Previous Allergy Research Articles

Sensitization against medical hyaluronidase in patients with confirmed hypersensitivity against hymenoptera species and its clinical implications.

Hyaluronidase is an ubiquitious enzyme, present, amongst others, in hymenoptera venom and in medical formulations. The latter include use as an emergency treatment or to correct undesired outcomes of medical and aesthetic procedures using hyaluronic acid fillers. By performing detailed allergy work-ups including prick-testing we investigated here if patients with a history of allergic reaction to hymenoptera venom are also sensitized to medical grade hyaluronidase. Ninety patients with a history of type-1 reaction to hymenoptera venom with and without a history of previous specific venom immunotherapy were included in the study. All underwent skin prick tests for medical hyaluronidase. All patients also underwent serological analysis for Api m2, the only commercially available IgE-test for a hymenoptera hyaluronidase. Of the 90 patients with previous type-1 reactions to hymenoptera venom hyaluronidase included in the study, 60 had undergone previous venom immunotherapy, 30 did not. A majority (73/90) were allergic to wasps, followed by honeybees (14/90) and 3 were allergic to both. Neither patients having undergone previous immunotherapy nor those allergic to bees showed positive skin prick tests to medical hyaluronidase. Of those with a wasp allergy and naïve to immunotherapy, over 20% (5/23) showed positive skin prick tests to medical hyaluronidase. Healthy controls (0/30) without previous allergic reactions to hymenoptera did not show positive skin prick tests to medical hyaluronidase. Sensitization to hyaluronidase is most common in wasp-allergic patients who have not had previous specific immunotherapy. As allergic reactions to medical hyaluronidase are reported to be scarce, this group is probably at the highest risk to develop anaphlaxis to medical hyaluronidase. While all patients with untreated anaphylaxis to hymenoptera venom should consult an allergy specialist, particularly those with untreated wasp allergies need to seek a specialist's advice before treatment with medical hyaluronidase is initiated.

P831 Acute infusion reactions due to different biologic agents in a large cohort of patients with Inflammatory Bowel Disease

Abstract Background The therapeutic armamentarium for inflammatory bowel disease (IBD) includes several biological agents: infliximab (IFX), adalimumab (ADA), vedolizumab (VED) and ustekinumab (UST). Persistence in therapy with these drugs is not satisfactory, not only due to the loss of clinical response over time but also due to adverse events. Acute infusion reactions (AIRs) occur during or within 24 hours of the infusion. The intensity of AIRs ranges from mild (flushing, dizziness, headache, itching, rash) to severe (anaphylactic). The primary aim of this study was to compare the prevalence rates of AIRs due to the different biological agents in a large cohort of patients with IBD and to assess risk factors for AIRs. Methods All reports of AIRs occurring from January 2021 to October 2023 in IBD patients treated with different biological agents (IFX, ADA, VED and UST) in a tertiary IBD center were retrospectively reviewed. The electronic records of the identified patients were checked for the type of IBD, whether Crohn's disease (CD) or ulcerative colitis (UC), type of biological agent, route of administration (intravenous or subcutaneous), concomitant immunosuppressive therapies, atopic status. Furthermore, the type of treatment for the AIRs and the subsequent therapy undertaken for IBD were also recorded. Results 22 AIRs were recorded out of 1911 patients (1.1%). Of these, 16/550 in patients on IFX biosimilars (2.9 %), 4/590 (0.7%) in patients on ADA biosimilars, 2/318 (0.6%) in patients on VED and 0/453 (0%) in patients on UST (Table 1). The difference in the prevalence of AIR rates observed with the different biological agents was statistically significant (p<0.01). 7 of 16 post-IFX AIRs were moderate-severe, with two episodes of anaphylaxis occurring in patients with CD. The two patients treated with VED experienced only mild symptoms, and no anti-reactive treatment has been used; two mild and two moderate AIRs, respectively, have been reported among patients on ADA. 12 of 22 AIRs occurred during the induction period (from the first to the third administration). 7 of 22 patients had previous allergic reactions. Conclusion Our real-world data on a large population of IBD patients treated with biologic agents confirm that AIRs are rare and occur mainly in patients treated with IFX biosimilars. Most patients who experienced AIRs were atopic. Almost all patients after AIRs changed biological agents within or out of the same biological class. Further studies are necessary to confirm our results and better characterise the profile of patients at greater risk of AIRs.

