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Periorifical dermatitis (POD) is a papular, chronic inflammatory skin disease commonly seen in women in their 2nd to 4th decade of life. The major differential diagnosis is persistent acne. In children, POD is less common than in adults. In infants and preschoolers POD is rare. We performed a narrative review for POD in children ≤6 years of age. Diagnosis is clinical. The disease presents with monomorphic erythematous papules that usually leave a 1–2 mm Grenz zone around the red lips unaffected. Perinasal skin, nostrils and eyelids can be involved, while extrafacial manifestations are rare. The granulomatous subtype of POD is more common in small children that in adults. The most important differential diagnoses in children include atopic and seborrheic dermatosis, pediatric rosacea, juvenile acne, and cutaneous sarcoidosis. While topical macrolides, azelaic acid, and calcineurin inhibitors are often used in mild cases of adult POD, oral tetracyclines are the treatment of choice in more advanced cases. In infants and preschoolers, tetracycline should be avoided since they can affect the calcification (hardening) of the bones and teeth and lead to permanent discoloration of teeth. There are no randomized controlled trials for POD in this age group available. Topical metronidazole or erythromycin and oral erythromycin are most used. New drugs like JAK inhibitors are on the horizon. What is Known? • Pediatric periorificial dermatitis is a chronic inflammatory disorder affecting perioral, perinasal and periocular skin. • The granulomatous variant is more common in infants and preschoolers than in adults. What is New? • Janus kinase inhibitors might be an option for milder cases. • Oral azithromycin and roxithromycin are alternatives, when oral erythromycin is unavailable or contraindicated. [ABSTRACT FROM AUTHOR]

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Scabies is a human ectoparasitosis caused by Sarcoptes scabei var. hominis. World-wide around 300 million patients are affected. Infants and children have the highest incidence rates. Poverty and overcrowding are social factors contributing to a higher risk of transmission and treatment failure. The leading symptom of the infestation is itch. Complications are bacterial infections that are responsible for mortality. Diagnosis is clinical. Non-invasive imaging technologies like dermoscopy can be used. Polymerase chain reaction (PCR) is less sensitive and specific than microscopy of skin scrapings. Treatment of choice is topical permethrin 5%. Ivermectin is the only oral drug FDA-approved for scabies. It should be used in cases non-responsive to topical therapy and in case of high number of infested patients in addition to topical therapy. Pseudo-resistance to treatment is not uncommon. New drugs are on the horizon. What is Known: • Pruritus is the leading symptom causing sleep disturbances and scratching with the risk of secondary bacterial infections. • Treatment failure is related to inappropriate application of topical drugs and asymptomatic family members. What is New: • COVID-19 pandemic and migration are contributing to an increased incidence of scabies. • New compounds to treat scabies are on the horizon. [ABSTRACT FROM AUTHOR]

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Self-inflicted dermatoses (SID) are not uncommon in dermatological practice. They can be classified into those associated with hidden or denied underlying behavior and those without hidden or denied underlying behavior. Malingering and factitious disorders are the most common of the first subgroup. Skin picking and related syndromes of compulsive and non-compulsive behavior belong to the second subgroup. Treatment is interdisciplinary, but sometimes frustrating. Conclusion: This method is a safe and efficient alternative to more invasive procedures by minimal to no social downtime and mild to no side effects. [ABSTRACT FROM AUTHOR]

Kerion Celsi is an inflammatory, deep fungal infection of the scalp. It is rare in neonates but gets more common in children about 3 years and older. It represents with swelling, boggy lesions, pain, alopecia and purulent secretions. Secondary bacterial infection is not unusual after maceration. Extracutaneous manifestations include regional lymphadenopathy, fever and very rare fungemia. Id-reactions can occur. Diagnosis is based on clinical suspicion, clinical examination and medical history. Diagnosis should be confirmed by microscopy, fungal culture and molecular procedures. The most common isolated fungal species are anthropophilic Trichophyton (T.) tonsurans and zoophilic Microsporum (M.) canis, while geophilic species and moulds rarely cause Kerion Celsi. Treatment is medical with systemic and topical antifungals supplemented by systemic antibiotics when necessary, while surgery needs to be avoided. Early and sufficient treatment prevents scarring alopecia. The most important differential diagnosis is bacterial skin and soft tissue infections. [ABSTRACT FROM AUTHOR]

