Allergy Test Results Research Articles

An Evaluation of Skin and Immunological Responses after Using a Novel Cross-Linked Porcine-Based Dermal Injectable Collagen with Lidocaine for Nasolabial Fold Correction.

Background: Hypersensitivity to the new dermal injectable porcine-based collagen with lidocaine featuring a novel cross-linking technology (test filler) for nasolabial fold correction was compared to the commercially available traditional cross-linked dermal injectable porcine-based collagen with lidocaine (control filler). Methods: Recruited participants (n = 279) received a single 0.1 mL intradermal injection of either test filler or control filler in the left forearm as a screening skin allergy test. Injection sites were assessed clinically at 24 h post-implant. Treatment was given to 252 successfully screened participants, and injection sites were monitored for 21 days. Immunological examinations were performed at screening and then at 4 and 24 weeks post-treatment. Observations for adverse events continued until the 52nd week. Results: Intradermal allergy testing results were negative for all the test recipients (0/124) and positive for two control recipients (2/132, 1.5%). Most of the participants exhibited no changes in serum immunoglobulin (IgG, IgM) and complement (C3, C4) levels. No serious adverse events related to the device were recorded. Most adverse events were common complications of dermal filler treatment and were related to the injection site. Most adverse effects were resolved or under control by 52 weeks. Conclusions: Hypersensitivity reactions with the test filler were lower than those with the control filler, validating the safe use of test filler for nasolabial fold correction without the need for pretreatment skin testing.

Psychological Status as an Effect Modifier of the Association Between Allergy Symptoms and Allergy Testing.

Patient-reported outcome measures, while valuable, may not correlate with diagnostic test results. To better understand this potential discrepancy, our objective was to determine whether psychological health is an effect modifier of the association between patient-reported allergy outcome scores and allergy test results. Prospective outcomes study. Tertiary care hospital and community-based clinic. This study included 600 patients at least 18 years of age who presented for symptoms related to allergic rhinitis and completed the related sinonasal outcome test (SNOT), which includes validated nasal, allergy, and psychological domains. Stratified analyses of odds ratios and Spearman correlation coefficients were utilized to assess for effect modification by psychological status. Worse patient-reported allergic rhinitis symptoms were significantly associated with positive allergy test results (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.22-2.34, P = .002) in patients with better psychological health. In contrast, there was no association in patients with worse psychological health (OR 1.06, 95% CI 0.36-3.10, P = .92). These findings were corroborated by assessments of correlation: allergy domain scores were positively correlated with allergy testing scores (Spearman rho 0.18, 95% CI 0.10-0.25, P < .001) in patients with better psychological health, while there was no correlation in patients with worse psychological health (-0.02, 95% CI -0.16-0.12, P = .77). Psychological status was an effect modifier of the association between allergy domain and allergy testing data. When assessing the relationship between subjective measures, such as sinonasal validated instruments, and objective measures, such as allergy test results, accounting for effect modifiers such as psychological state can provide clinical and research-related insights.

Color-Contrast Technique Using Fluorescein and Blue Marker to Maximize Visualization during Lymphaticovenous Anastomosis.

Lymphatic vessel wall and lumen visualization during anastomosis is challenging. Different techniques with variable efficacy have been described. Double-opposing color contrast is created using 10% fluorescein sodium, which stains lymphatic fluid yellow, causing a clear contrast to the blue marker-painted lymphatic wall, improving intralumen visualization during the anastomosis process. In this retrospective study, the authors evaluated the success rate of performing anastomosis between the side of the lymphatic vessel and the end of the vein (S-to-E LVA) in 281 patients. The LVA assessment showed mean lymphatic diameter of 0.44 ± 0.09 mm and mean vein diameter of 0.57 ± 0.14 mm with S-to-E success rate of 100% confirmed by postanastomosis indocyanine green lymphography. No adverse events were encountered. Fluorescein sodium was not used in 2 patients because of positive skin allergy test results. This method has the advantages of not needing an additional device, allowing clear visualization, and not staining the surrounding structures. This approach using opposing color contrast between fluorescent yellow and blue marker improved vessel edge identification, which translated into higher visualization and patency with 100% success rate in S-to-E LVA performance.

