Diagnosis Of Allergy Research Articles

Comparison of Conventional IgE Assay and Measurement of Specific IgE to Haemocyanin for the Diagnosis of Adult Crab Allergy.

Five potential allergens of freshwater crab (Somanniathelphusa sinensis), including hemocyanin, have been discovered. Specific IgE to haemocyanin was increased in crab-allergic than in crab-tolerant patients. The add-on of specific IgE to hemocyanin to skin prick test enhanced the specificity of the crab allergy diagnosis. IgE, immunoglobulin E; rHM, recombinant haemocyanin; sIgE, specific IgE; SPT: skin prick test.

The future of food allergy diagnosis

The future of food allergy diagnosis

Clinical diagnosis and management of wheat and buckwheat allergy: application and prospects of allergen component diagnostics

Wheat and buckwheat allergies are common food allergies that significantly impact patients' quality of life and health. Wheat allergy encompasses various forms, including wheat food allergy, exercise-induced allergic reactions (WDEIA), baker's occupational asthma/allergy, and contact urticaria. IgE-mediated allergic reactions involve sensitization to stable wheat allergens such as ω-5 gliadin and gluten. Although buckwheat allergy is less common, it is gaining attention in certain regions. Allergen component diagnostic technologies, by detecting specific allergen components [e.g., ω-5 gliadin, gliadins (α, β, γ), and Tri a 14], offer precise allergen source identification, aiding in the optimization of diagnosis and management processes. Oral challenge tests are considered the gold standard for diagnosing wheat allergy, and combining skin prick tests with specific IgE measurements can enhance diagnostic accuracy. While avoidance of allergens remains the primary management strategy, research into immunotherapy is ongoing. Future research should focus on a deeper understanding of the structural and immunological characteristics of wheat and buckwheat allergens to develop more accurate diagnostic tools and treatment methods, thereby improving allergy management and patient quality of life. This article provides a detailed interpretation of the Molecular Allergology User's Guide 2.0 (MAUG 2.0) published by the European Academy of Allergy and Clinical Immunology (EAACI) and recent research advances on wheat and buckwheat allergies, highlighting the crucial role of allergen component diagnostics in optimizing food allergy diagnosis and treatment processes, supporting clinicians in accurately identifying common allergens and their cross-reactivity, and formulating more personalized treatment plans for patients.

Effects of Sex and Gender in Immediate Beta-Lactam Antibiotic Allergy: A Systematic Review and Meta-analysis

BackgroundBeta-lactams are the most common antibiotic class reported to cause allergic drug reactions. Previous literature suggests an increased prevalence of penicillin drug allergy in female patients in both inpatient and outpatient settings. However, the effects of sex and gender have not been well characterized regarding the entire class of beta-lactam antibiotics. ObjectiveThis systematic review and meta-analysis aimed to identify sex and gender-based differences in the prevalence of immediate beta-lactam allergy. MethodsWe performed an electronic search of Ovid MEDLINE/PubMed, Embase, Web of Science, Scopus, and the Cochrane Library between 2013-2023. Patients with a documented beta-lactam allergy who underwent allergy testing with skin testing, oral drug challenge, or serum-specific IgE were included. We quantitatively assessed sex- and gender-based differences in beta-lactam allergy with meta-analysis. ResultsWe included 69 primary studies, assessing 53,989 participants from outpatient and inpatient cohorts. 7,558 patients had a confirmed beta-lactam allergy. There was no difference in the prevalence of positive beta-lactam allergy test between males and females. Sub-group analysis of studies that performed oral challenges did show a higher risk of beta-lactam allergy in females than males (RR 1.40, 95% CI 1.18-1.66, p < 0.001, I2 =77.8%). Finally, there was a higher proportion of females (64.8%) than males enrolled in beta-lactam allergy studies. ConclusionsOur findings suggest both sex-based and gender-based differences in the prevalence of immediate beta-lactam allergy. Both biological factors, such as sex hormones, and gender-based behaviors, including increased healthcare utilization, may contribute to higher rates of beta-lactam allergy diagnosis in females.

