Life-threatening Allergic Reaction Research Articles

Artificial intelligence and machine learning for anaphylaxis algorithms.

Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires rapid identification and intervention. Current management includes early recognition, prompt administration of epinephrine, and immediate medical attention. However, challenges remain in accurate diagnosis, timely treatment, and personalized care. This article reviews the integration of artificial intelligence and machine learning in enhancing anaphylaxis management. Artificial intelligence and machine learning can analyze vast datasets to identify patterns and predict anaphylactic episodes, improve diagnostic accuracy through image and biomarker analysis, and personalize treatment plans. Artificial intelligence-powered wearable devices and decision support systems can facilitate real-time monitoring and early intervention. The ethical considerations of artificial intelligence use, including data privacy, transparency, and bias mitigation, are also discussed. Future directions include the development of predictive models, enhanced diagnostic tools, and artificial intelligence-driven educational resources. By leveraging artificial intelligence and machine learning, healthcare providers can improve the management of anaphylaxis, ensuring better patient outcomes and advancing personalized medicine.

Double Imprinted Nanoparticles for Sequential Membrane-to-Nuclear Drug Delivery.

Efficient and site-specific delivery of therapeutics drugs remains a critical challenge in cancer treatment. Traditional drug nanocarriers such as antibody-drug conjugates are not generally accessible due to their high cost and can lead to serious side effects including life-threatening allergic reactions. Here, these problems are overcome via the engineering of supramolecular agents that are manufactured with an innovative double imprinting approach. The developed molecularly imprinted nanoparticles (nanoMIPs) are targeted toward a linear epitope of estrogen receptor alfa (ERα) and loaded with the chemotherapeutic drug doxorubicin. These nanoMIPs are cost-effective and rival the affinity of commercial antibodies for ERα. Upon specific binding of the materials to ERα, which is overexpressed in most breast cancers (BCs), nuclear drug delivery is achieved via receptor-mediated endocytosis. Consequentially, significantly enhanced cytotoxicity is elicited in BC cell lines overexpressing ERα, paving the way for precision treatment of BC. Proof-of-concept for the clinical use of the nanoMIPs is provided by evaluating their drug efficacy in sophisticated three-dimensional (3D) cancer models, which capture the complexity of the tumor microenvironment in vivo without requiring animal models. Thus, these findings highlight the potential of nanoMIPs as a promising class of novel drug compounds for use in cancer treatment.

Using machine learning to improve anaphylaxis case identification in medical claims data.

Anaphylaxis is a severe life-threatening allergic reaction, and its accurate identification in healthcare databases can harness the potential of "Big Data" for healthcare or public health purposes. This study used claims data obtained between October 1, 2015 and February 28, 2019 from the CMS database to examine the utility of machine learning in identifying incident anaphylaxis cases. We created a feature selection pipeline to identify critical features between different datasets. Then a variety of unsupervised and supervised methods were used (eg, Sammon mapping and eXtreme Gradient Boosting) to train models on datasets of differing data quality, which reflects the varying availability and potential rarity of ground truth data in medical databases. Resulting machine learning model accuracies ranged from 47.7% to 94.4% when tested on ground truth data. Finally, we found new features to help experts enhance existing case-finding algorithms. Developing precise algorithms to detect medical outcomes in claims can be a laborious and expensive process, particularly for conditions presented and coded diversely. We found it beneficial to filter out highly potent codes used for data curation to identify underlying patterns and features. To improve rule-based algorithms where necessary, researchers could use model explainers to determine noteworthy features, which could then be shared with experts and included in the algorithm. Our work suggests machine learning models can perform at similar levels as a previously published expert case-finding algorithm, while also having the potential to improve performance or streamline algorithm construction processes by identifying new relevant features for algorithm construction.

Ratiometric Fluorescence Aptasensor of Allergen Protein Based on Multivalent Aptamer-Encoded DNA Flowers as Fluorescence Resonance Energy Transfer Platform.

