Systemic Hypersensitivity Research Articles

Characteristics of childhood anaphylaxis in different age groups.

Anaphylaxis is a severe systemic hypersensitivity reaction that usually has a rapid onset and can be fatal. Presentations of childhood anaphylaxis vary widely in accordance with the triggers and the patient's age, geographical region and dietary and lifestyle habits. The medical records of 177 paediatric patients diagnosed with anaphylaxis between January 2021 and January 2024, whose disease progression was monitored at a single tertiary care centre, were reviewed retrospectively. The study included 177 patients diagnosed with anaphylaxis (107 males and 70 females with a median age of 48 months). The most common allergen responsible was food (53.7%). Egg allergy was the most common source of anaphylaxis, afflicting 35 patients (19.3%), while beta-lactam provoked the most common drug allergy, affecting 24 patients (13.6%). The most common organ involved was the skin (92.7%). When the patients were analysed by age group, there were more males in the infancy, preschool and school age groups, while there were more females in the adolescent group (p = 0.44). Food-induced anaphylaxis became less common with increasing age, whereas the rate of drug-induced anaphylaxis increased (p = 0.01 and p = 0.01, respectively). Cardiovascular system findings were observed more frequently in adolescents compared to other age groups (p = 0.003). Most cases stemming from a food allergy were mild, whereas most drug-induced cases were moderate or severe (p < 0.05). When severity was analysed by age group, mild cases in infants were more common than moderate to severe cases. The aetiological and clinical manifestations of childhood anaphylaxis vary among different age groups.

Descriptive Profile of Anaphylactic Reaction Patients Hospitalized at RSUP Prof. DR. I.G.N.G Ngoerah Period 2018-2023

Introduction: Anaphylactic reaction is a severe, potentially life-threatening systemic hypersensitivity reaction caused by a specific allergen. This study aimed to evaluate the clinical profile of anaphylactic patients hospitalized in Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar. Method: This was a cross-sectional descriptive study of anaphylactic patients hospitalized in our center from January 2018 to December 2023. Patients diagnosed with anaphylactic reactions were included in this study. All the data (demographic, clinical manifestations, potential trigger) were attained from medical records for descriptive analysis. Result: 292 patients were enrolled in this study; half were women (54,4%), and the median age was 38,50 years (interquartile range 24). The most common potential triggers were drugs (57%), followed by food (18,5%), blood products (14,1), insect bites, and other triggers (4,8%). Almost all patients experience skin and mucosal manifestations (99%). Anaphylactic shock occurs in only 22% of patients. Discussion: Previous studies have found similar results to our findings, and anaphylactic reaction caused by drugs was associated with a more severe reaction. The effect of estrogen hormones on more severe reactions has been reported in female mice, but human research is still limited. Conclusion: Further studies are needed to investigate the correlation between demographic characteristics or specific clinical manifestations with a severe reaction.

Chitosan as A Plant Pathogen Control Agent: A Review

Pathogen attacks can cause decreased yields, even crop failure. Proper control can suppress pathogens' development and maintain yields. The concept of integrated pest management emphasizes the application of several techniques, one of which is the use of organic products as vegetable pesticides. Chitosan is a natural product obtained from crustacean shells or skins which can be used in various fields, including agriculture. Indonesia is one of the countries producing raw products from crustacean animals (shrimp, crab, lobster, and squid). This also has an impact on the amount of shell or skin waste produced. The processing of crustacean animal skin waste into chitosan can go through several stages, namely deproteinized, demineralization, and deacetylation. Chitosan application can be done by seed treatment, foliar spraying, soil application, and post-harvest products. The mode of action of chitosan against pathogenic fungi is binding to phospholipids in the plasma membrane of fungal cells, causing changes in hyphal morphology, degrading fungal enzymes, increasing levels of phenolics, sugar, and proline, and activating antimicrobial compounds and defense-related enzymes. The modes of action against pathogenic bacteria are interfering with gene expression, causing cell lysis, destroying bacterial biofilms, increasing defense enzyme activity, inducing systemic resistance, damaging and changing cell membranes, and causing cell wall permeability. The mode of action against pathogenic viruses is to increase the expression of genes related to defense, inhibit systemic viral multiplication and hypersensitivity response. The utilization of chitosan products is very important to study, especially in suppressing the use of chemical products and maintaining ecosystem sustainability.

