Anaphylaxis Research Articles

Anaphylactic reaction to tranexamic acid infusion in a six-year-old child: a case report

BackgroundTranexamic acid (TXA) is commonly considered a safe drug to mitigate bleeding during and after various surgical settings among adults and children. In recent decades, anaphylaxis induced by TXA has been increasingly reported in adults. However, among pediatrics, there are fewer reported cases.Case presentationWe report a case of a 6-year-old female who experienced anaphylaxis after receiving intravenous TXA following unilateral cleft lip and palate repair surgery. She exhibited clinical symptoms involving the cardiovascular system, respiratory system, and skin. Following the administration of epinephrine, corticosteroid, and anti-histamine, the patient’s symptoms were relieved. A few months after discharge, an intradermal test, yielded a positive result, confirming TXA as the culprit drug.ConclusionOur report emphasizes the importance of considering anaphylaxis as a potential adverse reaction to TXA in pediatric patients, showing the criticality of rapid diagnosis and appropriate management for a successful outcome.

Clinical utility analysis of the Hoxb8 mast cell activation test for the diagnosis of peanut allergy.

Peanut allergy is among the most severe and common food allergies. The diagnosis has a significant impact on the quality of life for patients and their families. An effective management approach depends on accurate, safe, and easily implementable diagnostic methods. We previously developed a cell-based assay using Hoxb8 mast cells (Hoxb8 MCs) aimed at improving clinical allergy diagnosis. In this study, we assessed its diagnostic performance by measuring blinded sera from a prospectively enrolled and pre-validated peanut allergy cohort. Hoxb8 MCs were passively sensitized with sera from peanut-allergic and peanut tolerant children and adolescents (n = 112). Degranulation of Hoxb8 MCs was quantified upon stimulation with dose-titrated peanut extract by means of flow cytometry, using CD107a as activation marker. The results from the Hoxb8 mast cell activation test (Hoxb8 MAT) were compared to established diagnostic assays such as the skin prick test (SPT), specific IgE (sIgE) levels, and the basophil activation test (BAT). Additionally, serum samples from BAT nonresponders were assessed with the Hoxb8 MAT. Hoxb8 MAT displayed a robust dose-dependent activation to peanut extract, with a cutoff value of ≤5.2% CD107a positive cells. The diagnostic accuracy was highest at allergen concentrations ≥100 ng/mL, with an area under the receiver operating characteristic curve (AUROC) of 0.97, 93% sensitivity, and 96% specificity, outperforming traditional SPT and sIgE tests. When compared to BAT, Hoxb8 MAT exhibited comparable diagnostic efficacy. Moreover, sera from BAT nonresponders were accurately classified into allergics and nonallergics by the Hoxb8 MAT. The Hoxb8 MAT demonstrated a very good diagnostic precision in patients prospectively assessed for peanut allergy comparable to the fresh whole blood-based BAT. Additionally, it demonstrated its value for accurate classification of BAT nonresponders into allergic and nonallergic individuals. Further investigations into its utility in the routine clinical setting are warranted.

Cell wall nanoparticles from hyphae of Alternaria infectoria grown with caspofungin, nikkomycin, or pyroquilon trigger different activation profiles in macrophages.