The analysis of etiology and treatment of chronic rhinosinusitis in our own material.

&lt;b&gt;Introduction and aim:&lt;/b&gt; The aim of the study was the analysis of etiology and treatment of chronic rhinosinusitis in our own material.&lt;/br&gt;&lt;/br&gt; &lt;b&gt;Material and methods:&lt;/b&gt; The study was performed on 520 women aged 18-87 and 789 men aged 19-85, diagnosed and treated for chronic rhinosinusitis between 2016 and 2020. The analysis was based on the medical records, taking into account: gender; age; type of symptoms; allergy tests; probable cause of inflammation; type of anatomical anomalies; assessment of the stage based on the Lund-Mackay score for CT scans; number of operations; pathology report; postoperative complications.&lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; The study showed that the hospitalized patients were most often aged 41-50, 51-60, and 31-40 for women and 51-60, 41-50, and 31-40 for men, respectively. The results of allergy tests in chronic rhinosinusitis patients showed that women were most often allergic to Pyralgin + Ketonal + paracetamol + ibuprofen in 4.50%, to penicillins in 1.07%, and to house dust mites in 0.92%, while in men positive reactions were found in 3.36% for Pyralgin + Ketonal + paracetamol + ibuprofen, 0.99% for house dust mites and 0.92% for cat and dog hair, respectively. Absence of anatomical anomalies was found in 20.75% of women and 26.36% of men, but most often they occurred in the form of deviated nasal septum and enlarged middle nasal concha. The pathology reports revealed the following: chronic rhinosinusitis, chronic polypoid rhinosinusitis, chronic cystic rhinosinusitis, and chronic allergic rhinosinusitis.&lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusions:&lt;/b&gt; The main symptoms in patients with chronic rhinosinusitis included: nasal congestion + rhinorrhea, nasal congestion + nasal discharge + olfactory impairment, and nasal congestion + nasal discharge + headache. The most common probable causes of chronic rhinosinusitis in the studied patients included: anatomical anomalies, allergies, and irritants including tobacco smoke. Depending on the assessment of the stage based on the Lund-Mackay score for CT scans, it appears that moderate to severe inflammation prevailed in the studied patients.

Laboratory Test Results in Patients with Workplace Moisture Damage Associated Symptoms—The SAMDAW Study

The mechanisms of health effects of moisture damage (MD) are unclear, but inflammatory responses have been suspected. The usefulness of laboratory and allergy tests among patients in secondary healthcare with symptoms associated with workplace MD were examined. Full blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), total serum immunoglobulin E (IgE), fractional exhaled nitric oxide (FeNO), and skin prick testing were assessed and analyzed in relation to multiple chemical sensitivity (MCS) and perceived stress in 99 patients and 48 controls. In analysis, t-tests, Mann-Whitney tests, and chi-squared tests were used. Minor clinically insignificant differences in blood counts were seen in patients and controls, but among patients with asthma an elevated neutrophil count was found in 19% with and only in 2% of patients without asthma (p = 0.003). CRP levels and ESR were low, and the study patients' FeNO, total IgE, or allergic sensitization were not increased compared to controls. The level of stress was high among 26% of patients and 6% of controls (p = 0.005), and MCS was more common among patients (39% vs. 10%, p < 0.001). Stress or MCS were not significantly associated with laboratory test results. In conclusion, no basic laboratory or allergy test results were characteristic of this patient group, and neither inflammatory processes nor allergic sensitization were found to explain the symptoms among these patients. While the value of basic laboratory tests should not be ignored, the use of allergy tests does not seem necessary when symptoms are indicated to be workplace-related.