Systemic and skin-limited delayed-type drug hypersensitivity reactions associate with distinct resident and recruited T cell subsets.

Delayed-type drug hypersensitivity reactions are major causes of morbidity and mortality. The origin, phenotype, and function of pathogenic T cells across the spectrum of severity require investigation. We leveraged recent technical advancements to study skin-resident memory T cells (TRMs) versus recruited T cell subsets in the pathogenesis of severe systemic forms of disease, Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS), and skin-limited disease, morbilliform drug eruption (MDE). Microscopy, bulk transcriptional profiling, and single-cell RNA-sequencing (scRNA-Seq) plus cellular indexing of transcriptomes and epitopes by sequencing (CITE-Seq) plus T cell receptor sequencing (TCR-Seq) supported clonal expansion and recruitment of cytotoxic CD8+ T cells from circulation into skin along with expanded and nonexpanded cytotoxic CD8+ skin TRM in SJS/TEN. Comparatively, MDE displayed a cytotoxic T cell profile in skin without appreciable expansion and recruitment of cytotoxic CD8+ T cells from circulation, implicating TRMs as potential protagonists in skin-limited disease. Mechanistic interrogation in patients unable to recruit T cells from circulation into skin and in a parallel mouse model supported that skin TRMs were sufficient to mediate MDE. Concomitantly, SJS/TEN displayed a reduced Treg signature compared with MDE. DRESS demonstrated recruitment of cytotoxic CD8+ T cells into skin as in SJS/TEN, yet a pro-Treg signature as in MDE. These findings have important implications for fundamental skin immunology and clinical care.

Transient synovitis associated with leuprolide depot (Lupron).

A 6.6-year-old female presented to endocrinology with precocious puberty for evaluation and management. Workup was initiated, and a diagnosis of central precocious puberty was confirmed. A decision was made to initiate pubertal blockade using gonadotropin-releasing hormone agonist (GnRHa) therapy with depot leuprolide acetate injections every 3 months. The patient received the first depot leuprolide acetate injection in the right ventrogluteal area. Six hours following the injection, the patient was reported to be inconsolable in pain, which was localized to the right hip site of the earlier injection and associated with a refusal to ambulate. The pain and discomfort continued to progress over the next 24 h despite an alternating regimen of Tylenol and ibuprofen prompting admission to the emergency department. Vital signs demonstrated a low-grade fever and elevated C-reactive protein. An ultrasound of the right hip demonstrated fluid accumulation within the joint. Over the next week, the patient was unable to walk independently and required assistance for activities of daily living. By 2 weeks after the injection, the pain began to remit, and the patient resumed activities of daily living. Following consultation with allergy, a decision was made to continue GnRHa suppressive therapy with an alternative analog (Triptodur). The patient tolerated subsequent treatment without reaction. Although gonadotropin-releasing hormone agonists (GnRHa) have a generally good safety profile, there is a history of both local and systemic hypersensitivity reactions associated with their use. Despite the long-acting formulation of depot leuprolide acetate, the systemic reaction in this case appears to be self-limited. Discontinuation of therapy or a change to an alternative formulation of GnRHa analog should be considered based on the need for therapy versus the potential risk of rechallenge.

Anaphylaxis biomarkers: present and future.

Anaphylaxis is a severe, rapidly developing, and life-threatening systemic hypersensitivity reaction. The diagnosis of anaphylaxis is primarily clinical. Numerous studies on the mechanisms and the biomarkers of the disease are initiated every year. The biomarkers of anaphylaxis may become an important tool for the diagnosis, prevention, repeated risk assessment, severity stratification, and new therapeutic strategies for treatment of the disease. Various immune and non-immune mediators produced and released by effector cell populations are currently considered as biomarkers of anaphylaxis. Here, we review the current data on potential biomarkers of anaphylaxis and the possibilities and perspectives for their use in future clinical practice.

