ALERGOLOGÍA PARA MÉDICOS Y PACIENTES 2021

La biopsia cutánea en la urticaria crónica: cuándo realizarla, qué buscar y dónde hacerlo Autores: A. López Mateos, M.J. Sánchez Pujol y J.F. Silvestre Salvador Resumen: La urticaria crónica es una entidad relativamente frecuente en la práctica clínica habitual, cuyo diagnóstico se establece de forma clínica. Sin embargo, existen ocasiones en las que está indicada la realización de una biopsia cutánea para confirmar el diagnóstico y diferenciarla de otras patologías que pueden cursar con erupciones urticariformes. En este trabajo revisamos los hallazgos histopatológicos que podemos encontrar tanto en la urticaria crónica como en las patologías que plantean un diagnóstico diferencial. Con base en ello, proponemos un algoritmo que recoge las indicaciones para realizar una biopsia cutánea y la orientación del diagnóstico en función de los hallazgos histopatológicos que encontremos en la misma. DOI:   https://doi.org/10.1016/j.ad.2020.11.016

Managing Food Allergy When the Patient Is Not Highly Allergic Authors: Scott H. Sicherer, MD, Elissa M. Abrams, MD, Anna Nowak-Wegrzyn, MD, PhD, and Jonathan O’B. Hourihane, FRCPI Abstract: Few patients with food allergy are “highly allergic,” meaning they always have severe reactions and always react to very small amounts of allergen. Standard medical approaches for allergy management have focused on the safety and lifestyle modifications this group truly needs, but consequently families with food allergy are typically advised to strictly avoid any exposure to their implicated allergens. Most food-allergic subjects are actually not reactive to very low doses, and many never experience severe reactions. There are also notable conditions where a different care plan is already commonly offered: patients with pollen-related food allergy syndrome, with food-associated exercise-induced anaphylaxis, and with resolving or mild milk or egg allergy might be advised to ingest the allergens in sp

The International EAACI/GA²LEN/EuroGuiDerm/APAAACI Guideline for the Definition, Classification, Diagnosis and Management of Urticaria Authors: T. Zuberbier, A.H. Abdul Latiff, M. Abuzakouk, S. Aquilina, R. Asero, D. Baker, B. Ballmer-Weber, C. Bangert, M. Ben-Shoshan, J.A. Bernstein, C. Bindslev-Jensen, K. Brockow, Z. Brzoza, H.J. Chong Neto, M. Church, P.R. Criado, I.V. Danilycheva, C. Dressler, L.F. Ensina, L. Fonacier, M. Gaskins, K. Gáspár, A. Gelincik, A. Giménez-Arnau, K. Godse, M. Gonçalo, C. Grattan, M. Grosber, E. Hamelmann, J. Hébert, M. Hide, A. Kaplan, A. Kapp, A. Kessel, E. Kocatürk, K. Kulthanan, D. Larenas-Linnemann, A. Lauerma, T. Leslie, M. Magerl, M. Makris, R.Y. Meshkova, M. Metz, D. Micallef, C.G. Mortz, A. Nast, H. Oude-Elberink, R. Pawankar, P. Pigatto, H. Ratti Sisa, M.I. Rojo Gutiérrez, S.S. Saini, P. Schmid-Grendelmeier, B. Sekerel, F. Siebenhaar, H. Siiskonen, A. Soria, P. Staubach-Renz, L. Stingeni, G. Sussman, A. Szegedi, S.F. Thomsen, Z. Vadas, C. Vesterga