Cutaneous reactions following COVID‐19 vaccination assessed by dermatologists: a single‐institutional study in Germany

Cutaneous reactions following COVID-19 vaccination have been frequently described, whereas larger case series by dermatologists are lacking. This study assesses SARS-CoV-2 vaccination-associated skin reactions, severity, treatment, course, eliciting vaccines, allergy test results and tolerance to revaccination. Single-institutional, non-interventional study of dermatologists assessing cutaneous manifestations in 83 patients in Germany. 93 reactions were presented. Manifestations clustered into immediate (n=51, 54.8%) and delayed hypersensitivity reactions (n=10, 10.8%), chronic inflammatory skin diseases (n=13, 14.0%), reactivation of latent herpes virus infection (pityriasis rosea/herpes zoster; n=9; 9.7%) and others (n=10, 10.8%). Vaccination was associated with new (76.3%) - mostly hypersensitivity reactions - or exacerbation of known skin diseases (23.7%), in this case predominantly chronic inflammatory skin diseases. Reactions occurred primarily within the first week (72.8%) and after first vaccination (62.0%). Treatment was required in 83.9% and hospitalization in 19.4%. In 48.8% revaccination led to recurrence of the same reactions. Disease was ongoing at last consultation in 22.6%, primarily in chronic inflammatory skin diseases. Allergy tests were performed in 15 patients (18.1%) and resulted negative. It can be assumed that vaccination may trigger immune activation-related reactions especially in those patients predisposed to develop respective skin diseases.

555. Early Outcomes of Penicillin and Cephalosporin Allergy Assessment Tool

Abstract Background Penicillin allergy is reported in approximately 10% of the US population and is one of the most frequent medication allergies in children. Penicillin allergy labels are associated with more expensive care and adverse outcomes, such as MRSA and C. Diff infection. Studies suggest up to 90% of these patients could safely tolerate this class of drugs. Our team at M Health Fairview University of Minnesota Masonic Children’s Hospital (UMMCH) implemented an allergy assessment tool for inpatient use in January of 2020 to create an effective and accessible path for delabeling pediatric patients with penicillin and cephalosporin allergies. Methods Our pharmacists conducted the allergy assessment on inpatient pediatric patients with penicillin/cephalosporin allergies. Those deemed low to moderate risk for having a true IgE-mediated allergy by our assessment were recommended for outpatient allergy testing. Those deemed no risk were recommended for immediate delabeling. We performed manual chart reviews to describe pediatric patient risk stratification, allergy label status after assessment, outpatient allergy follow-up, and status and results of allergy testing. Results From January, 2020 to present, 140 patients received a pharmacist allergy assessment. During the 2020 calendar year, 51 allergy assessments were performed on 49 patients. 58 allergies were recorded, with penicillins as the most common (62%), followed by cephalosporins (24%), and penicillin combination drugs (14%). 1.9% of allergies were high risk, 68.8% moderate, 15.7% low, 9.8% no risk, and 3.8% difficult to determine. Of 42 patients deemed low to moderate risk, 8 (17%) were seen by an outpatient allergist. Of these, 5 proceeded with allergy testing and were found to be not allergic. Out of 58 allergy labels, 9 (15.5%) were removed, 5 after allergy testing, 2 immediately due to no risk, and 2 after further history review. Conclusion Our preliminary data show allergy assessments can inform pediatric allergy risk prior to outpatient allergy testing and assist with imminent delabeling. Next steps include analysis of our 2021 assessments as well as patient caregiver surveys to assess perception of the allergy assessment process and to elucidate on barriers to testing/delabeling. Disclosures Beth K. Thielen, MD, PhD, Horizon: Advisor/Consultant|Horizon: Honoraria|Merck: Grant/Research Support.

Ethical Considerations Surrounding Employment Mandated Coronavirus Disease 2019 Vaccination and Allergy Skin Testing for the Coronavirus Disease 2019 Vaccine.

Ethical Considerations Surrounding Employment Mandated Coronavirus Disease 2019 Vaccination and Allergy Skin Testing for the Coronavirus Disease 2019 Vaccine.