Trends in anaphylaxis management during COVID-19

BackgroundAnaphylaxis is an acute, potentially life-threatening systemic hypersensitivity reaction that commonly occurs in the community setting and is best managed with epinephrine. ObjectiveThe purpose of this study was to examine the effects of the COVID-19 pandemic on trends in acute at home anaphylactic events including Emergency Room (ER) visits and treatment for anaphylaxis. MethodsWe used data from two sources: survey data from the Food Allergy Research & Education (FARE) Patient Registry; and electronic medical records of patients who presented to Tampa General Hospital ER with a diagnosis of anaphylaxis. We collected data from events during the Covid epidemic and before and after vaccine availability. Data was analyzed using descriptive statistics. Results190 FARE survey responses were completed. Sixty-three patients reported that the COVID-19 pandemic changed how they responded to the allergic reaction. Of these 63 patients, 71% avoided seeking medical care outside the home, 30% used self-medication more quickly than usual, and 14% delayed the use of medication. Only 87 events (46%) were treated with epinephrine. 4358 presented to TGH ER from April 1, 2018, to March 31, 2022, with an ICD-10 diagnosis code of anaphylaxis or allergic reaction. Only 718 received epinephrine in the ER. 867 patients presented 1 year prior to March 1, 2020 (before vaccine availability) and 1,833 patients presented 1 year after April 1, 2021 (after vaccine availability). ConclusionsOnly 16% of patients received epinephrine by survey and ER data capture. After COVID vaccine availability there were more ER visits for anaphylaxis among patients seen in a tertiary care teaching hospital.

Risperidone Induced DRESS Syndrome: A case report

IntroductionDRESS (Drug Reaction with Eoshinophilia and Systemic Symptoms) syndrome, also called DIHS (Drug-Induced Hypersensitivity Syndrome) is a rare drug-induced systemic hypersensitivity reaction that can be potentially life-threatening (Choudhary et al. J Clin Aesthet Dermatol 2013; 6 -7). Risperidone is an antipsychotic drug with significant antagonist activity at the 5-HT2 and the D2 receptors. It has been reported that risperidone may be effective in controlling agitation, delusion, hallucination, and withdrawal behavior in geriatric patients (Yunusa &amp; El Helou. Front Pharmacol 2020;11:596).Objectives The aim of this study is to demonstrate the case of developed DRESS syndrome following the use of risperidone.Methods The 81-year-old female patient was admitted to the Dermatology Clinic due to skin rash, high fever and leukocytosis following the use of risperidone. The patient was consulted to Psychiatry.Results In her history it was determined that risperidone 0.5 mg/d was started to the patient with depression due to agitative symptom. On the 4th day of treatment, targeoid lesions, starting from the back and spreading first to the trunk and then to the extremities, were observed. Further laboratory examinations revealed that the fever was measured at 39.5 C°, liver enzymes were elevated (ALT= 119 IU/ lt, AST= 124 IU /lt), and significant leukocytosis (WBC =12.000) was present along with the lesions. The patient was planned to be hospitalized to Dermatology Clinic on the 5th day and risperidone was stopped. The patient’s agitation increased and following the risperidone discontinuation thereupon the lesions tended to fade and desquamation began. After the treatment of the DRESS syndrome, aripiprazole was given to the patient for agitative symptom. The level of agitation symptoms decreased, and the patient tolerated aripiprazole well without any observed side effects.Image:ConclusionsWhen initiating medication for the elderly population to address agitation, considering such rare side effects can prevent the patient from being hospitalized due to DRESS syndrome. To the best of our knowledge, this is the first case report associated with DRESS syndrome and risperidone treatment thus, it is necessary to be very careful when starting psychotropic medication for elderly patients.Disclosure of InterestNone Declared

Death Due to Furosemide Anaphylaxis and The Importance of Serum Tryptase Level in Diagnosing Anaphylaxis: A Case Report

Anaphylaxis is a severe systemic hypersensitivity reaction with a sudden onset and may result in death. In this study, we report the case of a 71-year-old female patient who died within seconds after the administration of intravenous furosemide in emergency service; she had high serum tryptase levels at postmortem examination and nonspecific findings at autopsy, and death due to anaphylaxis was reported. With this study, we wanted to point to the rare and potentially fatal drug anaphylaxis, such as furosemide anaphylaxis. Also, our results indicate the importance of serum tryptase levels in the diagnosis of death due to anaphylaxis.

