Skin Prick Test Results Research Articles

COVID-19 frequency and clinical course in children with asthma.

The epidemic of severe acute respiratory syndrome coronavirus 2 infection, known as the coronavirus disease 2019 (COVID-19), has caused a global health concern. Since its emergence, numerous studies have focused on various clinical manifestations and outcomes in different populations. However, studies are ongoing as the consequences and impact of COVID-19 in children with chronic diseases such as asthma are controversial. To fill this research gap by retrospectively evaluating the course, laboratory, and clinical findings of COVID-19 among 414 asthmatic children followed up from the pediatric allergy outpatient clinic and known to have had COVID-19. The data of 5510 patients over the age of 5 diagnosed with asthma in our hospital's data were retrospectively scanned with specific parameters using protocol numbers from the hospital filing system. The data included retrospective evaluation of pulmonary function test results before and after COVID-19, routine hematological and biochemical parameters, sensitization states (total IgE, specific IgE, and skin prick test results), and radiological (computed tomography) findings. To inquire about the course and symptoms of COVID-19, asthma patients or their parents were then called and evaluated with a questionnaire. As a result of retrospectively scanning the data of 5510 asthma patients over the age of 5, it was determined that 414 (7.5%) patients had COVID-19. The mean age of 414 patients was 17.18 ± 4.08 (min: 6; max: 28) years. Two hundred and three of our 414 patients are male, and 211 are female. When their vaccination status was questioned, 21.5% were vaccinated. When the symptoms of our 290 patients were questioned, it was stated that 59.0% had fever symptoms. The rate of using regular prophylactic asthma medications was 19%. The rate of using salbutamol in asthma was found to be 22%. The rate of patients using methylprednisolone was 1%. Emergency service admission was 17.2%, and hospitalization was found to be 4.8%. Leukopenia (< 4000) was found in 14.1% of patients, and 8.08% of our patients had neutropenia (< 1500). Lymphopenia (< 1500) was detected in 44.4% of patients, and lymphocytosis (> 4000) was found in 5.05% of patients. In 65% of our patients, the C-reactive protein value was elevated. A high aspartate aminotransferase and alanine aminotransferase value was detected in 3.2% and 5.4% of patients were found, respectively. 31% of patients had an elevated lactate dehydrogenase value. Typical radiological findings for COVID-19 were detected in 3/309 of patients. According to our study, there is a correlation between the severity of COVID-19 and asthma symptoms and the course of the disease. However, it is worth noting that the retrospective nature of the study and the differences in sample size, age, and demographic characteristics between the two groups do not allow for an optimal comparison. Therefore, further investigation is needed to explore the relationship between COVID-19 and asthma, and it can be suggested that COVID-19 may trigger asthma attacks and asthma may impact the course of COVID-19.

Preliminary analysis of seasonal pollen allergens of allergic rhinitis in a hospital of Nanchang City

The study was aimed to analyze the seasonal pollen allergen spectrum of patients with allergic rhinitis (AR) in Nanchang city, and to provide evidence for improving the clinical diagnosis, treatment, prevention and epidemiology of seasonal AR. A retrospective analysis was conducted on the results of skin prick test (SPT) among 1 752 patients with AR in outpatient at Department of Otolaryngology, the First Affiliated Hospital of Nanchang University from September 2020 to August 2021 (a total of 1 069 males and 683 females, age ranged from 2 to 84 years old). SPSS 22.0 software was used to analyze the positive rates of main allergens and their differences in gender, age, and month of visit. Differences among groups were compared by student t test, Wilcox rank sum test, or χ2 test. The results showed that among 1 752 SPT-positive patients, the number of simple seasonal AR and the number of perennial combined seasonal AR were 102 (5.82%) and 281 (16.04%), respectively. There was no significant difference between male and female patients in positive seasonal pollen allergens (χ2=2.181, P>0.05), but the positive rate of indoor seasonal pollen allergens in males was higher than that in females (χ2=7.901, P<0.05). The seasonal pollen allergens ranking top 5 of the positive rates were willow (6.62%, 116/1 752), humulus scandens (5.71%, 100/1 752), rape (5.54%, 97/1 752), grey pigweed (4.62%, 81/1 752) and birch (3.60%, 63/1 752). The positive rates of indoor and seasonal pollen allergens increased first and then decreased in different age groups, and the highest positive rates of seasonal pollen allergens were in the age group of 31-40 years old, with statistical significance compared with other groups (χ2=61.269, P<0.05). The seasonal allergen positive rate showed two peaks in time: March to May and September to November. The positive rate of pollen in spring was 60.27% (132/219), which was significantly higher than that in autumn (39.73%,87/219) (χ2=9.247, P<0.05). The positive rate of pollen combination in spring and autumn was 68.29% (112/164), which was significantly higher than that in spring and autumn alone (18.9%,31/164) and (12.8%, 21/164) (χ2=14.731, P<0.05). In summary, pollen allergy in Nanchang City cannot be ignored, accounting for more than 20% of the total number of AR. The incidence of seasonal AR in Nanchang City showed two peaks (March to May and September to November). The common allergens for seasonal AR in Nanchang City were willow, humulus scandens, rape, grey chenopods and birch.