Alternaria infectoria causes opportunistic human infections and is a source of allergens leading to respiratory allergies. In this work, we prepared cell wall nanoparticles (CWNPs) as a novel approach to study macrophage immunomodulation by fungal hyphal cell walls. A. infectoria was grown in the presence of caspofungin, an inhibitor of β(1,3)-glucan synthesis; nikkomycin Z, an inhibitor of chitin synthases; and pyroquilon, an inhibitor of dihydroxynaphthalene (DHN)-melanin synthesis. Distinct CWNPs were obtained from these cultures, referred to as casCWNPs, nkCWNPs, and pyrCWNPs, respectively. CWNPs are round-shaped particles with a diameter of 70-200 nm diameter particles that when added to macrophages are taken up by membrane ruffling. CWNPs with no DHN-melanin and more glucan (pyrCWNPs) caused early macrophage activation and lowest viability, with the cells exhibiting ultrastructural modifications such as higher vacuolization and formation of autophagy-like structures. CasCWNPs promoted the highest tumor necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β) increase, also resulting in the release of partially degraded chitin, an aspect never observed in macrophage-like cells and fungi. After 6 h of interaction with CWNPs, only half were viable, except with control CWNPs. Overall, this work indicates that compounds that modify the fungal cell wall led to CWNPs with new properties that may have implications for the effects of drugs during antifungal therapy. CWNPs provide a new tool to study the interaction of hyphal fungal cell wall components with phagocytic cells and enable to show how the modification of cell wall components in A. infectoria can modulate the response by macrophages.IMPORTANCEAlternaria species are ubiquitous environmental fungi to which the human host can continuously be exposed, through the inhalation of fungal spores but also of fragments of hyphae, from desegregated mycelia. These fungi are involved in hypersensitization and severe respiratory allergies, such as asthma, and can cause opportunistic infections in immunodepressed human host leading to severe disease. The first fungal structures to interact with the host cells are the cell wall components, and their modulation leads to differential immune responses. Here, we show that fungal cells grown with cell wall inhibitors led to cell wall nanoparticles with new properties in their interaction with macrophages. With this strategy, we overcame the limitation of in vitro assays interacting with filamentous fungi and showed that the absence of DNH-melanin leads to higher virulence, while caspofungin leads to cells walls that trigger higher hydrolysis of chitin and higher production of cytokines.

Hypersensitivity to erythritol in a 7-year-old boy

Hypersensitivity reactions to erythritol are rare, with an incidence of less than 1:1,000,000. In recent years, the widespread use of erythritol has increased significantly, which may result in an increase of the frequency of hypersensitivity reactions. We discuss the clinical features and the diagnostic process in a case of hypersensitivity to erythritol in a seven-year-old boy. The presented patient developed generalised urticaria, vomiting, weakness, and shortness of breath within minutes of eating a homemade cake containing erythritol. A few months later urticaria appeared on the boy’s face and trunk 30 minutes after eating a homemade cake containing maltitol. Skin prick tests and intradermal tests with erythritol were performed, yielding negative results. An oral challenge with erythritol, using increasing doses of 250 mg, 500 mg, and 1,000 mg every 30 minutes, was positive. It was recommended to eliminate sweeteners from the diet. It is important to remember about food additives when searching for the causative agents of anaphylactic reactions.

Anaphylaxis post-COVID-19 vaccinations in Singapore.

Anaphylaxis was the first serious adverse event (AE) of special interest surfaced in Singapore following coronavirus disease 2019 (COVID-19) vaccination. Individuals who developed physician-diagnosed severe allergic reactions to the mRNA vaccines would be medically ineligible for mRNA vaccines and offered non-mRNA alternatives. This paper describes anaphylaxis reports received by the Health Sciences Authority (HSA) and presents a review of individuals who received heterologous COVID-19 vaccination. Reports of anaphylaxis associated with the COVID-19 vaccines received till 31 July 2022 were reviewed and adjudicated using the Brighton Collaboration case definition criteria by an HSA-appointed expert panel. Additional review was conducted for cases with heterologous vaccination for any subsequent reactions until administration of third dose of COVID-19 vaccines. Among 112 adjudicated anaphylaxis cases, majority occurred in females, adults and persons with allergy histories, which were consistent with global observations. Most cases (71%) occurred within 30 minutes of vaccination. The reporting incidence rates (IRs) of 0.67 and 0.55 per 100,000 administered doses for Comirnaty and Spikevax vaccines, respectively, were comparable with IRs reported overseas, whereas the IRs for non-mRNA vaccines (Sinovac-CoronaVac and Nuvaxovid) were much higher at 4.14 and 29.82 per 100,000 administered doses, respectively, likely due to selection bias. Review of the 20 cases following heterologous vaccination found varying reactions to subsequent vaccinations. Anaphylaxis is a rare but serious AE in which outcomes can be mitigated with timely medical intervention. The case review helped to guide vaccination strategies and added to the cumulative knowledge of safety with heterologous vaccination.