This article presents a case study of a 59-year-old woman who developed systemic allergic dermatitis after receiving an iodinated contrast media injection for a computed tomography scan. The patient experienced erythematous and vesicular lesions, with skin manifestations lasting for about 3 months despite treatment with corticosteroids. Intradermal tests confirmed a reaction to the contrast media, leading to a major flare-up of symptoms. The study highlights the challenges and complexities of diagnosing and managing delayed hypersensitivity reactions to contrast media, emphasizing the importance of thorough testing and patient follow-up. [Extracted from the article]

Pediatric dermatitis seborrhoica (DS) is a common inflammatory disorder of infancy and adolescence distinct from atopic dermatitis. We performed a narrative review on clinical and therapeutic aspects of the disease. The prevalence varies geographically and can reach up to 10%. There is a slight male predominance. Although etiopathology is not well known, both endogenous and exogenous factors contribute. Skin microbiome and its interaction with sebaceous gland function is crucial. The inflammatory pathways include innate immune function and skin barrier disturbances. Malassezia spp. and certain bacteria are increased in lesional skin. DS develops in different clinical subtypes, from localized cephalic to disseminated disease with a risk of erythroderma and eczema herpeticatum. Treatment consists of skin care and topical and rarely systemic medical therapy. Cornerstones of treatment are antifungals and mild corticosteroids. Targeted treatment is on the horizon. Pediatric DS is a common disorder important in the differential diagnosis of skin problems in infants and and children. Due to better understanding of its pathogenesis, new treatment options are developed. [ABSTRACT FROM AUTHOR]

In drug hypersensitivity, drug provocation testing (DPT), also called drug challenge, is the gold standard for investigation. In recent years, risk stratification has become an important tool for adjusting the diagnostic strategy to the perceived risk, whilst still maintaining a high level of safety for the patient. Skin tests are recommended before DPT but may be omitted in low‐risk patients. The task force suggests a strict definition of such low‐risk patients in children and adults. Based on experience and evidence from studies of allergy to beta‐lactam antibiotics, an algorithm on how to adjust DPT to the risk, and when to omit skin tests before DPT, is presented. For other antibiotics, non‐steroidal anti‐inflammatory drugs and other drugs, skin tests are poorly validated and DPT is frequently necessary. We recommend performing DPT with chemotherapeutics and biologicals to avoid unnecessary desensitization procedures and DPT with skin tests negative contrast media. We suggest DPT with anesthetics only in highly specialized centers. Specifics of DPT to proton pump inhibitors, anticonvulsants and corticosteroids are discussed. This position paper provides general recommendations and guidance on optimizing use of DPT, whilst balancing benefits with patient safety and optimizing the use of the limited available resources. [ABSTRACT FROM AUTHOR]

Copyright of Kosmetische Medizin + Ästhetische Chirurgie is the property of gmc-Gesundheitsmedien & Congress GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Rosacea is a facial inflammatory disorder that shows an increasing incidence with age. While rosacea is common > 60 years of age, pediatric rosacea is uncommon. Diagnostic criteria are based on clinical symptoms. Laboratory investigations and histopathology are only needed to exclude other differential diagnoses. There are several subtypes such as erythemato-telangiectatic, papulo-pustular, periorificial, and granulomatous variants. In contrast to adult rosacea, phymatous subtypes do not belong to pediatric rosacea. A special subtype seen in infants and children is an idiopathic facial aseptic granuloma. Genetic and environmental factors contribute to its pathogenesis. Treatment options are in analogy to adult rosacea classified into topical and systemic drugs. In the case of oral tetracyclines, discoloration of teeth and impairment of enamel are possible adverse events. Conclusion: Pediatric rosacea belongs to the rosacea spectrum but has peculiarities compared to the adult subtype. What is Known: • Rosacea is a chronic inflammatory disorder different from acne. • Rosacea gets more common with advanced age. What is New: • Pediatric rosacea is an uncommon subtype with peculiar clinical presentation. • Demodicosis is very rare in immunocompetent children. [ABSTRACT FROM AUTHOR]