Lessons Learned From Ocular Graft versus Host Disease: An Ocular Surface Inflammatory Disease of Known Time of Onset.

The ocular surface inflammatory disorders (OSIDs) comprise a group of conditions characterized by persistent inflammation of the ocular surface and adnexal tissues. Systemic autoimmune diseases and hypersensitivity reactions cause them, and, if left untreated, can result in severe inflammatory dry eye, corneal damage, and vision loss. Ocular graft-versus-host disease (oGVHD) forms part of the ocular surface inflammatory disease umbrella. It is a condition occurring after allogeneic hematopoietic stem cell or bone marrow transplantation, usually in chronic graft-versus-host disease. oGVHD can virtually affect any ocular adnexal tissue, especially the meibomian glands, and cause persistent inflammation, tissue fibrosis, and subsequent chronic, severe dry eye disease. Among the OSIDs, oGVHD has the particularity that it has a "time zero," meaning we know when the disease started. As such, preclinical models have leveraged this to investigate the molecular mechanisms involved in the damage oGVHD causes to the ocular surface. In oGVHD, establishing a "time zero" allows for predicting the clinical course and establishing adequate treatment. This is also possible because the inflammatory infiltration occurs in ocular surface tissues, which are readily accessible. Using oGVHD, we might be able to understand the immune response mechanisms in other OSIDs better (i.e., Sjögren syndrome, Stevens-Johnson syndrome, among others). This review presents an up-to-date overview of the pathogenesis, clinical presentation, and treatment of oGVHD. In addition, we will discuss the value of the "time zero" concept in the study of oGVHD.

NButGT Reinforces the Beneficial Effects of Epinephrine on Cardiac Mitochondrial Respiration, Lactatemia and Cardiac Output in Experimental Anaphylactic Shock.

Anaphylactic shock (AS) is the most severe form of acute systemic hypersensitivity reaction. Although epinephrine can restore patients' hemodynamics, it might also be harmful, supporting the need for adjuvant treatment. We therefore investigated whether NButGT, enhancing O-GlcNAcylation and showing beneficial effects in acute heart failure might improve AS therapy. Ovalbumin-sensitized rats were randomly allocated to six groups: control (CON), shock (AS), shock treated with NButGT alone before (AS+pre-Nbut) or after (AS+post-Nbut) AS onset, shock treated with epinephrine alone (AS+EPI) and shock group treated with combination of epinephrine and NButGT (AS+EPI+preNBut). Induction of shock was performed with an intravenous (IV) ovalbumin. Cardiac protein and cycling enzymes O-GlcNAcylation levels, mean arterial pressure (MAP), heart rate, cardiac output (CO), left ventricle shortening fraction (LVSF), mitochondrial respiration, and lactatemia were evaluated using Western blotting experiments, invasive arterial monitoring, echocardiography, mitochondrial oximetry and arterial blood samples. AS decreased MAP (-77%, p < 0.001), CO (-90%, p < 0.001) and LVSF (-30%, p < 0.05). Epinephrine improved these parameters and, in particular, rats did not die in 15 min. But, cardiac mitochondrial respiration remained impaired (complexes I + II -29%, p < 0.05 and II -40%, p < 0.001) with hyperlactatemia. NButGT pretreatment (AS+pre-Nbut) efficiently increased cardiac O-GlcNAcylation level as compared to the AS+post-Nbut group. Compared to epinephrine alone, the adjunction of NButGT significantly improved CO, LVSF and mitochondrial respiration. MAP was not significantly increased but lactatemia decreased more markedly. Pretreatment with NButGT increases O-GlcNAcylation of cardiac proteins and has an additive effect on epinephrine, improving cardiac output and mitochondrial respiration and decreasing blood lactate levels. This new therapy might be useful when the risk of AS cannot be avoided.