Hereditary gluten enteropathy in irish setters: evaluation of external parameters, clinical symptoms and fatal risks

Aim. Determine the features of appearance, clinical signs and fatal risks in Irish setters with hereditary gluten enteropathy. Methods. The methods used were observation, eye examination, clinical examination, autopsy, histological. Results. It has been established that in hereditary gluten enteropathy in Irish setters there are violations of the parameters of appearance, weak ability to train, fulminant and chronic forms of damage to the intestinal wall by type of enteropathy, anaphylactic reactions and cerebral disorders. In the dead setters, the causes of death were hypovolemic shock due to intestinal bleeding and combined critical injuries of the brain, heart and lungs. Conclusions. Violations of the parameters of appearance in setters with hereditary gluten enteropathy led to their unsuitability for hunting. Dietary therapy with the exclusion of feed containing cereals was effective in stabilizing the condition of sick setters. Setters with hereditary gluten enteropathy are at risk of developing fatal cardiovascular, pulmonary, and cerebral insufficiency. The validity of the spread of hereditary gluten enteropathy in Irish setters depends on the accounting of the results of multi-year studies by a multidisciplinary group of specialists.

B cells drive neuropathic pain-related behaviors in mice through IgG-Fc gamma receptor signaling.

Neuroimmune interactions are essential for the development of neuropathic pain, yet the contributions of distinct immune cell populations have not been fully unraveled. Here, we demonstrate the critical role of B cells in promoting mechanical hypersensitivity (allodynia) after peripheral nerve injury in male and female mice. Depletion of B cells with a single injection of anti-CD20 monoclonal antibody at the time of injury prevented the development of allodynia. B cell-deficient (muMT) mice were similarly spared from allodynia. Nerve injury was associated with increased immunoglobulin G (IgG) accumulation in ipsilateral lumbar dorsal root ganglia (DRGs) and dorsal spinal cords. IgG was colocalized with sensory neurons and macrophages in DRGs and microglia in spinal cords. IgG also accumulated in DRG samples from human donors with chronic pain, colocalizing with a marker for macrophages and satellite glia. RNA sequencing revealed a B cell population in naive mouse and human DRGs. A B cell transcriptional signature was enriched in DRGs from human donors with neuropathic pain. Passive transfer of IgG from injured mice induced allodynia in injured muMT recipient mice. The pronociceptive effects of IgG are likely mediated through immune complexes interacting with Fc gamma receptors (FcγRs) expressed by sensory neurons, microglia, and macrophages, given that both mechanical allodynia and hyperexcitability of dissociated DRG neurons were abolished in nerve-injured FcγR-deficient mice. Consistently, the pronociceptive effects of IgG passive transfer were lost in FcγR-deficient mice. These data reveal that a B cell-IgG-FcγR axis is required for the development of neuropathic pain in mice.

Experimental study of heat pipe start-up characteristics and development of an enhanced model considering gas diffusion effects

Heat pipe-based cooling reactors, offering passive heat transfer and modularity, are becoming the preferred type for micro-reactors. Alkali metals such as sodium, potassium and lithium are usually used as the working medium of the heat pipe, which is in a frozen state at normal atmospheric temperature. After heating the heat pipe, the working medium will melt and enter the gas chamber, and its flow state will undergo a transition from discontinuous flow to continuous flow. The start-up of the heat pipe affects the heat export and neutron physical characteristics of the heat pipe cooling reactor. Building a model of heat pipe can predict the start-up of heat pipe effectively, which can be helpful to study the start-up and safety analysis of heat pipe cooling reactor. In this paper, a heat pipe flat-front model considering the gas diffusion effect is established, and the gas temperature distribution characteristics in the non-continuous flow region are obtained through the start-up experiment of heat pipe. The calculated results of the flat-front model considering gas diffusion effect and the vertical flat-front model are compared with the experiment. The results show that the model in this paper can better describe the start-up of heat pipe. At the same time, the evaporation and condensation coefficient model based on temperature change is used to deal with the evaporation and condensation mass flow at the phase change interface of the heat pipe, which can better describe the temperature difference at the interface of the heat pipe.

Mpox mRNA-1769 Vaccine Inhibits Orthopoxvirus Replication at Intranasal, Intrarectal, and Cutaneous Sites of Inoculation.

