Division Of Immunology Research Articles

CoronaVac/Sinovac COVID-19 Vaccine-Related Hypersensitivity Reactions and Second-Dose Vaccine Administration: Tertiary Allergy Center Experience

Introduction: The COVID-19 pandemic has caused a global health crisis. To prevent the disease, the Ministry of Health of Turkey gained approval for the CoronaVac COVID-19 vaccine for emergency use as the first-line. This study aimed to evaluate patients who developed hypersensitivity reactions (HRs) due to the CoronoVac vaccine and to share our experience of administering the second dose of vaccine to these patients. Methods: The study group included the patients who presented to the Ege University Allergy and Immunology Division between January and May 2021. Demographic data, atopic status, allergic reactions to the first dose of the COVID-19 vaccine and the route of second-dose vaccine administrations were recorded. Results: A total of 7 patients (four healthcare professionals), 6 (86%) of whom were women, with an average age of 53.4 years, were included in the study. The rate of allergic reactions among Ege University health workers was 0.036% (2/5,558). Six of our patients had a history of additional allergic diseases and comorbid diseases. None had any allergic reactions to previous vaccinations and latex allergy. Reactions developed commonly on the skin, as generalized urticaria/angioedema and pruritus. The severity of the reactions was evaluated as mild in 2, moderate in 3, and severe in 2 cases. The second-dose CoronaVac was safely administered by using a gradually increase dose in a total of 6 patients. Conclusion: In patients with HRs due to Sinovac in the first dose, the second dose can be safely performed using a gradually increased dose.

Selective COX-2 inhibitor continues to be a safe alternative in patients with nonselective NSAIDs hypersensitivity

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) cause different types of allergic and pseudo allergic reactions. This results in difficulties in clinical practice. Most cases of NSAID hypersensitivity are mediated by the inhibition of cyclooxygenase-1 enzyme (COX-1), which results in depletion of the protective prostaglandin E2, and promotes the unrestrained synthesis of inflammatory mediators from mast cells. Selective COX-2 inhibitors are considered safe alternatives in patients with NSAID allergy, although hypersensitivity reactions to COX-2 inhibitors have also been reported. Our study aimed to report the experience in Qatar for using COX2 inhibitors as an alternative treatment for nonselective NSAID allergy.Methods: Data of patients who underwent open challenge with a single dose of oral celecoxib 200 mg were retrieved from the procedure log of the Allergy and immunology Division in Hamad medical corporation, Doha, Qatar, from 2013 to 2022. The challenge was considered positive if the patient developed cutaneous or respiratory symptoms.Results: A total of 31 patients were identified; 4 with a history of celecoxib allergy. The remaining 27 (23 females and 4 males); with mean ( ± SD, range) age of 42 ( ± 12, 20–65) years had hypersensitivity to one (n = 11) or more than one (n = 16) nonselective NSAID, manifested as cutaneous, respiratory, or anaphylactic symptoms. Those 4 patients with celecoxib allergy were challenged and only one with a historical reaction of anaphylaxis developed anaphylaxis during the challenge. Celecoxib was well tolerated in all 27 patients with hypersensitivity reactions to nonselective NSAIDs. Also, patients were contacted by telephone call at 24 hours and after 1 week with no evidence of delayed reactions.Conclusions: Selective COX-2 and nonselective NSAIDs have similar overall efficacy as analgesic, anti-inflammatory, and antipyretic agents. Hypersensitivity reaction to COX-2 inhibitors has been reported; however, it is rare. So, it is safer to challenge the patients with COX-2 inhibitors before prescribing them as alternative medication in patients with Nonselective NSAID allergies. We plan to conduct a single-/double-blind placebo-controlled study for more patients, especially using graded challenges for high-risk profile candidates. Also, it may be of significance to test more than one type of selective COX-2 to avoid drug-specific reactions.