Clinical characteristics of Behçet's disease in an Egyptian cohort

Background: Behçet's disease is a multi-systemic vasculitis characterized by recurring lesions in the skin mucosa and sight-threatening uveitis. The aim of the research: This research aimed to investigate the clinical features of Behçet's disease (BD) in individuals residing in Egypt. Patients and methods: 150 individuals with BD were recruited, examined, and put through a skin allergy test, musculoskeletal assessment, laboratory tests, and comprehensive medical history. The disease's activity was evaluated using the Behçet Disease Current Activity Form (BDCAF). Complete ophthalmological evaluation and imaging studies were performed according to the organ involved. Results: Cases were 116 men (77.3%) and 34 women (22.7%) (M: F 3.4:1). Their mean age was 34.05 ± 9.28 years, and the disease duration range was 1–20 years. Oral and genital aphthosis were reported in 86.7% and 82.0%, respectively. Eye affection was observed in 68.7%, mainly in anterior uveitis (35.3%). Vascular manifestations occurred in 58.7%, affecting primarily the venous side (31.3%) in the form of deep venous thrombosis (DVT). 32.7% had joint affection, and the pathergy test was positive for 28%. Central nervous system (CNS), skin lesions, and gastrointestinal tract involvement were the slightest common manifestations observed in 26%, 25.3%, and 7.3%, respectively. Articular manifestations were markedly linked to skin lesions (P = 0.002), and there was a significant predominance of articular manifestations among females (P = 0.042). BDCAF score was significantly related to male gender (P = 0.037), smokers (P &lt; 0.000), those with older age (P = 0.028), delayed age of disease onset (P = 0.025), and additionally those with the eye (P = 0.000) and CNS involvement (P = 0.003). Conclusion: The clinical features of Egyptian Behçet's patients were significantly dominated by mucocutaneous involvement, followed by ocular affection. Articular manifestations were markedly more significant in women. The disease activity score was more remarkable in males, smokers, those of older age, and those with a delayed age of disease onset.

Safety and low incidence of anaphylaxis in performing oral drug and food challenges in mastocytosis

BackgroundPatients with mastocytosis (MC) have an increased risk of severe anaphylaxis. They report hypersensitivity reactions to drugs and food, but causality often remains questionable. Most allergy centers avoid oral challenge tests (OCT) in MC patients. ObjectiveTo determine the safety of food and drug OCT in patients with MC. MethodsTo retrospectively evaluate the safety and outcome of challenges to drugs and food including food additives, out of 126 adult MC inpatients, 83 patients had a suspicion of food or drug hypersensitivity and 445 OCTs were performed. History, clinical data and allergy test results highlighting OCTs were analyzed. ResultsOnly 10 of 445 OCTs (2.2%) in 9 patients resulted in anaphylaxis. Drugs elicited reactions in 4/170 (2.4 %) patients: two patients to acetylsalicylic acid (2/39 tested patients, 5.1%), one to tramadol (1/12, 8.3%) and one to flurbiprofen (1/1). Anaphylaxis to food was recorded in 6/275 OCTs (2.2%); two out of 48 (4.1%) to α-gal, two to other foods and two to sulfites. Flushing or diarrhea occurred to histamine in 5/48 (10.4%), but also in 5/50 (10.0%) placebo challenges strongly questioning its relevance. Patients with proven anaphylaxis had more bone marrow MC and higher basal serum tryptase (71.3 vs. 44.3ug/l; p<0.05). ConclusionsChallenge-confirmed food and drug anaphylaxis was rare in MC patients. Results have to be interpreted cautiously as placebo reactions did occur. Severe anaphylaxis was seldom, but may occur and should be met by emergency preparedness.

