Anaphylaxis Research Articles

Computed tomographic and endoscopic findings of multiple gastric anisakiasis.

A 36-year-old man presented with sudden onset of severe abdominal pain. A CT scan was performed first, which showed marked thickening of the gastric wall. Gastric anisakiasis was suspected because he had eaten sashimi (a raw fish dish), including salmon and tuna, the night before. An upper gastrointestinal endoscopy revealed three Anisakis larvae invading the gastric wall. All larvae were removed by the biopsy forceps. His symptoms were resolved after the removal. Anisakiasis is a gastrointestinal parasitic infection of humans caused by ingestion of raw or undercooked seafood containing Anisakis larvae, resulting in severe gastrointestinal disorders and allergic reactions. Salmon, herring, cod, mackerel, squid, and flounder are known intermediate hosts. Cases of anisakidosis are increasing globally. Although gastric anisakiasis is a relatively common disease in Japan, it is unusual to find marked thickening of the gastric wall on CT scans and multiple anisakiasis on upper endoscopy, as shown in this case. Our case highlights the importance of a careful history leading to prompt diagnosis and treatment of gastric anisakiasis in cases presenting with acute onset of severe abdominal pain several hours after ingestion of raw or undercooked seafood. Healthcare professionals and edible seafood handlers should increase their awareness of fish parasites. Proper freezing or cooking of seafood is an important prophylactic measure.

The current state of data to estimate prevalence and severity of food allergies in the United States

Currently, in the United States, there is no comprehensive surveillance system to collect data on food allergies; however, prevalence and severity data are critical to quantify the burden of food allergies, develop evidence-based control measures, detect emerging issues, and monitor trends. To address this gap, we conducted a literature search, and expert interviews to identify surveillance systems and datasets that could be used to estimate the prevalence and severity of food allergies in the United States overall and for specific foods. Inclusion and exclusion criteria were developed and used to screen each data source. Selected articles were evaluated according to quality parameters to identify the most appropriate studies. Most studies estimated prevalence of food allergies in children, investigated multiple foods, and used surveys to collect self-reported data. Despite the high quality, robust study designs, and comprehensive survey instruments that currently exist, the studies identified do not provide sufficiently recent data to estimate the current burden of food allergies in the country. Studies lack consistencies across the years making the analysis of trends over time a challenge. National surveys conducted by Northwestern University in 2009/2010 and 2015/2016 represented the best available data; however, these data are likely outdated and are limited in assessing temporal food allergy trends. Data to accurately estimate the current prevalence and severity of food allergies and related trends is lacking. U.S. public health agencies should explore the development of a comprehensive surveillance program to address this gap and help inform evidence-based policies in food allergy management and prevention.

Recommendations for the management of latex allergy in pediatrics

Latex allergy, or natural rubber latex allergy (NRLA), is a global health concern, even among the pediatric population, with symptoms varying in severity from mild to potentially life-threatening. Latex is derived from the Hevea Brasiliensis tree, producing twelve million tons annually for use in various everyday and medical products. Despite efforts to mitigate NRLA, its prevalence remains high, especially in at- risk groups such as children with spina bifida. Clinical manifestations include immediate and delayed symptoms, even anaphylactic reactions. Diagnosis involves a detailed medical history and specific tests. Prevention focuses on avoiding exposure, especially in medical and educational settings. Treatment, including immunotherapy, exhibits variable efficacy. NRLA has a strong negative impact on children's quality of life. The objective of this publication is to provide updated information and practical tools for the pediatrician's and allergist's practice.

Severe Food Allergy Reactions Are Associated With α-Tryptase.

Severe Food Allergy Reactions Are Associated With α-Tryptase.