Characteristics of Atopic Dermatitis Patients who Underwent Skin Prick Test

Background: Skin prick test (SPT) is indicated in type I hypersensitivity reactions (rapid type), among which is Atopic Dermatitis (AD). However, the results of SPT for the tested allergens are not always accompanied by history of known allergens in AD patients. Purpose: To identify the characteristics of AD patients who underwent SPT. Methods: This was a descriptive retrospective study to determine the demographics, allergy history, SPT results, and positive and negative clinical relevance in AD patients treated at Allergy Immunology Division of Dermatology and Venerology Outpatient Clinic Dr. Soetomo General Academic Hospital Surabaya-Indonesia from January 2017 to December 2019. Results: A total of 284 AD patients were included. The adult age group (20-59 years) predominated the AD patient’s visit every year with 58 patients (60.42%), 47 patients (46.08%), and 65 patients (75.58%) in 2017, 2018, and 2019, respectively. Only 60 AD patients underwent SPT, where most patients were allergic to dust with 30 patients (50.0%). House dust mite (HDM) allergen had the highest percentage of positive SPT result with 41 patients (63.3%). The greatest clinical relevance was found in cat fur allergen, where all patients (100.0%) had clinical relevance to their SPT result. Conclusion: This study shows that most AD patients were in adult age group and had a history of dust allergy. The highest percentage of positive SPT result was found in HDM allergen and the greatest clinical relevance was found in cat fur allergen.

Clinical relevance of skin prick test in atopic dermatitis patients at allergy immunology division dermatovenerology outpatient clinic Dr. Soetomo general academic teaching hospital Surabaya

Background: Positive specific IgE tests, including skin prick test (SPT), for several food allergens are frequently found in atopic dermatitis (AD) patients, most of which have no clinical relevance and are associated only with atopy. This study aimed to determine the allergic history of AD patients who were subjected to SPT and to determine its clinical relevance. This is a descriptive retrospective study on AD patients who were subjected to SPT from 2017 to 2019 using secondary data. Allergy history, SPT results, and its clinical relevance were collected and analyzed. From a total of 284 AD patients, only 60 patients who were subjected to SPT. Most of the patients had dust allergy (50.0%) and house dust mite (HDM) allergen also had the highest positive SPT result (63.3%). Furthermore, the highest clinical relevance was found in HDM allergen (93.3%). This study shows that most AD patients were allergic to dust. The highest positive SPT result was found in HDM allergen, where ultimately this allergen also had the highest clinical relevance.

Aspirin challenge and desensitization in patients with suspected AERD in Qatar.

Background: Aspirin-exacerbated respiratory disease (AERD) is a chronic disease characterized by chronic rhinosinusitis, nasal polyposis, asthma, and intolerance to nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin challenge is considered the gold standard for diagnosing AERD. Many patients with AERD have reported clinical benefits when desensitized to aspirin and maintained on daily aspirin therapy. In this study, we have summarized aspirin challenges and aspirin desensitization in our division during the past ten years.Methods: We reviewed aspirin challenges and desensitization procedures performed in the Allergy and Immunology Division at the Hamad Medical Corporation, Doha, Qatar, between 2010 and 2020 from our procedures log registry and reported the results of the procedures.Results: The procedures were performed for patients with chronic rhinosinusitis, nasal polyposis, and bronchial asthma with a historical reaction to NSAIDs or those never exposed to NSAIDs. The challenge and desensitization procedure protocol is outlined in table.1. Of the 45 procedures performed, 36 (80%) patients reacted during aspirin desensitization; and their characteristics, historical reaction to NSAIDs, provoking dose, length of desensitization, and types of reactions were reviewed. Of the reactors, 32 (88%) patients completed aspirin desensitization successfully. The mean ( ± SD) age of patients was 46 ( ± 11.6) years, and 51% were women. The historical symptoms were asthma symptoms (56%) and naso-ocular (21%). The common (71%) reaction during the procedure was asthma symptoms, and 29% had naso-ocular symptoms. The provoking dose was 50–75 mg in most patients. The desensitization procedure was carried out over 2 days in most patients; however, 29% of the patients needed more than 2 days to complete the desensitization. None of the reactors needed emergency epinephrine use or hospital admission.Conclusion: In our review, desensitization was successful in all the patients who reacted to aspirin, and it was the only therapeutic choice for patients with AERD before the era of biologics. The procedure was well tolerated in most patients. Aspirin challenge was positive in 80% of our patients with suspected AERD, and this has an important diagnostic value that may help in choosing the proper biologic, such as dupilumab, for these patients.