Poor Correlation Among Metal Hypersensitivity Testing Modalities and Inferior Patient-Reported Outcomes After Primary and Revision Total Knee Arthroplasties.

Metal allergy testing may influence clinical decision-making for patients undergoing a total knee arthroplasty (TKA). Limited data were found to examine the consistency of available testing modalities. This study compares different metal allergy test results and clinical outcomes after primary and revision TKAs in patients with and without metal hypersensitivity. Primary (n= 28) and revision (n= 20) TKA patients receiving hypoallergenic implants for metal allergies diagnosed by skin patch testing (SPT), lymphocyte proliferation testing (LPT), or lymphocyte transformation testing (LTT) were retrospectively reviewed. The agreement between tests was assessed by percentage and kappa statistic within patients who used multiple testing modalities. Postoperative clinical outcomes of these patients were compared to those of patients without metal hypersensitivity matched by age (±5 years), body mass index (±5), gender, and follow-up duration (±2 years). SPT and LPT showed weak agreement for nickel and minimal agreement for cobalt. SPT and LTT showed minimal agreement for nickel; weak agreement for titanium, bone cement, vanadium, and zirconium; but strong agreement for chromium and cobalt. LPT and LTT agreement was weak. Compared to matched controls, metal hypersensitivity patients undergoing primary TKAs with hypoallergenic implants experienced less improvement in Knee Society Scores, Veterans RAND 12 physical component scores, and range of motion. Patients undergoing revision TKAs for multiple indications including metal hypersensitivity had worse clinical outcomes with significantly worse improvements in Knee Society functional scores compared to matched controls. Metal allergy tests produce conflicting results. Hypersensitivity patients may experience inferior clinical outcomes even with hypoallergenic implants. Clinician awareness may influence the choice of testing and improve preoperative counseling of this patient population.

Communication of perioperative anaphylaxis under general anaesthetic to patients and within the multidisciplinary team

Background: Anaphylaxis is defined as a severe, life-threatening systemic hypersensitivity reaction. Its incidence is estimated to be 1 in 10 000 anaesthetics.1 The 6th National Audit Project (NAP6) on perioperative anaphylaxis revealed that one-third of patients experienced harm after the event, with anxiety about future anaesthetics being the most commonly reported consequence. The objective of this study is to assess the effectiveness of (1) communication of perioperative anaphylaxis and (2) emotional support provided to patients, and their consequent impacts on feelings towards future anaesthetics. This study also evaluates the current procedure for allergy referral after perioperative anaphylaxis. Methods: Thirty-four patients who experienced general anaesthetic-induced perioperative anaphylaxis in Addenbrooke’s Hospital, Cambridge between 5 January 2017 and 2 December 2020 were identified using electronic medical records. The subjective experiences of the communication of the anaphylactic event and the allergy testing results were evaluated in a telephone survey of 26 of these patients. The telephone survey also explored patients’ perception of the emotional support received after anaphylaxis and any negative impact on their feelings towards a subsequent general anaesthetic. In addition, the responsible person for making an Allergy department referral in all cases was investigated. Results: Communication of the anaphylactic event was considered excellent by 69% of patients, with a rating of 5/5 on a 1–5 rating scale. Of the 17 patients that were referred to the Allergy department for allergen testing, 16 felt communication of the test result was clear. Emotional support from hospital staff after anaphylaxis was considered excellent by 38% of patients, whereas 33% felt emotional support was poor on a 1–5 rating scale. Negative feelings towards a subsequent general anaesthetic were reported by 50% of patients. There is also a lack of consistency regarding who makes an allergy referral (surgeon or anaesthetist). Conclusions: The study data show that improvements in the process of referring patients to the Allergy department, and patient experience in terms of communication and emotional support after a traumatic anaphylactic event, should be made. This is in concordance with the findings of the NAP6 report. There need to be clearer local guidelines regarding which clinician is responsible for making an anaphylaxis referral to the Allergy department. Patients should be sent a letter explaining their anaphylaxis, the significance of it and the sources of support available if required. Anaesthetists and the Allergy department should be made aware of emotional support available to recommend to patients. We have presented our findings to the Anaesthetics and Allergy departments of Addenbrooke’s Hospital and are in the process of making changes to the practice. We will review again in 3–5 years’ time. 1.Harper NJN, Cook TM, Garcez T, et al. Br J Anaesth 2018: 121: 159–71