Multiple Abnormal Cutaneous Findings in a Patient With Hypomelanosis of Ito Undergoing General Anesthesia

Hypomelanosis of Ito (HI), a neurocutaneous syndrome, is characterized by skin depigmentation and skeletal, muscular, central nervous system, cardiac, and renal manifestations. A wide variety of cutaneous manifestations besides depigmentation have been reported. Herein we describe a 23-year-old woman with HI whose extracutaneous symptoms included severe mental and motor impairment, convulsions, and deformity of the orofacial region. She also had severe obesity, asthma, multiple allergies, and skin hypersensitivity. Although no extracutaneous manifestations were problematic during perioperative management of dental procedures under general anesthesia, erythema developed at 3 time points: during induction, during emergence, and in recovery. We speculated that mechanical stimuli to the skin and administration of multiple drugs likely caused histamine release, leading to the 3 episodes of erythema. Because patients with HI often have hypersensitivity reactions in the skin, both cutaneous and extracutaneous manifestations should be considered in the anesthetic management of patients with HI.

A Health Economic Analysis of Non-injectable Epinephrine Compared with Intramuscular Epinephrine

BackgroundNon-injectable epinephrine to treat allergic reactions addresses an unmet need. Intranasal epinephrine is approved and a sublingual form is under development. Inhaled epinephrine is poorly studied for anaphylaxis. These forms have unknown cost-effectiveness. ObjectiveThe aim of this research was to evaluate cost-effectiveness of commercially available non-injectable epinephrine compared with intramuscular epinephrine for treatment of anaphylaxis. MethodsMarkov cohort analyses evaluated the cost-effectiveness of non-injectable epinephrine forms. The base-case assumed exaggerated anaphylaxis fatality rates (50-fold increase) for using inhaled epinephrine given low certainty evidence in anaphylaxis, and deliberately reduced fatality risk for nasal or sublingual forms (10-fold reduction) theorizing higher adherence and early use during an allergic reaction. ResultsIn the base-case scenario, assuming a 10-fold decreased risk in peanut allergy fatality associated with intranasal or sublingual epinephrine treatment for a severe allergic reaction (net monetary benefit [NMB] $2,189,134) vs. intramuscular (IM) epinephrine use (NMB, 2,189,114), intranasal or sublingual epinephrine was the most cost-effective option (incremental cost-effectiveness ratio [ICER] $83,748/QALY), but only at a marginal annual cost of $4. IM epinephrine was cost-effective (ICER, $17,900/QALY) vs. inhaled epinephrine (NMB, $2,183,531), although inhaled epinephrine reached cost-effectiveness (Willingness To Pay [WTP $100,000/QALY]) if associated fatality risk fell below 2.5-fold. Substituting a single non-injectable form of epinephrine for a second injectable device (in patients prescribed two autoinjectors already) would be cost-effective; however, adding a supplemental non-injectable device was not cost-effective, even assuming a 10-fold risk reduction with multiple device carriage (ICER $858,462). ConclusionNon-injectable routes of epinephrine can be cost-effective options provided fatality risk is not significantly elevated. Carriage of redundant epinephrine autoinjectors with non-injectable forms is not cost-effective if associated with excess cost of redundant device packs.

Severe Anaphylactic Reactions to Home Doses of Oral Immunotherapy for Food Allergy.

Severe Anaphylactic Reactions to Home Doses of Oral Immunotherapy for Food Allergy.

Anaphylactic risk associated with iodinated and gadolinium-based contrast media

ABSTRACT Background This study aimed to analyze the risk signals of iodinated and gadolinium-based contrast media associated with anaphylaxis. Research design and methods Data from the United States Food and Drug Administration Adverse Event Reporting System (FAERS) were retrospectively reviewed from January 2004 to September 2022. Disproportionality and Bayesian analyses were used in data mining to screen for suspected anaphylaxis using contrast media. Results A total of 1240 reports of anaphylaxis associated with contrast media were identified (464 men, 37.4%). The average age of anaphylaxis associated with iodinated contrast media (ICM) and gadolinium-based contrast media (GBCM) was 56.8 ± 17.2 and 50.9 ± 18.0 years old, respectively (p < .001). Among ICM, iopamidol showed the highest reporting odds ratio (ROR) (29.0), and amidotrizoate showed the lowest ROR (7.4). Among low-osmolality ICM, iopamidol had the highest ROR (29.0), and iopromide had the lowest ROR (8.8). Among the macrocyclic agents, gadoteridol had the highest ROR (37.3), while gadoterate meglumine had the lowest (10.4). Among the linear agents, gadobenate dimeglumine had the highest ROR (28.8), and gadodiamide had the lowest (1.4). The mortality rate in ICM was significantly higher than that in GBCM (p < 0.001). Conclusions This study provides clinicians and pharmacists evidence for risk signals of anaphylactic reactions among contrast agents.

