Adult Allergy Research Articles

The Impact of COVID-19 Pandemic on Adult and Pediatric Allergy & Immunology Services in the UK National Health Service

BackgroundThe coronavirus disease 2019 pandemic imposed multiple restrictions on health care services.ObjectiveTo investigate the impact of the pandemic on Allergy & Immunology (A&I) services in the United Kingdom.MethodsA national survey of all A&I services registered with the Royal College of Physicians and/or the British Society for Allergy and Clinical Immunology was carried out. The survey covered staffing, facilities, personal protective equipment, appointments & patient review, investigations, treatments, and research activity. Weeks commencing February 3, 2020 (pre–coronavirus disease), April 6, 2020, and May 8, 2020, were used as reference points for the data set.ResultsA total of 99 services participated. There was a reduction in nursing, medical, administrative, and allied health professional staff during the pandemic; 86% and 92% of A&I services continued to accept nonurgent and urgent referrals, respectively, during the pandemic. There were changes in immunoglobulin dose and infusion regimen in 67% and 14% of adult and pediatric services, respectively; 30% discontinued immunoglobulin replacement in some patients. There was a significant (all variables, P ≤ .0001) reduction in the following: face-to-face consultations (increase in telephone consultations), initiation of venom immunotherapy, sublingual and subcutaneous injection immunotherapy, anesthetic allergy testing, and hospital procedures (food challenges, immunoglobulin and omalizumab administration); and a significant increase (P ≤ .0001) in home therapy for immunoglobulin and omalizumab. Adverse clinical outcomes were reported, but none were serious.ConclusionsThe pandemic had a significant impact on A&I services, leading to multiple unplanned pragmatic amendments in service delivery. There is an urgent need for prospective audits and strategic planning in the medium and long-term to achieve equitable, safe, and standardized health care.

Adult and Pediatric Food Allergy to Chickpea, Pea, Lentil, and Lupine: A Scoping Review

Nonpriority legume allergies, which include chickpea, pea, lentil, and lupine, are frequently implicated in severe allergic reactions. Yet, studies on public health knowledge and educational needs are near-absent. To summarize what is known from the existing literature about nonpriority legume food allergy. Eligible, original research articles reported on both nonpriority legume food allergy and 1 or more of prevalence, burden, food labeling information, or current education strategies. Screening was performed by 2 independent reviewers. Conflicts were discussed and if consensus could not be reached, a third reviewer was consulted. Of the 8976 titles identified, 47 were included subsequent to full-text screening. Most studies identified focused on prevalence, and were conducted in Europe, with additional studies from Asia, and North America. Although we defined burden quite broadly, few studies addressed the burden of nonpriority legume food allergens. Moreover, no studies addressed labeling or educational needs for these allergens. Our review of the literature found current research focused on the prevalence of nonpriority legume allergy with significant gaps regarding burden, allergen labeling, and education strategies. To this end, further research on these aspects of nonpriority legume allergy is warranted.

Effect of Omalizumab on Nasal Symptoms in Asthma and Perennial Allergic Rhinitis.

To determine the efficacy of omalizumab on nasal symptoms in patients having allergic asthma with rhinitis symptoms. Cohort study. University of Health Sciences, Izmir Tepecik Training and Research Hospital, İzmir, Turkey, between October and November 2019. This study included patients with perennial allergic rhinitis without nasal polyposis who were followed up in the adult allergy outpatient clinic, had findings consistent with allergic rhinitis upon nasal endoscopic examination. They were given 2-4 weekly subcutaneous omalizumab for more than six months changes in nasal symptoms were noted using nasal symptoms score. Each symptom was individually evaluated. There were 42 patients, consisting of 36 women (85.7%) and six men (14.3%), who received omalizumab treatment. Patient age ranged between 30 and 77 years, mean = 54.21±10.85 years. Median change in nasal symptom score of all cases after treatment was a 3.5 (2-6.25) decrease, which was statistically significant (p <0.001). When we examine the decrease in nasal symptoms after omalizumab compared to pre-omalizumab in all cases, the most prominent change was observed in the symptom of nasal congestion. Two-four weekly subcutaneous omalizumab for six months or more was effective in treating all rhinitis symptoms and had the greatest effect on nasal congestion compared to all other symptoms. Key Words: Allergic rhinitis, Anti-IgE, Omalizumab, Total nasal symptom score (TNSS), Asthma.