Life-threatening allergic reactions to food allergens, particularly peanut protein Ara h1, are a growing public health concern affecting millions of people worldwide. Thus, accurate and rapid detection is necessary for allergen labeling and dietary guidance and ultimately preventing allergic incidents. Herein, we present a novel ratiometric fluorescence aptasensor based on multivalent aptamer-encoded DNA flowers (Mul-DNFs) for the high-stability and sensitive detection of allergen Ara h1. The flower-shaped Mul-DNFs were spontaneously packaged using ultralong polymeric DNA amplicons driven by a rolling circle amplification reaction, which contains a large number of Ara h1 specific recognition units and has excellent binding properties. Furthermore, dual-color fluorescence-labeled Mul-DNFs probes were developed by hybridizing them with Cy3- and Cy5-labeled complementary DNA (cDNA) to serve as a ratiometric fluorescence aptasensor platform based on fluorescence resonance energy transfer. Benefiting from the combined merits of the extraordinary synergistic multivalent binding ability of Mul-DNFs, the excellent specificity of the aptamer, and the sensitivity of the ratiometric sensor to avoid exogenous interference. The developed ratiometric aptasensor showed excellent linearity (0.05-2000 ng mL-1) with a limit of detection of 0.02 ng mL-1. Additionally, the developed ratiometric fluorescence aptasensor was utilized for quantifying the presence of Ara h1 in milk, infant milk powder, cookies, bread, and chocolate with recoveries of 95.7-106.3%. The proposed ratiometric aptasensor is expected to be a prospective universal aptasensor platform for the rapid, sensitive, and accurate determination of food and environmental hazards.

A retrospective audit of adult and paediatric anaphylaxis management from two Australian metropolitan mixed emergency departments

BackgroundAnaphylaxis is a potentially life-threatening allergic reaction, with presentations to emergency departments (EDs) increasing across Australia. Understanding the features of those presenting with anaphylaxis and aspects related to its optimal clinical management across the admission, treatment and discharge settings is needed to minimise its impact. We aimed to evaluate the nature and management of presentations related to anaphylaxis across two Australian EDs.MethodsRetrospective audit of paediatric and adult patients presenting to a community or tertiary level ED with anaphylaxis from 1 May 2018 to 30 April 2019. Data extracted from medical records included demographic characteristics, causative agents, clinical features, treatments administered across community, ambulance or ED settings, as well as post-discharge care arrangements including provision of Adrenaline Auto-Injector (AAI) and Allergy/Anaphylaxis Action Plan (AAP).ResultsA total of 369 (107 paediatric and 262 adult) ED presentations were identified. A total of 94 (36%) adult and 46 (43%) paediatric patients received pre-hospital adrenaline, with a further 91 (35%) adult and 29 (27%) paediatric patients receiving a dose of adrenaline in the ED. The most commonly administered treatment in ED were corticosteroids, given to 157 (60%) adult and 55 (51%) paediatric patients. Among those requiring an AAI for discharge, 123/210 (59%) adult and 57/91 (63%) of paediatric patients left hospital with an AAI. In contrast, among those requiring an allergy/anaphylaxis action plan (AAP) on discharge, 61/206 (30%) adult and 30/90 (33%) of paediatric patients left hospital with one. Factors associated with an increased likelihood of receiving AAI on discharge in paediatric and adult patients included receipt of any adrenaline, receipt of two or more doses of adrenaline, and longer duration of hospital stay. Adults presenting within business hours were more likely to be discharged with AAI, but no such difference was observed for paediatric patients. Similar findings were evident for provision of AAP on discharge.ConclusionThese findings demonstrate the need to improve assessment and treatment in the ED. In particular, the observed large variability in provision of AAI and AAP on discharge presents opportunities to explore strategies to improve awareness and provision of these critical components of post-discharge care.