The increasing incidence of mpox in Africa and the recent global outbreak with evidence of sexual transmission have stimulated interest in new vaccines and therapeutics. Our previous study demonstrated that mice immunized twice with a quadrivalent lipid nanoparticle vaccine comprising four monkeypox virus mRNAs raised neutralizing antibodies and antigen-specific T cells and were protected against a lethal intranasal challenge with vaccinia virus. Here we extended these findings by using live animal imaging to demonstrate that the mRNA vaccine greatly reduced virus replication and spread from an intranasal site of inoculation and prevented detectable replication at intrarectal and cutaneous inoculation sites. Moreover, considerable protection was achieved with a single vaccination and a booster vaccination enhanced protection for at least 4 months. Protection was related to the amount of mRNA inoculated, which correlated with neutralizing antibody levels. The role of antibody in protection was demonstrated by passive transfer of immune serum pre- or post-challenge to immunocompetent and immunodeficient mice lacking mature B and T cells and therefore unable to mount an adaptive response. These findings provide insights into the mechanism and extent of mRNA vaccine induced protection of orthopoxviruses and support clinical testing.

Safety of COVID-19 Vaccines among People with History of Allergy: A European Active Surveillance Study.

Background: Conventional vaccines rarely cause severe allergic reactions. However, the rapid development and approval of COVID-19 vaccines left limited initial data on their adverse reactions, particularly in individuals with a history of allergy. The aim of this study was to assess and compare the safety profile of different doses and brands of COVID-19 vaccines in subjects with a history of allergy vs. those without a history of allergy. Methods: From February 2021 to February 2023, a web-based prospective study gathered vaccinee-reported outcomes using electronic questionnaires across eleven European countries. Baseline and up to six follow-up questionnaires captured data on vaccinee demographics, as well as both solicited and unsolicited adverse reactions. Results: Overall, 3476 vaccinees with a history of allergy were matched with 13,872 vaccinees from the general population at the first vaccination cycle and were included in the analysis. A total of 825 vaccinees with a history of allergy who had received a booster dose, matched to 3297 vaccinees from the general population, were included in the analysis. Higher rates of ADRs occurred after the first vaccination cycle compared to after the booster dose (64-91% vs. 56-79%). However, most reported ADRs were solicited and not serious, and no case of anaphylaxis was reported. Women and vaccinees with a history of allergy reported ADRs more frequently than men and the matched controls, respectively. Compared to other COVID-19 vaccines, a higher proportion of vaccinees experiencing at least one ADR following their first vaccination cycle was observed with Comirnaty and Vaxzevria. Statistically significant differences were observed among the study cohorts for median TTO after the second dose, and for median TTR following the first vaccination cycle and booster dose (p < 0.001). Conclusions: Typically, any drug or vaccine use carries a risk of severe allergic reactions, yet the benefits of vaccination generally outweigh these potential risks, as shown with the COVID-19 vaccines.

Modern Approaches to the Diagnosis o Food Allergy in Children: Oral Food Challenges (Review)

The diagnosis of food allergies significantly impacts the lives of patients and their families, restricting diets and social activities. A misdiagnosis can lead to severe allergic reactions, making accurate diagnosis crucial. Immunoglobulin E (IgE)-mediated food allergies are diagnosed using skin tests or serum-specific IgE levels. However, for most allergens, the only reliable method for confirming the diagnosis remains the oral food challenge (OFC). Objective — elucidation of the importance of oral provocation tests in the diagnosis of food allergy and their relevance for the future treatment of food allergy. Materials and methods. A search for information on OFC was conducted in scientometric databases such as Web of Science, Scopus, Google Scholar, ScienceDirect and PubMed using the following keywords: «food allergy», «oral food challenge», «children». After reviewing the publications, professional sources that met the query criteria and were published between 2017 and 2024 were selected for the review. Results and discussion. OFCs help determine allergen sensitivity and reaction severity, which is useful for further management. They also have therapeutic value, reducing anxiety related to food allergies and improving quality of life. Psychological aspects play an important role in food allergies, as the fear of severe reactions often exceeds actual risks.One limitation of OFCs is the need for substantial resources and specialized knowledge, available only in specialized medical centers. This leads to long waiting lists and delays in food introduction, increasing the risk of developing allergies. Additionally, OFCs are often conducted in controlled environments, which may not reflect real-world accidental exposures.OFC results can include false positives, false negatives, and inconclusive outcomes. They are also time-consuming and may affect school or work attendance for patients and caregivers. It is essential to standar­dize doses for each food according to portion sizes and patient age. Conclusions. The frequency of food allergies is currently increasing in Ukraine, highlighting the need for allergists to master the technique and implement oral food challenges in general allergy practice to establish food allergies in children.