INVESTIGATION OF ALLERGEN SENSITIVITY OF SYRIAN REFUGEE CHILDREN WITH ALLERGIC DISEASES

Background: The aim of this study was identification of the allergic sensitivities of Syrian refugee children residing in Western Turkey and diagnosed with various allergic diseases. Materials and methods: Syrian refugee children younger than 18 constituted the target population of this study. A group of patients were assigned to the control group. The levels of total immunoglobulin E, A, G, M, eosinophil counts and percentages, and the results of inhalant and food allergy tests of patients and controls were all recorded. Results: The entire study cohort consisted of 34 patients (23 boys, 11 girls) in the study group and 30 patients (20 boys, 10 girls) in the control group. There were statistically significant relationships between patients and controls about eosinophil counts and percentages (p= 0.005, p &lt; 0.0001, respectively). Conclusion: Our study is the first report investigating the allergic sensitivities of Syrian children to the best of our knowledge. We believe that our findings will enlighten the approach of the clinicians taking care of Syrian children in different countries hosting Syrian refugees. Keywords: inhalant allergen sensitivity, food allergen sensitivity, Syrian refugee, allergic disease

Application of a Cold Dry Air Provocation Test in Pediatric Patients with Asthma.

Asthma is a chronic inflammatory airway disease characterized by reversible airway obstruction and airway hyperreactivity. We proposed a cold dry air (CDA) provocation test and investigated its application in pediatric patients with asthma. We enrolled 72 children and adolescents older than 5 years who presented to our hospital with chronic cough, shortness of breath, and wheezing. We analyzed the results of allergy, pulmonary function, methacholine provocation, and CDA provocation tests. The FEV1 change 5 min after the provocation was recorded as CDA5 dFEV1; that after 15 min was recorded as CDA15 dFEV1. PT10 was the provocation time causing a 10% decrease in FEV1; a decrease of >10% in dFEV1 was considered a positive CDA test. Among the 72 subjects, 51 were diagnosed with asthma. A positive CDA test in patients with asthma correlated with non-eosinophilic asthma. In patients with asthma, sputum eosinophils and eosinophil cationic protein (ECP) levels of the patients with a positive CDA test were significantly lower than those of patients with a negative test. CDA5 dFEV1 correlated with PC20 and total immunoglobulin E. CDA15 dFEV1 correlated with PC20, sputum eosinophils, and ECP. PT10 became shorter as the peripheral blood eosinophil, FVC, FEV1, FEV1/FVC, and FEF25-75 decreased. The CDA provocation test showed airway hyperreactivity to non-specific stimuli, a high correlation with non-eosinophilic asthma, and the possibility of assessing asthma severity via PT10.

Характеристика особливостей клініко-діагностичних аспектів сезонного алергічного риніту в дітей Полтавського регіону