Ischemic Stroke After Bee Sting: A Case Report

Introduction The global impact of a bee sting extends beyond common perceptions, showing various indications that may range from local reactions to more severe complication. This report details a compelling case involving a 63-year-old male who developed neurological deficits merely six hours after a bee sting. Case Report A 63 -year-old male patient was brought to the emergency department because of widespread redness, pain and itching at the sting area after a bee sting while pruning roses in the garden. During the follow-up in the emergency room, the patient developed weakness in his right lower/upper extremities. However, the diffusion magnetic resonance imaging of the patient showed an infarction detected in the area adjacent to the left lateral ventricle (Figure1). Discussion Various clinical presentations after a bee sting have been described in the literature. Bee sting cases are generally associated with mild and transient local symptoms. Sometimes life-threatening allergic reactions may occur. Conclusion The scarcity of the reported after-sting strokes emphasizes the need for further exploration into this uncharted territory to better comprehend and manage these exceptional indications. This case is presented for its rarity, underscoring the imperative for increased attention and research on these complications. Keywords: Bee sting, ischemic, stroke.

Association Between Early Patient Characteristics and IgE-Mediated Allergy in the Perioperative Setting

BackgroundEarly recognition of perioperative anaphylaxis, a life-threatening, usually immunoglobulin E [IgE]-mediated, immediate hypersensitivity, is essential, but bedside diagnosis is not always straightforward as clinical presentation may vary. ObjectivesTo describe early characteristics of perioperative immediate hypersensitivity (POH), with a special attention on cutaneous phenotypes, and identify risk factors for IgE-mediated allergy. MethodsWe retrospectively analyzed data from adults with suspected POH who were investigated in two academic medical centers. Multivariable logistic regression was conducted to evaluate associations between patient, clinical, and paraclinical characteristics and IgE-mediated allergy. ResultsOut of 145 patients enrolled, 99 (68.3%) and 46 (31.7%) were respectively categorized in the IgE-mediated allergy and non-allergy groups. Cutaneous vasoconstriction phenotype (pallor, piloerection, thelerethism, sweating ± cyanosis) occurring within minutes (or even one minute) of drug-exposure, was strongly associated with IgE-mediated allergy (adjusted odds ratio [aOR]: 28.02, 95% confidence interval [CI]: 4.41-305.18). IgE-mediated allergy was always life-threatening in this setting. Other early factors associated with allergy were low end-tidal carbon dioxide (ETco2) ≤25mmHg (aOR: 5.45, 95%CI: 2.39-26.45), low mean arterial pressure (MAP) ≤60mmHg (aOR: 3.82, 95%CI: 1.28-17.31), and early cutaneous vasodilation (erythema, urticaria and/or angioedema) (aOR: 2.78, 95%CI: 0.73-20.54). Late cutaneous vasodilation following restoration of hemodynamics corroborated the diagnosis of allergy (aOR: 23.67, 95%CI: 4.94-205.09). The best-fit model including three readily available variables (cutaneous phenotype involving the three modalities [reference lack of cutaneous signs], low MAP and low ETco2) had an AUC of 0.91. ConclusionsCutaneous vasoconstriction phenotype is associated with the strongest risk of life-threatening allergy and may thus be regarded as pathognomonic of perioperative IgE-mediated anaphylaxis.

Severe anaphylaxis in children: Definitions, etiology, and preventive approaches

Anaphylaxis is a generalized allergic reaction, and its severe course has a potential risk of fatal outcome. The course of each episode of anaphylaxis is the result of a complex interaction between the patient and some internal and external factors (concomitant diseases, profile and level of sensitization, features of allergen exposure, intercurrent infections, etc.). Currently, the clinical and biological features of severe anaphylaxis are not well characterized; however, arterial hypotension and/or loss of consciousness are usually observed in these patients, possibly without typical symptoms from the skin, whereas the outcome of the disease is associated with the possibility of timely emergency medical care. The lack of generally accepted reliable individual prognostic predictors for determining this group of patients is a serious problem. Very little data are available on subfatal/fatal anaphylaxis in pediatric patients, and approaches to it are often based on clinical experience in other age groups. This article presents a systematization of data in the context of severe and subfatal/fatal anaphylaxis in pediatrics to understand the etiology, risk factors, and markers of severe life-threatening allergic reactions in children and the possibilities of their prevention.