Features of the clinical course and treatment of anaphylaxis in children in the Ryazan region according to survey data

Anaphylaxis is a life-threatening systemic hypersensitivity reaction with the rapid development of critical changes in hemodynamics and /or disorders of the respiratory system, which can lead to death. Despite the trend towards the spread of anaphylaxis among children, there are difficulties in monitoring statistical data, since there is no generally accepted cipher “Anaphylaxis” in the ICD-10, and designations from allergic urticaria to anaphylactic shock appear as a diagnosis. Epidemiological studies on anaphylaxis in the Russian Federation are isolated, so the assessment of data from each region is relevant.Objective: to study the clinical features and medical care for anaphylaxis in children of the Ryazan region in real clinical practice.Materials and methods: A retrospective analysis of medical documentation was carried out in 300 children who had suffered an “acute allergic reaction” over the past 5 years, followed by a telephone survey of patients’ parents about the disease, and based on the clinical criteria for the diagnosis of anaphylaxis presented by the World Organization of Allergists (WAO) in 2020 and in the Federal Clinical Guidelines for the Diagnosis and Treatment of anaphylaxis, 57 patients were selected for anaphylactic shock of the Russian Federation in 2022, whose data were compared in a spreadsheet and analyzed using SPSS V24.0, including descriptive statistics.Results: It was revealed that the average age of first—time anaphylaxis is 3.5 years. Clinical manifestations from the skin and mucous membranes were present in 67.2 % of patients, symptoms from the respiratory system in 11.8 % of cases. The leading trigger for the occurrence of anaphylaxis in children is the nutritional factor (n = 27 (40 %), (χ2 = 4.56; p = 0.033)). In 29 % of cases, the causally significant allergen remained unknown. The most common drugs in the treatment of anaphylaxis in real clinical practice were glucocorticosteroids (n = 48 (84.2 %)) and antihistamines of the first and second generation (n = 47 (82.5 %)). The frequency of epinephrine use was only 3 cases (5 %).Conclusion: The epidemiological study of anaphylaxis in the Ryazan region was a pilot project for our region. It showed difficulties both in the organization and in the interpretation of the data obtained. According to preliminary results, food allergy is a frequent trigger of anaphylaxis in children of the Ryazan region. Regional studies of anaphylaxis in children in real clinical practice make it possible to identify not only the features of this urgent pathology, but also to note the problems of providing primary medical care in order to improve it. Further study of population models of anaphylaxis, apparently, should be based on the creation of a unified questionnaire of the pediatric community, following the example of the ISAAC questionnaires or the creation of registers, which will more accurately help determine the true prevalence of anaphylaxis, determine the need to identify anaphylactogenic relevant molecules in the pediatric population, and improve the provision of assistance to children with these conditions.

Colon polyps with or without Schistosoma japonicum.

Schistosoma japonicum, which has been endemic for a long time, associated colon abnormality has also been sporadically reported. The majority of patients with Schistosomiasis japonicum infected may mainly presented as acute manifestation or become chronic complication, known as schistosomiasis liver change, intestinal tract lesions and other system involved. Interestingly, both states could be observed in this patient. Acute infection presented as systemic hypersensitivity reaction, characterized by elevated eosinophils and intestinal symptom.

Ciprofloxacin Ophthalmic DRESS Syndrome: Case Report

Introduction: Drug rash with eosinophilia and systemic symptoms (DRESS syndrome), also known as drug-induced hypersensitivity syndrome, is a rare severe systemic hypersensitivity drug reaction. Diagnosing DRESS syndrome is challenging due to non-specific manifestations that can make it difficult to recognize. Therefore, addressing and discussing this issue is extremely important, considering the potential lethality of a treatable syndrome. Clinical case: We describe the clinical characteristics of a 39-year-old female who presented with DRESS syndrome associated with the use of ciprofloxacin ophthalmic. The patient manifested a mild maculopapular rash located in the pelvic limbs with subsequent ascending distribution and generalized erythematoviolaceous affecting four extremities, trunk, facial region and scalp, together with fever and lymphadenopathy. Paraclinical tests revealed leukocytosis and eosinophilia. According to RegiScar's ranking, it scored 6 points, classifying it as the definitive case for DRESS. He concluded a schedule with prednisone 1 mg/kg/day with a slow reduction dose, obtaining a good response to treatment. Conclusions: DRESS syndrome should be suspected in a patient receiving medical treatment who presents with the following signs and symptoms: rash, fever (38°C), facial edema, and lymphadenopathy. Fortunately, this reaction is usually reversible, with a low incidence of residual damage or mortality, in the case of timely discontinuation of antibiotics and use of topical or systemic corticosteroids.