Delayed postoperative reactions to metamizole: a diagnostic challenge.

Background. Metamizole, a non-steroidal anti-inflammatory drug from the pyrazolone group, is a frequent cause of immediate hypersensitivity reactions and, more rarely, of delayed drug hypersensitivity reactions. Due to its favorable pharmacokinetic characteristics, metamizole is widely used in the postoperative period for pain control. Methods. Retrospective study of patients referred for allergological study between January 2012 and June2022 for postoperative hypersensitivity reactions. Clinical and diagnostic data were collected through review of patients' medical records. Twenty patients with postoperative hypersensitivity reactions were referred, of which 10 presented delayed reactions. We analyzed the results of skin prick, intradermal and patch tests performed with an intravenous metamizole solution as well as provocation tests performed with metamizole and acetylsalicylic acid. Cross-reactivity to non-steroidal anti-inflammatory drugs was excluded by confirmation of clinical tolerance to non-steroidal anti-inflammatory drugs or by acetylsalicylic acid provocation test. Results. In 7 of the 10 patients a delayed reaction to metamizole was diagnosed. These reactions were characterized as maculopapular exanthema, occurring in multiple postoperative settings. Skin tests were negative, except in one patient with late mild erythema in the ipsilateral upper limb and no reaction at the site of intradermal injection. Delayed hypersensitivity was demonstrated by late positive metamizole provocation tests. Conclusions. This study demonstrated that for a correct diagnosis a high degree of suspicion about possible delayed hypersensitivity drug reactions to metamizole in the postoperative setting is needed. In the investigation, provocation test with metamizole was decisive for diagnostic confirmation.

Clinical characteristics, allergic response to autologous semen, and desensitization in patients with postorgasmic illness syndrome.

Postorgasmic illness syndrome (POIS) is rare and includes a cluster of physical and cognitive symptoms that occur after ejaculation. The pathogenesis and effective treatments remain unclear. This study aimed to characterize the symptomatology of POIS, study the allergic response of autologous semen in patients and controls, and evaluate the effects of desensitization therapy. The clinical characteristics of 24 Chinese patients with POIS were analyzed. Skin prick tests, intracutaneous tests, and specific IgE detection were performed with autologous semen. Five patients were desensitized via subcutaneous injections of autologous semen. Evaluated outcomes included the clinical features of POIS; scores of the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and visual analog scale (VAS) of symptoms; skin reactions; desensitization with diluted autologous seminal fluid; and the IgE reactivity patterns of immunoblotting and enzyme-linked immunosorbent assay in vitro. The most common symptom cluster was the general cluster, and the most prevalent symptoms were extreme fatigue and inattention. A total of 66.67% (14/21) of the patients had no symptoms or milder symptoms after nocturnal emission than after intercourse or masturbation. Of the patients, 87.5% (21/24) had psychiatric symptoms and 53.85% (7/13) had abnormal sex hormone levels. The SAS and SDS scores of the high and low VAS groups were significantly higher than those of the control group. Pearson analysis showed that the correlation coefficient between the SAS and VAS was 0.607 (P < .01) and that between the SDS and VAS was 0.490 (P < .05). The patients and healthy donors all had positive intracutaneous test results with their own semen, negative skin prick test results, and no IgE specific to autologous semen. Most patients (4/5) did not achieve ideal therapeutic effects with desensitization. Allergy is not the main pathogenesis of POIS, and desensitization with autologous semen is not effective for most patients. This project included the largest number of patients with POIS in China and assessed the allergic response to autologous semen and the effect of desensitization therapy. There is no objective method for evaluating the efficacy of desensitization with autologous semen. IgE-mediated semen allergy is not the main pathogenesis of POIS, and there is a positive chance that POIS is related to psychological factors. Most patients do not respond to desensitization with autologous semen, and POIS treatment should be individualized, especially in cases with uncertain causes.