Optimizing Nutrition Care Management at Nutrition Care Center (NCC)

In nutrition care services, the creation and storage of medical records at the Nutrition Care Center (NCC) are still relatively simple and paper-based or manual. Additionally, management challenges, in the form of system constraints, are one of the obstacles to healthcare management at NCC. Therefore, there is a need for optimizing healthcare management at NCC. The aim of this study is to optimize nutrition care management at the NCC clinic through the use of EMR (Electronic Medical Records) facilitated by QR Codes and the implementation of a Whatsapp Bot. The results indicate that optimizing Nutrition Care Management through the Implementation of EMR with QR Codes and Whatsapp Bot simplifies nutritionists' access to previous client allergy and therapy history in one view and facilitates clients in accessing their medical record number without a physical card. This research has also designed a system that can be used both through web and mobile platforms

Transient Hematotoxicity After Emerald Horned Pitviper (Ophryacus smaragdinus) Envenomation: A Case Report

BackgroundA minority of snake envenomations in the United States involve non-native snakes. In this report, we describe what we believe is the first documented human envenoming from an emerald horned pitviper, Ophryacus smaragdinus. Case ReportA previously healthy 36-year-old woman was bitten on her left index finger by a captive emerald horned pitviper she was medicating at work. Swelling to the entire hand was present on emergency department arrival. She had no systemic symptoms and her initial laboratory studies were unremarkable. The affected limb was elevated. We administered five vials of Antivipmyn TRIⓇ (Bioclon), which specifically lists Ophryacus among the envenomations for which it is indicated. She developed pruritus and was treated with IV diphenhydramine and famotidine. Her swelling improved, but her repeat laboratory studies were notable for a platelet count of 102 K/µL and a fibrinogen level of 116 mg/dL. She declined additional antivenom because of the previous allergic reaction. She was admitted for further monitoring and pain control. Subsequent laboratory tests were better, but a small hemorrhagic bleb developed at the bite site. She was discharged the next day and followed up as an outpatient. Her swelling had resolved, her bleb had healed, and her laboratory studies continued to improve. Why Should an Emergency Physician Be Aware of This?Emergency physicians may be required to treat bites from non-native snakes. Many of these bites will warrant treatment with non–U.S. Food and Drug Administration–approved antivenoms. Consultation with a regional poison center or medical toxicologist may be necessary to procure the proper antivenom.

P04 A Complex Case of Urticaria

Abstract An 11 year old female, with Type 1 diabetes and no previous atopy or allergy , presented with a 6 week history of facial swelling and a generalised urticaria on the trunk and limbs. She had been seen privately by “Allergy” clinic and diagnosed with chronic spontaneous urticaria with angioedema. Blood tests for common allergens were negative, with a total IgE <20 kU/L. Treatment with Loratadine, Cetirizine 10mg, Fexofenadine 120mg QDS, Acrivastine 8mg BD, Montelukast 10mg OD and prednisolone 20mg OD had only a limited effect. Skin biopsy confirmed urticaria with no evidence of vasculitis. Immunology bloods were negative. Despite reporting compliance, she continued to experience debilitating symptoms with raised UAS scores. Desloratadine 2.5mg BD and multiple intermittent short courses of prednisolone were needed. Omalizumab was started at 300mg monthly for 6 months with partial improvement. However symptoms flared on cessation and following tertiary advice, a 2nd course of Omalizumab was commenced at 300 mg s/c monthly for 3 months & 300mg s/c fortnightly for 3 months with the addition of 100mg BD Ciclosporin and Famotidine 10mg BD. Ciclosporin was discontinued after 1 month due to side effects and substituted with Methotrexate 15mg OW. If control is not obtained, management plans include Mycophenolate Mofetil, or trialing omalizumab 450mg S/C monthly. This is a case of extremely difficult to control urticaria in a child highlighting available systemic treatment options1.

Management of non-healing post allergic ulcers with Yashtimadhu Ghrita and adjuvant Ayurvedic drugs-A Case Report

An allergic reaction arises when the immune system responds to a harmful substance. Symptoms of drug allergy can range from mild to severe and may include skin rashes, itching on hands, inner elbows, neck, feet and around the eyes, fever, swelling in the mouth and throat. In the current scenario of human health, there is a high prevalence of allergic reaction due to increasing use of unnatural sources in Food, Medicine and other substances used in routine life. In this case report a 62 year old male patient presented in Shalya Tantra outdoor patient department with complaints of multiple ulcers in bilateral leg since one year, accompanied by severe burning sensation in bilateral leg since six months. In the presentation of allergic ulcer patient had history of trauma on medial malleolus of right foot before four years and ulcer was developed at right medial malleolus. The patient also had a previous allergic reaction to debridement (debridace) ointment. This patient was managed with Vrana Prakshalan using Panchavalkala Kwatha, followed by the local application of Yashtimadhu Ghrita twice daily. Additionally, Avipattikar Churna (5g) mixed with Sootashekhar Rasa (125mg) was administered twice daily after meals with normal water for 21 days. Within 10 days of treatment, the burning sensation subsided, and bandaging with Yashtimadhu Ghrita was initiated. By the second week of treatment, signs of ulcer healing began to appear, and complete ulcer healing was achieved in six weeks. Generally inflammatory condition is seen in allergic reactions, but in this case, ulcers developed due to allergy. This single case report shows that Yashtimadhu Ghrita and adjuvant Ayurvedic medicines have properties to treat post allergic ulcer.