Background: Hydroxychloroquine (HCQ) is an antimalarial drug often employed in the treatment of various diseases, as a basic treatment for a prolonged period of time. Materials and Methods: Screening tests were analyzed in descending order of early detection of changes in HCQ toxicity. Results: The first ocular changes as a result of the toxicity of HCQ are those found during the visual field test, and the typical image of the fundus that highlights the bull’s-eye lesion signifies advanced, irreversible HCQ toxicity. Conclusion: Ophthalmologic screening is of great importance in daily practice. Physicians from different medical specialties should be aware of the side effects of HCQ and refer the patients to ophthalmology for screening and close follow-up. [ABSTRACT FROM AUTHOR]

Copyright of Kosmetische Medizin + Ästhetische Chirurgie is the property of gmc-Gesundheitsmedien & Congress GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This correction notice is for an article titled "Scabies in infants and children - a narrative review" published in the European Journal of Pediatrics. The correction states that the co-author, Anca E. Chiriac, was inadvertently omitted during the publication process and has now been added as the fourth author. The original article can be found online at the provided link. The publisher, Springer Nature, remains neutral regarding jurisdictional claims and institutional affiliations. The correction notice is reported by the authors: Anca Chiriac, Adriana Diaconeasa, Raluca Miulescu, Anca E. Chiriac, and Uwe Wollina. [Extracted from the article]

(1) Background: Isotretinoin (ISO) is a systemic retinoid known for its teratogenic effects on embryos and fetuses. The aim of this study was to compare the pregnancy outcomes of women who were exposed to isotretinoin with those of women without such exposure from a teratogenic point of view. (2) Methods: A total of 1459 female patients from three clinical hospitals in Poland and Romania, segregated into two groups depending on their ISO exposure, were evaluated between January and December 2019. Medical records were screened to identify the pregnancy outcomes and congenital malformation rates. (3) Results: The congenital malformation rate for the exposed group was 1.2% (four cases), and no specific signs of Accutane embryopathy were identified. Women from the unexposed group were more likely to deliver preterm and through cesarean deliveries and had a higher rate of newborn congenital malformations as compared to women from the exposed group. (4) Conclusions: Even though we could not find a significant association between ISO exposure and teratogenic effects in newborns, effective contraceptive measures are key to preventing unfavorable pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Pityriasis rosea (PR) is an inflammatory self-limiting dermatosis common in younger ages, whereas it is rather uncommon in patients 65+. We report a series of 7 patients (65 to 75 years old, 2 males and 5 females) with PR. The clinical presentation was peculiar because of widespread distribution with rather erythematous, inflammatory lesions but asymptomatic. There was no association to common viral disorders including H1N1 or COVID-19 nor to vaccination against. No drug-induced PR was noted. No treatment was necessary, and the course was mild. PR of elderly is uncommon but has some peculiarities. Treatment was unnecessary. [ABSTRACT FROM AUTHOR]

Facial psoriasis is a clinical form of psoriasis that has raised many debates, due to its relation with UV radiation and classification. In differential diagnosis, polymorphous light eruption is apparently easy to identify and is considered the most frequently reported photosensitivity dermatoses, especially in adolescents. Clinical picture may create confusion and, even, the term polymorphous is ambiguous. We present a case of a teenager who has been diagnosed and treated for three months, for many suspicions, such as: polymorphic light eruption, lupus erythematosus, contact dermatitis, skin lesions being limited to the nose. Laborious and extended lab investigations were within normal limits and only skin biopsy concluded a surprisingly diagnosis, namely psoriasis. A new subtype of facial psoriasis, with lesions localized only on the nose is reported. [ABSTRACT FROM AUTHOR]

Adoption and user perceptions are dominant on personal health records literature and have led to a better understanding of what individuals' behaviors and perceptions are about the adoption of personal health records. However, these insights are descriptive and are not actionable to allow creating personal health records that will overcome the adoption problems identified by users. This study uses action design research to provide actionable knowledge regarding user perceptions and adoption and their application in the case of the digital allergy card. To achieve this, the authors conducted interviews with patients and physicians as part of the evaluation of the digital allergy card mock-up and the first prototype. As results, they provided some research proposals regarding the benefits of, levers for, and barriers to adoption of the digital allergy card that can be tested for several other personal health records. [ABSTRACT FROM AUTHOR]

"Marjolin's ulcer" is known as malignant degeneration of ancient burn scars, but both words can induce misdiagnosis. Malignant degeneration of scarring tissue can occur and can vary in its clinical, histological manifestations and its pre-existing skin lesions. We present several cases to substantiate our observations. "Marjolin's ulcer" is not synonym to an ulceration appeared on an old burn scar, transformed into squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