Hypersensitivity to glucagon‐like peptide‐1 receptor agonists: A case of delayed urticaria‐like rash to dulaglutide and literature review

AbstractDulaglutide is a glucagon‐like peptide‐1 (GLP‐1) receptor agonist, which stimulates insulin release via activation of GLP‐1 receptors on pancreatic beta cells. We report the case of a 45‐year‐old woman with type 2 diabetes mellitus who started dulaglutide subcutaneously and developed, a few minutes after the fourth administration, a persistent itchy reaction at the injection site, followed, after two more administrations, by a diffuse itchy delayed urticaria‐like rash, healed in 7 days after drug interruption. Skin test performed after 3 months from the event demonstrated the culprit role of the drug. Given the limited evidence in literature, there is currently no standardised protocol for testing patients sensitised to one or more glucagon‐like peptide‐1 receptor agonists. Performing skin tests, especially intradermal tests, is pivotal to confirm the aetiological role of the drug in the suspected hypersensitivity reaction, and possibly to identify an alternative to be proposed before precluding the entire drug class. To the best of our knowledge, this is the first case of systemic hypersensitivity reaction to dulaglutide presenting as a delayed urticaria‐like rash and confirmed by positive skin test.

Why drug exposure is frequently associated with T-cell mediated cutaneous hypersensitivity reactions.

Cutaneous hypersensitivity reactions represent the most common manifestation of drug allergy seen in the clinic, with 25% of all adverse drug reactions appearing in the skin. The severity of cutaneous eruptions can vastly differ depending on the cellular mechanisms involved from a minor, self-resolving maculopapular rash to major, life-threatening pathologies such as the T-cell mediated bullous eruptions, i.e., Stevens Johnson syndrome/toxic epidermal necrolysis. It remains a significant question as to why these reactions are so frequently associated with the skin and what factors polarise these reactions towards more serious disease states. The barrier function which the skin performs means it is constantly subject to a barrage of danger signals, creating an environment that favors elicitation. Therefore, a critical question is what drives the expansion of cutaneous lymphocyte antigen positive, skin homing, T-cell sub-populations in draining lymph nodes. One answer could be the heterologous immunity hypothesis whereby tissue resident memory T-cells that express T-cell receptors (TCRs) for pathogen derived antigens cross-react with drug antigen. A significant amount of research has been conducted on skin immunity in the context of contact allergy and the role of tissue specific antigen presenting cells in presenting drug antigen to T-cells, but it is unclear how this relates to epitopes derived from circulation. Studies have shown that the skin is a metabolically active organ, capable of generating reactive drug metabolites. However, we know that drug antigens are displayed systemically so what factors permit tolerance in one part of the body, but reactivity in the skin. Most adverse drug reactions are mild, and skin eruptions tend to be visible to the patient, whereas minor organ injury such as transient transaminase elevation is often not apparent. Systemic hypersensitivity reactions tend to have early cutaneous manifestations, the progression of which is halted by early diagnosis and treatment. It is apparent that the preference for cutaneous involvement of drug hypersensitivity reactions is multi-faceted, therefore this review aims to abridge the findings from literature on the current state of the field and provide insight into the cellular and metabolic mechanisms which may contribute to severe cutaneous adverse reactions.