Evaluating the Relative Effectiveness of Methotrexate and Acitretin in Chronic Plaque Psoriasis Treatment

Background: Chronic plaque psoriasis is a prevalent autoimmune skin disorder characterized by persistent red, scaly plaques. Methotrexate and acitretin are established systemic therapies, but their comparative efficacy in treating chronic plaque psoriasis needs further research. Objective: To compare the efficacy of methotrexate and acitretin in chronic plaque psoriasis treatment. Study Design: Randomized Controlled Trial. Settings: This study was conducted at DHQ Hospital, Muzaffargarh Pakistan. Duration: December 2022 to May 2023. Methods: Total 155 patients diagnosed with Chronic Plaque Psoriasis, aged 18 to 55 years, are recruited from the OPD of hospital. Inclusion criteria comprise a confirmed diagnosis of chronic plaque psoriasis and no prior exposure to methotrexate or acitretin within the last six months. Patients with previous intolerance or allergic reactions to methotrexate or acitretin, presence of severe hepatic impairment or chronic liver disease and known pregnancy or lactating mothers were excluded. Participants were randomized into two groups using computer-generated random numbers. Group A receives methotrexate at a dose once a week for 12 weeks as a tablet at a dosage of 0.3-0.5 mg/kg and Group B is treated with Acitretin in which patients were given a capsule at a dosage of 0.4 mg/kg daily for duration of 12 weeks. Statistical analysis is performed using SPSS version 23. Results: The study involved 150 patients with a mean age of 52.33± 16.55. Gender distribution indicated that 47(31.33%) were male, and 103(68.66%) were female. The baseline PASI scores for the methotrexate and acitretin groups were 14.12±3.21 and 14.79±1.08, respectively. At the 3-month, the PASI scores were 7.92±2.07 for methotrexate and 8.14±1.03 for acitretin. The mean reduction in PASI scores was 54.12±9.22 for methotrexate and 47.31 ± 11.31 for Acitretin, with a significant difference favoring Methotrexate (p =0.031*). Of the total participants, 68.66% demonstrated efficacy, with 78.66% in the methotrexate group and 58.66% in the acitretin group, indicating a significant difference (p < 0.005*). Conversely, 31.33% showed no efficacy, with 21.33% in the methotrexate group and 41.33% in the acitretin group. Conclusion: In conclusion, the frequency of effectiveness was significantly higher with methotrexate (78.66% vs. 58.66%) p=<0.005) as compared to acitretin in treating chronic plaque psoriasis.

Clinical trial research on furagin-induced anaphylactic shock: assessing mechanisms and preventive strategies

Background. The study investigates the pressing issue of furagin-induced anaphylactic shock, addres-sing the immediate need to understand its mechanisms and create preventive strategies. Anaphylactic shock due to furagin, a widely used antimicrobial drug, has raised serious concerns. The goal is to elucidate the underlying mechanisms and risk factors of furagin-induced anaphylactic shock. Materials and methods. This research delves into this critical subject through a controlled longitudinal study on both humans and induced anaphylaxis in rats. Results. Using an advanced blind controlled longitudinal design, the study evaluates allergic reactions in humans and induced anaphylaxis in rats. It also explores the safety, tolerability, and pharmacokinetics of furagin over five days in adult patients. Moreover, the study assesses the efficacy of antihistamine pre-treatment in reducing allergic reactions. Results reveal a dose-dependent trend in allergic reactions in rats, demonstrating the effectiveness of antihistamine pre-treatment in reducing the severity of allergic symptoms. Patients with previous allergies, especially to medications, exhibited increased susceptibility to furagin-induced anaphylactic symptoms. The study underscores the potential for antihistamine pre-treatment as a preventive strategy and contributes to the understanding of allergic responses. This research informs clinical practice by providing insights into risk factors and preventive measures for furagin-induced hypersensitivity, ultimately enhancing patient safety. Conclusions. The study findings hold promise for personalized interventions and advance our understanding of drug-induced hypersensitivity reactions.