Expert consensus on the diagnosis and management of IgE mediated food allergy in children

The prevalence of food allergy in children is increasing, which seriously affects the quality of life of children and their families. Among children and adolescents, IgE-mediated food allergy is the most common type. In recent years, allergen specific IgE (sIgE) and skin prick testing (SPT) have been widely used in clinical practice, with component resolved diagnosis (CRD) also gaining traction for precise diagnosis of IgE-mediated food allergy. However, a challenge persists in clinical practice due to the tendency to over-interpret food allergen test results without considering the patient's clinical history. While food avoidance remains the most effective treatment for IgE-mediated food allergy, there are varying approaches to clinical management. Strict food avoidance for non-severe food allergies may increase the patient's burden and impact their quality of life. To address these challenges, a consensus on the diagnosis and management of IgE-mediated food allergy in children has been developed based on the latest guidelines and research evidence. This consensus aims to guide physicians in standardizing the management of IgE-mediated food allergy in children.

Canine atopic dermatitis and recurrent otitis

The development of canine atopic dermatitis (CAD) and recurrent otitis are frequently interrelated conditions in dogs, representing a significant challenge in veterinary diagnosis and treatment. This case study details the experience of the dog crossbred (SRD), adopted with year of age, who suffers from CAD and frequent episodes of recurrent otitis caused by Malassezia sp. The objectives of this study were to investigate the relationship between CAD and recurrent otitis, as well as to develop an integrated approach for the effective management of these conditions. The dog underwent a comprehensive clinical evaluation, which included a detailed history, observation of symptoms, and allergy testing. Treatment consisted of the use of antihistamines, corticosteroids and immunosuppressants, in addition to the application of monoclonal antibodies every four weeks to control itching. Immunotherapy has been introduced to modulate the long-term immune response. Recurrent otitis was managed with regular cleaning and topical treatments with Chlorhexidine; miconazole and omega 3,6 and 9, applied three times a week, complemented by a restrictive diet to minimize food allergens. The results showed that the combination of these strategies provided significant relief from dog symptoms, improving their quality of life. The integrated approach, including environmental control, drug therapy and dietary management, proved effective in controlling CAD and recurrent otitis. This study highlights the importance of personalized and ongoing management, as well as suggesting the need for more research into new therapeutic approaches for these chronic conditions. It is concluded that coordination between veterinarians and owners is essential for the success of treatment and the well-being of affected dogs.

EAACI guidelines on the management of IgE-mediated food allergy.

This European Academy of Allergy and Clinical Immunology (EAACI) guideline provides recommendations for the management of IgE-mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Following the confirmation of IgE-mediated food allergy diagnosis, allergen avoidance and dietary advice (with support of a specialised dietitian, if possible) together with the provision of a written treatment plan, education on the recognition of allergic symptoms and prescription of medication including adrenaline using an auto-injector are essential. Patients with significant anxiety and requirement for coping strategies may benefit from support from a clinical psychologist. As immunomodulatory interventions, omalizumab is suggested for treatment of IgE-mediated food allergy in children from the age of 1 and adults; and oral allergen-specific immunotherapy is recommended for children and adolescents with peanut allergy and suggested for milk and egg allergies (generally after 4 years of age for milk and egg). Sublingual and epicutaneous immunotherapy are suggested for peanut allergy but are not yet available at the point of care. Future research into disease modifying treatments for IgE-mediated food allergy are highly needed, with standardised and patient-focused protocols and outcomes.

Regional differences in diagnosis and management of cow's milk allergy.

: Various guidelines for the diagnosis and management of cow's milk allergy (CMA) have been pu- blished. : This study aimed to compare voting outcomes of experts from Mexico, the Middle East, and the European Society of Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) on statements regarding CMA. : The 3 expert groups voted on the same 10 state- ments. Each participant voted anonymously using a score of 0-9 (≥6 meant agreement; <5 reflected disagreement). If <75% of the participants agreed with the statement, it was rejected. None of the groups was aware of the voting outcomes of another group. : There was broad consensus amongst the 3 groups. Agreement was reached that infant colic as a sin- gle manifestation is not suggestive of CMA. All groups confirmed that an extensively hydrolysed formula is the preferred elimination diet in mild/moderate CMA cases; however, hydrolysed rice formula is an alternative. Amino acid-based formulas should be reserved for infants with severe symptoms. The discrepancy in voting outcomes re- garding soy formulas highlights the differences in opinions. Two of 13 ESPGHAN experts (15%), 1 of 14 Middle East experts (7%), and 6 of 26 Mexican experts (23%) disagreed with the statement that soy formula should not be the first choice for the diagnostic elimination diet but can be considered in some cases for economic, cultural, and pala- tability reasons. All of the ESPGHAN and Mexican ex- perts agreed that there was no added value of probiotics, prebiotics, or synbiotics to the efficacy of elimination diets on CMA, whereas 3 of 14 Middle East experts (21%) deter- mined that there was sufficient evidence. : Although all statements were accepted by the 3 groups, there were relevant differences illustrating va- riations according to geography, culture, cost, and formula availability. These findings emphasize the need for region-specific guidelines.