Safety and Efficacy of Single-Dose Ad26.COV2.S Vaccine against Covid-19 Authors: J. Sadoff, G. Gray, A. Vandebosch, V. Cárdenas, G. Shukarev, B. Grinsztejn, P.A. Goepfert, C. Truyers, H. Fennema, B. Spiessens, K. Offergeld, G. Scheper, K.L. Taylor, M.L. Robb, J. Treanor, D.H. Barouch, J. Stoddard, M.F. Ryser, M.A. Marovich, K.M. Neuzil, L. Corey, N. Cauwenberghs, T. Tanner, K. Hardt, J. Ruiz‑Guiñazú, M. Le Gars, H. Schuitemaker, J. Van Hoof, F. Struyf, and M. Douoguih Abstract: BACKGROUND The Ad26.COV2.S vaccine is a recombinant, replication-incompetent human adenovirus type 26 vector encoding full-length severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein in a prefusion-stabilized conformation. METHODS In an international, randomized, double-blind, placebo-controlled, phase 3 trial, we randomly assigned adult participants in a 1:1 ratio to receive a single dose of Ad26.COV2.S (5×1010 viral particles) or placebo. The primary end points were vaccine efficacy again

 Autoimmune Diseases Are Linked to Type IIb Autoimmune Chronic Spontaneous Urticaria Authors: Pavel Kolkhir, Sabine Altrichter, Riccardo Asero , Alvaro Daschner, Marta Ferrer , Ana Giménez-Arnau, Tomasz Hawro, Thilo Jakob, Tamar Kinaciyan, Arno Kromminga, George N Konstantinou, Michael Makris, Martin Metz , Per Stahl Skov, Petra Staubach, Gordon Sussman , Ke Zhang, Marcus Maurer Abstract: Purpose: Patients with chronic spontaneous urticaria (CSU) have an increased risk for comorbid autoimmune diseases. In this retrospective multicenter study of CSU patients, we evaluated clinical and laboratory features of CSU associated with a higher risk of comorbid autoimmune diseases. Methods: We analyzed records of CSU patients (n = 1,199) for a history or presence of autoimmune diseases. Patients were diagnosed with type IIb autoimmune CSU (aiCSU) if all 3 tests were positive: autologous serum skin test (ASST), basophil histamine release assay (BHRA) and/or basophil activation test (BAT), and Ig

Adaptive immunity to SARS-CoV-2 and COVID-19 Authors:  Alessandro Sette and Shane Crotty Abstract: The adaptive immune system is important for control of most viral infections. The three fundamental compo- nents of the adaptive immune system are B cells (the source of antibodies), CD4+ T cells, and CD8+ T cells. The armamentarium of B cells, CD4+ T cells, and CD8+ T cells has differing roles in different viral infections and in vaccines, and thus it is critical to directly study adaptive immunity to SARS-CoV-2 to understand COVID-19. Knowledge is now available on relationships between antigen-specific immune responses and SARS-CoV-2 infection. Although more studies are needed, a picture has begun to emerge that reveals that CD4+ T cells, CD8+ T cells, and neutralizing antibodies all contribute to control of SARS-CoV-2 in both non-hospitalized and hospitalized cases of COVID-19. The specific functions and kinetics of these adaptive immune responses are discussed, as well as their interp

Hypersensitivity to β-lactam antibiotics: algorithms of management and desensitization as a vital therapeutic alternative Authors:  Ricardo Cardona, Luis Santamaría, Liliana Guevara-Saldaña, Ana Calle Abstract:  Hypersensitivity reactions can be complex and life-threatening to patients, especially when drugs such as β-lactam antibiotics are involved. To this day, there are diagnostic algorithms and mobile applications that improve the clinical approach, as well as laboratory tests and more specialized procedures, such as skin tests and controlled exposure tests; which are useful for identifying the drug involved and for selecting safe and effective therapeutic alternatives. For several years, the desensitization procedure has been positioned as a vital tool for clinical allergists and for their patients, and it is key to improving clinical outcomes such as survival and quality of life. DOI:   10.29262/ram.v68i1.892