Rare Event of Anaphylaxis Reaction in a Rabies Post-Exposure Prophylaxis Vaccine: A Case Report

Background. One of the most fatal infectious illnesses, rabies can result in severe symptoms in humans and almost 100% fatality if patients don't receive prompt and sufficient PEP (Post Exposure Prophylaxis). Despite the rarity of allergic responses following rabies immunization, vaccines that protect against infectious illnesses can cause anaphylaxis. Determine if the patient will respond quickly to therapy, pass away in a matter of minutes, or recover on their own as a result of endogenous adrenaline, angiotensin II, and endothelin I secretion. The care of children suffering from anaphylactic shock will be the main topic of this case report. Case Presentation. A six-year-old male patient was admitted to emergency department with shortness of breath, swelling of the whole face and body, gasping for air, and cyanosis of lips, hands, and feet. Previously, the patient was bitten by a dog on the front and right side of his neck 90 minutes prior. He was sent to the community health care facility and administered PEP immediately. It was administered in two ampules without any direct adverse reactions were seen in the following 30-minute observation. Neither previous illnesses nor allergies were reported by his parents. When the patient arrived in emergency room, cyanosis was evident, and he was agitated. Airway was secured using head tilt and chin lift. Oxygen saturation was 60%, thus was given 10 liters/minutes oxygen. He was then given an intramuscular injection of 1:1000 0.3 mg epinephrine and fluid challenge of 300 cc ringer’s lactate solution. Upon reassessing, his vitals sign was not getting better. He had cardiac arrest, resuscitated, but to no avail. Conclusion. During the treatment of rabies, anaphylaxis reactions were inevitable. Post procedure monitoring and emergency management of anaphylaxis reactions must always be prepared to prevent a fatal adverse reaction. Adequate preparation for both equipment and medical personnel is necessary to produce a better outcome. Keywords: Anaphylaxis, Rabies, Post-Exposure Prophylaxis, Vaccine, Children, Case Report

To Reverse Sensitization By Co-Administration of Bortezomib and Rituximab with Conventional Chemotherapy for Patients Who Developed Neutralizing Hypersensitivity Reactions Against Asparaginase

Background: Acute lymphoblastic leukemia (ALL) patients undergoing Pegylated asparaginase (Peg-asp) or Erwinia-asparaginase (Erw-asp) preparation therapy may experience silent inactivation and allergy to asparaginase (ASP), leading to decreased therapeutic efficacy. How to treat ASP sensitized patients, especially those who are allergic to both Peg-asp and Erw-asp, without compromising the treatment outcome remains a problem for hematologists.This study aims to investigate whether the sensitization to Peg-asp can be reversed through the co-treatment of bortezomib and rituximab with conventional chemotherapy for patients hypersensitive to both Peg-asp and Erw-asp. Method: ALL Patients who developed silent inactivation and allergic reaction to both Peg-asp and Erw-asp enrolled in the study. The study featured 2 courses of combined conventional chemotherapy with rituximab and bortezomib co-treatment. In the second course of desensitization, Peg-asp was re-exposed according to the severity of previous allergic reaction against Peg-asp. For those with silent inactivation or previous allergic reactions of grade ≤ III, a split intramuscular injection was administered (the first dose was given at 1/10th of the required dosage, and then the remaining dose was given at an interval of 2 hours if there was no allergic reaction). Patients with grade IV previous allergic reactions underwent a standard 3-bag desensitization procedure. ASP activity was measured on days 1, 3, 7, 10, 14, and 21 after the first Peg-asp re-challenge. If re-exposure to the first dose did not result in an allergic reaction, a subsequent intramuscular single full dose was administered based on the results of ASP activity monitoring. Primary endpoint: to observe the percentage of allergic reaction on re-exposure and the duration of sustained ASP activity. Result: From August 2020 to May 2023, 10 patients of ALL who developed a neutralizing allergy or silent inactivation to both Peg-asp and Erw-asp preparation were recruited to the study. Among them, six cases were B-ALL, and four were T-ALL. The median age of the participants was 8 years, with seven boys and three girls. Seven children experienced Peg-asp neutralizing allergy or silent inactivation during remission induction, while three children experienced it during the interphase treatment. Eight of them had clinical manifestations of allergy and two had silent inactivation. During the second desensitization course, none of the children showed any allergic reaction after the first re-exposure to Peg-asp. Three children maintained >3 weeks of therapeutic activity after the first Peg-asp re-exposure, while one child maintained 14 days, and three children maintained 10 days. Three children detected Asp activity below 100U/L on day 3 monitoring. After two courses of desensitization, the patients returned to the original chemotherapy regimen. Nine patients (90%) maintained activity above 0.1IU/ML for more than three weeks after subsequent Peg-asp administration. One child developed pancreatitis after the last dose of Peg-asp but recovered soon. Another child experienced silent inactivation and was discontinued from all ASP administration. During desensitization therapy, eight children developed febrile neutropenia. Three were recovered with outpatient antibiotic treatment, while five required hospitalization for 5-7 days. As of July 30, 2023, all ten children survived without any adverse events, with a median follow-up time of 28 months from the start of desensitization therapy. Conclusion： Rituximab and bortezomib co-treatment effectively reverse ASP sensitization and restore the sustained potent activity of Peg-asp. This co-treatment is a safe and promising desensitization therapy after ASP sensitization in ALL patients.