AI-Enhanced Allergy Diagnostics: Streamlining Healthcare and Reducing Costs

Abstract Issue/Problem WHO projects a shortfall of 10 million health workers by 2030. One area particularly lacking technological support is allergy diagnostics. The World Allergy Organization recognizes skin tests as the gold standard for allergy diagnostics, yet these tests are still manually assessed. General practitioners lack the time and tools, leading them to focus on treating the symptoms without addressing the causes. Description of the problem Symptomatic treatment of allergy can lead to the development of asthma in 30-40% of patients, increasing healthcare costs and causing lost productivity. The shortage of allergists further exacerbates this issue in many countries. Results Research conducted by the Military Institute of Medicine in Warsaw, in collaboration with a company producing automated allergy testing systems, explored a solution for allergy diagnostics, analyzing the entire process from the patient’s initial visit to desensitization therapy. The solution uses AI algorithms to reusable existing patient data and analyze patient history, correlate symptoms, medications, and allergen exposure, streamlining diagnostics and treatment. Patients at high risk undergo a computer-assisted interview to determine allergen panels. The only manual step is applying allergens to the skin, after which AI performs the reading and diagnosis. Clinical trials involving around 300 patients demonstrated high sensitivity and specificity, along with significant time savings for allergists and other medical staff, averaging 40 minutes per patient. The HTA evidence base will be ready by the end of this year. Lessons The integration of this AI-supported diagnostic method can eliminate bottlenecks in allergy diagnostics, improving health outcomes and reducing healthcare costs. However, its effectiveness depends on having at least few years of patient treatment data available. Without access to patient data, the method can be used in part to objectify PRICK test readings. Key messages • AI-supported diagnostics streamline allergy testing, reducing time and costs in the healthcare system. • The most accurate technique currently available for the automated reading of test results is that which evaluates the response to an allergen in the dermis in two spectra.

From the clinic to the wards, the evolution of penicillin allergy testing by non-allergists in a UK hospital

From the clinic to the wards, the evolution of penicillin allergy testing by non-allergists in a UK hospital

Adult penicillin allergy programmes in Australian hospitals: a practical guide from the National Antibiotic Allergy Network.

Penicillin allergy is a significant burden on patient, prescribing and hospital outcomes. There has been increasing interest in the incorporation of penicillin allergy testing (i.e. delabelling) into antimicrobial stewardship (AMS) programmes to reduce the burden of penicillin allergy labels and improve prescribing. In particular, there has been a focus on point-of-care penicillin allergy assessment and direct oral challenge for low-risk phenotypes. The National Antibiotic Allergy Network has provided a guide to assist AMS clinicians with the incorporation of penicillin allergy programmes, in particular direct oral challenge, into Australian hospitals.

Sensitizations to pollen differ between Central European and Sub-Saharan African atopic dermatitis patients