Copyright of Farmacia is the property of Societatea de Stiinte Farmaceutice Romania and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Becker’s nevus syndrome (BNS) is a rare epidermal nevus syndrome characterized by Becker’s nevi and other, often unobtrusive, systemic symptoms and/or skin lesions, often ipsilateral. A Becker’s nevus (BN) is a hamartoma that is unilateral, hyperpigmented, and often hairy. Systemic symptoms typically involve breast gland hypoplasia and skeletal and muscular disorders. Herein, we describe three rare cases of Becker’s nevus syndrome. In the first case, the BN coexisted with ipsilateral breast gland hypoplasia; in the second case, the BN coexisted on both sides with breast gland hypoplasia and keratosis pilaris only in the left antecubital region and with scoliosis; in the third case, we found two Becker’s nevi in the left and right hip area associated with hypoplasia of the third canine tooth on the right side and with scoliosis. Our three cases were sporadic and all occurred in males. Coexisting symptoms of BN were found accidentally. We describe two new coexisting symptoms: atypical keratosis pilaris and hypoplasia of the canine teeth. [ABSTRACT FROM AUTHOR]

Copyright of Wiener Medizinische Wochenschrift is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Kosmetische Medizin + Ästhetische Chirurgie is the property of gmc-Gesundheitsmedien & Congress GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chlorhexidine is a synthetic antiseptic of the biguanide family, with a broad spectrum of antibacterial action. Chlorhexidine allergy was confirmed with at least two confirmatory tests: positive prick or intradermal test and positive chlorhexidine serum-specific IgE (ImmunoCap ThermoFischer Scientific, Uppsala, Sweden: positive chlorhexidine threshold was defined as equal or above 0.1 kUA/L). Chlorhexidine allergy diagnosis was confirmed by prick testing and positive chlorhexidine-specific serum IgE. [Extracted from the article]

Chemotherapeutic drugs have been widely used in the treatment of cancer disease for about 70 years. The development of new treatments has not hindered their use, and oncologists still prescribe them routinely, alone or in combination with other antineoplastic agents. However, all chemotherapeutic agents can induce hypersensitivity reactions (HSRs), with different incidences depending on the culprit drug. These reactions are the third leading cause of fatal drug‐induced anaphylaxis in the United States. In Europe, deaths related to chemotherapy have also been reported. In particular, most reactions are caused by platinum compounds, taxanes, epipodophyllotoxins and asparaginase. Despite their prevalence and relevance, the ideal pathways for diagnosis, treatment and prevention of these reactions are still unclear, and practice remains considerably heterogeneous with vast differences from center to center. Thus, the European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology organized a task force to provide data and recommendations regarding the allergological work‐up in this field of drug hypersensitivity reactions. This position paper aims to provide consensus on the investigation of HSRs to chemotherapeutic drugs and give practical recommendations for clinicians that treat these patients, such as oncologists, allergologists and internists. Key sections cover risk factors, pathogenesis, symptoms, the role of skin tests, in vitro tests, indications and contraindications of drug provocation tests and desensitization of neoplastic patients with allergic reactions to chemotherapeutic drugs. Statements, recommendations and unmet needs were discussed and proposed at the end of each section. [ABSTRACT FROM AUTHOR]

Background: Serum total tryptase has been shown to increase during acute allergic reactions (acute tryptase, TA); however, few studies have investigated the values of TA or a combination of TA and baseline tryptase (TB) to discriminate positive from negative testing in perioperative hypersensitivity reaction (POH) allergy work‐up. The aim of this study was to determine the diagnostic performance of TA in order to differentiate positive from negative allergy testing suspected POH and analyse the diagnostic performance of serial tryptase levels using several formulas. Methods: All patients from the University hospital of Montpellier and Strasbourg, France, who presented with suspected POH and underwent complete drug allergy work‐up between March 2011 and December 2019 with available TA and TB were included. Four formulas, including a change in TA > 11 (F1), or >2 + 1.2 × TB (F2), or >3 + TB (F3), or >120%TB (F4), were applied. Results: One hundred and sixty‐two patients were included, and 131 of them (80.8%) had Grade III or IV reactions. Ninety patients had positive allergy testing. The optimal cut‐off value of TA to distinguish positive from negative allergy testing patients was 9.8 μg/L with an AUC of 0.817 (95% CI: 0.752–0.882, p <.001). The 93% PPV threshold for TA was 33 μg/L (95.8% specificity). Paired tryptase levels according to formulas F2 and F3 yielded the highest Youden index (0.54 and 0.53, respectively). Conclusion: The optimal cut‐off point for TA for distinguishing positive from negative allergy testing suspected POH was 9.8 μg/L. TA value of 33 μg/L was required to achieve >90% PPV. [ABSTRACT FROM AUTHOR]