The high prevalence of seasonal allergic rhinitis (SAR) among children continues to rise steadily. However, there is not only an increase in the frequency of allergy, as an independent nosology, but also its combination with other atopic diseases. It should be noted that the comorbidity of SAR with asthma, allergic conjunctivitis, atopic dermatitis significantly impairs the daily activities and quality of children’s life. Purpose - to study the peculiarities of seasonal allergic rhinitis in children on the background of comorbidities depending on the age of the patient and to analyze the structure of pollen sensitization taking into account the retrospective results of skin allergy testing. Materials and methods. For a retrospective study, 890 case histories of children with SAR aged 3-15 years from 2010 to 2020 were selected and analyzed. The inclusion criteria were children with positive skin allergy testing for at least one pollen allergen in the test panel. During the analysis, patients were divided into three age subgroups: preschool children (3-6 years), primary school age (7-10 years) and middle school age (11-15 years). Results. Our results show that the comorbidity of SAR depended in some ways on the age of the child. Thus, among children of the first group the combination of SAR with recurrent obstructive bronchitis and atopic dermatitis was mostly often registered, while in patients of the second and the third groups - with allergic conjunctivitis and asthma. It was also found that the clinical picture of the disease did not differ significantly from the patient’s age and was characterized by moderate severity of allergic rhinitis. The study of the spectrum of sensitization to pollen allergens revealed a significant prevalence of children with hypersensitivity to ragweed allergen. It was found that more than a third of preschool and primary school children were also more likely to be sensitive to wormwood and corn, while middle school children - timothy, fescue, wormwood, ryegrass and cyclachaena. Conclusions. Therefore, the study allowed to establish the features of the clinical course, severity, combination of SAR with other diseases and identify the most etiologically significant pollen allergens, which are a priority in the occurrence of seasonal allergic rhinitis in children of Poltava region. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: children; seasonal allergic rhinitis; clinical and diagnostic features; sensitization spectrum.

Clinical parameters influencing the results of anterior rhinomanometry in children.

Nasal obstruction is a frequent symptom in both adults and children and it is a common reason to see an otorhinolaryngologist. Endoscopy of the nasal cavity and the epipharyngeal space along with anterior rhinomanometry is regarded the gold standard since many years to estimate the severity of nasal obstruction in the particular patient. Endoscopy shows anatomical reasons for an obstruction, whereas the nasal flow volume and nasal resistance can be determined using anterior rhinomanometry. Currently, there are only few data available for rhinomanometry results in children. The purpose of the present study was to evaluate the application of this technique in the pediatric population for objective evaluation of nasal flow. Whether it achieves reproducible results and which clinical parameters have some influence on the results were studied. 427 children (average age of 8.5years, range 7months through 17years) who were admitted to evaluate nasal patency or for allergy testing were examined. After clinical examination and endoscopy of the nasal cavity and epipharyngeal space, anterior rhinomanometry was performed before and after application of decongestant nose drops separately for each nose side in 334 children. The nasal flow with a pressure of 150 Pasc was measured and served for statistical evaluation. Flow values were correlated to clinical and endoscopic parameters along with results of allergy tests (prick tests). Reproducible rhinomanometric measurements were possible in children age 3years and older. However, the standard deviation and variation of measurements were significant in this cohort of patients. Statistically highest significant correlations were found between flow measurements and body height along with the age of the children (p < 0.01) and status following adenoidectomy (p < 0.05). No statistically significant correlations were found between rhinomanometry and results of prick tests. The study demonstrates that rhinomanometry can be applied in the pediatric population for objective evaluation of nasal obstruction and for determining the effects of decongestant nose drops. The highest correlation was found between nasal flow and children's body height, children's age and status following adenoidectomy. The correlation between nasal flow and clinically/endoscopically determined degree of nasal obstruction was lower. However, definition of normal flow values for particular age groups is challenging since the results showed high variation and standard deviation. Yet with regard to individual patient, the technique achieves reliable results in nasal provocation tests, which are widely used for allergy testing in children. When performed in children it should always be considered that there are age-specific requirements for the examination and interpretation of results in this patient cohort.

Handsanitizer Formulation 70% with the Addition of Natural Performance

Background: The use of hand antiseptics in the form of gel preparations among the upper middle class has become a lifestyle. Several hand sanitizer preparations can be found in the market and usually contain a lot of alcohol. The purpose of this study was to formulate a hand sanitizer as an antiseptic.&#x0D; Methods: Handsanitizer formulations were carried out in the pharmacy laboratory of the Aufa Royhan University health faculty in Padangsidimpuan City and then the preparations were tested with preference and allergy tests.&#x0D; Results: Of the 50 panelists, 46 liked the hand sanitizer preparation 70%, while the allergy test carried out showed that 2 panelists did not dare to try because of a history of allergies and 2 people had moderate allergies.&#x0D; Conclusion: Based on the results of acceptability testing and allergy testing, this product can recommended as an antiseptic with a note still have to pay attention to allergic reactions in the wearer.