The bradykinin-forming cascade in anaphylaxis and ACE-inhibitor induced angioedema/airway obstruction

Anaphylaxis is a potentially life-threatening multi-system allergic reaction to a biological trigger resulting in the release of potent inflammatory mediators from mast cells and basophils and causing symptoms in at least two organ systems that generally include skin, lungs, heart, or gastrointestinal tract in any combination. One exception is profound hypotension as an isolated symptom. There are two types of triggers of anaphylaxis: immunologic and non-Immunologic. Immunologic anaphylaxis is initiated when a foreign antigen directly binds to IgE expressed on mast cells or basophils and induces the release of histamine and other inflammatory substances resulting in vasodilation, vascular leakage, decreased peripheral vascular resistance, and heart muscle depression. If left untreated, death by shock (profound hypotension) or asphyxiation (airway obstruction) can occur. The non-immunologic pathway, on the other hand, can be initiated in many ways. A foreign substance can directly bind to receptors of mast cells and basophils leading to degranulation. There can be immune complex activation of the classical complement cascade with the release of anaphylatoxins C3a and C5a with subsequent recruitment of mast cells and basophils. Finally, hyperosmolar contrast agents can cause blood cell lysis, enzyme release, and complement activation, resulting in anaphylactoid (anaphylactic-like) symptoms. In this report we emphasize the recruitment of the bradykinin-forming cascade in mast cell dependent anaphylactic reactions as a potential mediator of severe hypotension, or airway compromise (asthma, laryngeal edema). We also consider airway obstruction due to inhibition of angiotensin converting enzyme with a diminished rate of endogenous bradykinin metabolism, leading not only to laryngeal edema, but massive tongue swelling with aspiration of secretions.

Anaphylaxis in children: Effect of age and atopic status.

Anaphylaxis is a life-threatening allergic reaction with rising incidence worldwide. Young children's limited ability to express symptoms adds unique diagnostic challenges. To study on anaphylaxis in children, including triggers, symptoms, treatment, atopic status impact, and adrenaline injection time intervals. In-patient medical records of children who were diagnosed with anaphylaxis during 2014-2021 were reviewed. One hundred thirty-three anaphylaxis events were identified. Food (47%) was the most common trigger, followed by drugs (31%), blood components (17%), insects (3%), and idiopathic causes (2%). Ten cases of refractory anaphylaxis, 2 cases of biphasic reactions, and 1 case of persistent anaphylaxis were found. There were no reported fatalities. The most common presentations involved the skin (94%), followed by the respiratory (73%), gastrointestinal (47%), and cardiovascular (42%) systems. In atopic patients, wheezing was more prominent than in those without atopy (p-value = 0.017). In the non-atopic patients, there was a higher incidence of cardiovascular symptoms, particularly hypotension (p-value = 0.001), compared to individuals with atopy. Children under 5 years old with mild-moderate anaphylaxis required more time to reach the hospital (147.0 vs. 45.0 minutes, p = 0.033) and to receive adrenaline injections (35.0 vs. 9.0 minutes, p-value = 0.017) than those with severe anaphylaxis. Childhood anaphylaxis is prevalent. Children with mild-moderate anaphylaxis experienced delays in hospital visits and adrenaline administration. Education on allergies is needed to improve the identification and prompt response to anaphylactic reactions, especially in young children.

Quality of Life in the Management of Anaphylaxis in Food-Allergic Adults.

Anaphylaxis is a life-threatening allergic reaction that can significantly affect the quality of life of those affected. Factors including undiagnosed allergies, lack of allergen information, and insufficient emergency training can impact the quality of life for food-allergic individuals. Well-informed patients are less likely to experience severe allergic responses, ensuring their safety and quality of life. This study aims to evaluate the effectiveness of following preventive behavior, focusing on routine counseling and training provided by healthcare professionals in preventing anaphylaxis and assessing the impact of strict adherence to an allergen avoidance regimen against anaphylaxis. This study was a descriptive, cross-sectional survey conducted in the Makkah region of Saudi Arabia. It involved adults aged 18 and above who had food allergies. A structured online questionnaire of seven items was developed and distributed to achieve the study's goals from October 2023 to January 2024. The data collected was automatically exported to Excel and then analyzed using the Statistical Package for the Social Sciences. The study involved 93 participants, 65.6% female and 34.4% male. Among those with food allergies, 34.4% had experienced anaphylaxis, with 50% allergic to eggs and seafood. The study found no significant association between specific food allergens and a history of anaphylaxis, but strict allergen avoidance was linked to lower anaphylaxis rates. Counseling or training for managing food allergy reactions also showed potential benefits. The research indicated that males were less likely to have anaphylaxis than females, and age increased the severity of anaphylaxis reactions regardless of gender. The study emphasizes the importance of preventive behaviors and healthcare professional support in reducing the risk of anaphylactic reactions for food-allergic adults. Future research could focus on improving their quality of life through education programs, policy development, and better access to emergency medications and psychosocial support strategies.