Summary Background Atopic dermatitis (AD) is often associated with allergic comorbidities, such as allergic asthma or allergic rhinoconjunctivitis (ARC). Sensitizations to pollen can directly impact AD, as patients can experience exacerbation during pollen season. This study aims to gain more insights into the pollen sensitization patterns of AD patients in Central Europe compared with sub-Saharan Africa (SSA). Methods We performed a case–control study involving a total of 90 participants: 20 AD patients and 10 healthy controls (HC) each from Switzerland (CH), Tanzania (TZ), and Madagascar (MD). We collected clinical data and serum samples and performed a multiplex IgE test (ALEX2 Allergy Explorer, MacroArray Diagnostics, Vienna, Austria). Results The prevalence of ARC and asthma in AD patients was similar in all countries (ARC: 60% TZ, 70% CH, 75% MD; asthma: 25% TZ, 30% CH, 20% MD). Total IgE levels were significantly higher in both SSA HC populations compared with the Swiss HC. The analysis of specific IgE levels revealed major differences in sensitization patterns between Africa and Europe, especially regarding grass pollen allergens. Swiss AD patients were sensitized to various grass pollen such as Bahia grass, Bermuda grass, common reed, perennial ryegrass, rye, and timothy grass. However, these allergens were irrelevant in the SSA population: no AD patient or HC subject was sensitized to the tested grass pollen. Conclusion The considerably different sensitization patterns between European and SSA AD patients warrant the development of allergy testing and desensitization therapies tailored to the African setting. Therefore, there is a need to characterize local pollen types and counts.

Diagnosis and management of shrimp allergy.

Shrimp allergy, the most common food allergy in the United States, affects up to 2% of the population. Its etiology is multi-factorial with the combination of genetic predisposition and environmental exposures. This review summarizes the latest diagnosis and management strategies for shrimp allergy. Currently, the double-blind, placebo-controlled food challenge is the gold standard for diagnosis. Moreover, mainstream and experimental management strategies include food allergen avoidance, the FDA-approved omalizumab, and oral immunotherapy. Herein, we emphasize the urgent need to develop more effective diagnostic tools and therapies for shrimp allergy.

Questionnaire-based real-world survey of diagnosing food allergy in children: Utilization of oral food challenge tests and other diagnostic methods

BackgroundOral food challenge tests are considered the gold standard for diagnosing food allergies; however, studies on their real-world implementation rates are limited. ObjectiveThe study aimed to investigate the proportion of school-aged children who underwent the oral food challenge test and to understand the motivations behind food elimination and utilization of various healthcare services. MethodsThe questionnaire-based survey for the parents of the students who submitted the "certificate for school life management (for allergic diseases)" was conducted across public elementary and junior high schools in Gifu Prefecture, Japan. ResultsThe study encompassed parents of 3457 children with food allergies who submitted the certificate. Approximately one-third of those eliminating the three major allergens—eggs (32.5%), milk (27.6%), and wheat (33.5%)—were diagnosed via oral food challenge tests, and approximately two-thirds were diagnosed using a combination of symptoms and blood tests, suggesting that majority of them were diagnosed appropriately. However, many children were diagnosed and eliminated foods based solely on blood tests without any symptoms of other allergens, such as buckwheat (55.8%), peanuts (29.2%), and tree nuts (21.2%), suggesting that there was likely unnecessary food elimination in these children. The elimination of buckwheat due to anxiety was associated with eliminating other foods for the same reason and eliminating two or more foods. ConclusionExamination of the real-world application of the proposed recommendations for the accurate diagnosis of food allergies suggests that close monitoring of the practical application should be conducted in each case to avoid unnecessary food elimination from children's diets.

Association Of Eosinophil And Total Ige Values With Allergy Test Results In Patients With Atopic Dermatitis

AOBJECTIVES: Atopic dermatitis (AD) is a chronic, recurrent, allergic inflammatory skin disease that may have a genetic predisposition. Eosinophilia is a common finding in patients with atopy. In our study, we aimed to investigate the relationship between eosinophil and IgE levels and allergy test results in patients with atopic dermatitis. METHODS: In this descriptive study, the files of patients diagnosed with atopic dermatitis and followed up in our Pediatric Allergy and Immunology Clinic between January 2021 and December 2022 were retrospectively reviewed. Age, gender, eosinophil, total IgE and specific IgE (for food and inhaled allergens) values were analyzed in the study. Skin prick test (SPT) was also performed in patients who had negative results for allergen-specific IgE. RESULTS: The absolute eosinophil count, eosinophil (%) and total IgE values of patients sensitized to at least one of the food and aeroallergens were significantly higher than those without allergen sensitization. The cut-off point of total IgE in predicting allergen sensitization was found to be 91.5 by ROC analysis. The sensitivity and specificity values for the cut-off point of total IgE were 73.3% and 72.9%. CONCLUSION: In this study, allergen sensitization was detected in 3 out of every 4 AD patients with total IgE and eosinophil values above the cut-off point we analyzed. Accordingly, we think that total IgE and eosinophil values are successful in predicting allergen sensitization. In clinics where specific IgE or SPT cannot be performed, eosinophil and total IgE values in whole blood will be useful for preliminary diagnosis.