COVID-19 mRNA vaccine allergy.

Purpose of reviewA known history of a severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine is the only contraindication to coronavirus disease 2019 (COVID-19) mRNA vaccination. It is important for pediatricians to understand the likelihood of an allergic reaction to COVID-19 mRNA vaccines, including its excipients.Recent findingsEpisodes concerning for anaphylaxis were immediately reported following early administration of COVID-19 mRNA vaccines to adults. Although allergic type symptoms were reported equally in recipients of placebos and test vaccines in phase 3 clinical trials, post-authorization prospective studies state that 0.2–2% of vaccine recipients have experienced allergic reactions. Subsequent allergy testing of affected individuals has focused largely on evaluation of allergic sensitization to a novel vaccine excipient, polyethylene glycol (PEG). PEG is a polymer incorporated in numerous pharmaceutical products because of its favorable, inert properties. The results of allergy testing in adults to date indicate that IgE mediated anaphylaxis to PEG allergy is rarely identified after COVID-19 mRNA vaccine reactions. Numerous individuals with presumed anaphylaxis have tolerated a second vaccine after evaluation and testing by an allergist, suggesting either misdiagnosis or a novel immune mechanism.SummaryConfirmed anaphylactic reactions to COVID-19 mRNA vaccines are rare, likely due to a lack of preexisting IgE against the vaccine components, including PEG.

Integration of in vitro allergy test results and ratio analysis for the diagnosis and treatment of allergic patients (INTEGRA).

The introduction of molecular diagnosis into routine clinical practice has substantially improved the diagnosis and management of allergic patients by allowing clinicians to precisely identify the allergenic molecule responsible for immunoglobulin E (IgE)‐mediated allergies. However, it can be challenging to accurately interpret the results of molecular assays, partly due to the limited evidence base. In this context, a panel of experts with extensive experience in interpreting in vitro measures of total and serum specific IgE reviewed the available scientific evidence. After this review, the panel selected a series of representative case studies to demonstrate how determination of specific and total IgE values and the relationship between them (ratio analysis) can add value to the diagnostic process by more precisely defining the patient’s sensitization profile. Finally, the experts developed a series of recommendations on the clinical application of ratio analysis to optimize and complement the classical approach to allergy diagnosis.

Delivery mode and the incidence of atopic sensitization and food allergy in a Finnish child population.

Caesarean section (CS) has been associated with an increased risk of subsequent atopic diseases, particularly asthma and respiratory allergies, but controversial findings have also been reported. Our aim was to clarify the association between the delivery mode and longitudinal (atopic) outcomes. The target population was identified from the population register and comprised all children born between 2001 and 2006 and living in the province of South Karelia, Finland (N=5564). The information on the delivery mode was available for 5552 children from the Finnish Medical Birth Register. Results of allergy tests (skin prick tests, specific IgE and open food challenges, OFCs) were collected from patient records of all healthcare units in the area. By 12years of age, the cumulative incidence of atopic sensitization was 15% for those born by normal vaginal delivery (VD), 20% (adjusted RR 1.28; 95% CI 0.99-1.65) by assisted VD, 20% (adjusted RR 1.28; 95% CI 1.02-1.61) by elective CS and 20% (adjusted RR 1.24; 95% CI 0.99-1.56) by others, for example emergency CS. Among the offspring of mothers without atopic diseases, the incidence of food allergy (positive OFC) was 6% for those born by elective CS and 2% for those born by normal VD (adjusted RR 2.41; 95% CI 1.19-4.88), while the respective incidences were 5% and 6% (adjusted RR 0.82; 95% CI 0.33-2.06) among the offspring of mothers with atopic diseases. By adolescence, the cumulative incidences of atopic sensitization was highest among those born by assisted VD or CS. The incidence of food allergy was highest among those born by elective CS among the offspring of mothers without atopic diseases.