Allergic reaction following reintroduction of cow’s milk in a 2-month-old infant on an elimination diet for atopic dermatitis

Atopic dermatitis, a multifactorial, relapsing, and inflammatory condition, can affect the patient’s quality of life to a great extent. Simultaneous food allergy has also been noted in many patients with atopic dermatitis. Cow milk protein allergy is a commonly reported issue in children. Here, we presented a case of allergic reaction in a 2-month-old boy diagnosed with cow’s milk allergy based on mild atopic dermatitis despite the absence of immediate symptoms after milk ingestion. Dietary modifications (feeding of the exclusive hydrolyzed formula; elimination diet) were suggested; however, as there was no apparent improvement in the child’s symptoms, the parents reintroduced regular formula to his diet. The first re-exposure led to immediate reactions in the form of hives and irritability. The condition was diagnosed with an allergic reaction on presentation to the emergency room and was managed successfully. The follow-up visit confirmed the diagnosis of IgE-mediated cow’s milk allergy based on the history and the positive allergy testing to cow’s milk. Putting the child suffering from atopic dermatitis on a strict elimination diet might not be prudent as it increases the financial burden and the risk of developing severe life-threatening allergic reactions following accidental exposure to the allergen, as repeated oral exposure to allergens is very important for the development of tolerance.

A case-control study for comorbidity and laboratory factors associated with food-induced anaphylaxis.

Background: Food-induced anaphylaxis (FIA) is a serious and potentially life-threatening allergic reaction triggered by food allergens. Objective: This case-control study aimed to investigate comorbidities and laboratory factors associated with FIA in the pediatric population of Israel. Methods: Retrospective data from the electronic health records of Leumit Health Care Services were used to identify 711 pediatric patients with FIA and 2560 subjects with food allergy and without anaphylaxis matched for age, gender, and ethnicity. Comorbidities were identified based on medical billing diagnosis codes, and laboratory characteristics were compared between the two groups. Results: The mean ± standard deviation age of patients with FIA was 4.1 ± 4.1 years, and 37.3% were girls. Laboratory analysis revealed increased eosinophil counts (p < 0.001), elevated immunoglobulin E (IgE) (p < 0.001), and IgA levels (p = 0.001) in the FIA group compared with the controls. With regard to comorbidities, the FIA group had higher prevalence rates of allergic diseases, including allergic rhinitis (odds ratio [OR] 1.72; p < 0.001), allergic conjunctivitis (OR 1.84; p = 0.001), asthma (OR 1.36; p < 0.001), angioedema (OR 6.37; p < 0.001), atopic dermatitis (OR 1.77; p < 0.001), and contact dermatitis (OR 1.42; p = 0.001). There was a trend toward significance for chronic spontaneous urticaria (p = 0.051). There was a significant negative association between helminthiases, particularly enterobiasis, and FIA (OR 0.76 [95% confidence interval, 0.59-0.98]; p = 0.029). Conclusion: This study provides valuable epidemiologic evidence on the associations among FIA, comorbidities, and laboratory factors in the pediatric population.

Soybean, Gly m 4, and Birch Pollen Allergy

Several types of soy foods are consumed worldwide. Soybean products have shown some potential benefits for health, but soy allergy can cause life-threatening allergic reactions. Pollens of birch trees can be associated with food allergy-related disease such as pollen/food allergy syndrome.