 Latest Developments in the Management of Nut Allergies Authors:  H A Brough, R Gourgey, S Radulovic, J C Caubet, G Lack, A Anagnostou Abstract: Purpose of review: In this review, we sought to describe the most recent advances in the dietary and medical management of peanut and tree nut allergy, including selective introduction and immunotherapy. Recent findings: Dietary updates include changes to labeling laws, improved information sources, and new apps for buying foods in shops and overseas to better protect individuals with nut allergies. There are still issues in the management of nut allergies in schools, such as parents having to resort to packed lunches instead of school meals and patients experiencing bullying. Air travel also poses concern, but additional resources are now available to travelers, and recent evidence suggest limited airborne exposure to nuts. The medical management of anaphylaxis is use of epinephrine; however, this remains underutilized. Needle length and admi

 Effects of pregnancy on chronic urticaria: Results of the PREG-CU UCARE study Authors: Emek Kocatürk, Mona Al-Ahmad, Karoline Krause, Ana M Gimenez-Arnau, Simon Francis Thomsen, Niall Conlon, Alexander Marsland, Ekin Savk, Roberta F Criado, Inna Danilycheva, Daria Fomina, Kiran Godse, Maryam Khoshkhui, Aslı Gelincik, Ece Nur Degirmentepe, Semra Demir, Luis Felipe Ensina, Alicja Kasperska-Zajac, Michael Rudenko, Solange Valle, Iris Medina, Andrea Bauer, Zuotao Zhao, Petra Staubach, Laurence Bouillet, Özlem Su Küçük, Can Ateş, Marcus Maurer Abstract: Background: Chronic urticaria (CU) predominantly affects women, and sex hormones can modulate disease activity in female CU patients. As of now, the impact of pregnancy on CU is largely unknown. Aim: To analyze the course and features of CU during and after pregnancy. Patients and methods: PREG-CU is an international, multicenter study of the Urticaria Centers of Reference and Excellence (UCARE) network. Data were collected via a 47-item qu

Reactivation of Varicella Zoster Virus after Vaccination for SARS-CoV-2 Authors:  Mina Psichogiou, Michael Samarkos, Nikolaos Mikos, and Angelos Hatzakis Abstract: Seven immunocompetent patients aged > 50 years old presented with herpes zoster (HZ) infection in a median of 9 days (range 7–20) after vaccination against SARS-CoV-2. The occurrence of HZ within the time window 1–21 days after vaccination defined for increased risk and the reported T cell-mediated immunity involvement suggest that COVID-19 vaccination is a probable cause of HZ. These cases support the importance of continuing assessment of vaccine safety during the ongoing massive vaccination for the COVID-19 pandemic and encourage reporting and communication of any vaccination-associated adverse event. DOI:   10.3390/vaccines9060572

Transitioning From Immunosuppressants to Dupilumab in Pediatric Atopic Dermatitis Authors: Catherine M. Ludwig,  Jennifer L. Hsiao, Peter A. Lio, and Vivian Y. Shi Abstract: Dupilumab has recently been approved by the Food and Drug Administration for use for treatment of moderate to severe atopic dermatitis in children aged 6 to 11 years. It presents a novel treatment option with a favorable safety profile for patients who are currently reliant on immunosuppressants, including cyclosporine A, methotrexate, and mycophenolate mofetil. Particularly during the current COVID-19 pandemic, immunosuppression should be avoided to retain intrinsic antiviral immunity. Transitioning to dupilumab should be executed strategically tapering immunosuppressants and minimizing risk of flare by overlapping with the biologic. Herein, we use results of outcome measurements from LIBERTY AD ADOL and LIBERTY AD PEDS trials of dupilumab in adolescents aged 12 to 18 years and children aged 6 to 11 years, respect