Predictive factors of amoxicillin immediate hypersensitivity and validation of PEN-FAST clinical decision rule

BackgroundThe challenge of delabeling amoxicillin allergy is an important issue for patients and clinicians, especially when anaphylaxis is reported. A recent study has proposed a clinical decision rule, PEN-FAST, to identify low-risk penicillin allergies. ObjectiveTo validate the PEN-FAST clinical decision rule in a population with high risk of suspected immediate amoxicillin allergy and to identify clinical predictive factors of amoxicillin immediate hypersensitivity. MethodsWe retrospectively analyzed medical records of patients with a suspected immediate amoxicillin allergy who carried out an allergologic evaluation by a specialist in the Allergy Unit of Strasbourg University Hospital from 2015 to 2020. ResultsA total of 142 adult patients (88 women [62.0%]; median age, 52 [interquartile range, 40.3-62.0] years) were analyzed. Most of them reported anaphylaxis (68.8%). Internal validation of PEN-FAST score revealed a good discrimination with area under the curve of 0.86 (95% confidence interval, 0.79-0.92). A cutoff of less than 3 points for PEN-FAST was used to classify 29 from 142 patients at low risk of allergy, of whom only 2 (6.9%) received positive results of allergy testing. The negative predictive value for successful delabeling was 0.93 (95% confidence interval, 0.77-0.99). Predictive clinical features for immediate amoxicillin hypersensitivity were time since reaction (P < .001), time elapsed between drug intake and first symptom (P < .001), severity grade reaction (P < .001), and treatment or hospitalization required (P < .001). ConclusionPEN-FAST has been validated to identify low-risk penicillin allergies in our European cohort of patients mainly reporting anaphylaxis. This is the first reported external validation of a penicillin allergy clinical decision rule internationally.

The association between serum apolipoprotein B and fractional exhaled nitric oxide in bronchial asthma patients.

BackgroundAsthma and lipid metabolism are associated with systemic inflammation. However, the studies about the relationship between lipid profile, fractional exhaled nitric acid (FeNO) and pulmonary function test (PFT) results are currently lacking.MethodsWe enrolled asthma patients who had serum lipid profiles including apolipoprotein levels from March 1, 2019 to December 31, 2019. We classified the asthma patients into two groups according to the diagnosis method: (I) patients who were diagnosed based on clinical symptoms/signs and PFT results and (II) patients diagnosed with clinical symptoms/signs. Clinical characteristics including age, underlying diseases, smoking status, allergy test results and treatment agents were compared between the two groups. The associations between blood cholesterol levels including apolipoprotein and pulmonary functions were analyzed. Moreover, patients were divided into two groups according to the median value of apolipoprotein B (Apo B), and lung function test results were compared between the patients who had high and low Apo B levels.ResultsAmong the 167 patients, 93 (55.7%) were PFT-proven asthma patients. In PFT-proven asthma patients, the levels of total cholesterol (TC) (r =0.37, P=0.03), low-density lipoprotein (LDL) (r =0.46, P=0.01) and Apo B (r =0.38, P=0.02) showed a significant correlation with FeNO, which had no statistical significance in physician-diagnosed asthma group. In multivariate regression analysis, log (FeNO) showed a significant correlation with Apo B (P<0.01) after adjustment for presence of PFT-proven asthma (P=0.01) and current smoking (P=0.01). Patients with high Apo B levels had a lower post-bronchodilator (BD) forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio (69.8 vs. 74.9, P=0.02) and lower post-BD FEV1 (%) (77.5 vs. 85.0, P=0.04) compared with those showing low Apo B levels.ConclusionsThe levels of Apo B and FeNO had positive correlations and high Apo B levels were associated with severe airflow obstruction and low FEV1 (%). Apo B could reflect the uncontrolled status of bronchial asthma and poor lung function.