Developing and validating clinical models to identify candidates for allergic rhinitis pre-exposure prophylaxis

Purpose Few risk-forecasting models of allergic rhinitis (AR) exist that may aid AR pre-exposure prophylaxis (PrEP) in clinical practice. Therefore, this study aimed to develop and validate an effective clinical model for identifying candidates for AR PrEP using a routine medical questionnaire. Methods This study was conducted in 10 Chinese provinces with 13 medical centers (n = 877) between 2019 and 2021. Clinical characteristics and exposure history were collected via face-to-face interviews. Well-trained physicians diagnosed patients with AR based on skin prick test results and clinical performance. The least absolute shrinkage and selection operator model was used to identify potential risk factors for AR, and the logistic regression model was used to construct the risk-forecasting model. Predictive power and model reliability were assessed using area under the receiver operating characteristic curve and calibration curves, respectively. Results This study diagnosed 625 patients with AR who had positive responses to at least one indoor or outdoor allergen and 460 to at least one outdoor pollen allergen. Two nomograms were established to identify two types of AR with various sensitization patterns. Both models had an area under curve of approximately 0.7 in the development and internal validation datasets. Additionally, our findings found good agreement for the calibration curves of both models. Conclusion Early identification of candidates for AR PrEP using routine medical information may improve the deployment of limited resources and effective health management. Our models showed good performance in predicting AR; therefore, they can serve as potential automatic screening tools to identify AR PrEP candidates.

Relationship Between the Type of Allergen and Night Sweat in Allergic Children.

Atopic diseases can accompany allergic sensitization. The amount of allergen is as important to know since allergen exposure affects sensitization development. Some allergic children complain of intense sweating during the first few hours of transition to sleep especially at night. This study was carried out to investigate the relationship between the type of allergen to which children are sensitized and night sweating. Children aged two to 18 years old with single allergic sensitization were included. A specific immunoglobulin E (IgE)skin prick test results were obtained from the medical records of the patients. Then, the patients' families were asked to evaluate the levels of sweating from 0 to 10 with the Visual Analogue Scale (VAS) questionnaire and the Sleep Disturbance Scale for Children (SDSC). Sensitization to mites was more prevalent in the group of patients with night sweating (p<0.001), and pollen allergy was more prevalent in the group of patients without night sweating (p<0.001). Conclusion: The amount of mites and wetness in bed sheets might be responsible for allergic sensitization. A change in clothes and bed sheets for those with intense sweatingmight ensure better sleep and reduce the severity of the atopic symptoms. Such a recommendation might provide a better clinical outcome in these patients.

The link between early childhood lower airway symptoms, airway hyperresponsiveness, and school-age lung function

BackgroundThe role of early airway hyperresponsiveness (AHR) in the lung function of school-age children is currently unclear. ObjectiveTo conduct a prospective follow-up study of lung function in schoolchildren with a history of lower airway symptoms and AHR to methacholine in early childhood and to compare the findings to schoolchildren with no previous or current lung diseases. We also explored symptoms and markers of type 2 inflammation. MethodsIn 2004 to 2011, data on atopic markers, lung function, and AHR to methacholine were obtained from 193 symptomatic children under 3 years old. In 2016 to 2018, a follow-up sample of 84 children (median age, 11 years; IQR, 11-12) underwent measurements of atopic parameters, lung function, and AHR to methacholine. Moreover, in 2017 to 2018, 40 controls (median age, 11 years; IQR, 9-12) participated in the study. ResultsSchoolchildren with early childhood lower airway symptoms and increased AHR had more frequent blood eosinophilia than their peers without increased AHR and lower prebronchodilator forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity Z-scores than those without increased AHR and controls. Post-bronchodilator values were not significantly different between the two AHR groups. Atopy in early childhood (defined as atopic eczema and at least 1 positive skin prick test result) was associated with subsequent lung function and atopic markers, but not AHR. ConclusionIn symptomatic young children, increased AHR was associated with subsequent obstructive lung function, which appeared reversible by bronchodilation, and blood eosinophilia, indicative of type 2 inflammation.