Wet Wrap Therapy in Moderate to Severe Atopic Dermatitis Authors:   Noreen Heer Nicol, Mark Boguniewicz Key points: - Atopic dermatitis (AD) remains a complex, common, chronic, and relapsing skin disorder, and a global public health problem. - National and international guidelines address AD care in a stepwise fashion. Wet wrap therapy (WWT) is a therapeutic intervention for moderate to severe AD. - WWT plays an important role as an acute therapeutic intervention for management of moderate to severe AD used with undiluted topical corticosteroids of appropriate potency. - WWT should not be used for mild AD or as a chronic or maintenance therapy. - WWT should be considered as a treatment option ahead of the systemic therapies for pa- tients failing conventional topical therapy. DOI:   10.1016/j.iac.2016.08.003

Benefits of baked milk oral immunotherapy in French children with cow's milk allergy Authors:   Vianney Gruzelle, Agnès Juchet, Audrey Martin-Blonde, Marine Michelet, Anne Chabbert-Broue, Alain Didier Abstract:  Background: Introduction and gradual incremental escalation of a low dose of baked milk may accelerate the resolution of severe cow's milk (CM) allergy for some children. The purpose of our study was to evaluate the efficacy and safety of baked milk oral immunotherapy (OIT) in children with CM allergy after a low-dose baked milk oral food challenge (OFC). Methods: In a retrospective analysis of OFC performed between 2013 and 2018 at the Children's Hospital of Toulouse (France), we identified 64 children with CM allergy and high milk and casein-specific IgE levels, who underwent a total of 171 milk OFC. Mean age at 1st OFC was 4.8 years. Mean CM-specific IgE was 47.9 kUA/L, and mean casein-specific IgE was 42.3 kUA/L. Results: Most children were treated with baked mi

Contact urticaria: Frequency, elicitors and cofactors in three cohorts (Information Network of Departments of Dermatology; Network of Anaphylaxis; and Department of Dermatology, University Hospital Erlangen, Germany) Authors: Helene Süß, Sabine Dölle-Bierke,  Johannes Geier, Burkhard Kreft, Eva Oppel, Claudia Pföhler, Christoph Skudlik, Margitta Worm, Vera Mahler Abstract:   Background: Contact urticaria (CU) is an infrequent, mostly occupational disease that may be life-threatening (CU syndrome stage 4). Objectives: To identify the current frequency, elicitors and cofactors of CU. Patients: Three cohorts were retrospectively analysed for CU: (a) patients from the Information Network of Departments of Dermatology (IVDK) database (2000-2014; n = 159 947); (b) patients from an allergy unit (Department of Dermatology, University Hospital Erlangen, 2000-2015; n = 4741); and (c) patients from the Anaphylaxis Registry (2007-2015: 6365 reported cases, including 2473 patients with Ring and Mes

Crisaborole Ointment, 2%, for Treatment of Patients with Mild-to-Moderate Atopic Dermatitis: Systematic Literature Review and Network Meta-Analysis Authors: Kyle Fahrbach . Jialu Tarpey . Evelien Bergrath Washington . Rachel Hughes . Howard Thom . Maureen P. Neary . Amy Cha . Robert Gerber . Joseph C. Cappelleri Abstract:  Introduction: There is a need to compare efficacy and safety profiles of crisaborole ointment, 2%, versus other topical treatments across randomized clinical trials (RCTs). We performed this review/network meta-analysis to evaluate the comparative efficacy and safety of crisaborole versus other topical pharmacologic therapies for mild-to-moderate atopic dermatitis (AD) among patients aged >2 years Methods: Searches were conducted in MEDLINE, Embase, the Cochrane Collection Central Register of Clinical Trials, and the Database of Abstracts of Reviews of Effects using Ovid to identify English language articles reporting RCTs of topical anti-inflammatory agents in pa