Walter Brendel and the dawn of transplantation research in Germany.

Walter Brendel was a physiologist who headed the Institut of Experimental Surgery at the University of Munich (LMU) from 1961 until 1989. His legendary career began with the development of an anti-human lymphocyte globulin (ALG) at his Institute during the late 1960s. The initial successful treatment of a small number of patients culminated in the co-treatment of the first successfully heart-transplanted patient in Capetown, South Africa (successful reversal with ALG of an acute allograft rejection). Walter Brendel was a pioneering personality whose work has laid a wide platform for the promotion of interdisciplinarily conducted innovative research programs in various domains of translational science and medicine. Among the many innovative achievements, the most notable are: discovery of involvement of the alternative pathway of complement activation in hyperacute xenograft rejection; induction of immunological tolerance to horse IgG as a means to prevent anaphylactic reactions during ALG therapy; development and clinical implementation of the extracorporeal shock wave lithotripsy for extracorporeal destruction of renal and ureteral calculi. The legacy of Brendel continues with the foundation of the Walter-Brendel Kolleg für Transplantationsmedizin (i.e., the German Transplant School for Transplantation Medicine), which has been held annually since 1994.

Omalizumab reduces anaphylactic reactions and allows food introduction in food-allergic in children with severe asthma: An observational study.

In Europe, Omalizumab (anti-IgE) is indicated for the treatment of moderate to severe asthma, but not for IgE-mediated food allergy (FA). We assessed the impact of Omalizumab on efficacy, safety, and quality of life (FA-QoL) in patients with moderate to severe asthma and who have a history of anaphylaxis to peanut, tree nuts, fish, egg, milk, and/or wheat. Food-allergic children (6-18 years) with moderate to severe asthma underwent oral food challenges (OFCs) to establish the threshold of reaction to the culprit food(s) at baseline (T0) and at 4-month intervals (T1, T2, and T3) during their first year of treatment with Omalizumab. We recorded the number and severity of food-allergic reactions, Asthma Control Test (ACT) scores, FA-QoL, and total IgE levels. In 65 patients allergic to 107 foods, the No Observed Adverse Events Level (NOAEL) at T1 increased: 243- and 488-fold for fresh and baked milk, respectively; 172- and 134-fold for raw and baked egg; 245-fold for hazelnut; 55-fold for peanut; 31-fold for wheat; and 10-fold for fish. Full tolerance was achieved in 66.4% of OFCs at T1, 58.3% at T2, and 75% at T3. Ninety-five foods were liberalized in the diet of 55 patients; the remaining 12 were introduced by 10 patients at least in traces. Throughout the study, 40 out of 65 were able to get a free diet. ACT increased from 17 (Q1-Q3: 15-17) to 23.6 (Q1-Q3: 23-25). The FA-QoL score in children ≤12 years decreased from 4.63 ± 0.74 to 2.02 ± 1.13, and in adolescents from 4.68 ± 0.92 to 1.90 ± 1.50. During Omalizumab therapy, a safe reintroduction of allergenic foods is feasible. ClinicalTrials.gov, NCT06316414.

PSI-17 Anti-endotoxin immunoglobulin (Ig) Y time course of oral passive transfer and impacts on growth performance in foals