Real-world experience of the clinical effectiveness of omalizumab use in Qatar - a study protocol.

Omalizumab (XOLAIR®) is a recombinant DNA-derived humanized IgG1κ monoclonal antibody that binds to IgE and was first introduced in Qatar in 2009. Omalizumab is used to treat moderate-to-severe allergic asthma (SAA), chronic idiopathic urticaria (CIU), and chronic rhinosinusitis with nasal polyposis (CRSwNP). In this study, we have described a proposal to investigate the outcomes and impact of the clinical use of omalizumab for the labeled indications (SAA, CIU, and CRSwNP) and other off-label indications (food allergy, dermatitis, and others) in clinical practice in Qatar. This is a mixed-design study in which the first stage included a chart review of all the patients from the Allergy and Immunology Division registry who received omalizumab since May 2009. The second stage was a cross-sectional questionnaire to review all (previous and current) patients and identify their current health status and treatment outcomes. The third stage was a proof of concept and consisted of selecting a cohort to investigate the omalizumab mechanism for patients before and after administration. Patients with a physician diagnosis of asthma and/or urticaria fulfilling the diagnostic criteria for omalizumab administration and patients with off-label indications were recruited. Expected outcomes included identifying the real-life effectiveness and the experience of using omalizumab in Qatar and reporting all potential adverse effects that might have been missed during early trials or other published studies. This study was essential to observe Qatar’s local clinical practice regarding the use of omalizumab; and in addition, we could gather data about the risk factors contributing to disease recovery or progression and those resulting in favorable or unfavorable outcomes. We expect the results to augment the current knowledge about understanding diseases and the global experience on the use of omalizumab.

SCIG administration: A promising and patient convenient alternative for those receiving long-term IVIG.

Background: Intravenous immunoglobulin (IVIG) therapy has been used as antibody replacement therapy in primary immunodeficiency diseases (PID) for more than 50 years. In this study, we aimed to define IVIG usage and adverse reactions and complications in PID and explain how subcutaneous immunoglobulin (SCIG) replacement therapy is an alternative that improves the patient experience. In addition, the additional nursing responsibilities associated with this service were also identified.Methods: Data and service satisfaction surveys for the last 10 years were reviewed from the Allergy and Immunology Division log registry for those on IVIG and SCIG.Results: IVIG practice: Most patients currently on IVIG in our unit have PID. Adverse reactions occur during the initial 30 to 60 minutes of the infusion and are mild and self-limited. Infusion reactions are more likely to occur in patients receiving IVIG for the first time. Infusion-related complications included pyrogenic reactions, allergic reactions, and vasomotor symptoms. Complications reported in the literature such as the transmission of blood-borne pathogens and other serious complications, including thrombotic events, renal adverse events, and aseptic meningitis were never reported. Pyrogenic reactions occurred at a rate ≥ 100 mL/hr in at least 3 patients, and a slower infusion rate of ≤ 75 mL/hr mitigated this rate-related complication.SCIG program: This program started in Qatar in 2017. Usually, the clinician assesses and evaluates several factors to help select candidates for this therapy, including the perceptions of inconvenience and/or pain of IV infusions, presence of difficult vein access, and other relevant clinical and social factors. Once training in the appropriate techniques has been accomplished (3–6 sessions), it is most often self-administered in the home setting by the patient or a parent for a child. Table 1 summarizes patients on SCIG.Additional nursing responsibilities: The nursing role in subcutaneous IgG administration is primarily that of an educator and to help the patient/family become independent. This can be achieved by the assessment of appropriate patient selection for self-administration. Determining which patients are suitable include adequate patient education with return demonstration of the necessary skill set, monitoring parameters, educating patients about their medication, and providing educational resources and support.Conclusion: SCIG administration can be a convenient alternative for patients with PID receiving long-term IVIG.