Prevention in food allergies

Preventing food allergies is key to reducing the incidence of the disease. Exclusive breastfeeding is recommended during the first months of life, in addition to supplementation with vitamin D and, due to the importance of the microbiota, addition of probiotics, prebiotics and symbiotic. Currently, late exposure to foods is controversial, and it is suggested to introduce allergenic foods early, trying not to expose the cutaneous route. The application of biologics in food allergy is an evolving area of research and treatment. Biologics are indicated in diseases evaluated in various studies, such as atopic dermatitis, and are approved by the FDA for prescription; However, its potential administration in the treatment of severe allergic reactions caused by food is still debated. These therapies may change the way food allergy is addressed in the future, but they are still in experimental stages and not widely available. Food anaphylaxis is a life-threatening allergic reaction that requires quick action. Prevention involves avoiding the triggering food, awareness of symptoms, and availability of epinephrine for immediate administration in case of a reaction.

Au@Ag Core-Shell Nanoparticles for Colorimetric and Surface-Enhanced Raman-Scattering-Based Multiplex Competitive Lateral Flow Immunoassay for the Simultaneous Detection of Histamine and Parvalbumin in Fish.

Foodborne allergies and illnesses represent a major global health concern. In particular, fish can trigger life-threatening food allergic reactions and poisoning effects, mainly caused by the ingestion of parvalbumin toxin. Additionally, preformed histamine in less-than-fresh fish serves as a toxicological alert. Consequently, the analytical assessment of parvalbumin and histamine levels in fish becomes a critical public health safety measure. The multiplex detection of both analytes has emerged as an important issue. The analytical detection of parvalbumin and histamine requires different assays; while the determination of parvalbumin is commonly carried out by enzyme-linked immunosorbent assay, histamine is analyzed by high-performance liquid chromatography. In this study, we present an approach for multiplexing detection and quantification of trace amounts of parvalbumin and histamine in canned fish. This is achieved through a colorimetric and surface-enhanced Raman-scattering-based competitive lateral flow assay (SERS-LFIA) employing plasmonic nanoparticles. Two distinct SERS nanotags tailored for histamine or β-parvalbumin detection were synthesized. Initially, spherical 50 nm Au@Ag core-shell nanoparticles (Au@Ag NPs) were encoded with either rhodamine B isothiocyanate (RBITC) or malachite green isothiocyanate (MGITC). Subsequently, these nanoparticles were bioconjugated with anti-β-parvalbumin and antihistamine, forming the basis for our detection and quantification methodology. Additionally, our approach demonstrates the use of SERS-LFIA for the sensitive and multiplexed detection of parvalbumin and histamine on a single test line, paving the way for on-site detection employing portable Raman instruments.

A Rare Incidence of Ketorolac-induced Anaphylaxis: A Case Report

Anaphylaxis or type I hypersensitivity is a class of potentially life-threatening allergic reactions that may be caused by exposure to any drug or substance. These reactions are unpredictable, not dose-related and are not known adverse reactions. Medications as a cause or trigger of anaphylaxis are of concern to health practitioners not only because of the potentially deadly outcomes, but also that it may affect treatment efficacy and patient compliance. In resource-poor settings like ours, confirming anaphylaxis would be a challenge, requiring a high index of suspicion, and well-educated patients. Allergic reactions to analgesics are not common occurrences and ketorolac has been rarely implicated. We present a case of ketorolac-induced anaphylaxis in a 32-year-old man. We also discussed the contemporary scholarly literature.

Using machine learning to improve anaphylaxis case identification in medical claims data.