Augmenting breast cancer diagnosis: Incorporating MRI for the assessment of major molecular subtypes

Objectives: Breast cancer (BC) is one of the commonly encountered cancer in women around the world. It is a diverse medical disorder with multiple molecular subtypes that respond differently to therapy and have different prognoses. Subjects with the same stage of cancer and identical histological findings, on the other hand, can have disparities in clinical features and prognosis. Luminal A, Luminal B, Human epidermal growth factor receptor 2 (HER2) enriched, and triple-negative molecular subtypes were identified using novel technologies in expression analysis with DNA microarray. The precise identification of these subtypes is crucial for tailoring appropriate treatment strategies and improving patient outcomes. Dynamic contrast-enhanced magnetic resonance imaging (DCEMRI) is an excellent imaging technique for determining the extent of disease in BC patients prior to surgery. DECMRI with gadolinium-based contrasts is now the most sensitive identification tool for diagnosis, and it can be used in conjunction with mammography and ultrasound (USG). It aids in the detection of lesions that are not visible using other approaches. Material and Methods: Cross-sectional, observational study done over a period of 1 year. Sample size: 50 Inclusion criteria: Patients with morphological features of Breast Imaging Reporting and Data System (BI-RADS) 4b,4c,5 on USG or mammogram. Patients with malignancy confirmed through biopsy - BI-RADS 6. Patients aged above 18 years. Patients who provided informed consent to participate in the study. Exclusion criteria: Pregnant and lactating women. Patients with pacemakers, prosthetic heart valves, cochlear implants, or any metallic implants. Patients having a history of claustrophobia. Patients with prior surgery in the breast, hormonal therapy, radiation, or chemotherapy. Patients with previous allergic or anaphylactoid reactions to a gadolinium-based contrast. Patients with altered renal function test and estimated glomerular filtration rate <30 mL/min/1.73 mm2. Results: There was a substantial relationship between shape and molecular subtype. The majority of the luminal type of cancers was irregular, whereas the basal type was round. There was no link found between margin and molecular subtypes. Noncircumscribed margins, on the other hand, were more common in luminal subtypes. Internal enhancement and molecular subtypes were found to be significantly related. Rim enhancement was more prevalent in the basal subtype. According to ANOVA analysis, there was a significant relationship between volume and molecular subtypes. At the time of presentation, Luminal B tumors had a significant tumor volume. Conclusion: In conclusion, MRI plays a pivotal role in the evaluation of molecular subtypes of breast cancer, providing valuable information for personalized treatment decisions. Advancements in MRI technology and radiogenomics hold great promise for enhancing subtype-specific characterization and improving patient outcomes.

Opioid prescribing, pain, and hospital stay of general surgery patients with oxycodone allergies in South Australia.

The frequency of oxycodone adverse reactions, subsequent opioid prescription, effect on pain and patient care in general surgery patients are not well known. This study aimed to determine prevalence of documented oxycodone allergy and intolerances (independent variables) in a general surgical cohort, and association with prescribing other analgesics (particularly opioids), subjective pain scores, and length of hospital stay (dependent variables). This retrospective cohort study included general surgery patients from two South Australian hospitals between April 2020 and March 2022. Multivariable logistic regression evaluated associations between previous oxycodone allergies and intolerances, prescription records, subjective pain scores, and length of hospital stay. Of 12 846 patients, 216 (1.7%) had oxycodone allergies, and 84 (0.7%) oxycodone intolerances. The 216 oxycodone allergy patients had lower odds of receiving oxycodone (OR 0.17, P < 0.001), higher odds of tramadol (OR 3.01, P < 0.001) and tapentadol (OR 2.87, P = 0.001), but 91 (42.3%) still received oxycodone and 19 (8.8%) morphine. The 84 with oxycodone intolerance patients had lower odds of receiving oxycodone (OR 0.23, P < 0.001), higher odds of fentanyl (OR 3.6, P < 0.001) and tramadol (OR 3.35, P < 0.001), but 42 (50%) still received oxycodone. Patients with oxycodone allergies and intolerances had higher odds of elevated subjective pain (OR 1.60, P = 0.013; OR 2.36, P = 0.002, respectively) and longer length of stay (OR 1.36, P = 0.038; OR 2.24, P = 0.002, respectively) than patients without these. General surgery patients with oxycodone allergies and intolerances are at greater risk of worse postoperative pain and longer length of stay, compared to patients without. Many still receive oxycodone, and other opioids that could cause cross-reactivity.