Synchronous Telemedicine in Allergy: Lessons Learned and Transformation of Care During the COVID-19 Pandemic

BackgroundThe outbreak of the COVID-19 pandemic facilitated a rapid transition to non–face-to-face models of care across the allergy services.ObjectiveTo describe the outcomes of the use of synchronous telemedicine for outpatient consultations in a tertiary adult allergy center.MethodsWe retrospectively reviewed all non–face-to-face appointments during the second month of the pandemic in the United Kingdom.ResultsA total of 637 non–face-to-face appointments for unique patients were booked between April 1 and 30, 2020; 91% were new consultations. Most referrals (81.5%) were related to nondrug reactions. The overall “Did Not Attend” rate was 15.7%. A total of 439 patients were assessed for nondrug reactions; 87% were new appointments. Food-related reactions (50.4%), urticaria/angioedema (23.2%), and rhinitis (18.1%) were the most common reasons for new referrals. Two hundred twenty-one (57.7%) of these patients required further allergy testing, primarily for suspected food allergy. More than 42% of the new patients, mainly referred for urticaria/angioedema, were discharged after their remote assessment. Less than 10% of the follow-up patients required additional testing. Ninety-seven new patients were assessed for a suspected drug reaction, predominantly to beta-lactam antibiotics (57.7%). Sixty-nine patients (71%) required further investigations, but a notable 29% did not require further allergy input. The overall experience was very good/good for most patients (85%).ConclusionTelemedicine can transform the current models of allergy care. Screening criteria for selecting suitable new patients are required. A telemedicine-based drug allergy service model can be more time- and cost-effective, and improve patient access to specialist care.

Immunisation and allergy in children and adults: A case-based approach.

Adverse events following immunisation (AEFIs) are often attributed to vaccine hypersensitivity. However, many of these possible allergic reactions are unlikely to be confirmed as true vaccine allergies but rather coincidental symptoms that may mimic an allergic reaction. By using case studies, the authors show the variation of presentations of potential hypersensitivity AEFIs. Case studies are used to illustrate a general approach to investigation and management of these reactions. AEFIs are commonly seen in general practice, and it can often be difficult todifferentiate between the underlying mechanisms. It is important to be able toidentify a potential hypersensitivity reaction so that it can be reported to theappropriate local pharmacovigilance system and patients can be reviewed byimmunisation specialists to evaluate, investigate and manage future immunisations where required.

BET 2: The accuracy of self-reported penicillin allergies in adults

A short-cut review of the available medical literature was carried out to establish the proportion of patients who self-report an allergy to penicillin have a true penicillin allergy. After abstract...

Detection of specific IgE against linear epitopes from Gald1 has additional value in diagnosing hen's egg allergy in adults.

BackgroundAlthough hen's egg allergy is more prevalent in children, up to 0.6% of adults from different European countries suffer from a persistent or newly onset hen's egg allergy, making accurate diagnosis in adults necessary. However, sensitization to hen's egg extracts, components and linear epitopes is solely studied in children.MethodsHen's egg allergic (n = 16) and tolerant (n = 19) adults were selected by sensitization towards recombinant components rGal d 1 and/or 3. Sensitization profiles towards egg white and yolk extract and the native components Gal d 1, 2, 3 and 4 were respectively evaluated with the ImmunoCAP or the EUROLINE system. Characterization of linear epitopes was performed with a peptide microarray containing 15mer peptides representing the entire sequence of mature Gal d 1 and 3.ResultsOverall, sIgE titres against hen's egg extracts and single components overlapped largely between allergic and tolerant adults. Although the median sIgE/sIgG4 ratio to Gal d 1 was increased in allergic adults, the range was comparable between both groups. Clinically relevant sensitization to Gal d 1 was confirmed by sIgE‐binding to the linear epitopes aa30‐41, aa39‐50 or aa84‐95 in 6/13 allergic adults, mainly suffering from objective symptoms. In comparison, these epitopes were recognized by 1/15 tolerant patient. Only a few linear epitopes were detected for Gal d 3, suggesting a greater importance of conformational epitopes for the recognition of Gal d 3.Conclusion and Clinical RelevanceSpecific IgE‐binding to linear epitopes of Gal d 1 is highly specific in identifying hen's egg allergic adults with objective symptoms.