Anaphylaxis is a severe life-threatening allergic reaction, and its accurate identification in healthcare databases can harness the potential of "Big Data" for healthcare or public health purposes. This study used claims data obtained between October 1, 2015 and February 28, 2019 from the CMS database to examine the utility of machine learning in identifying incident anaphylaxis cases. We created a feature selection pipeline to identify critical features between different datasets. Then a variety of unsupervised and supervised methods were used (eg, Sammon mapping and eXtreme Gradient Boosting) to train models on datasets of differing data quality, which reflects the varying availability and potential rarity of ground truth data in medical databases. Resulting machine learning model accuracies ranged between 47.7% and 94.4% when tested on ground truth data. Finally, we found new features to help experts enhance existing case-finding algorithms. Developing precise algorithms to detect medical outcomes in claims can be a laborious and expensive process, particularly for conditions presented and coded diversely. We found it beneficial to filter out highly potent codes used for data curation to identify underlying patterns and features. To improve rule-based algorithms where necessary, researchers could use model explainers to determine noteworthy features, which could then be shared with experts and included in the algorithm. Our work suggests machine learning models can perform at similar levels as a previously published expert case-finding algorithm, while also having the potential to improve performance or streamline algorithm construction processes by identifying new relevant features for algorithm construction.

Treatment of idiopathic anaphylaxis with dupilumab: a case report

BackgroundAnaphylaxis is an acute, potentially life-threatening allergic reaction that typically occurs after exposure to a trigger, while idiopathic anaphylaxis (IA) occurs in the absence of a trigger. Acute management of both triggered anaphylaxis and IA relies on the use of epinephrine. In some patients with recurrent IA, glucocorticoid prophylaxis with prednisone can be effective. While there is currently no high quality evidence for the use of other prophylactic options to prevent recurrent IA, evolving data exists to support the consideration of biologics that target IgE or the Th2 pathway.Case presentationWe present the case of a 28 year old female with no atopic or autoimmune history with recurrent episodes of IA since childhood occurring up to twice weekly. There was improvement in acute symptoms with administration of first or second generation antihistamines and/or intramuscular epinephrine. Without an identifiable trigger, she was diagnosed with IA and frequent idiopathic urticaria and omalizumab was added to her treatment regimen with improvement in symptom frequency. After being lost to follow up, she had recurrence of symptom frequency and severity without omalizumab therapy and subsequently presented to our institution. Her workup at this point was negative for food allergy, alpha gal syndrome, systemic mastocytosis, hereditary alpha tryptasemia, carcinoid syndrome, and pheochromocytoma, and she was trialed on dupilumab with near resolution of her symptom frequency over a six month time period.ConclusionRecurrent IA is a diagnosis of exclusion that is associated with high morbidity. Prophylaxis remains an area of uncertainty, although prednisone has been effective in some cases. When prednisone is contraindicated or ineffective for the prevention of IA, biologic therapies that target IgE or the Th2 pathway may present a reasonable consideration. This case adds support to the suggestion that dupilumab may be a logical off-label consideration for prophylaxis of recurrent IA. The data for dupilumab in this clinical scenario is still very limited, and further research is required before any recommendation can be made.

The Prevalence of Questionnare Based Food Allergy in Adult Population of Eastern Blacksea Region of Turkey

Objective: Food allergy (FA) is an important public health problem which affects children and adults, its prevelance is increasing with the change of dietary habits in recent years. FA is a life-threatening allergic reaction which can lead to anaphylaxis and is very difficult to treat. In our study, we wanted to contribute to the literature by investigating the prevalence of FA in the Eastern Black Sea Region based on a questionnaire. Methods: This study was planned as a cross-sectional web-based survey study. The questionnaire was prepared including 12 questions related with health problems that develop following food intake. Eastern Black Sea Region of Turkey was chosen as the target group of the study population. The questionnaire was published in local online and printed media during three months and the participants were allowed to fill it out. Results: The study included 920 people (604 female, 316 male) who completed the questionnaire and 157 (17%) of the participants noted that they had food allergies. The most common allergen foods were spices (15%), tomatoes (10.9%), and cow's milk (7.5%). The most common symptoms were urticaria (63.5%), gastrointestinal symptoms (30.2%), rhinitis (15.1%), oral allergy syndrome (OAS) symptoms (11.3%). Young age (p= 0.004), presence of atopic disease or family history of atopy (p=0.001) were found to be risk factors for the development of food allergy. Conclusion: The prevalence of self-reported FA based on web-based survey in Eastern Black Sea residents is relatively high and specific to the region.