Overdiagnosis of vaccine allergy: Skin testing and challenge at a public specialized unit (CRIE) in Rio de Janeiro, Brazil.

Vaccination is an extremely safe public health intervention, but rare IgE-mediated adverse events must be identified to avoid the risk of anaphylaxis in the event of reexposure. However, using only clinical history to diagnose previous allergic reactions may lead to overdiagnosis of vaccine allergy and even to the use of medical exemptions as a subterfuge to mandatory vaccination. We conducted a retrospective study to describe the outcomes of patients with a history of vaccine or vaccine component allergy who were evaluated at our unit from 2011 to 2017. Data on allergy history, skin test results, vaccines prescribed, and adverse events were retrieved from the medical records at the Centro de Referência para Imunobiológicos Especiais (Reference Center of Special Immunobiologicals)-Fiocruz, in Rio de Janeiro, Brazil. Of 34 adults with history of allergy to vaccine or vaccine components, 32 (94.1%) were successfully vaccinated without serious adverse events after our evaluation. In 12 patients (35%), the time elapsed between the allergy symptoms and evaluation in the Centro de Referência para Imunobiológicos Especiais-Fiocruz was more than 10 years. Specialized care and use of skin tests allowed safe vaccination of the majority of patients. An objective, systematic evaluation of a history of vaccine allergy can prevent its improper use to avoid mandatory vaccination and reduce missed opportunities for immunization.

Mental Health and Cognitive Development in Symptomatic Children and Adolescents Scoring High on Habitual Snoring: Role of Obesity and Allergy.

Obstructive sleep apnea can have a negative impact on children's and adolescents' neurocognitive abilities and hinder their academic and adaptive progress in academic, social, and/or behavioral dimensions. In this retrospective cross-sectional study, we investigated the influence of body weight conditions and allergy status on long-term mental health, cognitive development, and quality of life in children and adolescents who snored. The study sample included 47 subjects (age range 4.1 to 15.3 years) who exhibited high levels of snoring and underwent home-based polysomnography between 2015 and 2019. Follow-up assessments (3 years on average between baseline and follow-up) entailed phone interviews with the subject's parents/caregivers who completed three validated questionnaires investigating sleep, quality of life, and parental ratings. We found a correlation between age at diagnosis and being retrospectively overweight and high levels of snoring. In addition to a higher risk of developing emotional symptoms (8.2% increase in retrospective overweight status for each unit increase in the emotional score at follow-up) and oppositional behavior (9% increase in retrospective overweight status for each unit of oppositional T points at follow-up), we also noted reduced long-term social symptoms (11% decrease in retrospective overweight status for each unit increase in the social score at follow-up) and cognitive symptoms (10.6% decrease in retrospective overweight status for each unit increase in the cognitive score at follow-up), as well as a 6.1% increase in retrospective allergy status for each unit increase in academic performance at follow-up. Snoring can have negative impacts on mental health and cognitive development in the long term. Early detection and intervention for neuropsychological disorders is important in children and adolescents who score high on snoring. In the long term, the effects of snoring on neuropsychological disorders may vary based on previous body weight and allergy status.

Diclofenac sodium and Allopurinol induced Stevens Johnson Syndrome in pulmonary tuberculosis patients receiving intensive phase first-line antituberculosis drugs