Case Report: The tree that hides the forest, a case of renal ANCA vasculitis concurrent with Fabry nephropathy.

This case report presents a complex case of a 65-year-old female with a history of hypertension and a family history of polycystic kidney disease and Fabry disease presented with acute pancreatitis and subsequent renal insufficiency. Despite initial corticosteroid therapy for immuno-allergic nephropathy, the patient’s condition deteriorated with the development of a skin rash, uremic syndrome, and neurological symptoms. A renal biopsy revealed cellular crescents and cytoplasmic vacuolization in podocytes and tubular cells. Genetic testing confirmed a GLA gene mutation, consistent with Fabry disease. While undergoing treatment with cyclophosphamide, the patient experienced severe allergic reactions, ultimately leading to acute respiratory distress syndrome and fatal outcome. Despite the Fabry disease variant being primarily associated with cardiac involvement, renal involvement was evident. This case highlights the rarity of this co-occurrence, the diagnostic challenges, the importance of genetic factors in autoimmune kidney diseases, and the impact of drug allergies on patient management.

Takotsubo Following Severe Anaphylactic Reaction during Anesthesia Induction

Introduction: Takotsubo cardiomyopathy (apical ballooning or broken heart syndrome) is a reversible left ventricular dysfunction due to apical asynergy that occurs typically after sudden emotional stress in a subject without coronary disease. Anaphylaxis is a severe, life-threatening, generalized hypersensitivity reaction, most often starting with urticaria and/or angioedema, that may involve cardiovascular and respiratory systems. Cardiovascular symptoms, including hypotension, cardiac arrhythmia and chest pain, are presumably linked to cardiac mast cell mediator release. Case Report: We describe the case of a woman who experienced a profound reversible cardiomyopathy with typical features of Takotsubo's syndrome during an anaphylactic reaction. Conclusion: Exposure to catecholamines and beta-receptor agonists used routinely during procedures and diagnostic tests can precipitate all the features of stress cardiomyopathy, including cardiac isoenzyme elevation and rapidly reversible cardiac dysfunction. These observations strongly implicate excessive sympathetic stimulation as central to the pathogenesis of this unique syndrome.

Antigenicity evaluation of lac color and exploratory study for identifying potential biomarkers of anaphylaxis

BackgroundLac color, a natural red dye derived from the larvae of laccifer lacca kerr, is one of the most commonly used substances in food. To date, no studies have reported on the antigenicity of lac color and the other biomarkers that can determine anaphylactic reactions. To address this, we evaluated the antigenicity of lac color through active systemic anaphylaxis (ASA) in addition to identifying potential biomarkers performing exploratory studies. For ASA test, Guinea pigs (n = 5) were sensitized with 0(negative control), 4 mg/kg of lac color, 4 mg/kg of lac color + FCA, and 5 mg/kg of ovalbumin + FCA (positive control) 3 times a week for three weeks. Fourteen days after the last sensitization, animals were challenged intravenously weekly for two weeks. Hematological and histopathological analyses were performed and compared to control groups.ResultsIn the ASA test, all lac color groups showed mild symptoms such as nose rubbing, urination, and evacuation, which are insufficient indicators of anaphylaxis. Exploratory studies identified several biomarkers: decreased platelet count, and increased basophil count; distention in the lung, and redness on the inner wall of trachea; mononuclear inflammatory cell infiltration (MICI) in the ear, and heart hemorrhage. When these biomarkers were applied to the ASA test of lac color, in comparison to the negative control group, the positive control group (ovalbumin + FCA) showed a significant over 60-fold reduction in platelet count and nearly threefold higher basophil count compared to other groups. Furthermore, only positive control group exhibited full lung distention and severe redness on the inner wall of the trachea. Mononuclear inflammatory cell infiltration (MICI) in the ear was about three times higher, and heart hemorrhage was only present in the positive control group compared to others. None of the lac color groups were different from the negative control group (p > 0.05), whereas the positive control group was significantly different (p < 0.05).ConclusionsOur study concludes that lac color, at the tested concentrations, does not induce antigenicity in the guinea pig model, providing valuable safety data. Furthermore, the biomarkers identified in this study offer a supportive approach to evaluating the immunogenicity of substances in future research.