Simulation Training in Teaching Pediatricians the Skills of Providing Emergency Care for Anaphylaxis Using the ABCDE Algorithm

Anaphylaxis is the most severe, potentially life-threatening systemic hypersensitivity reaction, which in children ranges from 10.5 to 70 cases per 100,000 person-years, with the highest incidence at the age of 5-17 years. As before, late diagnosis remains in pediatrics — in 50% of cases, the diagnosis of anaphylaxis is not actually made, which makes it necessary to develop skills in diagnosis and treatment tactics. The results of the training on one of the life-threatening conditions on the basis of the Multidisciplinary Simulation Center of the Tyumen State Medical University for five years are described.

Mast Cells and Basophils in IgE-Independent Anaphylaxis.

Anaphylaxis is a life-threatening or even fatal systemic hypersensitivity reaction. The incidence of anaphylaxis has risen at an alarming rate in the past decades in the majority of countries. Generally, the most common causes of severe or fatal anaphylaxis are medication, foods and Hymenoptera venoms. Anaphylactic reactions are characterized by the activation of mast cells and basophils and the release of mediators. These cells express a variety of receptors that enable them to respond to a wide range of stimulants. Most studies of anaphylaxis focus on IgE-dependent reactions. The mast cell has long been regarded as the main effector cell involved in IgE-mediated anaphylaxis. This paper reviews IgE-independent anaphylaxis, with special emphasis on mast cells, basophils, anaphylactic mediators, risk factors, triggers, and management.

Anaphylaxis management in a French pediatric emergency department: Lessons from the ANA-PED study.

Anaphylaxis is a serious systemic hypersensitivity reaction that requires immediate recognition and prompt administration of epinephrine/adrenaline. The present study aimed to assess the appropriateness of epinephrine/adrenaline use in children identified as allergic by physicians in the emergency department (ED) at the time of the reaction, and to identify factors that are possibly associated with epinephrine/adrenaline administration, auto-injector prescription, and further referral to an allergist. We performed a retrospective cross-sectional study at the pediatric ED of the University Hospital of Montpellier, France. We included all consecutive children who attended the ED between 2016 and 2020 with an allergy-related diagnosis at discharge. We included 1056 allergy-related visits, including 224 (21.2%) with a diagnosis of anaphylaxis at discharge; only 17.0% of them received an epinephrine/adrenaline injection, and 57.1% consulted an allergist after the acute episode. An auto-injector was prescribed to 63 (28.1%) patients at discharge from the ED. Besides the severity of the clinical presentation, factors associated with a guidelines-based management of the anaphylactic reaction and with an increased administration rate of epinephrine/adrenaline included presence of asthma symptoms and presence of extended skin reactions. Our study underlines persistent gaps in the management of pediatric anaphylaxis in ED, focusing on hereby identified levers. By disseminating current knowledge and guidelines on anaphylaxis and allergies, specialists could work together with emergency physicians to establish effective management algorithms and improve anaphylaxis management and care pathways for children experiencing allergic reactions, especially anaphylaxis. Clinical Trials, number NCT05112367.

Host Resistance to Virus Diseases Provides a Key Enabler towards Fast Tracking Gains in Grain Lupin Breeding.

Four lupin species, Lupinus angustifolius, L. albus, L. luteus, and L. mutabilis, are grown as cool-season grain legume crops. Fifteen viruses infect them. Two of these, bean yellow mosaic virus (BYMV) and cucumber mosaic virus (CMV), cause diseases that threaten grain lupin production. Phytosanitary and cultural control measures are mainly used to manage them. However, breeding virus-resistant lupin cultivars provides an additional management approach. The need to develop this approach stimulated a search for virus resistance sources amongst cultivated lupin species and their wild relatives. This review focuses on the progress made in optimizing virus resistance screening procedures, identifying host resistances to BYMV, CMV, and additional viral pathogen alfalfa mosaic virus (AMV), and the inclusion of BYMV and CMV resistance within lupin breeding programs. The resistance types found in different combinations of virus and grain lupin species include localized hypersensitivity, systemic hypersensitivity, extreme resistance, and partial resistance to aphid or seed transmission. These resistances provide a key enabler towards fast tracking gains in grain lupin breeding. Where studied, their inheritance depended upon single dominant genes or was polygenic. Although transgenic virus resistance was incorporated into L. angustifolius and L. luteus successfully, it proved unstable. Priorities for future research are discussed.