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Coronavirus disease 2019-associated multisystem inflammatory syndrome and Kawasaki disease.

Pediatrics InternationalAccepted Articles e15349 Clinical NoteFree Access COVID-19-associated multisystem inflammatory syndrome and Kawasaki disease Yoji Uejima, Corresponding Author Yoji Uejima uejima.yoji@saitama-pho.jp orcid.org/0000-0002-0755-7560 Division of Infectious Diseases and Immunology, Saitama Children’s Medical Center, Saitama, Japan Department of Clinical Laboratory and Molecular Pathology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan Correspondence Yoji Uejima, MD, Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, 1–2 Shintoshin, Chuou-ku, Saitama 330-8777, Japan, Tel: +81- 48-601-2200; Fax: +81-48-601-2201. Email: uejima.yoji@saitama-pho.jpSearch for more papers by this authorEisuke Suganuma, Eisuke Suganuma Division of Infectious Diseases and Immunology, Saitama Children’s Medical Center, Saitama, JapanSearch for more papers by this authorKaede Matsunaga, Kaede Matsunaga Department of Clinical Laboratory and Molecular Pathology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, JapanSearch for more papers by this authorIsao Kitajima, Isao Kitajima Department of Clinical Laboratory and Molecular Pathology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, JapanSearch for more papers by this authorHideki Niimi, Hideki Niimi Department of Clinical Laboratory and Molecular Pathology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, JapanSearch for more papers by this author Yoji Uejima, Corresponding Author Yoji Uejima uejima.yoji@saitama-pho.jp orcid.org/0000-0002-0755-7560 Division of Infectious Diseases and Immunology, Saitama Children’s Medical Center, Saitama, Japan Department of Clinical Laboratory and Molecular Pathology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan Correspondence Yoji Uejima, MD, Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, 1–2 Shintoshin, Chuou-ku, Saitama 330-8777, Japan, Tel: +81- 48-601-2200; Fax: +81-48-601-2201. Email: uejima.yoji@saitama-pho.jpSearch for more papers by this authorEisuke Suganuma, Eisuke Suganuma Division of Infectious Diseases and Immunology, Saitama Children’s Medical Center, Saitama, JapanSearch for more papers by this authorKaede Matsunaga, Kaede Matsunaga Department of Clinical Laboratory and Molecular Pathology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, JapanSearch for more papers by this authorIsao Kitajima, Isao Kitajima Department of Clinical Laboratory and Molecular Pathology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, JapanSearch for more papers by this authorHideki Niimi, Hideki Niimi Department of Clinical Laboratory and Molecular Pathology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, JapanSearch for more papers by this author First published: 01 September 2022 https://doi.org/10.1111/ped.15349 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ped.15349 AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future.e15349 RelatedInformation

Universal Cardiology Electronic Consultations

HomeCirculation: Cardiovascular Quality and OutcomesVol. 15, No. 1Universal Cardiology Electronic Consultations No AccessEditorialRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessEditorialRequest AccessFull TextUniversal Cardiology Electronic Consultations Neelam A. Phadke, MD, MPH Neelam A. PhadkeNeelam A. Phadke Correspondence to: Neelam A. Phadke, MD, MPH, Massachusetts General Hospital, 40 2nd Ave, Waltham, MA 02451. Email E-mail Address: [email protected] https://orcid.org/0000-0002-5173-275X Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA. Harvard Medical School, Boston, MA. Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston. Search for more papers by this author Originally published18 Jan 2022https://doi.org/10.1161/CIRCOUTCOMES.121.008709Circulation: Cardiovascular Quality and Outcomes. 2022;15This article is a commentary on the followingLonger-Term Results of a Universal Electronic Consultation Program at the Cardiology Department of a Galician Healthcare Area"Universal Cardiology Electronic Consultations." Circulation: Cardiovascular Quality and Outcomes, 15(1), pp. e008709–FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Disclosures, see page 26.Correspondence to: Neelam A. Phadke, MD, MPH, Massachusetts General Hospital, 40 2nd Ave, Waltham, MA 02451. Email [email protected]org