Clinical Characteristics and Proposed Wheat-Cofactor Challenge Protocol with a High Diagnostic Yield in Adult-Onset IgE-Mediated Wheat Allergy.

BackgroundIgE-mediated wheat allergy in adults can be childhood or adulthood onset. Adult-onset wheat allergy has been reported, but data on clinical characteristics and practical food challenge protocols are scarce.ObjectiveWe aimed to describe the clinical characteristics of adult-onset wheat allergy, laboratory results, and outcomes of a modified 3-day challenge protocol using a combination of aspirin, wheat, and exercise.Patients and MethodsPatients with histories compatible with adult-onset wheat allergy were recruited from Siriraj Hospital, Thailand. Clinical history, skin prick tests (SPTs), and specific IgE (sIgE) levels were ascertained. Patients with no food challenge contraindications were asked to volunteer for wheat challenge. A modified 3-day protocol using 300 mg of acetylsalicylic acid, 60–75 g of wheat flour, and exercise was used for confirmatory diagnosis of conventional wheat allergy (WA) and wheat-dependent exercise-induced anaphylaxis (WDEIA).ResultsThirty-three patients were recruited. The mean age of onset was 29.7 years (SD 10.5). SPTs yielded positivity rates of 9.1%, 84.8%, and 81.8% in commercial wheat, in-house gliadin, and in-house glutenin extracts, respectively. sIgE yielded a positivity rate of 61% and 88% in wheat and ω5-gliadin, respectively. Eighteen patients underwent oral wheat challenges. Of these, 17 patients (94.4%) had positive challenges leading to definite diagnoses of WA (35%), and WDEIA (65%). One WDEIA patient developed hypotensive anaphylaxis in the protocol.ConclusionWDEIA was the most common phenotype. Our modified 3-day protocol could differentiate WA and WDEIA and yielded a high positivity rate (94.4%). It should be used cautiously as severe reactions can occur.

Development of a screening questionnaire for the study of food allergy in adults

Background & aimsAs far as we know, no screening questionnaire has been developed and validated for identification of adverse food reactions in Portuguese-speaking adults, as an initial approach towards the investigation of cases of possible food allergy. Thus, the objective of this study was to develop and validate a screening questionnaire of food allergy in adult Portuguese-speaking patients. MethodsThis was a multicentre, cross-sectional study using a simple random sample of 186 adults between 18 and 82 years old from various parts of the centre of Portugal. Intelligibility of the questionnaire was first assessed in 24 patients with confirmed IgE- or non-IgE-mediated food allergy, and in 24 volunteers without food allergies. The 17-item questionnaire was subsequently applied by phone to 78 food allergic patients (66 IgE-mediated and 12 non-IgE mediated) and to 60 non-food allergic volunteers, with subsequent reassessment (re-test). Face and content validity, intelligibility, construct validity, and test-retest reliability (temporal stability) were analysed. ResultsFace and content validity allowed item reduction from 30 to 17 items with adequate content validity index >0.78. Construct validity was confirmed in the 66 confirmed IgE-mediated food allergic patients, 12 non-IgE-mediated food allergic patients, and 60 non-allergic patients. Test-Retest Reliability (general temporal stability) of the test had a Spearman correlation coefficient value of 0.845 for the retest. Cohen's Kappa values for the relevant questions were greater than 0.890 for almost all items. No differences were found when sex, age, and volunteers' recruitment origin were analysed. An inverse relationship was found between reliability and retest time interval. ConclusionsDue to the quick and easy implementation, confirmation of face, content and construct validity as well as high temporal reproducibility, this screening questionnaire may be a useful study tool for an initial approach to detection of food allergies in adults.