Prevention and management of allergic reactions to food in child care centers and schools: Practice guidelines Authors:  Susan Waserman, MD, MSc,a Heather Cruickshank, BA,a Kyla J. Hildebrand, MD, MSsCH,b Douglas Mack, MD,a Laura Bantock, RN,c Theresa Bingemann, MD,d,e Derek K. Chu, MD, PhD,a Carlos Cuello-Garcia, MD, PhD,f,g Motohiro Ebisawa, MD,PhD,hDavidFahmy,MD,aDavidM.Fleischer,MD,i,j Lisa Galloway, BA,BEd,kGreg Gartrell, MA,k Matthew Greenhawt, MD,j Nicola Hamilton, RN, Jonathan Hourihane, MD,l,m Michael Langlois, CES, CHSC, CRSP,n Richard Loh, MD,o Antonella Muraro, MD, PhD,p Lana Rosenfield, MD,q Sally Schoessler, MSEd, BSN, RN, AE-C,r Mimi L. K. Tang, MD,s,t Brenda Weitzner, MD,u Julie Wang, MD,v and Jan L. Brozek, MD, PhDa,f Abstract: Food allergy management in child care centers and schools is a controversial topic, for which evidence-based guidance is needed. Following the Grading of Recommendations Assessment, Development, and Evaluation approach, we conducted systematic l

Triggers of Exacerbation in Chronic Urticaria and Recurrent Angioedema—Prevalence and Relevance Authors:  Anete Sevciovic Grumach, MD, MS, PhD , Petra Staubach-Renz, MD, Ricardo Cardona Villa, MD, MS, Susana Diez-Zuluaga, MD, Imke Reese, PhD, and William R. Lumry, MD Abstract: Patients with urticaria and angioedema often have triggers that cause an outbreak or a swelling episode or worsen their chronic condition. Exploring these factors with each patient may result in better understanding and control of their disease. Patients should be advised to avoid known triggers, if feasible, or prepare to prevent or control an exacerbation with appropriate pretreatment if avoidance is not possible. In this review, we describe and discuss a variety of factors for which there is evidence that they cause or exacerbate chronic spontaneous urticaria and angioedema. These potentially exacerbating factors include drugs, food additives, and naturally occurring pseudoallergens, mental stress, and trauma.

A Consensus Approach to the Primary Prevention of Food Allergy Through Nutrition: Guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical Immunology Authors:  David M Fleischer  1 , Edmond S Chan  2 , Carina Venter  1 , Jonathan M Spergel  3 , Elissa M Abrams  4 , David Stukus  5 , Marion Groetch  6 , Marcus Shaker  7 , Matthew Greenhawt  8 Abstract Recently published data from high-impact randomized controlled trials indicate the strong potential of strategies to prevent the development of food allergy in high-risk individuals, but guidance in the United States at present is limited to a policy for only the prevention of peanut allergy, despite other data being available and several other countries advocating early egg and peanut introduction. Eczema is considered the highest risk factor for developing IgE-mediated food allergy, but children without risk factors still

US HAEA Medical Advisory Board 2020 Guidelines for the Management of Hereditary Angioedema Authors:  Paula J Busse  1 , Sandra C Christiansen  2 , Marc A Riedl  2 , Aleena Banerji  3 , Jonathan A Bernstein  4 , Anthony J Castaldo  5 , Timothy Craig  6 , Mark Davis-Lorton  7 , Michael M Frank  8 , H Henry Li  9 , William R Lumry  10 , Bruce L Zuraw  11 Abstract Scientific and clinical progress together with the development of effective novel therapeutic options has engendered multiple important changes in the diagnosis and management of hereditary angioedema (HAE). We now update and extend the 2013 United States Hereditary Angioedema Association Medical Advisory Board guidelines for the treatment and management of HAE. The guidelines are based on a comprehensive literature review with recommendations indicating both the strength of our recommendation and the quality of the underlying evidence. Guidelines are provided regarding the classification, diagnosis, on-demand treatment, prophyla

 Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs Authors:  Ana Dioun Broyles  1 , Aleena Banerji  2 , Sara Barmettler  2 , Catherine M Biggs  3 , Kimberly Blumenthal  2 , Patrick J Brennan  4 , Rebecca G Breslow  5 , Knut Brockow  6 , Kathleen M Buchheit  4 , Katherine N Cahill  7 , Josefina Cernadas  8 , Anca Mirela Chiriac  9 , Elena Crestani  1 , Pascal Demoly  9 , Pascale Dewachter  10 , Meredith Dilley  1 , Jocelyn R Farmer  2 , Dinah Foer  4 , Ari J Fried  1 , Sarah L Garon  11 , Matthew P Giannetti  4 , David L Hepner  12 , David I Hong  4 , Joyce T Hsu  4 , Parul H Kothari  4 , Timothy Kyin  13 , Timothy Lax  14 , Min Jung Lee  15 , Kathleen Lee-Sarwar  16 , Anne Liu  17 , Stephanie Logsdon  18 , Margee Louisias  4 , Andrew MacGinnitie  1 , Michelle Maciag  1 , Samantha Minnicozzi  19 , Allison E Norton  20 , Iris M Otani  21 , Miguel Park  22 , Sarita Patil  2 , Elizabeth J Phillips  23 , Matthieu Picard  24 , Craig D Platt  25 , R

 World allergy organization anaphylaxis guidance 2020 Authors:  VictoriaCardonaaIgnacio J.AnsoteguibMotohiroEbisawacYehiaEl-GamaldMontserratFernandez RivaseStanleyFinemanfMarioGellergAlexeiGonzalez-EstradahPaul A.GreenbergeriMarioSanchez BorgesjGianenricoSennaKAzizSheikhlLuciana KaseTannomBernard Y.ThongnPaul J.Turnero1MargittaWormp1 Abstract:  Anaphylaxis is the most severe clinical presentation of acute systemic allergic reactions. The occurrence of anaphylaxis has increased in recent years, and subsequently, there is a need to continue disseminating knowledge on the diagnosis and management, so every healthcare professional is prepared to deal with such emergencies. The rationale of this updated position document is the need to keep guidance aligned with the current state of the art of knowledge in anaphylaxis management. The World Allergy Organization (WAO) anaphylaxis guidelines were published in 2011, and the current guidance adopts their major indications, incorporating some nov

Cold urticaria - What we know and what we do not know Authors Natalya Maltseva  Elena Borzova  Daria Fomina  Mojca Bizjak  Dorothea Terhorst‐Molawi  Mitja Košnik Kanokvalai Kulthanan  Raisa Meshkova  Simon Francis Thomsen  Marcus Maurer  Abstract Cold urticaria (ColdU) is a common form of chronic inducible urticaria characterized by the development of wheals, angioedema or both in response to cold exposure. Recent research and guideline updates have advanced our understanding and management of ColdU. Today, its pathophysiology is thought to involve the cold‐induced formation of autoallergens and IgE to these autoallergens, which provoke a release of proinflammatory mediators from skin mast cells. The classification of ColdU includes typical and atypical subtypes. We know that cold‐induced wheals usually develop on rewarming and resolve within an hour and that anaphylaxis can occur. The diagnosis relies on the patient's history and cold stimulation testing. Additional diagnostic wor

Maintaining Safety with SARS-CoV-2 Vaccines Authors:  Mariana C. Castells, M.D., Ph.D.,  and Elizabeth J. Phillips, M.D. Abstract  To date, the development of mRNA vaccines for the prevention of infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a success story, with no serious concerns identified in the ongoing phase 3 clinical trials.1 Minor local side effects such as pain, redness, and swelling have been observed more frequently with the vaccines than with placebo. Systemic symptoms such as fever, fatigue, headache, and muscle and joint pain have also been somewhat more common with the vaccines than with placebo, and most have occurred during the first 24 to 48 hours after vaccination.1 In the phase 1–3 clinical trials of the Pfizer–BioNTech and Moderna mRNA vaccines, potential participants with a history of an allergic reaction to any component of the vaccine were excluded. The Pfizer–BioNTech studies also excluded participants with a history o