Idiopathic recurrent pericarditis: review of the literature and the Geneva experience

The notion of idiopathic recurrent pericarditis (IRP) appeared in the scientific literature in the 1930s. In 1955, W. Dressler published a case series of IRP in which treatment of cortisone and salicylates (i.e. Aspirin) was effective. About 30 years later, De La Serna et al. in 1987 and Guindo et al. in 1990, reported a beneficial effect of colchicine. In recent years, several clinical studies have helped to i mprove the management of this disease. In this present literature review of IRP, we will focus on the definition, differential diagnoses, pathophysiological hypotheses and available treatments. We will also discuss the clinical experience at the division of clinical immunology at the University Hospitals of Geneva.

Editorial introductions.

Current Opinion in Allergy and Clinical Immunology was launched in 2001. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of allergy and clinical immunology are divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS M. Teresa (Maite) de la MorenaM. Teresa (Maite) de la MorenaM. Teresa (Maite) de la Morena is Professor of Pediatrics in the Department of Pediatrics, Division of Immunology at University of Washington and Seattle Children's Hospital, USA. She graduated from medical school at Universidad Complutense de Madrid, Spain. This was followed by residency and fellowships training in pediatrics, allergy and immunology, and laboratory immunology at the University of South Florida, St. Petersburg, Florida, USA. Dr de La Morena has a clinical interest in allergy and immunology, clinical immunology with particular focus on the primary immunodeficiency diseases. Her research interests include long term clinical outcomes of patients with X-linked Hyper IgM syndrome, DiGeorge syndrome and microRNAs in primary immunodeficiency disorders, including their role in thymic development. Stephen JollesStephen JollesDr Jolles is a Consultant Clinical Immunologist and Honorary Professor at the University Hospital of Wales, UK. He is Clinical Lead in the Immunodeficiency Centre of Wales and Co-Director of the Hub Immunology Diagnostic Laboratory of Wales. Dr Jolles trained in immunology and allergy, and obtained his PhD on Langerhans cell migration at the National Institute for Medical Research, London. He has a particular interest in the clinical use of immunoglobulin and its mechanism of action and research interests include development of new therapeutic products, new screening strategies to improve the laboratory diagnosis of primary and secondary immunodeficiency and allergy, and better ways to monitor primary immunodeficiency disease and the impact of treatments. Giovanni PassalacquaGiovanni PassalacquaProf. Giovanni Passalacqua was born in Genoa in 1964, graduated in 1990 from the Genoa University Medical School, Italy, and was appointed by the specialty degrees in Allergy and Clinical Immunology and Respiratory Medicine in 1994 and 2002. He is the Co-Chairman of the Immunotherapy Scientific Committee of the WAO and member of the ARIA editorial board. Prof. Passalacqua serves as a section editor for Current Opinion in Allergy and Clinical Immunology, and also as a reviewer for Allergy, JACI, Clin Exp Allergy and ERJ. Prof. Passalacqua is the co-author of several international position papers, including ARIA guidelines, WAO Pos pap on SLIT, EAACI Pos Pap on local immunotherapy. His main fields of research are sublingual immunotherapy, mechanisms of allergic inflammation, antihistamines, corticosteroids, respiratory allergy, hymenoptera venom allergy. Under the chairmanship of Professor Canonica, he developed and investigated sublingual immunotherapy in the last 20 years. He has had 450 full articles published in peer reviewed journals indexed in MedLine plus 15 chapters in international handbooks. He currently heads the Allergy and Respiratory Diseases Department, and chairs the Specialty School in Respiratory Diseases, University of Genoa, Italy. Robert BushRobert BushDr Robert Bush received his MD degree from West Virginia University, USA. After completing his residency in internal medicine and fellowship in allergy and immunology at the University of Wisconsin – Madison, USA, he joined the faculty. He is currently Professor (Emeritus) of Medicine and was the former Chief of Allergy at the William S Middleton VA Hospital, Madison, Wisconsin, USA. His research interests include sublingual immunotherapy, allergen characterization, fungal allergy, food allergy, and occupational asthma.