Incidence of Food allergy among patients with allergic conjunctivitis

The prevalence of ocular allergy is increasing worldwide. Skin prick test is widely recognized as the most reliable method for diagnosing the incriminating allergen as regards type I hypersensitivity reactions. Food allergy results as immunological response to food protein which leads to occurrence of allergic conjunctivitis (AC), allergic rhinitis, asthma, atopic dermatitis, and eosinophilic esophagitis. There is a scarcity of research investigating the association between food allergy and AC. This retrospective cohort study aimed to determine the incidence of food allergy within AC patients and its linkage to disease intensity and to compare the response to sublingual immunotherapy after 4 months of therapy. The study included 240 individuals diagnosed with AC. Of these patients, only 214 (89.16%) cases exhibited positive skin prick test results and showed incidence of food allergy of 29.6 %. After 4 months of sublingual allergen immunotherapy, the total serum IgE level and the grades of severity decreased significantly (p &lt;0.001 for each). On comparing patients with food allergy on sublingual immunotherapy and patients without food allergy and on sublingual immunotherapy, the change in total serum IgE concentration and the grade of severity did not differ among the two groups (p value was 0.63 and 1.00 respectively). In conclusion, food allergies can contribute to the development of AC. Sublingual allergen immunotherapy can be proposed as a promising therapeutic option for AC patients.

The distribution of sensitization to common aeroallergens in patients with rhinitis and asthma in Şanlıurfa, Türkiye.

Sensitization to common environmental aeroallergens plays a significant role in the pathogenesis and severity of asthma and allergic rhinitis. Knowledge on the sensitization pattern helps allergen avoidance, prediction of the severity of the disease, and use of specific immunotherapy for the most common allergens. The distribution of sensitization to aeroallergens differs in every region of Türkiye. In this study, it was aimed to investigate the allergen sensitization profiles of patients with asthma and rhinitis in Şanlıurfa, which is in Southeast Türkiye. Patients with rhinitis and asthma who presented to the outpatient clinic of adult immunology and allergy between April 2021- 2022 were retrospectively evaluated. Demographic information (age, sex), rhinitis and asthma duration, location of residence, allergic and non-allergic comorbidities, smoking history and skin prick test results were extracted from medical records. A total of 472 skin prick tests were performed on patients (35.4% males; 64.6% females), with a mean age of 33.8 years, and 120 (25.4%) were negative for skin reaction. The frequency of sensitivity to allergens was: grass (42.6%), cereal mixtures (41.5%), timothy grass (37.9%), cockroach (37.3%), olive tree (35%), house dust mites (Dermatophagoides farinae 27.5%, Dermatophagoides pteronyssinus 20.8%). In patients with only rhinitis (n= 305), the most frequent aeroallergen was pollen (grasses 43.6%; cereal mixtures 43.3%; timothy grass 41.6%; olive pollen 37.4%). In patients with asthma and rhinitis (n= 134), the most frequent aeroallergen was grass (44.8%). In patients with only asthma (n= 33), the most frequent aeroallergens were D. farinae (27.3%) and cockroach (27.3%). The most frequently detected allergens in this study were pollen, cockroach, and house dust mites, respectively. The findings revealed that pollen was the most frequent aeroallergen in subjects with allergic rhinitis with and without asthma. In patients with only asthma, the most frequent aeroallergen was house dust mites.

ВЛИЯНИЕ ПОЛА НА ЧАСТОТУ СЕНСИБИЛИЗАЦИИ ИНГАЛЯЦИОННЫМИ АЛЛЕРГЕНАМИ ПРИ АЛЛЕРГИЧЕСКОМ РИНИТЕ, БРОНХИАЛЬНОЙ АСТМЕ И ИХ СОЧЕТАНИИ