Investigation on thermal response of high temperature heat pipe under thermal mismatch conditions

As an efficient and reliable passive heat transfer equipment, high temperature heat pipes (HTHPs) plays an important role in HTHP solid state reactor system. HTHPs often encounter thermal mismatch in reactor applications, which will lead to capillary action, entrainment, and other characteristics, resulting in HTHP failure due to heat transfer limits. In this paper, the thermal response test of liquid metal HTHP under thermal mismatch conditions is studied, and the simulation test platform of HTHP mismatch is designed and built to measure the important physical parameters. The test results show that the heat transfer performance of the HTHP is the best under the condition of horizontal inclination of 60°, and the condenser power is 5.66 kW. This condition is selected as the reference condition for the transient condition test. When the HTHP experienced a transient power increase, the middle of the evaporator section, as the part with the largest heat flux of heating power, appeared a severe overheating phenomenon. The wall temperature of the evaporator section soared from 750 ℃ to 1050 ℃ in a short time, and the heating rate reached 18.9 ℃/min, which affected the smooth operation of the HTHP. When the HTHP encounters an inclination angle transient increase condition, the entrainment phenomenon is more severe, the temperature fluctuation of the condenser section is intensified, and the heat transfer of the HTHP is in an unstable state. When the HTHP encounters an inclination angle transient decrease condition, the temperature rise of the evaporator section is less than 10 ℃, the temperature at the end of the condenser section is increased, and the start-up performance of the HTHP is improved. In summary, this paper obtains the thermal response rule of HTHPs under thermal mismatch conditions through experimental research, which provides support for the safe application of HTHPs for special equipment.

A méh- vagy darázscsípés okozta anafilaxiás sokk vizsgálata a triptáz enzim és a méh-, illetve darázsméreg specifikus immunglobulin E szintek vérből történő meghatározása alapján, egyes rendkívüli haláleseti eljárásokban

Aim: Systemic allergic reactions triggered by bee and wasp venom affect approximately 3% of adults, and in severe cases, can lead to anaphylactic reactions and death. The exact cause of extraordinary deaths resulting from insect stings is often not determined in a significant number of cases. The aim of this study is to provide guidance through methodological recommendations to investigate the precise cause of deaths presumably resulting from insect stings, specifically focusing on uncovering the facts and causes of anaphylaxis. Methodology: The study reviews literature related to anaphylaxis caused by insect stings and animal toxins, as well as its immunological background. It seeks to translate the information found in the literature into the realm of official activities related to extraordinary deaths. The study also summarises knowledge about groups of animals in Hungary that are medically significant due to their venom, providing guidance for on-site recognition, search, documentation, and recording of the most common Hymenoptera species with venom capable of frequently inducing anaphylactic reactions. Findings: The key to diagnosing deaths caused by anaphylaxis lies in crime scene investigation. The attending medical doctor must recognise the symptoms of insect stings and ensure the collection of a blood sample for allergological purposes. A special blood collection kit has been assembled for this purpose. The blood sample, which must be stored at 2–8ºC, should be sent to the Semmelweis University Institute of Laboratory Medicine within 2 days. By measuring the level of tryptase enzyme in the blood sample and detecting the presence of specific immunoglobulin E for the venom of the respective bee or wasp species, the cause of the anaphylactic reaction can be confirmed. The crime scene investigation team should also make an effort to locate and secure the potential insect species responsible for the sting. If the forensic entomologist successfully identifies the species, it facilitates the specific IgE allergological examination for the respective venom. Value: In cases of death resulting from insect stings, the cause is often not determined due to lack of proper caution and appropriate methods. The procedural approach recommended in the study establishes the basis for determining the precise cause of death in cases of suspected insect stings.