Keywords: anaphylaxis; drug allergy; drug provocation test EN anaphylaxis drug allergy drug provocation test 1233 1237 5 09/04/21 20210901 NES 210901 To the editor, Drug provocation test (DPT) is considered the gold standard test to diagnose drug hypersensitivity reactions (DHR). Patients with suspicions of DHR who underwent drug allergy work-up and presented with signs/symptoms evocative of shock during the tests were included in the analysis. In conclusion, patients with sign/symptoms and signs evocative of shock are extremely rare during drug allergy work-up, therefore BP measurement could be reduced in number according to patient clinical history of DHR and drug class risk stratification. [Extracted from the article]

Copyright of Kosmetische Medizin + Ästhetische Chirurgie is the property of gmc-Gesundheitsmedien & Congress GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Alopecia areata (AA) is a T-cell-mediated autoimmune disease and affects up to 2% of the population. There is a need for a more profound and rigorous understanding of the structure and composition of human hair affected by AA in order to manage this disease. The aim of this article is to understand the effects of AA on the structure and composition of human hair. Methods: Several physico-chemical investigation methods, such as Scanning Electron Microscopy (SEM), Transmission Electron Microscopy (TEM), Energy-Dispersive X-ray Spectroscopy (EDX), and microbeam Small Angle X-ray Scattering (SAXS), were used to analyze human hair samples obtained from healthy donors and patients with AA. Results: SEM revealed more severe hair surface defects for the white regrown hair (W-AA) samples. TEM showed the presence of air-like vesicles located in the endocuticle of regrown hair. Analysis of ultrathin sections of W-AA showed the existence of empty vesicles and smaller melanin granules compared to control samples. SAXS demonstrated that unaffected hair of patients with AA (B-AA) and W-AA melanin aggregates are different in their sizes and shapes compared to the control samples. EDX data showed that W-AA elemental composition was significantly different from the other sample groups. Our study showcases promising non-invasive techniques for a better and more accurate understanding of changes in the internal structure and composition of hair affected by AA. [ABSTRACT FROM AUTHOR]

Background: Hand eczema, in time of COVID-19, is one of the most frequently diagnosed skin disorders in nurses. In this study, we sought to investigate whether smoking could be an additional risk factor for hand eczema in nurses during the COVID-19 pandemic. Method: Using a questionnaire about smoking details and hand eczema, we conducted a study among nurses involved in the frontline management of COVID-19 patients. A total of 1,000 questionnaires were sent out. The questionnaires were anonymous and based on self-reported answers, with no clinical examination or medical data evaluation. All nurses enrolled in the study were women, working in shifts for the last three months since the start of the COVID-19 pandemic. Results: Two-hundred forty-seven questionnaires were accepted for the study, after eliminating non-responders and nurses without hand eczema. The majority of nurses denied smoking (87.85%) in the past and at the moment of the study. Statistics related to years of smoking and occurrence of hand eczema showed no increase in the number of cases in correlation with the number of years of smoking. Similarly, a random distribution of cases of hand eczema was observed when compared to the number of cigarettes per day. Conclusion: Our data does not support the hypothesis that smoking is an independent risk factor for the development of occupational hand eczema during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) is a recurrent chronic inflammatory condition of the skin with a debilitating potential, especially in adolescents who may experience psychosocial disorders and impaired quality of life. Recognition of typical, recurrent lesions, history of the disease and family investigation establishes the diagnosis. The rarity of the disease in males and the appearance of this condition in children, which is also rare, in two of our adolescent patients, respectively, are the reasons for publishing this article. We reviewed the literature and found that variation exists across international treatment for this HS, and much collaboration is needed to put forth unified and updated recommendations. It is of major importance that the early recognition of the condition and the establishment of treatment in the multidisciplinary team. Psychotherapy, health education, the adoption of a healthy lifestyle, the application of local prevention measures, and long-term medical treatment are components of a correct management. Extensive surgical treatment should be restricted only to severe cases because it may lead to complications, extend the hospitalization period and increase psychological problems in adolescents. The treatment will be personalized, performed according to the stage of evolution, and the approach will be a multidisciplinary one. [ABSTRACT FROM AUTHOR]

