94 months). Of the suspected drugs, the main culprit drug was amoxicillin-clavulanic acid for 89 children (81.7%). The most common clinical manifestation was maculopapular exanthema, which occurred in 85 children (78%), and 8 (7.3%) had a positive DPT result. Three children (2.8%) developed a reaction after the first DPT dose. The remaining children continued to use the suspected BLA at home. Five children (4.7%) developed a reaction while using the drug at home. All the children with positive DPT results developed mild cutaneous signs and presented with a reaction to amoxicillin-clavulanic acid. None had a systemic or severe cutaneous reaction. Conclusion: Initial direct single therapeutic dose challenge with a 5-day prolonged DPT is a useful and safe way to assess low-risk NIRs to BLAs in children.

Background: There is a greater prevalence of cognitive impairment among ethnic and/or racial minorities, and cognitive impairment is a barrier to asthma self-management (SM) behaviors and outcomes in older adults. Objective: The aim of this study was to examine the relationship between cognitive impairment, assessed by using the Montreal Cognitive Assessment (MoCA), and asthma SM behaviors and outcomes in a sample of predominantly Black and Latino participants. In addition, we evaluated whether using two different MoCA cutoff scores influenced the association between cognitive impairment and asthma outcomes. Methods: Baseline cross-sectional data were extracted from a longitudinal study of older adults with asthma (N = 165) ages ≥60 years. Cognition was assessed by using the MoCA. Asthma Control Questionnaire, asthma-related quality of life (AQOL), and inhaled corticosteroid (ICS) adherence were assessed by using self-report. ICS dosing was collected through chart review and inhaler technique was observed and rated. Results: Using established MoCA cutoff scores of 23 and 26 yielded 45% and 74% cognitive impairment rates, respectively. Cognitive impairment, defined by using the cutoff score of 23, was significantly associated with worse asthma control (p = 0.04) and worse ICS adherence (p = 0.01). With a cutoff score of 26, only AQOL was significantly associated with cognitive impairment (p = 0.03). Race and/or ethnicity moderated the relationship between cognitive impairment and asthma control with a MoCA cutoff score of 23, and between cognitive impairment and AQOL with a MoCA cutoff score of 26. Conclusion: Cognitive impairment in older adults with asthma is associated with important clinical outcomes, but this relationship is influenced by the cutoff score used to define cognitive impairment.

Background: Hereditary angioedema (HAE) is a complex disorder with a wide array of treatment options. Shared decision-making (SDM) should be used to ensure that patients are choosing their best treatment option. The goal was to develop and psychometrically test a brief instrument for assessing the patient's perspective of the SDM process during his or her clinical encounters with an HAE specialist/allergist. Method: We hypothesized that SDM could be used effectively to help patients in their choice of therapy for HAE. Ten HAE treating physicians from the United States with a total of 50 patients with HAE used SDM to help patients choose the best prophylactic therapies (oral kallikrein inhibitor, androgens, subcutaneous C1 inhibitor replacement therapy, intravenous C1 inhibitor replacement therapy, monoclonal antibody kallikrein inhibitor) for their HAE and then completed surveys to analyze the effectiveness of the implementation of SDM as a quality indicator in health services assessment. Results: The congruence of answers between the physicians and the patients was then analyzed; 90% of the patient-physician pairs agreed that the advantages and disadvantages of the treatment options were precisely explained; 92% of the patient-physician pairs agreed that the physician helped them understand all the information and that the physician asked them which treatment option they preferred; 88% of the pairs agreed that the different treatment options were thoroughly weighed and 92% of the pairs felt that they selected a treatment option together. Conclusion: In summary, SDM is being implemented by treating physicians to determine the best management options for their patients with HAE.

Background: Patients with aspirin-exacerbated respiratory disease (AERD) frequently experience symptoms consistent with eustachian tube dysfunction (ETD), which can substantially impair patient quality of life. Methods: We analyzed a cohort of 98 adult patients with AERD who participated in a longitudinal, survey-based study. Results: By assessing data over 1 year, we established that, in patients with AERD, the ear/facial subdomain of the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire could predict performance on the 7-item Eustachian Tube Dysfunction Questionnaire, a validated instrument for the diagnosis of ETD. We then performed a re-analysis of data from a prospective, open-label study of 22 adult patients with AERD treated with dupilumab for 3 months. We found that treatment with dupilumab was associated with a significant decrease in the SNOT-22 ear/facial subdomain score, which reflects a substantial reduction in otologic symptoms and ETD within 1 month of initiating dupilumab and was sustained for 3 months afterward. Conclusion: Our findings provide evidence that dupilumab significantly improved ETD and otologic symptoms in AERD, evidenced by changes in the SNOT-22 ear/facial subdomain score. The presence of ETD and otologic symptoms should be considered when determining the optimal therapeutic course for patients with AERD.

Background: Various formulations of dog allergen extracts, including conventional dog (also known as dog epithelium) and acetone precipitated (AP) dog, have been used for skin-prick testing (SPT), with AP dog showing improved antigen content but experiencing stability issues due to precipitant formation. Ultrafiltered (UF) dog extract has been developed to address these concerns by offering comparable allergen content to AP dog. This study retrospectively compared UF dog with conventional dog and AP dog in SPT. Objective: To compare the efficacy of UF dog extract with conventional dog and AP dog extracts in detecting dog sensitization through SPT. Methods: Retrospective analysis of SPT results from a single U.S. allergy clinic was conducted. Tests performed between October 2022 and March 2024 were included. Primary and secondary outcomes were analyzed by using descriptive statistics and statistical tests. Results: UF dog, AP dog, and conventional dog showed positivity rates of 24.2%, 23.5%, and 16.3%, respectively. UF dog demonstrated significantly higher average wheal and erythema sizes compared with conventional dog and AP dog, but UF dog was not statistically different from AP dog in terms of test positivity. Conclusion: UF dog extract showed comparable number of positive tests to AP dog and a greater number of positive tests to conventional dog. Results of the study suggest UF dog as a viable alternative to AP dog, which offered improved stability and similar test responses. Further research with larger sample sizes is recommended to confirm these findings.