Abstract Foal diarrhea is the leading cause of morbidity in neonatal foals and is often caused by various environmental pathogens. The adaptive immune system of foals depends on postpartum Ig absorption from maternal colostrum. To date, there lacks an easy way to supplement the immune system before intestinal closure. Thus, an anti-endotoxin IgY supplement derived from hyperimmunized hens may provide pathogen-specific protection if successful in passive transfer. Therefore, the objective was to determine the effects of an oral anti-endotoxin IgY on growth, stress, and passive transfer in neonatal foals with the hypothesis that IgY would successfully cross the gut barrier, positively impact growth, and ameliorate stress. To test this, Quarter Horse foals (n = 11) were randomly assigned based on foaling date to one of two treatment groups for a 28-d trial. Upon signs of impending parturition, mares were moved to box stalls (3.7 × 7.3 m) and parturition was attended. At birth, foals were assigned to either the control (CON; n = 5) or treatment group (TRT; n = 6). Foals assigned to TRT were supplemented with 40 g egg-derived anti-endotoxin IgY oral supplement (Camas, Inc.) dissolved in 50 mL ddH20 at 20 min after nursing and again at 12 h postpartum. The CON foals received isovolumetric ddH2O. Beginning at h 24, and daily thereafter, TRT foals received 1 g egg-derived anti-endotoxin IgY diluted in 5 mL ddH2O. Blood samples were collected from foals prior to nursing at h 0 and following the first oral treatment at h 2, 6,12, 24 and d 3, 7, 14, 21, 28. Harvested serum was analyzed for IgG, IgA, IgY, and cortisol by commercial ELISA. Data were analyzed using PROC MIXED in SAS v9.4 with repeated measures of time. Vital signs were similar for all foals regardless of treatment (P &amp;gt; 0.24) and all growth parameters increased over time (P &amp;lt; 0.01). There tended to be a treatment × time interaction for wither height (P = 0.10) where TRT wither height was greater at d 28 (P = 0.07). There was a treatment × time interaction (P &amp;lt; 0.01) for serum IgY concentrations where CON foals had undetectable concentrations for the duration of the study and TRT foals peaked on d 7 with detectable l concentrations remaining on d 28. Cortisol, however, was not influenced by treatment (P &amp;gt; 0.29), and IgG and IgA concentrations were only influenced by time (P &amp;lt; 0.01). In conclusion, despite having no effect on vital signs and stress, IgY is passively absorbed following oral administration to neonatal foals without negatively impacting the passive transfer of maternal IgG or IgA, lending to future work on pathogen-specific protection against foal diarrhea.

Anaphylactic Reaction to Penicillin in Malaria-Infected Patients: A Case Study and Implications for Clinical Management

Malaria remains a significant global health challenge, often necessitating a combination of antimalarial and antibiotic treatments to manage both the primary infection and secondary bacterial complications. This review focuses on a critical case study involving a 35-year-old male with recurrent malaria who experienced a severe anaphylactic reaction to penicillin, highlighting the complex interplay between malaria management and drug allergies. The patient, already compromised by malaria, developed anaphylaxis shortly after receiving penicillin for a suspected bacterial infection. Despite immediate treatment, including epinephrine, antihistamines, and corticosteroids, the patient’s condition worsened due to the exacerbation of symptoms of malaria, leading to a fatal outcome. This case underscores the diagnostic and management challenges of drug allergies in malaria-infected patients, emphasizing the need for improved allergy assessment protocols, better training for healthcare providers, and enhanced patient education. The review advocates for the development of comprehensive allergy management strategies, improved allergy history documentation, and ongoing research to refine drug allergy testing and treatment protocols. Effective management of drug allergies, particularly in complex infection scenarios, is essential for optimizing patient safety and treatment efficacy. Keywords: Anaphylaxis, Penicillin Allergy, Malaria, Drug Reactions, Allergy Management, Clinical Protocols.