Background. In the Republic of Belarus, allergic diseases affect from 10 to 15% of the population, and there is a steady increase in the incidence of allergic rhinitis (AR) and bronchial asthma (BA). The purpose of the study was to evaluate the effect of gender and age on the nature of sensitization to inhalation allergens in residents of the Grodno region suffering from AR, BA and a combination of these diseases (AR + BA). Material and methods. Based on the results of skin prick tests with household, epidermal and pollen allergens, we analyzed the sensitization profiles of 237 patients (97 women, 140 men) suffering from AR (101 patients), BA (89 patients) and AR + BA (57 patients). Results. In AR, men are statistically significantly more likely than women (with a frequency exceeding 50%) to develop sensitization to cereals and early flowering trees, while household allergens are major for female representatives. In patients with BA, sensitization to household allergens, pollen of cereals and trees / shrubs is detected more often, while gender differences in the sensitization profile are less pronounced than in AR: in men, allergy to house dust is somewhat more common, and women are significantly more likely to be allergic to ash pollen. When BA is combined with AR, the sensitization profile is similar to that in patients with isolated BA: allergy to house dust, pollen of cereals and trees is detected most often, and gender differences are also slightly expressed: sensitization to epidermal allergens is significantly more common in women than in men, while sensitization to the pollen of timothy grass and creeping wheatgrass occurs less often. Conclusions. The gender of patients with BA and/or AR significantly affects the spectrum of causally significant allergens.

Sustained unresponsiveness development in wheat oral immunotherapy: predictive factors and flexible regimen in the maintenance phase.

Background and aim. Immunotherapy may induce sustained unresponsiveness (SU) in which the patient can tolerate the allergen without any severe symptoms after discontinuing immunotherapy. The present study evaluated serum and cutaneous markers for predicting SU in patients with wheat anaphylaxis who underwent oral immunotherapy. Moreover, we investigated the effectiveness of a flexible regimen of 5 to 10 g wheat protein (WP) in the maintenance phase of oral immunotherapy (OIT). Methods. This study was conducted on 19 patients with wheat anaphylaxis who underwent OIT. The result of the skin prick test (SPT), besides specific serum IgE (sIgE) and IgG4 (sIgG4) to WP, were evaluated before the desensitization. The maintenance dose started from the preferred dose of 5 to 10 g WP after the build-up phase, if the patient could tolerate it. All patients were recruited 7 to 9 months after undergoing this flexible regimen, and the results of SPT and sIgE, and sIgG4 levels were obtained once more. The patients underwent oral food challenge (OFC) after a 3-4-week avoidance to evaluate SU. Results. There was an association between mean IgE reduction and SU (p less than 0.0006), while no association was observed between the mean increase in specific IgG4 (p = 0.1) and the mean wheal diameter decrease (p = 0.29). In the present study, a 50% reduction in sIgE was associated with SU. Thirteen patients were considered to have a SU. Moreover, there was no association between the flexible regimen and the desensitization rate. Conclusions. The results revealed that the reduction of 50% sIgE is a predictive factor for SU in patients with IgE-mediated wheat allergy.

The Danger of Disappearing Allergen Skin Test Substances

Allergic diseases affect approximately one-quarter to one-half of the average population under 50 years of age in Central Europe. Due to the high proportion of affected individuals, allergy testing needs to be performed on a large scale, with high sensitivity and specificity at a low cost. Skin tests are the most important diagnostic measure fulfilling these requirements: they can be performed immediately and, quite in contrast to laboratory tests, the results of skin prick tests for the diagnosis of immediate allergy (IgE-mediated: Type I) can be assessed, and discussed with the patients 15–20 minutes later. Patients do not need to be called in for a second appointment to discuss the results of serum-based determination of specific IgE. Recently, we demonstrated that the sensitivity of skin prick tests is superior to the measurement of allergen-specific IgE, even for modern molecular allergens. In T cell mediated allergy of the delayed type (contact dermatitis: Type IV), patch tests read after 48–72 hours are the only available diagnostic measure.