One of the life-threatening multi-organ emergency conditions is Stevens-Johnson Syndrome (SJS). Although this is a rare disease and manifests as drug reactions, this condition can cause death.We present a case of a 63-year-old male with Diclofenac sodium and Allopurinol induced Stevens_Johnson Syndrome in pulmonary tuberculosis patients receiving intensive phase first-line antituberculosis drugs.The patient was undergoing outpatient TB treatment at the end of the first month. The patient comes to the emergency department of the hospital because of shortness of breath, fever, blistered skin, nasal and oral mucosa, cracks and wounds, visible pus, red eyes accompanied by erythematous rash all over the body after previously taking diclofenac sodium and allopurinol given by the doctor because felt joint pain all over body and uric acid increased. On physical examination of the lungs, crackles and wheezing were heard in both lung fields. The chest radiograph shows infiltrates in both lung fields. Laboratory results showed leukocytosis and the results of other blood laboratory tests were still within normal limits. Patient diagnosed Stevens-Johnson Syndrome based on clinical, laboratory, and radiology examination results. The patient was given treatments using nasal canule oxygen of 5 litres/minute, intravenous fluid dehydration D5% : NaCl 0.9%, ceftriaxone injection, gentamicin injection, dexamethasone injection, cetirizine ranitidine injection, compresses with 0.9% NaCl liquid, 2.5% hydrocortisone ointment. The patient was treated in the Intensive Care Unit for 8 days. The patient had no history of previous drug allergies. In this case, the likelihood of Diclofenac sodium and Allopurinol induced Stevens_Johnson Syndrome in pulmonary tuberculosis patients receiving intensive phase first-line antituberculosis drugs, needs to be a concerned, as well as the importance of evaluation and strict follow-up to prevent Stevens Johnson Syndrome disease.

Confianza y actitud tras un diagnóstico negativo de alergia a fármacos betalactámicos y/o AINE

Objective: to determine the level of trust in the diagnosis excluding allergy in patients with suspected hypersensitivity to betalactam antibiotics and/or NSAIDs. Additionally, it was intended to describe the attitude of patients towards taking in the future the drug which motivated the study. Method: a descriptive cross-sectional study was conducted; 103 >18-year old patients were selected, of both genders and with a negative result in diagnostic tests for betalactam drugs and/or NSAIDs. Participants were evaluated through a heteroadministered questionnaire at their usual Allergology clinical practice. Results: the level of trust towards the previous allergy label was moderate for betalactam antibiotics (6.4/10) and for NSAIDs (6.1/10), high towards the negative diagnosis for allergy (betalactam drugs: 7.5/10; NSAIDs: 7.9/10), and moderate regarding taking in the future the drug under study, after a negative diagnosis for allergy (betalactam drugs: 6.7/10; NSAIDs: 6.3/10). The degree of trust towards the diagnosis excluding allergy to betalactam drugs or NSAIDs increased regarding the previous degree for suspected allergy, in both drugs (p= 0.01). Conclusions: there is a high degree of trust in patients regarding their diagnosis excluding allergy to betalactam drugs and/or NSAIDs. However, trust regarding taking in the future the drug which motivated the study, after a negative diagnosis of allergy, was reduced to moderate. Health professionals must provide effective health education that solves uncertainties in terms of conducting the test and reinforces trust by patients for taking the drug in the future.

Documented Contact Allergy Impacts Risk for Surgical Adhesive–Associated Contact Dermatitis after Shoulder Arthroplasty

The purpose of this study is to report on the incidence and risk factors for allergic contact dermatitis (ACD) in patients who received Prineo after total shoulder arthroplasty (SA). A retrospective case-control study was conducted to investigate patients who experienced ACD after having SA by a single surgeon during a defined period when Prineo was routinely used as an adjunct to wound closure. Known risk factors for ACD (e.g., history of contact dermatitis, smoking) were analyzed for association development of Prineo-associated ACD using Fisher exact and Wilcoxon rank sum tests. From June 2019 through July 2021, 236 consecutive patients were identified as having Prineo applied after SA. Nine cases of Prineo-ACD (3.8%) were documented, whereas 227 patients were unaffected. In all 9 affected patients, the complication was identified and treated without compromising the outcome of the SA. Previous allergy to medical adhesives was a statistically significant risk factor for Prineo-associated ACD in this series (P= .01). The odds of having Prineo-associated ACD among those with adhesive or contact allergy was 38.5 times that of their nonallergic counterparts in a multivariate model. Prineo adhesive ACD had an incidence of 3.8% in this study, and a history of adhesive or contact allergy was highly associated with its development. Level III, case-control study.