Translation and Validation of the Greek Food Allergy Quality of Life Questionnaire-Parental Form.

Background: The prevalence of food allergy is increasing, posing a significant health concern. Assessing health-related quality of life (HRQOL) in individuals with food allergies is crucial, and various questionnaires exist for this purpose. However, translation and validation of these tools are necessary to ensure cultural relevance. This study aimed to translate the FAQLQ-PF into Greek and perform a cross-sectional validation to assess its effectiveness in evaluating HRQOL among Greek children with food allergies. Methods: Parents of children aged 0 to 12 years diagnosed with food allergy completed the Greek version of the FAQLQ-PF, consisting of 30 items across three subscales. Socio-demographic and clinical data were collected. Statistical analyses included nonparametric tests, correlation analysis for validity, and Cronbach's alpha for internal consistency. Results: Out of 85 participants, 81 were included. The FAQLQ-PF demonstrated excellent internal consistency (Cronbach's α = 0.94). Validity evaluation indicated its ability to measure HRQOL in younger children. HRQOL in the Greek pediatric population was significantly correlated with the number of food allergies, symptoms, parental and child concerns, anxiety levels, and activity restrictions. However, sex and general health status were not significantly correlated with HRQOL. Conclusions: The Greek translation and validation of FAQLQ-PF provides insights into HRQOL among Greek children with food allergies. Factors such as anaphylactic reactions, epinephrine autoinjector usage, number of food allergies, and symptoms influenced HRQOL in this population.

Safety of oral immunotherapy for cashew nut and peanut allergy in children - a retrospective single-centre study.

Oral immunotherapy (OIT) is increasingly used for the treatment of childhood food allergies, with limited data available on cashew nut OIT. This real-life study investigated the safety and feasibility of cashew nut OIT, comparing it with peanut OIT, with a focus on the up-dosing process. We analysed cashew nut (n = 24) and peanut (n = 38) OIT cases with treatment initiated between 2018 and 2022 at the University Children's Hospital Basel. All patients who commenced therapy within this time frame were enrolled without prior selection. Two different starting protocols were used. Within the up-dosing protocol, the nut intake was incrementally increased by 20-30% every 2 weeks until reaching a maintenance dose of 1 g of nut protein. After consuming the maintenance dose regularly for 18-24 months, a second oral food challenge was performed. Patients who passed this challenge were considered desensitised. The safety of the therapy was evaluated based on the severity of adverse reactions during the up-dosing phase. Symptom severity was evaluated using the validated ordinal food allergy severity scale (o-FASS-5). Over the study period, 33% of cashew nut-allergic and 63% of peanut-allergic patients experienced mild to moderate allergic reactions. Severe allergic reactions occurred in five peanut-allergic children with high baseline allergen-specific IgE levels. Six patients with peanut, and none with cashew nut OIT, discontinued the therapy due to adverse reactions. The mean duration to reach the maintenance phase was longer for children with asthma or another food allergy. Among children who already underwent the second oral food challenge, desensitisation was achieved in 91% (11 out of 12) of cashew nut- and 73% (11 out of 15) of peanut-allergic patients. Cashew nut OIT had a low severity of adverse reactions and was generally well-tolerated. However, patient characteristics influenced side effect risk and treatment duration, emphasising the need for individualised OIT strategies.