Editorial introductions.

Editorial introductions.

Clinical Manifestations and Outcomes of Activated Phosphoinositide 3-Kinase δ Syndrome from the USIDNET Cohort

Activated phosphoinositide 3-kinase δ syndrome is a combined primary immunodeficiency characterized by gain-of-function mutations in PIK3CD and PIK3R1. Activated phosphoinositide 3-kinase δ syndrome demonstrates a large range of phenotypes including respiratory and herpesvirus infections, lymphadenopathy, autoimmunity, and developmental delay. To describe clinical phenotypes and disease outcomes of a large activated phosphoinositide 3-kinase δ syndrome cohort from the United States Immunodeficiency Network Registry. A total of 38 patients were enrolled in the United States Immunodeficiency Network Registry, and 2 additional patients were obtained from the Clinical Immunology Division at Mount Sinai Hospital. Each patient's demographic characteristics, disease complications, genetic studies, laboratory data, therapeutic interventions, and clinical outcomes were reviewed. There was a high frequency of respiratory infections (70.0% pneumonia) and herpesvirus infections (37.5%). Bronchiectasis was observed in 45.0% of patients. Lymphadenopathy was common (52.5%), and 12.5% of patients developed lymphoma. Neurological and developmental findings were common: 20.0% had developmental delay, 15.0% had seizures, and 10.0% had dysmorphic features. Asthma was more common in PIK3CD compared with PIK3R1 patients (63.6% vs 14.3%). More subjects with PIK3CD had CD3 lymphopenia compared with the PIK3R1 cohort. Seven patients underwent hematopoietic stem cell transplantation. One patient died from infectious complications. This is the first cohort comparing clinical manifestations in PIK3CD and PIK3R1 patients from the USIDNET Registry. Similar frequencies of respiratory and herpesvirus infections, lymphadenopathy, and developmental delay were observed compared with previous cohort studies. However, a higher frequency of asthma and CD3 lymphopenia in the PIK3CD cohort compared with the PIK3R1 cohort was observed.

Black in Immuno ‐ amplifying, celebrating, and supporting Black voices in immunology

Black in Immuno ‐ amplifying, celebrating, and supporting Black voices in immunology

Treatment-Resistant Bacterial Lymphadenitis in an Otherwise Healthy Girl.

1. Oze Henig, MD*,† 2. Soma Jyonouchi, MD‡,§ 3. Torsten Joerger, MD¶ 4. Katie Kennedy, MD‡ 1. *Division of General Pediatrics 2. ‡Division of Allergy and Immunology, and 3. ¶Department of Infectious Disease, Children’s Hospital of Philadelphia, Philadelphia, PA 4. †Children’s Hospital of Philadelphia Inpatient Pediatrics at Virtua, Voorhees, NJ 5. §Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA A previously healthy 5-year-old girl presents to the pediatric emergency department of a community hospital with 3 days of fever and neck swelling. She reports pain when moving the neck upward and to the right, but there is no neck stiffness. On physical examination she has a temperature of 102.2°F (39°C) but is well appearing. She has a 2-cm, left-sided, mobile, tender mass along the anterior cervical chain and shotty lymphadenopathy of the right anterior cervical chain. She is diagnosed as having lymphadenitis and is discharged with a prescription for clindamycin. Despite consistently taking the antibiotic, she returns 3 days later with persistent fever and worsening swelling. On physical examination her left-sided swelling has increased to 3 cm, but she continues to have normal range of motion of her neck. A complete blood cell count reveals a white blood cell count of 11,000/µL (11×109/L); hemoglobin concentration, 9.0 g/dL (90 g/L); and platelet count, 424×103/µL (424×109/L). The differential cell count includes 63% neutrophils, 24% lymphocytes, 12% monocytes, and 1% eosinophils. Ultrasonography is performed and demonstrates 2 lymph nodes in the left cervical chain that seem reactive in nature and with no abscess formation. The patient is admitted on intravenous (IV) ampicillin-sulbactam for presumed outpatient treatment failure of acute lymphadenitis. However, her symptoms persist, and further testing is needed to reveal the etiology of her infection. While receiving IV ampicillin-sulbactam, the patient continued to have persistent fever. Serologic tests for Epstein-Barr virus, cytomegalovirus, and Bartonella henselae as well as a tuberculin skin test and rapid human immunodeficiency virus testing were negative. A chest radiograph showed no abnormality. After 10 days of fever with stable physical examination findings, otolaryngology performed an excisional biopsy, with resultant …

Editorial introductions.