A retrospective study on the incidence, management and risk factors of skin rash in patients with advanced prostate cancer in Japan

BackgroundWorldwide, prostate cancer (PC) is the second most diagnosed cancer and the fifth leading cause of cancer death in men. Hormonal therapies, commonly used for PC, are associated with a range of treatment-emergent adverse events (TEAEs). The population from Japan seems to be at higher risk of developing TEAEs of skin rash compared to the overall global population. This study was conducted to get a better insight into the incidence, management, and risk factors for skin rash during active treatment for advanced PC in Japan.MethodsA retrospective cohort of PC patients was identified and subsequently categorized, into non-metastatic and metastatic castration-resistant prostate cancer patients (nmCRPC and mCRPC), and metastatic castration-naïve prostate cancer patients (mCNPC). The analysis was based on a dataset from the Medical Data Vision (MDV) database. Descriptive statistics were determined, and a multivariate Cox proportional hazards model was used to the associated risk factors for the onset of rash.ResultsOverall, 1,738 nmCRPC patients, 630 mCRPC patients, and 454 mCNPC patients were included in this analysis. The median age was 78 years old and similar across the three cohorts. The skin rash incidence was 19.97% for nmCRPC cohort, 28.89% for mCRPC cohort, and 28.85% for mCNPC cohort. The median duration of skin rash ranged from 29 to 42 days. Statistically significant risk factors for developing skin rash included a history of allergy or hypersensitivity (all cohorts), increased age (nmCRPC and mCRPC), a body mass index (BMI) of < 18.5 (nmCRPC and mCRPC), and a PSA level higher than the median (nmCRPC). Skin rash was commonly managed with systemic and topical corticosteroids which ranged from 41.76% to 67.03% for all cohorts. Antihistamines were infrequently used.ConclusionThis study provides a better understanding of the real-world incidence, onset, duration, management and risk factors of skin rash in patients on active PC treatment in Japan. It was observed that approximately 20–30% of PC patients experience skin rash. Development of skin rash was associated with previous allergy or hypersensitivity, BMI of < 18.5, increased age and higher PSA levels, and was usually treated with corticosteroids.

Desensitization Protocols for Anti-SARS-CoV-2 Vaccines in Patients with High Risk of Allergic Reactions.

Vaccines for SAR-CoV-2 are the most effective preventive treatment able to reduce the risk of contracting the infection and experiencing worse outcomes whenever the infection is contracted. Despite their rarity, hypersensitivity reactions to the anti-SARS-CoV-2 vaccine have been described and could become the reason not to complete the vaccination. Desensitization protocols for other vaccines have been described and validated, while the use of this approach for anti-SARS-CoV-2 vaccines is still anecdotal. We herein describe our experience with 30 patients with previous allergic reactions to anti-SARS-CoV-2 vaccines or to any of their excipients, proving that they are effective and safe; only two patients experienced hypersensitivity reaction symptoms during the desensitization procedure. Moreover, in this article, we propose desensitization protocols for the most common anti-SARS-CoV-2 vaccines.

Comparison in Patient Satisfaction Between Structural Component and Hybrid T-bar Preservation Rhinoplasty: A Retrospective Propensity Score Matched Cohort Study.

Recently, a modified dorsal split preservation technique has been described. In this method, the integrity of the elastic keystone area is preserved by separation of the upper lateral cartilages from the septal T-bar. Our study aimed to evaluate the aesthetical and functional outcome in patients treated with the dorsal T-bar preservation versus the 'gold' standard dorsal split component reduction approach. We performed a retrospective propensity score matched analysis in 234 patients enrolled for rhinoplasty. The severity of nasal obstruction was measured with the nasal obstruction symptom evaluation questionnaire (NOSE score). Aesthetic evaluation was performed with the FACE-Q nose and nostrils and Utrecht Questionnaire (UQ). Assessments were conducted prior to surgery, at 3 and at 6 months after surgery. After propensity score matching, 172 patients in two cohorts were retained. The following covariates were taken into the statistical calculation: age, gender, ethnicity, previous nasal surgery, nasal trauma, respiratory allergy, and preoperative NOSE scores. The first cohort of 110 patients underwent rhinoplasty with T-bar preservation technique (TDP). The control cohort consisted of 62 patients who underwent dorsal split component reduction (SCR). The mean preoperative scores for FACE-Q nose, FACE-Q nostrils, UQ and VAS score improved significantly in all patients postoperatively. Both techniques had comparable aesthetic outcome measures that remained unchanged between 3 and 6 months postop. Functional outcome as measured by the NOSE score was in favor of SCR at 3 months postop but the difference between both techniques was not significant anymore at 6 months postop. In contrast to SCR, in TDP, only 31% of the patients needed spreader grafts or autospreader flaps at the internal valve area only for functional reasons. The data in this study suggest similar patient satisfaction with SCR and TDP techniques for aesthetics as well as nasal function after 6 months postop. TDP is a very versatile cartilage-sparing method to aesthetically adapt the middle vault without interrupting the keystone area. It combines the popular component separation concept with the preservation of the delicate anatomy of the mid-vault. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .