ALERGOLOGÍA PARA MÉDICOS Y PACIENTES 2021

 Food allergies and food-induced anaphylaxis: Role of cofactors Authors: Meeyong Shin   Abstract Food allergies and food-induced anaphylaxis are important health problems. Several cofactors modulating the onset of anaphylaxis have been identified. In the presence of cofactors, allergic reactions may be induced at lower doses of food allergens and/or become severe. Exercise and concomitant infections are well-documented cofactors of anaphylaxis in children. Other factors such as consumption of nonsteroidal anti-inflammatory drugs, alcohol ingestion, and stress have been reported. Cofactors reportedly play a role in approximately 30% of anaphylactic reactions in adults and 14-18.3% in children. Food-dependent exercise-induced anaphylaxis (FDEIA) is the best-studied model of cofactor-induced anaphylaxis. Wheat-dependent exercise-induced anaphylaxis, the most common FDEIA condition, has been studied the most. The mechanisms of action of cofactors have not yet been fully identified. This re

 Omalizumab Updosing in Chronic Spontaneous Urticaria: an Overview of Real-World Evidence Authors: Martin Metz, Zahava Vadasz, Emek Kocatürk & Ana M. Giménez-Arnau Abstract Chronic spontaneous urticaria (CSU) is defined as the spontaneous development of itchy hives and/or angioedema due to known or unknown causes that last for at least 6 weeks. At any given time, CSU is believed to affect 0.5–1% of the global population. Omalizumab (a recombinant, humanized anti-immunoglobulin-E antibody) is the only approved treatment for antihistamine refractory CSU. However, ~ 30% of patients remain symptomatic at licensed doses of omalizumab 150 mg and 300 mg, even after a treatment period of over 6 months. In the recent years, there have been several studies on updosing of the drug, suggesting that the individualized approach for urticaria treatment with omalizumab is useful. In this article, we provide an overview of these studies and the real-world data on omalizumab updosing as it became ne

 Rhinitis Phenotypes Authors: Joaquim MullolMD, PhDabAlfonsodel CuvilloMD, PhDcRichard F.LockeyMDd Abstract Rhinitis is an umbrella term of a group of upper airway diseases with nasal symptoms and signs with different etiologies and various clinical features or traits. It can be classified into different “phenotypes,” based on these observable traits. A proper differential diagnosis is necessary to adequately manage the disease. The objective of this review is to clarify the concept of rhinitis phenotypes while analyzing the clinical features and/or traits of each in order to determine a proper differential diagnosis and appropriate treatment. 10.1016/j.jaip.2020.02.004

 Progress in understanding hypersensitivity reactions to nonsteroidal anti-inflammatory drugs Authors: Inmaculada Doña  1   2 , Natalia Pérez-Sánchez  1   2   3 , Ibon Eguiluz-Gracia  1   2 , Rosa Muñoz-Cano  4   5 , Joan Bartra  4   5 , María José Torres  1   2   3   6 , José Antonio Cornejo-García  1 Abstract Nonsteroidal anti-inflammatory drugs (NSAIDs), the medications most commonly used for treating pain and inflammation, are the main triggers of drug hypersensitivity reactions. The latest classification of NSAIDs hypersensitivity by the European Academy of Allergy and Clinical Immunology (EAACI) differentiates between cross-hypersensitivity reactions (CRs), associated with COX-1 inhibition, and selective reactions, associated with immunological mechanisms. Three phenotypes fill into the first group: NSAIDs-exacerbated respiratory disease, NSAIDs-exacerbated cutaneous disease and NSAIDs-induced urticaria/angioedema. Two phenotypes fill into the second one: single-NSAID-induced ur

 A butterfly flaps its wings: Extinction of biological experience and the origins of allergy Authors: Susan L.PrescottMD, PhD, FRACP∗† Abstract Objective To explore links between biodiversity on all scales and allergic disease as a measure of immune dysregulation. Data Sources PubMed and Web of Science were searched using the keywords biodiversity, nature relatedness, allergic disease, microbiome, noncommunicable diseases, coronavirus disease 2019, and associated terms. Study Selections Studies were selected based on relevance to human health and biodiversity. Results Contact with natural environments enriches the human microbiome, promotes regulated immune responses, and protects against allergy and both acute and chronic inflammatory disorders. These important links to ecopsychological constructs of the extinction of experience, which indicates that loss of direct, personal contact with biodiversity (wildlife and the more visible elements of the natural world), might lead to emotiona

 Clinical Control of CSU with Antihistamines Allows for Tolerance of NSAID-Exacerbated Cutaneous Disease Authors: Jorge Sánchez  1 , Susana Diez  2 , Ricardo Cardona  2 Abstract Background: Many patients with chronic spontaneous urticaria (CSU) experience exacerbations after the administration of nonsteroidal anti-inflammatory drugs (NSAIDs), with clinical implications for the selection of therapeutic options for pain management. Case reports suggest that antihistamines could prevent these reactions. Objective: To determine whether antihistamines can prevent NSAID-exacerbated reactions in patients with CSU. Methods: Data on 121 patients with CSU and a history of NSAID exacerbations were evaluated. Two types of challenge with NSAIDs were performed using the NSAIDs reported in the medical record (a diagnostic challenge test without the use of antihistamines and a challenge test using antihistamines). The order in which the tests were performed in each patient was dependent on the treatin

 Neuromuscular blocking agents induced anaphylaxis: Results and trends of a French pharmacovigilance survey from 2000 to 2012 Authors: N Petitpain  1 , L Argoullon  1 , K Masmoudi  2 , S Fedrizzi  3 , J Cottin  4 , C Latarche  5 , P M Mertes  6 , P Gillet  7 , French Network of Regional Pharmacovigilance Centres Abstract Background: Perioperative anaphylaxis mainly involves neuromuscular blocking agents (NMBAs) with an IgE-mediated mechanism. In France, this life-threatening condition is reported by anesthetists and allergologists, and two safety alerts concerning suxamethonium were raised in 2011 and 2012. This led to start a national survey over the 2000-2012 period which objectives were to provide a descriptive analysis, to estimate incidence rates, and to analyze the trends over this period. Methods: The French pharmacovigilance database was retrospectively queried for all the available NMBAs. Anaphylaxis cases with elevated tryptase and positive skin tests were qualified as "

 Delayed Pressure Urticaria: A Systematic Review of Treatment Options Authors: Kanokvalai Kulthanan  1 , Patompong Ungprasert  2 , Papapit Tuchinda  1 , Leena Chularojanamontri  1 , Norramon Charoenpipatsin  1 , Marcus Maurer  3 Abstract Background: Delayed pressure urticaria (DPU) is characterized by recurrent erythematous and often painful swelling after the skin is exposed to sustained pressure. Treatment is challenging. Antihistamines, the first-line and only approved treatment, are often not effective. Objective: To systematically review the treatment options for DPU. Method: A literature search of electronic databases for all relevant articles published till April 29, 2019, was conducted using the search terms "delayed pressure urticaria" and "pressure urticaria." This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Results: Twenty-one studies (8 randomized controlled tr

 Clinical and in vitro cross-reactivity of cereal grains in children with IgE-mediated wheat allergy Authors: Witchaya Srisuwatchari  1 , Surapon Piboonpocanun  2 , Unchalee Wangthan  1 , Orathai Jirapongsananuruk  1 , Nualanong Visitsunthorn  1 , Punchama Pacharn  3 Abstract Introduction and objectives: Wheat and cereal grains have a broad range of cross-reactivity, but the clinical relevance of this cross-reactivity is uncertain. This study aimed to evaluate clinical and in vitro cross-reactivity with barley, oat, and Job's tears among wheat-allergic patients. Materials and methods: Patients aged 5 to 15 years with IgE-mediated wheat allergy were enrolled. Skin prick test (SPT) and specific IgE (sIgE) to wheat, barley, and oat, and SPT to Job's tears were performed. Oral food challenge (OFC) was conducted if the SPT was ≤5 mm in size and there was no history of anaphylaxis to each grain. Profiles of sIgE bound allergens of wheat, barley, and oat, and inhibition ELISA of IgE b

 Age at introduction to complementary solid food and food allergy and sensitization: A systematic review and meta-analysis Authors: John A Burgess  1 , Shyamali C Dharmage  1   2 , Katrina Allen  2   3 , Jennifer Koplin  2 , Vanessa Garcia-Larsen  4 , Robert Boyle  5 , Nilakshi Waidyatillake  1 , Caroline J Lodge  1 Abstract Background and objective: An infant's age at introduction of complementary solids may contribute to food allergy. We aimed to synthesize the literature on the association between age at introduction of complementary solids, excluding milk products, and food allergy and sensitization. Design: We searched the electronic databases PubMed and EMBASE (January 1946-February 2017) using solid food, allergy and sensitization terms. Methods: Two authors selected papers according to inclusion criteria, identifying 16 cohort studies, 1 case-control study and 8 randomized controlled trials (RCTs). Pooled effects across studies were estimated using random-effects meta-anal

 Peptic Ulcer Disease is Associated with Increased Risk of Chronic Urticaria Independent of Helicobacter pylori Infection: A Population-Based Cohort Study Authors: Chun-Ming Chen  1   2 , Wan-Ting Huang  3 , Li-Jen Chang  4 , Chih-Cheng Hsu  5   6 , Yueh-Han Hsu   Abstract Background: Some studies showed patients with chronic urticaria have a higher rate of peptic ulcer disease (PUD). Whether PUD is a risk factor for chronic urticaria is unclear. Objective: The objective of this study was to evaluate the incidence of and risk factors for chronic urticaria in patients with PUD using the Taiwan National Health Insurance Research Database. Methods: We conducted a retrospective nationwide cohort study of the period 2000-2012 and involving 11,901 patients with PUD who underwent Helicobacter pylori (HP) therapy (PUD + HP group) and an equal number of matched patients without HP infection (PUD - HP group). Furthermore, we enrolled 23,802 patients without PUD for comparison (non-PUD group). Th

 Paracetamol exposure in pregnancy and early childhood and development of childhood asthma: a systematic review and meta-analysis Authors: M Cheelo  1 , C J Lodge  1 , S C Dharmage  2 , J A Simpson  3 , M Matheson  1 , J Heinrich  4 , A J Lowe  2 Affiliations  expand Abstract Background and objective: While paracetamol exposure in pregnancy and early infancy has been associated with asthma, it remains unclear whether this is confounded by respiratory tract infections, which have been suggested as an alternative explanation. We undertook a systematic review and meta-analysis of longitudinal studies that reported the association between paracetamol exposure during pregnancy or infancy and the subsequent development of childhood asthma (≥5 years). Methods: Two independent researchers searched the databases EMBASE and PUBMED on 12 August 2013 for relevant articles using predefined inclusion and exclusion criteria. Study quality was assessed and results were pooled using fixed effect models

 Global Trends in Anaphylaxis Epidemiology and Clinical Implications Authors: Paul J Turner  1 , Dianne E Campbell  2 , Megan S Motosue  3 , Ronna L Campbell  4 Abstract The true global scale of anaphylaxis remains elusive, because many episodes occur in the community without presentation to health care facilities, and most regions have not yet developed reliable systems with which to monitor severe allergic events. The most robust data sets currently available are based largely on hospital admissions, which are limited by inherent issues of misdiagnosis, misclassification, and generalizability. Despite this, there is convincing evidence of a global increase in rates of all-cause anaphylaxis, driven largely by medication- and food-related anaphylaxis. There is no evidence of parallel increases in global all-cause anaphylaxis mortality, with surprisingly similar estimates for case-fatality rates at approximately 0.5% to 1% of fatal outcomes for hospitalizations due to anaphylaxis across

 Cyclosporine for Chronic Spontaneous Urticaria: A Meta-Analysis and Systematic Review Authors: Kanokvalai Kulthanan  1 , Pichanee Chaweekulrat  1 , Chulaluk Komoltri  2 , Saowalak Hunnangkul  2 , Papapit Tuchinda  3 , Leena Chularojanamontri  1 , Marcus Maurer  4 Abstract Background: Despite widely recommended usage of cyclosporine A (CsA) in chronic spontaneous urticaria (CSU), there is no meta-analysis concerning its efficacy and safety. Objective: To meta-analyze and review the efficacy and safety of CsA in CSU. Methods: Efficacy was assessed by the relative change in urticaria activity score at 4 weeks and response rates at 4, 8, and 12 weeks. Safety was assessed by analyzing the number of patients with 1 or more adverse event. Results: Eighteen studies (909 participants) including 2 randomized controlled trials were included, with 125, 363, and 266 patients with CSU receiving very low (<2 mg/kg/d), low (from 2 to< 4 mg/kg/d), and moderate (4-5 mg/kg/d) doses of CsA, respect

 Chronic urticaria and thyroid pathology Authors: Sandra Nora Gonzalez-Diaz,a Mario Sanchez-Borges,b Diana Maria Rangel-Gonzalez,a,∗ Rosa Ivett Guzman-Avilan,a Jose Ignacio Canseco-Villarreal,a and Alfredo Arias-Cruza Abstract Urticaria is defined as the sudden appearance of erythematous, itchy wheals of variable size, with or without angioedema (AE) (swelling of the deeper layers of the skin). Its classification depends on time course of symptoms and the presence of eliciting factors. When it lasts less than 6 weeks it is classified as acute urticaria (AU), and if the symptoms persist for more than 6 weeks, it is classified as chronic urticaria (CU). Current International Guidelines also classify CU as chronic spontaneous urticaria (CSU) and inducible urticarial, according to the absence or presence of environmental triggering factors. CSU is defined as urticaria and/or angioedema in which there is no evidence of a specific eliciting factor. CSU is associated with autoimmunity in 30–4

 Drug allergy in children and adults: Is it the double X chromosome? Authors: Allison Eaddy Norton  1 , Ana Dioun Broyles  2 Abstract Objective: This article reviews the latest science and epidemiologic studies related to drug allergy in children and adults to explore possible mechanisms related to female propensity for drug allergy. Data sources: PubMed literature review, focusing primarily on the last 5 years. Study selections: Articles reviewing the science behind female predisposition to atopic and asthmatic conditions and epidemiologic studies reviewing drug allergy and drug-induced anaphylaxis. Results: Despite adult female predilection for atopic conditions, few laboratory studies explore sex-specific mechanisms in atopic/allergic diseases, and most are focused on autoimmunity and asthma. Drug allergy is more frequently reported in adult females compared with adult males. Adult females are also more likely to have drug-induced anaphylaxis (DIA), although no clear sex predominanc

 Epicutaneous sensitization in the development of food allergy: What is the evidence and how can this be prevented? Authors: Helen A. Brough  Kari C. Nadeau  Sayantani B. Sindher  Shifaa S. Alkotob  Abstract There is increasing evidence regarding the importance of allergic sensitization through the skin. In this review, we provide an overview of the atopic march and immune mechanism underlying the sensitization and effector phase of food allergy. We present experimental models and human data that support the concept of epicutaneous sensitization and how this forms one half of the dual‐allergen exposure hypothesis. We discuss specific important elements in the skin (FLG and other skin barrier gene mutations, Langerhans cells, type 2 innate lymphoid cells, IL‐33, TSLP) that have important roles in the development of allergic responses as well as the body of evidence on environmental allergen exposure and how this can sensitize an individual. Given the link between skin barrier impairment

Ligelizumab for Chronic Spontaneous Urticaria Authors:  Marcus Maurer, M.D., Ana M. Giménez-Arnau, M.D., Ph.D., Gordon Sussman, M.D., Martin Metz, M.D., Diane R. Baker, M.D., Andrea Bauer, M.D., Jonathan A. Bernstein, M.D., Randolf Brehler, M.D., Chia-Yu Chu, M.D., Ph.D., Wen-Hung Chung, M.D., Inna Danilycheva, M.D., Clive Grattan, M.D., et al. Abstract BACKGROUND In the majority of patients with chronic spontaneous urticaria, most currently available therapies do not result in complete symptom control. Ligelizumab is a next-generation high-affinity humanized monoclonal anti-IgE antibody. Data are limited regarding the dose–response relationship of ligelizumab and the efficacy and safety of ligelizumab as compared with omalizumab and placebo in patients who have moderate-to-severe chronic spontaneous urticaria that is inadequately controlled with H1-antihistamines at approved or increased doses, alone or in combination with H2-antihistamines or leukotriene-receptor antagonists. METHODS

 EAACI position paper on how to classify cutaneous manifestations of drug hypersensitivity Authors: Knut Brockow  1 , Michael R Ardern-Jones  2   3 , Maja Mockenhaupt  4 , Werner Aberer  5 , Annick Barbaud  6 , Jean-Christoph Caubet  7 , Radoslaw Spiewak  8 , María José Torres  9 , Charlotte G Mortz  10 Abstract Drug hypersensitivity reactions (DHRs) are common, and the skin is by far the most frequently involved organ with a broad spectrum of reaction types. The diagnosis of cutaneous DHRs (CDHR) may be difficult because of multiple differential diagnoses. A correct classification is important for the correct diagnosis and management. With these guidelines, we aim to give precise definitions and provide the background needed for doctors to correctly classify CDHR. DOI 10.1111/all.13562

 Peanut Allergy: New Advances and Ongoing Controversies Auhtors: Elissa M Abrams  1 , Edmond S Chan  2 , Scott Sicherer  3 Abstract Peanut allergy is one of the most common food allergies in children, with increasing prevalence over time. The dual-allergen exposure hypothesis now supports transcutaneous sensitization to peanut as a likely pathophysiologic mechanism for peanut allergy development. As a result, there is emerging evidence that early peanut introduction has a role in peanut allergy prevention. Current first-line diagnostic tests for peanut allergy have limited specificity, which may be enhanced with emerging tools such as component-resolved diagnostics. Although management of peanut allergy includes avoidance and carrying an epinephrine autoinjector, risk of fatal anaphylaxis is extremely low, and there is minimal risk related to cutaneous or inhalational exposure. Quality of life in children with peanut allergy requires significant focus. Moving forward, oral and epicutan

 Therapeutic Strategy According to Differences in Response to Omalizumab in Patients With Chronic Spontaneous Urticaria Authors: A M Giménez Arnau  1 , A Valero Santiago  2 , J Bartra Tomás  3 , I Jáuregui Presa  4 , M Labrador Horrillo  5 , F J Miquel Miquel  6 , J Ortiz de Frutos  7 , J Sastre  8 , J F Silvestre Salvador  9 , M Ferrer Puga  10 Abstract Chronic spontaneous urticaria (CSU) is a heterogeneous condition that can severely impact quality of life. Consequently, rapid disease control is essential. First-line treatment of the symptoms of CSU is the licensed dose of second-generation H1 antihistamines. For second-line treatment, this dose may be increased by up to 4 times. In patients who fail to respond to higher doses of H1 antihistamines, omalizumab for up to 24 weeks is recommended to achieve disease control. After this 24-week period, the patient's response to omalizumab should be assessed in order to identify refractory patients. Optimal management of refractory pati

 Cross-reactivity in beta-lactams after a non-immediate cutaneous adverse reaction: experience of a reference centre for toxic bullous diseases and severe cutaneous adverse reactions Authors: V. Berot,1 G. Gener,1,2,† S. Ingen-Housz-Oro,1,2,3,† O. Gaudin,1,2 M. Paul,3,4 O. Chosidow,1,2,5 P. Wolkenstein,1,2,5, H. Assier1,2,* Abstract Background Cross-reactivity among beta-lactam antibiotics (BL) is essentially reported in immediate hypersensitivity. Objectives To evaluate cross-reactivity beyond BLs in patients with non-immediate cutaneous adverse drug reaction (non-immediate CADR) managed in a dermatology reference centre of toxic bullous and severe CADRs. Patients/Materials/Methods We conducted a retrospective single-centre study in consecutive patients consulting between 2010 and 2018 with an active BL-suspected non-immediate CADR and explored by cutaneous tests [patch tests (PT) and intradermal tests (P-IDR)] for at least three penicillin’s subclasses and amino- and non-amino-cepha

 Granulomatosis eosinofílica con poliangitis (GEPA) Dra. Natalia Aguirre 

Atopic Dermatitis Is a Barrier Issue, Not an Allergy Issue Authors: Monica T Kraft  1 , Benjamin T Prince  2 Abstract Atopic dermatitis (AD) is a chronic, relapsing disease that typically manifests in childhood and improves with age. Studies have demonstrated that the presence of AD increases the risk of developing food allergy, allergic rhinitis, and asthma later in life. Although children with AD are more likely to produce allergen-specific immunoglobulin E, there is conflicting evidence that allergen avoidance improves disease severity. Furthermore, food-elimination diets in patients with AD may increase the risk of developing immediate, life-threatening reactions to the removed food. The most effective treatments of AD aim to repair and protect the skin barrier and decrease inflammation. Keywords: Allergic rhinitis; Asthma; Atopic dermatitis; Atopic march; Eczema; Food allergy. DOI  10.1016/j.iac.2019.07.005

Pediatric Drug Allergies: Updates on Beta-Lactam, Nonsteroidal Anti-Inflammatory Drug, and Chemotherapeutic Reactions Authors: Shazia Lutfeali  1 , David A Khan  2 Abstract Adverse drug reactions are frequently reported in pediatric patients. In this review article, the authors discuss pediatric drug allergies with emphasis on the most common culprits, beta-lactam antibiotics and non-steroidal anti-inflammatory drugs. The authors also discuss reactions to non-beta-lactam antibiotics and chemotherapeutics. Skin testing has not yet been validated for many drugs, although notable exceptions include penicillin and carboplatin. The gold standard for diagnosis in most cases remains drug challenge, and the need for penicillin skin testing prior to oral provocation challenge has been questioned in recent studies. Successful desensitizations have also been reported with several drugs. Keywords: Beta lactam antibiotics; Chemotherapeutics; Hypersensitivity reactions; Non-beta lactam antibiotics;

 

Predictors of severe anaphylaxis in Hymenoptera venom allergy The importance of absence of urticaria and angioedema Authors: Maria Chapsa, MD Henriette Roensch, MSScMathias Langner, MScStefan Beissert, MDAndrea Bauer, MD Abstract Background Severe anaphylaxis (SA) in Hymenoptera venom allergy has been associated with a number of risk factors. However, the effect of several of those risk factors on the severity of anaphylaxis is poorly defined. Objective To evaluate risk factors for SA in Hymenoptera venom allergy. Methods We evaluated data from 500 patients who were referred to our department for the diagnosis of Hymenoptera venom allergy during a period of 11 years to identify risk factors for SA. Results Six significant risk factors for SA were identified ( P < .05): short interval from sting to reaction, absence of urticaria or angioedema (U/A) during anaphylaxis, older age, male sex, elevation of baseline serum tryptase (BST) level, and diagnosis of systemic mastocytosis. Moreov

 Spanish Guidelines for Diagnosis, Management, Treatment, and Prevention of DRESS Syndrome Authors: R Cabañas 1 2 3 4, E Ramírez 2 3 5, E Sendagorta 3 6, R Alamar 7, R Barranco 3 8 9, N Blanca-López 10, I Doña 11 12, J Fernández 13, I Garcia-Nunez 14, J García-Samaniego 15, R Lopez-Rico 16, E Marín-Serrano 17, C Mérida 18, M Moya 19, N R Ortega-Rodríguez 20, B Rivas Becerra 2 21, P Rojas-Perez-Ezquerra 3 22, M J Sánchez-González 3 23, C Vega-Cabrera 2 21, C Vila-Albelda 24, T Bellón 2 3 25 Abstract Background and objective: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft a re

Drug hypersensitivity in the fast lane: What clinicians should know about phenotypes, endotypes, and biomarkers Authors: Baruch D Jakubovic  1 , Leticia de Las Vecillas  2 , Teodorikez Wilfox Jimenez-Rodriguez  3 , Soledad Sanchez-Sanchez  4 , Mariana Castells  5 Abstract Objective: To review novel concepts in drug hypersensitivity and the management of immediate hypersensitivity reactions. Data sources: English language literature on MEDLINE and Embase surrounding drug hypersensitivity and desensitization. Study selections: References were selected based on relevance, date of publication, and originality. Results: There are numerous citations looking at categorizing drug reactions, pathogenesis, biomarkers, and desensitization. Current understanding supports the use of a phenotype-endotype-biomarker model for categorizing immediate hypersensitivity reactions. Drug desensitization is a powerful therapeutic strategy that enables temporary induction of tolerance to medication

Biomarkers and clinical characteristics of autoimmune chronic spontaneous urticaria: Results of the PURIST Study Authors: Nicole Schoepke  1 , Riccardo Asero  2 , André Ellrich  1 , Marta Ferrer  3 , Ana Gimenez-Arnau  4 , Clive E H Grattan  5 , Thilo Jakob  6   7 , George N Konstantinou  8 , Ulrike Raap  9 , Per Stahl Skov  10   11 , Petra Staubach  12 , Arno Kromminga  13   14 , Ke Zhang  15 , Carsten Bindslev-Jensen  16 , Alvaro Daschner  17 , Tamar Kinaciyan  18 , Edward F Knol  19 , Michael Makris  20 , Nadine Marrouche  21 , Peter Schmid-Grendelmeier  22   23 , Gordon Sussman  24 , Elias Toubi  25 , Martin K Church  1 , Marcus Maurer  1 Abstract Background: Autoimmune chronic spontaneous urticaria (aiCSU) is an important subtype of chronic spontaneous urticaria (CSU) in which functional IgG autoantibodies to IgE or its high-affinity receptor (FcεRI) induces mast cell degranulation and subsequent symptom development. However, it has not been tightly characterized. This stu

Hypersensitivities to sesame and other common edible seeds Authors: A. Patel  S. L. Bahna Abstract Several seeds have been increasingly incorporated in various food items, with consequent risk of hypersensitivity reactions that are often severe. Identification of the specific seed as the culprit is often not explored or is difficult to verify. In this article, we reviewed the English literature from January 1930 to March 2016 using PubMed and Google Scholar searching for publications relevant to hypersensitivity to common edible seeds, namely sesame, sunflower seed, poppy seed, pumpkin seed, flaxseed, and mustard seed. Considering the worldwide consumption of those seeds, the number of published articles on the subject was relatively small and was mainly as case reports rather than large series. Allergy to sesame was more reported than to other seeds, with an estimated prevalence of 0.1–0.2%. In this review, we summarize the information relevant to each of the six seeds and their

Risk and Management of Patients with Mastocytosis and MCAS in the SARS-CoV-2 (COVID-19) Pandemic: Expert Opinions  Authors: PeterValentM.D.1CemAkinM.D., Ph.D.2PatriziaBonadonnaM.D.3KnutBrockowM.D.4MarekNiedoszytkoM.D., Ph.D.5BoguslawNedoszytkoPh.D.6Joseph H.ButterfieldM.D.7IvanAlvarez-TwoseM.D., Ph.D.8KarlSotlarM.D.9JulianaSchwaabM.D.10MohamadJawharM.D.10AndreasReiterM.D.10MarianaCastellsM.D., Ph.D.11Wolfgang R.SperrM.D.1Hanneke C.Kluin-NelemansM.D., Ph.D.12OlivierHermineM.D., Ph.D.13JasonGotlibM.D., M.S.14RobertaZanottiM.D. Abstract The COVID-19 (SARS-CoV-2) pandemic has massively distorted our health care systems and caused catastrophic consequences in our affected communities. The number of victims continues to increase and patients at risk can only be protected to a degree, since the virulent state may be asymptomatic. Risk factors concerning COVID-19-induced morbidity and mortality include advanced age, an impaired immune system, cardiovascular or pulmonary diseases, obesity

Risk Factors Influencing Tolerance and Clinical Features of Food Protein-induced Allergic Proctocolitis Authors: Betul Buyuktiryaki  1 , Ilknur Kulhas Celik  1 , Semiha B Erdem  2 , Murat Capanoglu  3 , Ersoy Civelek  1 , Belgin Usta Guc  4 , Hakan Guvenir  1 , Murat Cakir  5 , Emine Dibek Misirlioglu  1 , Omer Akcal  2 , Burcu Volkan  3 , Muge Toyran  1 , Elif Sag  5 , Alev C Kertel  3 , Tayfur Ginis  1 , Can N Kocabas  6 , Fazıl Orhan  5 , Demet Can  2   7 Abstract Objective: Continued progress in our understanding of the food protein-induced allergic proctocolitis (FPIAP) will provide the development of diagnostic tests and treatments. We aimed to identify precisely the clinical features and natural course of the disease in a large group of patients. Also, we investigated the predicting risk factors for persistent course since influencing parameters has not yet been established. Methods: Infants who were admitted with rectal bleeding and had a diagnosis of food protein-in

Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis Authors: Derek K Chu, Elie A Akl, Stephanie Duda, Karla Solo, Sally Yaacoub, Holger J Schünemann, on behalf of the COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors* Summary Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person- to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. Methods We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to- person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respirato

Macrolide Allergic Reactions Authors: Kristy M Shaeer  1 , Elias B Chahine  2 , Sheeba Varghese Gupta  3 , Jonathan C Cho  4 Abstract Macrolides are antimicrobial agents that can be used to treat a variety of infections. Allergic reactions to macrolides occur infrequently but can include minor to severe cutaneous reactions as well as systemic life-threatening reactions such as anaphylaxis. Most reports of allergic reactions occurred in patients without prior exposure to a macrolide. Cross-reactivity among macrolides may occur due to the similarities in their chemical structures; however, some published literature indicates that some patients can tolerate a different macrolide. Most published reports detailed an allergic reaction to erythromycin. Desensitization protocols to clarithromycin and azithromycin have been described in the literature. The purpose of this article is to summarize macrolide-associated allergic reactions reported in published literature. An extensive lite

Hypersensitivity Reactions to Food Additives Authors: Guillermo Velázquez-Sámano 1, Rodrigo Collado-Chagoya, Rubén Alejandro Cruz-Pantoja, Andrea Aída Velasco-Medina, Juan Rosales-Guevara Abstract  Food additives are ingredients that are intentionally added to food in order to modify its physical, chemical, biological, or sensorial characteristics. Food additives may act as allergens and generate IgE-mediated immune reactions, or they may act as pseudo allergens and generate non-IgE-mediated immune reactions. Such reactions can generate diverse clinical pictures or they may exacerbate diseases as diverse as eosinophilic esophagitis, bronchial asthma, atopic dermatitis, contact dermatitis, chronic urticaria, or anaphylaxis. Thousands of food additives are being used daily in industrialized countries and, although their use has been globalized, there is not much science information about their adverse effects; especially about their hypersensitivity reactions that, despite being

Clinical Characteristics of 182 Pediatric COVID-19 Patients With Different Severities and Allergic Status Authors; Hui Du 1, Xiang Dong 2, Jin-Jin Zhang 2, Yi-Yuan Cao 3, Mubeccel Akdis 4, Pei-Qi Huang 1, Hong-Wei Chen 1, Ying Li 1, Guang-Hui Liu 2, Cezmi A Akdis 4, Xiao-Xia Lu 1, Ya-Dong Gao 2 Abstract Background: The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has made widespread impact recently. We aim to investigate the clinical characteristics of COVID-19 children with different severities and allergic status. Methods: Data extracted from the electronical medical records, including demographics, clinical manifestations, comorbidities, laboratory and immunological results and radiological images of 182 hospitalized COVID-19 children were summarized and analyzed. Results: The median age was 6 years old, ranging from 3 days to 15 years, and there were more boys (male-female ratio about 2:

Glycopeptide Hypersensitivity and Adverse Reactions Authors: Vanthida Huang 1, Nicola A Clayton 2, Kimberly H Welker 3 Abstract Glycopeptides, such as vancomycin and teicoplanin, are primarily used in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections, such as cellulitis, endocarditis, meningitis, pneumonia, and septicemia, and are some of the most commonly prescribed parenteral antimicrobials. Parenteral glycopeptides are first-line therapy for severe MRSA infections; however, oral vancomycin is used as a first-line treatment of Clostridioides difficile infections. Also, we currently have the longer-acting lipoglycopeptides, such as dalbavancin, oritavancin, and telavancin to our armamentarium for the treatment of MRSA infections. Lastly, vancomycin is often used as an alternative treatment for patients with β-lactam hypersensitivity. Common adverse effects associated with glycopeptide use include nephrotoxicity, ototoxicity, and Redman Syndrome (R

Diagnosis and prevention of food-dependent exercise-induced anaphylaxis Authors: Filipe Benito-Garcia, Ignacio Javier Ansotegui & Mário Morais-Almeida ABSTRACT Introduction: Food-dependent, exercise-induced anaphylaxis (FDEIA) is a rare type of anaphylaxis with a growing incidence. Although the precise mechanism by which the patient reacts only in a combination of a culprit food and cofactors are not currently understood, many advances in diagnosis and management have been made since their first description. Areas covered: A literature search in PubMed was performed to review the diagnosis and management of FDEIA. Clinicians should have a high level of suspicion for identification of the culprit foods and the cofactors involved. Component-resolved diagnosis and more accurate provocation tests have revolutionized the diagnosis accuracy. Management is not easy and involves educating the patient to evict the combination of exposure to the culprit foods and the cofactors t

Immune responses in COVID-19 and potential vaccines: Lessons learned from SARS and MERS epidemic Authors: Eakachai Prompetchara,1,2,3 Chutitorn Ketloy,1,2 Tanapat Palaga4,5  From: 1 Center of Excellence in Vaccine Research and Development (Chula Vaccine Research Center Chula VRC), Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand 2 Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand 3 Vaccines and Therapeutic Proteins Research Group, the Special Task Force for Activating Research (STAR), Chulalongkorn University, Bangkok 10330, Thailand 4 Department of Microbiology, Faculty of Science, Chulalongkorn University, Bangkok 10330, Thailand 5 Center of Excellence in Immunology and Immune-mediated Diseases, Chulalongkorn University, Bangkok 10330, Thailand Abstract As the world is witnessing the epidemic of COVID-19, a disease caused by a novel coronavirus, SARS-CoV-2, emerging genetics and clinical evi

Red Meat Allergy in Children and Adults Authors: Jeffrey M Wilson  1 , Thomas A E Platts-Mills Abstract Purpose of review: To highlight recent advances in our understanding of the clinical features, prevalence, and pathophysiology of red meat allergy. Recent findings: Allergic reactions to red (i.e. mammalian) meat have historically been considered rare and described primarily in young atopic children. It is now clear that red meat allergy is not uncommon in some parts of the world in other age groups. Strikingly, the majority of these cases relate to specific IgE to galactose-α-1,3-galactose, an oligosaccharide of nonprimate mammals. The mechanism of sensitization in this syndrome relates to bites of certain hard ticks and the clinical reactions often have a delay of 3 to 6 h. An additional form of red meat allergy relates to inhalant sensitization to mammalian proteins. The best characterized example involves cat-sensitized patients with specific IgE to cat serum albumin who

COVID-19 and allergen immunotherapy: theoretical benefits invite to adjustments in practice recommendations Authors: Désirée Larenas-Linnemann, MD,∗ Noel Rodríguez-Pérez, MD, Jose Antonio Ortega-Martell, MD, Virginia Blandon Vijil, MD, Jorge A. Luna-Pech, MD, PhD, and Mexican Immunotherapy Working Group Abstract  Introduction During the pandemic of COVID-19 the world is facing at this moment, professional groups have made specialty-specific recommendations. Thus, suggestions on how to manage allergen immunotherapy (AIT) have been published by several workgroups,(1, 2, 3) that are timely and adequate for the present situation. However, none of the manuscripts reviews the immune effects of AIT in the light of the immunological changes brought about by coronavirus, and more specifically SARS-CoV-2. Taking a closer look at what is known in this field at present, one could conclude there might be a theoretical advantage for allergic patients to receive sublingual or subcutaneous A

SARS-CoV-2 Antibody Testing – Questions to be asked Authors:  K.ÖzçürümezMD1AndreasAmbroschMD2∗OliverFreyMD34∗VerenaHaselmannMD5∗StefanHoldenriederMD6∗MichaelKiehntopfMD7∗MichaelNeumaierMD5∗MichaelWalterMD89∗FolkerWenzelMD10∗RomanWölfelMD1112∗HaraldRenzMD13∗ COVID-19 Task Force of theGerman Society for Clinical Chemistry and Laboratory Medicine (DGKL) Abstract  SARS-CoV-2 infection and development of COVID-19 disease presents a major healthcare challenge of global dimensions. Laboratory diagnostics of infected patients, and the assessment of immunity against the SARS-CoV-2 virus presents a major cornerstone in handling the pandemic. Currently there is an increase in demand of antibody testing and a large number of tests are already marketed or in the late stage of development. However, the interpretation of test results depends on many variables and factors, including sensitivity, specificity, potential cross-reactivity and cross-protectivity; the diagnostic value of antibodies

Pólenes  Autor: Dra. Diana Martínez 

Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages Authors: Miriam Merad & Jerome C. Martin  Abstract The COVID-19 pandemic caused by infection with SARS-CoV-2 has led to more than 200,000 deaths worldwide. Several studies have now established that the hyperinflammatory response induced by SARS-CoV-2 is a major cause of disease severity and death in infected patients. Macrophages are a population of innate immune cells that sense and respond to microbial threats by producing inflammatory molecules that eliminate pathogens and promote tissue repair. However, a dysregulated macrophage response can be damaging to the host, as is seen in the macrophage activation syndrome induced by severe infections, including in infections with the related virus SARS-CoV. Here we describe the potentially pathological roles of macrophages during SARS-CoV-2 infection and discuss ongoing and prospective therapeutic strategies to modulate macrophage

Clinical Characterization and Diagnostic Approaches for Patients Reporting Hypersensitivity Reactions to Quinolones Authors: InmaculadaDoñaMD, PhDabNataliaPérez-SánchezMDabMaríaSalasMD, PhDabEstherBarrionuevoMD, PhDcdArturoRuiz-San FranciscoMDeDoloresHernández Fernández de RojasMD, PhDfgJaumeMartí-GarridoMDgInmaculadaAndreu-RosPhDfRamónLópez-SalgueiroMDfEstherMorenoMD, PhDhiMaría JoséTorresMD, PhDabjk Abstract  Background Quinolones are the second most frequent cause of hypersensitivity reactions (HSRs) to antibiotics. A marked increase in the number of patients with HSRs to quinolones has been detected. Objective To describe the clinical characteristics of patients with HSRs to quinolones and present methods for their diagnosis. Methods Patients attending the allergy unit due to reactions suggestive of HSRs to quinolones were prospectively evaluated between 2005 and 2018. Diagnosis was achieved using clinical history, skin tests (STs), basophil activation tests (BATs),

Alergia a epitelios de animales  Autor: Dra Natalia Aguirre 

Pro/Con Debate CON: Skin testing with fresh foods Aikaterini Anagnostou, MD, PhD Texas Children’s Hospital Division of Immunology, Allergy and Rheumatology; Baylor College of Medicine Division of Immunology, Allergy and Rheumatology, Houston, Texas 10.1016/j.anai.2019.12.010 Pro/Con Debate Pro: Skin prick testing with fresh foods Arnon Elizur, MD *, y; Michael R. Goldberg, MD * * Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel 10.1016/j.anai.2019.11.032

Hydroxychloroquine or Chloroquine With or Without a Macrolide for Treatment of COVID-19: A Multinational Registry Analysis Authors: Mandeep R Mehra 1, Sapan S Desai 2, Frank Ruschitzka 3, Amit N Patel 4 Affiliations expand Abstract Background: Hydroxychloroquine or chloroquine, often in combination with a second-generation macrolide, are being widely used for treatment of COVID-19, despite no conclusive evidence of their benefit. Although generally safe when used for approved indications such as autoimmune disease or malaria, the safety and benefit of these treatment regimens are poorly evaluated in COVID-19. Methods: We did a multinational registry analysis of the use of hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19. The registry comprised data from 671 hospitals in six continents. We included patients hospitalised between Dec 20, 2019, and April 14, 2020, with a positive laboratory finding for SARS-CoV-2. Patients who received one of

Hypersensitivity to Tetracyclines: Skin Testing, Graded Challenge, and Desensitization Regimens Authors: Michelle C Maciag  1 , Stephanie L Ward  2 , Amy E O'Connell  3 , Ana D Broyles  4 Abstract Background: Hypersensitivity reactions (HSRs) to tetracyclines and the related compound, tigecycline, can limit the use of these medications and compromise optimal patient care. Despite this, there is little discussion in the literature describing the presentation of these reactions or guiding clinicians on the management of these reactions in adult and pediatric patients. Objective: To describe the clinical features, optimal diagnostic approach, and management of HSRs to tetracyclines. Methods: Patients with reactions to tetracyclines at our institution from 2011 to 2019 were identified by retrospective chart review. Skin testing protocols were designed for each antibiotic. Graded challenge and desensitization procedures were devised based on medical history, skin testing resul

Eleven Faces of Coronavirus Disease 2019 Authors: Xiang Dong  1 , Yi-Yuan Cao  2 , Xiao-Xia Lu  3 , Jin-Jin Zhang  1 , Hui Du  3 , You-Qin Yan  4 , Cezmi A Akdis  5 , Ya-Dong Gao  1 Abstract Background and aims: The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has recently spread worldwide and been declared a pandemic. We aim to describe here the various clinical presentations of this disease by examining eleven cases. Methods: Electronic medical records of 11 patients with COVID-19 were collected, and demographics, clinical manifestations, outcomes, key laboratory results, and radiological images are discussed. Results: The clinical course of the eleven cases demonstrated the complexity of the COVID-19 profile with different clinical presentations. Clinical manifestations range from asymptomatic cases to patients with mild and severe symptoms, with or without pneumonia. Laboratory detection o