111 Factors affecting transfer of passive immunity in beef calves

Abstract Data from 9 calving experiments were used to investigate relationships of dam, calf, and colostrum factors with passive transfer in beef calves. Serum was collected at 48.33 ± 1.25 (SD) h of age for 313 calves, and single rear quarter colostrum yields were determined pre-suckling for dams of 117 calves. Serum and colostrum IgG concentrations were determined by ELISA. Relationship of serum IgG with colostrum variables was determined using Pearson correlation coefficients. Serum IgG was positively correlated (P ≤ 0.002) with colostrum IgG (r = 0.47) and protein (r = 0.45) concentrations and colostrum total IgG (r = 0.28) but tended to be negatively correlated (r = -0.17, P = 0.06) with colostrum yield. Based on passive transfer thresholds in the literature, 3 calves (0.96%) had &amp;lt; 8 mg/mL serum IgG, 16 calves (5.1%) &amp;lt; 16 mg/mL, and 43 calves (13.7%) had &amp;lt; 24 mg/mL. For this analysis, calves with serum IgG &amp;lt; 24 mg/mL at 48 h were considered to have failure of passive transfer (FPT). Continuous variables (dam BW and calf size, 48-h serum chemistry panel, and time to stand) were compared for FPT versus non-FPT calves using a mixed model with FPT class (fixed effect) and experiment (random effect). Calves with FPT had less (P ≤ 0.03) circulating triglycerides, glucose, calcium, magnesium, total protein, globulin, and gamma-glutamyl transferase but greater (P ≤ 0.001) circulating non-esterified fatty acids, sodium, chloride, and total bilirubin than non-FPT. Effects of categorical variables on calf 48-h serum IgG were determined using separate mixed models with variable (fixed) and experiment (random). Primiparous dams gave birth to calves that had less (P = 0.05) serum IgG at 48 h than multiparous dams. Calves born to moderate dams (BCS = 5) had less (P = 0.007) serum IgG than those born to fleshy dams (BCS ≥ 6) and tended to have less (P = 0.08) serum IgG than calves born to thin dams (BCS &amp;lt; 5). Calf sex, calving season, calving difficulty score, and vigor score at 10 min did not affect (P ≥ 0.19) serum IgG. Relationships of calf 48-h serum IgG with continuous variables was also determined using Pearson correlation coefficients, and only r ≥ 0.20 or ≤ -0.20 are reported. Serum IgG was positively correlated (P ≤ 0.005) with 48-h serum total protein (r = 0.75), globulin (r = 0.76), gamma-glutamyl transferase (r = 0.32), and potassium (r = 0.20). Serum IgG was negatively correlated (P &amp;lt; 0.001) with gestation length (r = -0.22) and 48-h serum albumin (r = -0.43), sodium (r = -0.24), and total bilirubin (r = -0.27). Overall, beef calves in this dataset generally had successful passive transfer that was associated with several dam, calf, and colostrum factors.

Dupilumab and House Dust Mite Immunotherapy in Patients with Atopic Dermatitis: A Preliminary Study.

Severe atopic dermatitis (AD) is a complex disease requiring systemic treatment. This study aimed to assess the effectiveness of combined therapy consisting of dupilumab and sublingual dust mite allergen immunotherapy (SLIT-HDM) in patients with severe AD and HDM allergies. Patients diagnosed with severe AD were included in this randomised, placebo-controlled, double-blind 12-month trial; they received SLIT for HDMs and/or dupilumab for 12 months and were compared with patients on cyclosporine. The primary outcomes for the treatment arms were changes in the Eczema Area and Severity Index (EASI), body surface area (%BSA), and Investigator Global Assessment (IsGA) over 12 months. The secondary outcomes were the proportion of patients who achieved IsGA success and reduced medication scores. Significant improvements were observed in all analysed groups after 12 months of therapy based on the EASI, %BSA, and IsGA. However, the most substantial changes were observed in the groups treated with dupilumab or a combination of SLIT-HDM and dupilumab. Additionally, the proportion of patients who achieved an IsGA reduction was significantly greater in the group receiving combination therapy than in the other groups (9/14 [64% of the group receiving SLIT-HDM] vs. 11/14 [73% of the group receiving dupilumab] vs. 15/17 [88% of the group receiving dupilumab and SLIT-HDM] vs. 7/13 [53% of the group receiving cyclosporine]) (p < 0.05). In patients with severe AD and HDM allergies, combination treatment with dupilumab and allergen immunotherapy for HDMs may increase the therapeutic benefit over treatment with these methods separately.

The Role of the Basophil Activation Test in the Diagnosis of Drug-Induced Anaphylaxis.

The diagnosis of drug-induced anaphylaxis (DIA) is a serious health problem. The Basophil activation test (BAT) is considered a specific in vitro provocation, and compared to in vivo provocation, it is more convenient, cheaper, and safer for the patient. This study aimed to evaluate the usefulness of the BAT in the diagnosis of DIA. This study included 150 patients referred to a reference allergy clinic with suspected drug allergies. All patients underwent a detailed clinical evaluation supplemented with the BAT. Positive BAT results were obtained in two out of 21 patients who were to receive the COVID-19 vaccine. The sensitivity and specificity of the BAT were 40% and 75% for the COVID-19 vaccine, 67% and 58% for DMG PEG 2000, and 100% and 75% for PEG 4000, respectively. Nine out of 34 patients with suspected antibiotic allergies had positive BAT results with 14 different antibiotics. Positive BAT results were also obtained with NSAIDs in two patients and with local anesthetics in three patients. The confirmation of allergy by the BAT improves the safety profile of the diagnostic work-up as it may defer the need for drug provocation, preventing potential anaphylactic reactions.