Audit of medication allergy referrals to an allergy outpatient service at a tertiary hospital

AbstractMedication allergy is a significant cause of morbidity and mortality and proper evaluation and management by an allergy service is of paramount importance. We audited all adult medication allergy outpatient referrals received by a tertiary allergy/clinical immunology service for completeness. A 6‐month prospective audit of all medication allergy referrals was undertaken at a tertiary public hospital in South Australia. Each referral was assessed against the Australasian Society for Clinical Immunology and Allergy (ASCIA) medication allergy referral template. A total of 73 medication allergy referrals were received. There was an overall poor level of adherence to all criteria (44.7%) and general practitioner (GP) referrals were generally more detailed than internal referrals. Inadequately detailed referrals may have the knock‐on effect of inappropriate triaging of referrals. Future studies are required to identify barriers to doctors providing sufficiently detailed referrals, and investigate appropriate interventions to improve this.

The role of food atopy patch test in the diagnosis of food allergy in adults with atopic dermatitis

The role of food atopy patch test in the diagnosis of food allergy in adults with atopic dermatitis

Editorial introductions

Editorial introductions

UK allergy and immunology in a post‐COVID‐19 era

UK allergy and immunology in a post‐COVID‐19 era

Reduced polyfunctional T cells and increased cellular activation markers in adult allergy patients reporting adverse reactions to food

BackgroundThe underlying cellular mechanisms causing adverse reactions to food are complex and still not fully understood. Therefore, in this study we aimed to identify functional and/or phenotypical immune cell signatures characteristic for adult patients reporting adverse reactions to food.By mass cytometry, we performed high-dimensional profiling of peripheral blood mononuclear cells (PBMC) from adult patients reporting adverse reactions to food and healthy controls. The patients were grouped according to sIgE-positive or sIgE-negative serology to common food and inhalant allergens. Two broad antibody panels were used, allowing determination of major immune cell populations in PBMC, as well as activation status, proliferation status, and cytokine expression patterns after PMA/ionomycin-stimulation on a single cell level.ResultsBy use of data-driven algorithms, several cell populations were identified showing significantly different marker expression between the groups.Most striking was an impaired frequency and function of polyfunctional CD4+ and CD8+ T cells in patients reporting adverse reactions to food compared to the controls. Further, subpopulations of monocytes, T cells, and B cells had increased expression of functional markers such as CD371, CD69, CD25, CD28, and/or HLA-DR as well as decreased expression of CD23 in the patients. Most of the differing cell subpopulations were similarly altered in the two subgroups of patients.ConclusionOur results suggest common immune cell features for both patient subgroups reporting adverse reactions to food, and provide a basis for further studies on mechanistic and diagnostic biomarker studies in food allergy.

Drug allergy to CFTR modulator therapy associated with lumacaftor-specific CD4+ T lymphocytes

Drug allergy to CFTR modulator therapy associated with lumacaftor-specific CD4+ T lymphocytes

P346 A review of recording of antibiotic-related adverse reactions and allergies in adults with cystic fibrosis across paper and electronic medical records

P346 A review of recording of antibiotic-related adverse reactions and allergies in adults with cystic fibrosis across paper and electronic medical records

Food allergy in adults in Europe: what can we learn from geographical differences?