However, the addition of electrostatic precipitation to PIPAC-Ox was recently shown to be associated with important systemic uptake.10 Patient 5 had a reaction to oxaliplatin and benefited from PIPAC with cisplatin without allergy investigations and without allergic recurrence. The allergic reaction occurred during the 5th PIPAC for patient 1 and the 12th for patient 2. The allergy work-up included ST performed according to the European Network on Drug Allergy recommendations.5 All patients gave their informed consent for their anonymous data to be used for research purposes. [Extracted from the article]

Background: Patients with a penicillin allergy label tend to have worse clinical outcomes and increased healthcare use. Drug provocation tests (DPT) are the gold‐standard in the diagnostic workup of penicillin allergy, but safety concerns may hinder their performance. We aimed to assess the frequency of severe reactions following a DPT in patients with reported allergy to penicillins or other β‐lactams. Methods: We performed a systematic review, searching MEDLINE, Scopus, and Web of Science. We included primary studies assessing participants with a penicillin allergy label who underwent a DPT. We performed a Bayesian meta‐analysis to estimate the pooled frequency of severe reactions to penicillin DPTs. Sources of heterogeneity were explored by subgroup and metaregression analyses. Results: We included 112 primary studies which included a total of 26,595 participants. The pooled frequency of severe reactions was estimated at 0.06% (95% credible interval [95% CrI] = 0.01%–0.13%; I2 = 57.9%). Most severe reactions (80/93; 86.0%) consisted of anaphylaxis. Compared to studies where the index reaction was immediate, we observed a lower frequency of severe reactions for studies assessing non‐immediate index reactions (OR = 0.05; 95% CrI = 0‐0.31). Patients reporting anaphylaxis as their index reaction were found to be at increased risk of developing severe reactions (OR = 13.5; 95% CrI = 7.7–21.5; I2 = 0.3%). Performance of direct DPTs in low‐risk patients or testing with the suspected culprit drug were not associated with clinically relevant increased risk of severe reactions. Conclusions: In patients with a penicillin allergy label, severe reactions resulting from DPTs are rare. Therefore, except for patients with potentially life‐threatening index reactions or patients with positive skin tests—who were mostly not assessed in this analysis ‐, the safety of DPTs supports their performance in the diagnostic assessment of penicillin allergy. [ABSTRACT FROM AUTHOR]

Immediate and nonimmediate hypersensitivity reactions to iodinated contrast media (ICM) have been reported to occur in a frequency of about 0.5%‐3% of patients receiving nonionic ICM. The diagnosis and management of these patients vary among guidelines published by various national and international scientific societies, with recommendations ranging from avoidance or premedication to drug provocation test. This position paper aims to give recommendations for the management of patients with ICM hypersensitivity reactions and analyze controversies in this area. Skin tests are recommended as the initial step for diagnosing patients with immediate and nonimmediate hypersensitivity reactions; besides, they may also help guide on tolerability of alternatives. Re‐exposition or drug provocation test should only be done with skin test‐negative ICMs. The decision for performing either re‐exposition or drug provocation test needs to be taken based on a risk‐benefit analysis. The role of in vitro tests for diagnosis and pretreatment for preventing reactions remains controversial. [ABSTRACT FROM AUTHOR]

Circulating memory T cells are heterogeneous in their tissue tropism. The skin-seeking T cell subset expresses the cutaneous lymphocyte-associated antigen (CLA) on their surface. CLA+ memory T cells not only migrate from blood to skin but also recirculate between blood and skin. Studying CLA+ memory T cells in cutaneous diseases has allowed a better understanding of immune-inflammatory mechanisms that take place. The analysis of the phenotypical features of these cells, their antigen specificity, cytokine production profile, and changes in relationship to clinical status and therapies among other characteristics have led to the concept that they constitute peripheral cellular biomarkers in T cell-mediated cutaneous conditions. CLA+ memory T cells are of relevance in the pathogenesis of several cutaneous diseases, such as psoriasis (PSO), atopic dermatitis, vitiligo, and drug-induced allergic reactions, to name a few. The interaction of circulating CLA+ T cells with skin-resident cells has been investigated in different ex vivo coculture models made out of clinical samples. Interestingly, microbes that are present in the skin or related with human skin diseases are preferentially recognized by CLA+ T cells. Thus, the interaction of Streptococcus pyogenes with CLA+ T cells in PSO is providing novel concepts that help to understand disease immunopathogenesis. The goal of this review is to present latest results in the field of CLA+ T cells in T cell-mediated inflammatory skin diseases and their translational relevance for human immunodermatology. [ABSTRACT FROM AUTHOR]