112 Effects of maternal body condition on colostrum, foal weight, and foal IgG concentration

Abstract Foals are born with little to no immunity and rely on maternal colostrum to develop adequate circulating immunoglobulin G (IgG) concentrations in the periparturient period. Colostrum directly impacts the health of the foal, and there are limited data assessing how maternal metabolism and body condition impacts IgG in colostrum and in the foal postnatally. To determine the influence of maternal body condition score (BCS) and cresty neck score (CNS) on glucose and insulin metabolism in the pregnant mare, colostrum composition, and colostrum and foal IgG concentrations, light breed mares (n = 6) were divided into two groups based on BCS and CNS at 315 ± 0.45 d of gestation. The groups were identified as moderately obese (MO; n = 3, BCS) and lean (LN; n = 3). Mares were fasted overnight and then underwent an intravenous (iv) glucose tolerance test at 315 ± 0.45 d gestation. Blood samples were collected at -30, -15 and 0 min and mares were administered dextrose iv [0.3 g/kg body weight (BW)] over 3.7 ± 0.17 min followed by an intravenous infusion of insulin (0.3 mU/kg BW) 20-min later. Additional blood samples were collected 2, 5, 10, 15, 20, 25, 30, 45, 60, and 120 min after initiation of dextrose infusion. At parturition, a colostrum sample was collected before foals nursed and analyzed for protein and fat, and IgG concentration. A foal blood sample was collected 18 h after birth to determine passive transfer of IgG. Placental, mare, and foal weights were measured at birth. Data were analyzed using a t-test with significance at P ≤ 0.05 and a tendency at 0.05 &amp;lt; P ≤ 0.10. The MO group had greater BCS (P = 0.01) and CNS (P = 0.01) than the LN group. Moderately obese mares tended to have 9% greater glucose area under the curve (AUC) after dextrose (P = 0.10) and a 9% greater glucose AUC after insulin infusion (P = 0.10) than LN mares. Colostrum IgG concentrations, and protein and fat content (P ≥ 0.3) did not differ between groups. Foal serum IgG concentrations, foal BW, and placental weights were similar between groups (P ≥ 0.8). The ratios between foal BW and placenta weight, and between foal BW and mare BW were similar between groups (P ≥ 0.3). Moderately obese maternal BCS and CNS scores may decrease maternal glucose clearance during late gestation but did not impact colostrum quality or foal IgG concentrations within 24 h postpartum. As the equine fetus matures later in gestation than other livestock species and relies heavily on glucose uptake from the placenta, it is critical to increase our understanding of the impacts of maternal obesity and glucose clearance on foal development and pre- and post-natal health.

Assessing hepatitis B virus serologies when transitioning patients from intravenous immune globulin therapy to rituximab for the treatment of autoimmune neuromuscular diseases.

Intravenous immune globulin (IVIG) has been used as early treatment for autoimmune neuromuscular diseases, but due to cost and frequency, may be switched to rituximab. Rituximab and other B-cell-depleting medications require screening of hepatitis B virus (HBV) serologies given the risk of HBV reactivation (HBVr). We aimed to describe the incidence and characteristics of passively transferred antiviral serologies from IVIG and how to differentiate between passive antibody transfer and resolved HBV infection. This was a single-center descriptive study of neurology patients prescribed rituximab and IVIG. Retrospective medical record reviews were performed and patient-specific variables were collected. Twelve patients had reactive anti-HBc results after starting IVIG, but only 9 were confirmed to have reactive anti-HBc from passive transfer. Whether reactive anti-HBc in the remaining three patients was from passive IVIG transfer could not be confirmed. Five patients with reactive anti-HBc results during rituximab screening did not have pre-IVIG anti-HBc results for comparison and were started on antiviral prophylaxis. Reactive anti-HBc serologies changed to nonreactive after IVIG discontinuation 44-321 days after the last IVIG infusion. This study confirms IVIG can passively transfer anti-HBc serologies in a neurologic cohort. Ideally, HBV serologies would be checked before starting IVIG to help later determine if passive transfer occurred. With the increasing use of B-cell-depleting medications for neuromuscular conditions, it is important for providers to be knowledgeable on the interpretation of HBV serologies for patients on IVIG and to ensure implementation of an HBVr prophylaxis management strategy for patients when appropriate.