Risk factors for recurrent wheezing after bronchiolitis

BackgroundThis study aimed to determine whether there was an association between certain factors in patients with bronchiolitis and recurrent wheezing in childhood.MethodIn 2021 we tracked children hospitalized for bronchiolitis at Chengdu Women’s and Children’s Central Hospital in 2017. The patients were classified into recurrent wheezing group (RWG) and non-recurrent wheezing group (NRWG). Possible risk factors including maternal age, school-age siblings, allergic history, atopic dermatitis, allergic rhinitis, atopic family history, severity of the condition, duration of hospitalization, nasopharyngeal secretions culture, blood eosinophil counts, FeNO and skin prick test were compared between the two groups. Continuous variables were analyzed by independent sample t-test for normal distribution and Mann-Whitney U-test for non-normal distribution. Categorical variables were tested using chi-square tests. Multifactor analysis was conducted by stepwise logistics regression analysis.ResultsIn total 167 participants were included, of which 26 and 141 were in RWG and NRWG respectively. In RWG children represented higher maternal age (P = 0.02) and greater probability of allergic history, atopic dermatitis, allergic rhinitis, atopic family history (odds ratio [OR] = 4.0,3.7, 7.8, 10.9 respectively, P < 0.01). However, school-age siblings, severity of the condition, duration of hospitalization, blood eosinophil counts, fractional exhaled nitric oxide and skin prick test results seemed unrelated to recurrent wheezing. In the subgroup analysis of nasopharyngeal secretion culture, there were more Moraxella catarrhalis-positive in RWG(P = 0.043). Atopic dermatitis, allergic rhinitis and atopic family history were identified as independent risk factors for recurrent wheezing.ConclusionSome children with bronchiolitis will develop recurrent wheezing, and the risk factors are allergic history, Moraxella catarrhalis infection or colonization, atopic dermatitis, allergic rhinitis and atopic family history; the latter three are independent risk factors.

Inconsistent Skin Prick Tests for Allergy to Birch Homologous Trees May Result from Cross-Reacting Allergens or Technical Errors

Introduction: Skin prick tests (SPTs) are the gold standard for diagnosis of allergic rhinitis (AR). A decrease in the number of allergens included in standard SPT panels has recently been debated – particularly regarding the cross-reacting homologous pollen from birch, alder, and hazel trees – but has not yet been implemented in clinical guidelines. Methods: A subgroup of patients with AR (n = 69) who showed inconsistent SPT results among birch, alder, and hazel was investigated in detail. Beyond SPT, patient workup included assessment of clinical relevance and various serological parameters (total IgE, and specific IgE to birch, alder, and hazel and to Bet v 1, Bet v 2, and Bet v 4). Results: More than half the study group had negative SPT results for birch but positive results for alder and/or hazel, and 87% of the study group was polysensitized, showing at least one more positive SPT result for other plants. Whereas 30.4% of patients showed serological sensitization to birch pollen extract, only 18.8% displayed positive specific IgE to Bet v 1. Clinical assessment revealed that most patients with AR were polysensitized and had perennial symptoms or symptoms also occurring during times other than tree flowering times. If the SPT panel is limited to testing birch only, 52.2% of patients in this subgroup would have been overlooked. Conclusion: Inconsistent SPT results in the birch homologous group may result from cross-reacting allergens or technical errors. If patients report convincing clinical symptoms despite negative results from a reduced SPT panel or inconsistent results for homologous allergens, SPT should be repeated, and molecular markers should be added to achieve a correct diagnosis.

INMUNOCAT study: The impact of molecular diagnosis on immunotherapy prescription in pollen polysensitized patients from Catalonia.

Recognition of specific allergens triggering immune response is key for the appropriate prescription of allergen-specific immunotherapy (SIT). This study aimed at evaluating the impact of using the commercially available microarray ImmunoCAPTM ISAC 112 (Thermo Fisher Scientific) on the etiological diagnosis and SIT prescription compared to the conventional diagnostic methods in patients with allergic rhinitis/rhinoconjunctivitis and/or asthma. 300 patients with respiratory allergic disease, sensitized to three or more pollen aeroallergens from different species, as assessed by a skin prick test (SPT) and specific IgE assays (sIgE), were included in this multicentric, prospective observational study. SPT and a blood test were performed to all patients. Total serum IgE and sIgE (ImmunoCAPTM) for allergens found positive in the SPT and sIgE allergen components (ImmunoCAPTM ISAC 112) were measured. According to SPT results, the most prevalent pollen sensitizers in our population were Olea europaea followed by grass, Platanus acerifolia and Parietaria judaica. The molecular diagnosis (MD) revealed Ole e 1 as the most prevalent pollen sensitizer, followed by Cup a 1, Phl p 1, Cyn d 1, Par j 2, Pla a 1, 2, and 3 and Phl p 5. Immunotherapy prescription changed, due to MD testing, in 51% of the cases, with an increase of prescription of SIT from 39% to 65%. The identification of the allergen eliciting the respiratory disease is essential for a correct immunotherapy prescription. The advances in allergen characterization using methods, such as the commercial microarray ImmunoCAPTM ISAC 112, can help clinicians to improve SIT prescription.