Clinical study on the utility of allergy tests to detect IgE-mediated anaphylaxis after diclofenac etalhyaluronate administration.

This study was conducted to investigate factors involved in anaphylaxis related to diclofenac etalhyaluronate (DEH) [product name: Joyclu® (JCL)] (containing DEH and macrogol 400), which is used to treat patients with osteoarthritis. Patients with osteoarthritis were divided into two groups that had (experienced patients) or had not experienced anaphylactic symptoms after JCL administration (non-experienced patients). Five tests performed to assess factors related to anaphylaxis consisted of a skin prick test (SPT) as the primary endpoint and the other tests including basophil activation test, allergen-specific IgE (sIgE) tests using enzyme-linked immunosorbent assay or immunochromatographic kits, and genetic study were secondary endpoints. The SPT showed 4 (wheal)/7 (erythema) of 15 experienced patients and 0/3 of 19 non-experienced patients were positive for any of the test reagents containing DEH. The basophil activation test showed two experienced patients were positive for test reagents containing DEH. DEH- and diclofenac-sIgE were detected in 3 and 1 of 12 experienced patients, respectively. No clear results were shown in the other tests. DEH may be the main factor involved in the development of anaphylaxis. The SPT was more sensitive than the basophil activation and allergen-sIgE tests for identifying factors associated with anaphylaxis.

First episode depression during the perinatal period is associated with atopic diseases and persistently increased eosinophil and basophil levels.

A previous diagnosis of depression is a strong predictor for perinatal depression, apart from other mental disorders, stress, and atopies. It is less clear which factors interfere if perinatal depression occurs as a first depression episode (fePND). We examined the associations with atopies and related blood parameters using data of CoLaus|PsyCoLaus. Newly occurring depression during the perinatal period but not recurrent depression was associated with a lifetime diagnosis of allergies and asthma together with persistently increased levels of basophils and eosinophils. The results imply that immune function may play a relevant role in the risk of a fePND. If confirmed and detailed, these findings could serve as the basis for designing preliminary prevention strategies by observing eosinophil and basophil levels as well as symptoms of atopic diseases before/during pregnancy.

Knowledge, Awareness and Attitude of Pharm.D. Students on Antimicrobial Stewardship: A Report

Antimicrobial Stewardship (AMS) is a strategy to optimize antimicrobials and prevent the emergence of antimicrobial resistance (AMR). Pharm.D. students are future Clinical pharmacists who play a key role in promoting rational use and implementing AMS programs. Only a few studies about their knowledge, awareness and attitude regarding AMS exist. A cross-sectional study was conducted in the middle of December 2023, among Pharm.D. students of different academic years from three Pharmacy colleges and Pharm.D. graduates in South India. The survey was conducted online using a validated questionnaire and Pharm.D. students audited the results under the guidance of an Infectious disease specialist. The survey comprised 17 questions covering demographic information, AMS knowledge, attitude and awareness questionnaires. This study included a total of 190 respondents. However, only 32.11% reported having participated in any AMS activity during their period of pharmacy education. Pharm.D. students have a positive attitude (72.48%) and optimal awareness (65.13%) but they lack sufficient knowledge (45.19%) towards AMS, specifically regarding surgical prophylaxis and antibiotic allergy testing. It serves as a valuable resource for educators, policymakers and stakeholders involved in shaping the curricula of Pharm.D. programs to enhance the training and preparedness of students in AMS practices. In the future, AMS education programs should target not only clinicians but also Pharm.D. students and interns.