Honey as a rare cause of severe anaphylaxis: Case report and review of literature

AbstractFood allergies are a significant health concern worldwide, with anaphylaxis being one of the most severe manifestations. This report describes a case of a 65‐year‐old male patient with recurrent grade III anaphylaxis of unknown origin. Through detailed diagnostic testing, a prick‐to‐prick test revealed an allergy to honey, identifying it as the trigger for his severe allergic reactions. Honey allergies are rare but often associated with sensitization to pollen from the Compositae family, to which our patient was also sensitized. Based on these findings, the patient was advised to strictly avoid honey and was provided with an emergency kit. To date, the patient experienced no further anaphylactic episodes.

Health Benefits of Prebiotics, Probiotics, Synbiotics, and Postbiotics.

The trillions of microbes that constitute the human gut microbiome play a crucial role in digestive health, immune response regulation, and psychological wellness. Maintaining gut microbiota is essential as metabolic diseases are associated with it. Functional food ingredients potentially improving gut health include prebiotics, probiotics, synbiotics, and postbiotics (PPSPs). While probiotics are living bacteria that provide health advantages when ingested sufficiently, prebiotics are non-digestible carbohydrates that support good gut bacteria. Synbiotics work together to improve immunity and intestinal health by combining probiotics and prebiotics. Postbiotics have also demonstrated numerous health advantages, such as bioactive molecules created during probiotic fermentation. According to a recent study, PPSPs can regulate the synthesis of metabolites, improve the integrity of the intestinal barrier, and change the gut microbiota composition to control metabolic illnesses. Additionally, the use of fecal microbiota transplantation (FMT) highlights the potential for restoring gut health through microbiota modulation, reinforcing the benefits of PPSPs in enhancing overall well-being. Research has shown that PPSPs provide several health benefits, such as improved immunological function, alleviation of symptoms associated with irritable bowel disease (IBD), decreased severity of allergies, and antibacterial and anti-inflammatory effects. Despite encouraging results, many unanswered questions remain about the scope of PPSPs' health advantages. Extensive research is required to fully realize the potential of these functional food components in enhancing human health and well-being. Effective therapeutic and prophylactic measures require further investigation into the roles of PPSPs, specifically their immune-system-modulating, cholesterol-lowering, antioxidant, and anti-inflammatory characteristics.

Allergic contact dermatitis to benzoyl peroxide mimics anaphylactic reaction

Allergic contact dermatitis to benzoyl peroxide mimics anaphylactic reaction

Symptomatology and Management of Adult Anaphylaxis according to Trigger: A Cross-Sectional Study

Introduction: Anaphylaxis is an acute life-threatening allergy, most commonly provoked by food, venom, or drugs. There is limited data regarding differences in symptomatology between anaphylaxis provoked by different triggers. This study aimed to assess sociodemographic characteristics, clinical symptoms, and management of anaphylaxis, according to triggers in adults. Methods: We conducted a cross-sectional study recruiting adult patients with anaphylactic reactions across 8 emergency departments (EDs) and 1 electronic medical service (EMS) in Canada. Univariate and multivariate regression models were used to evaluate symptoms involving all patients with the outcome of drug-induced anaphylaxis (DIA), venom-induced anaphylaxis (VIA), peanut-induced anaphylaxis (PIA), shellfish-induced anaphylaxis, tree-nut induced anaphylaxis (TIA) and nut-induced anaphylaxis (NIA). We assessed comorbidities associated with severe reactions, stratified by triggers listed above. Additionally, we evaluated the association of each trigger with treatment through regression models involving all patients with medications used as outcome and anaphylaxis triggers used as independent variables. Results: From April 2011 to November 2023, 1,135 adults presenting with anaphylaxis to EDs were recruited. The median age was 35.5 (interquartile range 25.3–51.1). Most of the patients presented with FIA (50.3%). Regarding symptomatology, hypotension was more likely associated with DIA (aOR = 1.20, 95% CI = 1.11–1.30, p < 0.01). When adjusted for age at reaction and male sex, alcohol was more likely associated (aOR = 1.51, 95% CI = 1.04–2.19, p = 0.035) with NIA. Regarding management, TIA was more likely associated with inpatient epinephrine (aOR = 2.05, 95% CI = 1.16–3.64, p = 0.014). DIA was less likely associated with outpatient antihistamine (aOR = 0.68, 95% CI = 0.48–0.89, p < 0.01) whereas TIA was more likely associated with outpatient antihistamine (aOR = 1.81, 95% CI = 1.03–3.19, p = 0.040). Conclusion: Our study underscores associations between specific triggers, clinical manifestations and managements, such as the potential link between TIA and throat tightness and hypotension and VIA. Identifying such associations can aid with the prompt diagnosis of anaphylaxis in patients presenting to the ED, leading to swifter treatment initiation and improving overall outcomes.