The aim of this article is to characterize the present state-of-the-art on the topic of food allergies across Europe. A systematic review and metaanalysis on the epidemiology of food allergy in Europe have been performed by the Food Allergy and Anaphylaxis Guidelines Group of the European Academy of Allergology and Clinical Immunology. The authors had made an extensive search of four different electronic databases which retrieved thousands of hits. A critical appraisal of the documents reduced their number to just over 100 articles covering the period 2000-2012, revealing striking methodological inhomogeneity and blank areas on the map of the continent, particularly for the adult population. A major new development intending to fill in the gaps in the field of food allergy is the launch and implementation of the European Union-funded project 'Prevalence, Cost and Basis of Food Allergy Across Europe,' acronym 'EuroPrevall.' Among the deliverable of the project are several seminal articles on food allergy in adults which are presented in this review. The EuroPrevall project confirmed much more reliably and in more detail the existing inhomogeneity in the prevalence of food allergy, which reflects environmental and climate differences between the separate countries, but possibly also the level of public awareness.

The predominance of seafood allergy in Vietnamese adults: Results from the first population-based questionnaire survey

BackgroundFood allergy (FA) is a serious, costly and growing health problem worldwide. FA occurs in both children and adults; however, there is a paucity of information on FA prevalence and its clinical features in the adult population, especially in Asia. We sought to assess the prevalence of FAs in Vietnamese adults and the distribution of offending food items among different regions throughout Vietnam. MethodsA nationwide, cross-sectional, population-based survey was conducted among University students aged 16–50 years. We used a structured, anonymous questionnaire, which was modified from recently published FA epidemiologic studies and based on European Academy of Allergy and Clinical Immunology (EAACI) guidelines, to collect data on FA prevalence, clinical presentations, and implicated food groups. Statistical analysis was performed to generate the prevalence of self-reported and doctor-diagnosed FA and to examine the association of key environmental factors and FA incidence in this population. ResultsOf the 14,500 surveys distributed, a total of 9,039 responses were returned, resulting in a response rate of 62.4%. Among participants who reported food-induced adverse reactions, 48.0% have repeated reactions. 18.0% of the participants perceived FA symptoms, but less than half of them sought medical services for confirmation (37.9%). Stratifying for true FA symptoms, the prevalence of self-reported FA was 11.8% and of doctor-diagnosed FA, 4.6%. The most common doctor-diagnosed FA was to crustacean (3.0%; 95% CI, 2.6–3.3), followed by fish (1.6%; 95% CI, 1.3–1.8), mollusk (1.3%; 95% CI, 1.0–1.5) and beef (1.0%; 95% CI, 0.8–1.2). The prevalence of doctor-diagnosed FA differed among participants living in urban (6.5%) and rural regions (4.9%) (P < 0.001). Atopic family history was the strongest predictor for FA (odds ratio 8.0; 95% CI, 6.2–10.4). ConclusionsSeafood allergy among adults is predominant in Vietnam, followed by beef, milk, and egg, while peanut, soy, and tree nut allergy are much less common. Populations in rural regions have considerably less FA; however, the protective environmental factors have yet to be identified.

Prevalence and Characteristics of Adult Peanut Allergy

Prevalence and Characteristics of Adult Peanut Allergy

Evaluation of neutrophil-to-lymphocyte ratio in patients with symptomatic rhinitis

Objectives: In this study, we aimed to measure the diagnostic value of neutrophil-to-lymphocyte ratio (NLR) in both perennial allergic rhinitis (AR) and non-allergic rhinitis (NAR) patients during their period of active symptoms. Patients and Methods: A total of 161 patients (101 males, 60 females; mean age 34.0±11.1 years; range, 18 to 56 years) consisting of 70 persistent allergic rhinitis (PAR) and 39 NAR patients diagnosed between March 2018 and March 2019 in the adult allergy outpatient clinic, having a Total Nasal Symptom Score (TNSS) of ≥8, and recent complete blood count results available before undergoing any medical treatment and 52 control patients (28 males, 24 females; mean age 31.7±7.8 years; range, 18 to 44 years). The NLR was calculated by dividing the number of neutrophils by the number of lymphocytes. Results: There was no statistically significant difference in the age or gender between the groups (p&gt;0.05). There was no statistically significant difference in the neutrophil, lymphocyte, and NLR between the groups (p&gt;0.05). Conclusion: Our study shows that NLR is not a useful tool in the diagnosis and management of treatment in PAR and NAR in adults