Skin prick tests are not useful for the qualification for venom immunotherapy in children

BackgroundThe basis for qualification for venom immunotherapy (VIT) is the fulfilment of both the clinical and immunological criteria. Diagnostic tests that confirm the immunological criterion of an IgE-mediated sensitization include skin prick tests (SPT), intradermal tests (IDT), and serum specific IgE (sIgE) for the culprit venom. ObjectiveThis study aimed to assess the usefulness of SPT as the immunological marker in the diagnosis of insect venom sensitization in children with history of systemic reaction (SR) to insect sting evaluated by means of I-IV-grades Mueller's scale. There are no such studies in children. MethodsThis cross-sectional study sample consisted of 416 children aged 3–18 years (mean age 10.6 ± 3.8), 76% males, all with the history of a systemic reaction (SR) after a Hymenoptera sting (48% of grade III/IV according to Mueller scale), diagnosed between 1999 and 2019 in the tertiary referral centre. The standard diagnostic tests were used. Specificity, sensitivity, and positive and negative predictive values were computed to assess the diagnostic properties of the clinical tests to distinguish between mild and severe SR. To assess the relative value of an individual test in predicting the qualification to VIT we incorporated the Shapley value (SV). ResultsPositive SPT results were found in up to no more than 3% of children; among them less than 1% had only positive SPT and were negative for sIgE and IDT. Approximately 85% of the children had detectable venom sIgE, followed by positive IDT (75%). Almost 70% of children had positive both sIgE and IDT results. In children with grade III/IV reaction, about 80% of children had positive results of both of these tests. sIgE and IDT had sensitivity >0.80, whereas SPT had high specificity (>0.97) in differentiating between mild and severe SR. Relative value of diagnostic tests in predicting qualification to VIT varied between venoms. Bee venom IDT had higher SV (0.052) than sIgE (0.041). In contrast, wasp venom sIgE had higher SV (0.075) than IDT (0.035). ConclusionSPTs are not an useful immunological marker of venom sensitization in children, and eliminating SPT does not result in a loss of diagnostic accuracy. Limiting diagnostics to venom sIgE and IDT would shorten the procedure and reduce costs. Future studies are needed to determine if venom sIgE as the first line diagnostic test, with IDT added only if the venom sIgE is undetectable, is an optimal diagnostic process.

Changes in risk factors for food sensitization in early life: Analysis over a period of 10 years.

Although epidemiological trends of childhood food sensitization (FS) in IgE-mediated food allergy were reported in China, few studies have examined at changes in its risk factors. To investigate the change in early-life risk factors associated with childhood food sensitization during 2009-2019 in China. Data from two cross-sectional surveys conducted in 2009 and 2019 (401 and 513 children, respectively) were analyzed. The results of skin prick tests and information on food sensitization-related risk factors in children were summarized, including family history of atopic disease (FHA), demographic characteristics, method of delivery, feeding patterns, sibship size, pet ownership, and vitamin D supplementation. Binary logistic regression was used to calculate the odds ratio and the regression coefficient β-value of risk factors in the 2009 and 2019 surveys separately. Then, coefficient β-value differences between the two surveys were analyzed by the bdiff command in STATA to describe the change in risk factors over 10 years. The 2009 survey revealed that FHA, age, only child, and feeding patterns were associated with food sensitization. The 2019 survey showed that food sensitization was affected by age, sex, and feeding patterns. However, from 2009 to 2019, the probability of food sensitization in the only-child group significantly increased by 226.0% (β-value difference = 0.81, P = 0.024) and decreased by 65.0% in female children (β-value difference = -1.06, P = 0.008). The effect of age on food sensitization decreased by 50.0% (β-value difference = -0.69, P < 0.001) over 10 years. The effect of FHA and common lifestyle factors on food sensitization did not significantly change during 2009-2019. However, the influence of demographic characteristics on food sensitization has changed since 2009; that is, older age, male gender, and only child are more likely to develop food sensitization, which needs to be considered in future epidemiological surveys. http://www.chictr.org.cn/, identifier ChiCTR1900024338.