PEAKO and peakTree: tools for detecting and interpreting peaks in cloud radar Doppler spectra – capabilities and limitations

Abstract. Cloud radar Doppler spectra are of particular interest for investigating cloud microphysical processes, such as ice formation, riming and ice multiplication. When hydrometeor types within a cloud radar observation volume have different terminal fall velocities, they can produce individual Doppler spectrum peaks. The peaks of different particle types can overlap and be further broadened and blended by turbulence and other dynamical effects. If these (sub-)peaks can be separated, properties of the underlying hydrometeor populations can potentially be estimated, such as their fall velocity, number, size and to some extent their shape. However, this task is complex and dependent on the operation settings of the specific cloud radar, as well as atmospheric dynamics and hydrometeor characteristics. As a consequence, there is a need for adjustable tools that are able to detect peaks in cloud radar Doppler spectra to extract the valuable information contained in them. This paper presents the synergistic use of two algorithms used for analyzing the peaks in Doppler spectra: PEAKO and peakTree. PEAKO is a supervised machine learning tool that can be trained to obtain the optimal parameters for detecting peaks in Doppler spectra for specific cloud radar instrument settings. The learned parameters can then be applied by peakTree, which is used to detect, organize and interpret Doppler spectrum peaks. The application of the improved PEAKO–peakTree toolkit is demonstrated in two case studies. The interpretation is supported by forward-simulated cloud radar Doppler spectra by the Passive and Active Microwave TRAnsfer tool (PAMTRA), which are also used to explore the limitations of the algorithm toolkit posed by turbulence and the number of spectral averages chosen in the radar settings. From the PAMTRA simulations, we can conclude that a minimum number of n = 20–40 spectral averages is desirable for Doppler spectrum peak discrimination. Furthermore, small liquid peaks can only be reliably separated for eddy dissipation rate values up to approximately 0.0002 m2 s−3 in the simulation setup which we tested here. The first case study demonstrates that the methods work for different radar systems and settings by comparing the results for two cloud radar systems which were operated simultaneously at a site in Punta Arenas, Chile. Detected peaks which can be attributed to liquid droplets agree well between the two systems, as well as with an independent liquid-predicting neural network. The second case study compares PEAKO–peakTree-detected cloud radar Doppler spectrum peaks to in situ observations collected by a balloon-based holographic imager during a campaign in Ny-Ålesund, Svalbard. This case demonstrates the algorithm toolkit's ability to identify different hydrometeor types but also reveals its limitations posed by strong turbulence and a low n. Despite these challenges, the algorithm toolkit offers a powerful means of extracting comprehensive information from cloud radar observations. In the future, we envision PEAKO–peakTree applications on the one hand for interpreting cloud microphysics in case studies. The identification of liquid cloud peaks emerges as a valuable asset, e.g., in studies on cloud radiative effects, in seeder–feeder processes, or for tracing vertical air motions. Furthermore, the computation of the moments for each subpeak enables the tracking of hydrometeor populations and the observation of growth processes along fallstreaks. On the other hand, PEAKO–peakTree applications could be extended to statistical evaluations of longer data sets. Both algorithms are openly available on GitHub, offering accessibility for the scientific community.