Editorial introductions.

Joachim R. Kalden (1937–2021)

Joachim R. Kalden (1937–2021)

Treatment of Peanut Allergy.

1. Amy Burris, MD*,† 2. Theresa Bingemann, MD*,† 1. *Department of Medicine: Allergy, Immunology, and Rheumatology and 2. †Division of Pediatric Allergy and Immunology, University of Rochester Medical Center, Rochester, NY Peanut allergy (PA) affects 0.5% to 2% of children and is often a persistent condition that poses the risk of life-threatening reactions on exposure to peanut. It is the most common food allergy to cause anaphylaxis and death. Because allergy testing does not predict the severity of reactions, it is imperative that peanut-allergic children have access to epinephrine autoinjectors at all times. Although cutaneous reactions, including generalized urticaria, angioedema, and atopic dermatitis, are the most common, anaphylaxis accounts for more than one-third of reactions. Recently, research has focused on prevention strategies for PA. In high-risk infants, early introduction of peanut at younger than 11 months of age plays a crucial role in preventing PA. Conversely, avoidance of peanut is associated with increased risk of PA. Guidelines recommend early introduction of peanut to infants with no eczema or mild to moderate eczema. Infants with severe eczema should be promptly referred to an allergist for evaluation of peanut sensitization before introduction. Disruption of the skin barrier, as with eczema, plays a role in the development of food allergy. Transcutaneous exposure of food allergens may promote allergic sensitization, whereas allergen exposure through the gut may promote tolerance. Studies show that increased environmental peanut exposure leads to increased risk of PA, especially in children with eczema. Aggressive emollient therapy early in life may decrease the risk of developing eczema. Studies examining the role of early emollient therapy and development of food allergy are ongoing. The cross-reactivity between peanut allergens and environmental allergens means that apparent sensitization to peanut does not necessarily …

An Australian State-Based Cohort Study of Autoimmune Encephalitis Cases Detailing Clinical Presentation, Investigation Results, and Response to Therapy.

Introduction: Autoimmune encephalitis is a disorder associated with antibodies directed against central nervous system proteins with variable clinical features. This study aims to add to knowledge of the disease by reporting the details of a cohort of patients with autoimmune encephalitis in Queensland, Australia.Methodology: We surveyed patients with autoimmune encephalitis diagnosed and managed through public hospitals in Queensland, Australia between 2010 and the end of 2019. Cases were identified via case detection through a centralized diagnostic neuroimmunology laboratory (Division of Immunology, HSQ Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia) and a survey of neurologists. Data including demographic details, clinical presentation, investigation results, treatments including immune therapy and outcomes was collected.Results: Sixty cases of antibody positive autoimmune encephalitis were identified. Twenty-eight were of anti-NMDA-receptor encephalitis with other cases associated with antibodies against LGi1, Caspr2, glycine receptor, DPPX, GABAB receptor, IgLON5, GFAP, and SOX1. The number of diagnosed cases, especially of anti-NMDA-receptor encephalitis has markedly increased over the period 2017 to 2019. Clinical presentations were marked by heterogeneous symptom complexes and prolonged hospital admissions. Imaging studies were largely normal or non-specific. There was a response to immune therapy and a low mortality rate. Most cases affected by this disorder were left with ongoing symptoms associated with mild disability.Conclusion: Autoimmune encephalitis in Queensland, Australia is an increasingly common but complex clinical entity marked by heterogeneous presentations, response to immune therapy and outcome results marked by low mortality and incomplete recovery.