Skin Prick Test Reactivity to Common Allergens among Allergic Rhinitis Patients in Kocaeli Province, Turkey

Objective: The identification of the most common aeroallergens causing allergic rhinitis (AR) in a specific geographic area is important in the diagnosis and treatment of AR. This study evaluates the prevalence of sensitivity to aeroallergens among patients with AR who live in Kocaeli province, Turkey. Methods: This cross-sectional, descriptive study included a retrospective review of skin prick test (SPT) results from patients with suspected AR who were examined at a tertiary hospital rhinology clinic. Results: The SPT results of 85 patients with an AR diagnosis were included in this study. House dust mites (HDM) had the highest frequency of positive test responses (57.6%), followed by tree pollen (40.0%), grass pollen (36.5%), weed pollen (32.9%), cockroach (18.8%), animal dander (14.1%), and mold (11.8%). The majority of the AR patients were polysensitized (57.6%), and the most common allergens in polysensitized patients were tree pollen (61.2%), grass pollen (57.1%), and HDM (55.1%), respectively. The strongest single allergen in monosensitized subjects was HDM, with a rate of 61.1%. Conclusion: The most prevalent allergen was HDM among AR patients in the Kocaeli region, followed by tree pollen and grass pollen. Polisensitization occurs more frequently than monosensitization. These allergens should be prioritized in the diagnosis and treatment of allergic rhinitis in Kocaeli region patients.

Cow’s milk allergy skin tests: fresh milk, commercial extracts, or both?

BackgroundThe diagnosis of food allergy is based on a history of immediate allergic reaction following food ingestion, and skin prick test (SPT) demonstrating sensitization with commercial extracts (CE) or fresh food (FF). For most food allergens, the SPT with FF is considered more accurate and predictive. Regarding cow’s milk, the results are inconclusive. This retrospective study aimed to evaluate the accuracy of SPT with fresh milk compared to CE (cow’s milk and casein) for evaluation of cow’s milk allergy (CMA).MethodsThis study summarized the medical records of children, diagnosed with CMA. The data include demographics, skin tests and oral food challenge results, as well as atopic comorbidities.ResultsRecords of 698 patients with the diagnosis of CMA were reviewed, 388 fulfilled the inclusion criteria. Overall, 134 patients (34.54%) had an additional atopic disease. The SPT wheal size with fresh milk was significantly larger than with CE (cow's milk and casein) at first evaluation or before oral food challenge (OFC). Combination of SPT results (CE and FF) gave the maximal odds ratio for reaction during OFC and SPT with fresh milk alone gave the minimal OR (34.18 and 4.74, respectively).ConclusionsSPT with CE for CMA evaluation is more reliable than SPT performed with fresh milk. In patients suspected of having IgE-mediated CMA, before deciding on performing OFC, it is advised to perform SPT with at least two different extracts, and always include casein. Fresh milk can serve as a backup if commercial extracts are not available. In cases that the SPT with fresh milk is 3 mm or less, there is 93.3% chance that the OFC will pass without reaction.Trial registration This study protocol was reviewed and approved by the Ethics Committee of Meir Medical Center, IRB Number 0083-18 MMC.

The natural history of childhood-onset nonallergic rhinitis; a long-term follow-up study.

Non-allergic rhinitis (NAR) is characterized by symptoms of nasal inflammation without allergic sensitization. The long-term outcome of NAR in children is poorly defined. To determine the natural history of childhood-onset NAR and the development of allergic rhinitis (AR) in these children. NAR patients who were followed for more than 10 years were evaluated at 3-5 years (E2) and 9-12 years (E3) after the first evaluation (E1). Nasal symptoms, disease severity, comorbidities, medication used, and aeroallergen sensitization were assessed. Eighty-two NAR patients (58.5% male) completed all 3 evaluations. The age at onset was 2.0 (range 2.0-4.0) years. The follow-up period was 13.6 (range 12.3-14.3) years. At E2, 37.8% of patients developed AR. At E3, the patients were classified into four groups based on results of skin prick tests in E2 and E3 (group I: NAR→NAR→NAR, 39.0%, group II: NAR→NAR→AR, 23.2%, group III: NAR→AR→NAR, 12.2% and group IV: NAR→AR→AR, 25.6%). The most common aeroallergen sensitization was house dust mite. The family history of atopy, asthma and allergic rhinitis were higher in group III and IV than other groups (p < 0.05). The atopic dermatitis, obstructive sleep apnea and adenotonsillar hypertrophy at E1 and E2 were predominantly found in group IV (p < 0.05). At E2, group III and IV patients had higher proportion of exposure to house dust, animal dander and smoking compared to other groups (p < 0.05). The overall remission rate was 14.6%. Children with NAR should be reevaluated periodically to determine aeroallergen sensitization for the appropriate diagnosis and management.