Clinicians working in drug allergy should be aware of this unusual delay, since these may be true drug allergies, confirmed by flare-up of primarily negative skin tests. Delayed positive drug provocation tests to beta-lactams with flare-up reactions of skin tests sites Keywords: beta-lactams; drug allergy; Flare-up; T cells; test EN beta-lactams drug allergy Flare-up T cells test 499 502 4 03/08/21 20210301 NES 210301 To the Editor, Non-immediate allergic drug hypersensitivity reactions (DHR) to beta-lactams are attributed to T-cell-dependent mechanisms, varying from mild/moderate reactions, such as maculopapular exanthema (MPE) or delayed urticaria, to more severe cutaneous adverse reactions (SCAR).1 Patch tests (PT) and/or delayed-reading intradermal tests (IDT) have been proposed for in vivo diagnosis of this allergic phenotype, with the latter being generally reported as more sensitive.1 When skin tests are negative and there is no contraindication, a drug provocation test (DPT) may be performed, to confirm or rule out the DHR. [Extracted from the article]

The aim of this study was to estimate the prevalence of self-reported work-related and occupational hand eczema, as well as associated risk factors in hospitals and out-patient clinics in Romania. A standardized questionnaire was addressed to health professionals from different medical fields. Out of 245 healthcare providers who completed the survey, 235 were women (95.9%), and 243 were working more than 8 hours/day in hospitals (99.18%). Hand eczema was self-reported and documented in almost one third of the nurses (33.49%), the most frequently involved trigger factor being powdered latex gloves. A total of 207 (84.48%) individuals denied any present or past allergic diseases. Only one nurse declared that severe hand eczema was the cause of losing her job at the hospital. Exposure assessment is essential for the diagnosis of work-related or occupational skin diseases. [ABSTRACT FROM AUTHOR]

Coronavirus disease (COVID‐19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) primarily affects the epithelium of the airways. With the increasing involvement of dermatologist in management of this crisis, cutaneous symptoms gained more and more attention. In this review, we will describe cutaneous symptoms of patients of all ages in association with COVID‐19. We will focus on such disorders that are caused by direct action of SARS‐CoV‐2 on tissues, complement, and coagulation system and on nonspecific eruption of the systemic viral infection. Drug‐induced reactions are only mentioned in the differential diagnoses. Although more systematic investigations are warranted, it becomes clear that some symptoms are clinical signs of a milder COVID‐19 course, while others are a red flag for a more severe course. Knowledge of the cutaneous manifestations of COVID‐19 may help in early diagnosis, triage of patients, and risk stratification. [ABSTRACT FROM AUTHOR]

Prevalence of self-reported and confirmed penicillin allergy in a Belgian outpatient population To the editor, -lactam antibiotics ( -LABs), especially penicillins, are one of the predominant causes of drug hypersensitivity reactions (DHRs) with significant morbidity and mortality. As both were unwilling to repeat the DC, they were included in the group of the patients with incomplete diagnostic work-up. gl A total of 120 participants with a self-reported penicillin allergy agreed to have additional testing as mentioned before. Alternatively, in 9 cases a diagnosis of hypersensitivity towards natural and semi-synthetic penicillin, amoxicillin or amoxicillin/clavulanic acid was established. [Extracted from the article]

Background: Calciphylaxis is associated with end-stage renal failure or kidney transplant, although, cases of non-uremic calciphylaxis have been reported. It is a rare disorder, with high mortality, characterized by vascular calcification within cutaneous vessels; vascular calcification can occur in other organs, besides skin, like heart, lung, or pancreas, which is named visceral calciphylaxis. Objective: The purpose was to review current knowledge regarding diagnosis and therapeutic approach to cutaneous calciphylaxis. Methods: A literature review has been conducted associated to word "calciphylaxis". Results: The diagnosis is based mainly on clinical features and histologic findings. Therapeutic options are still controversial. Conclusions: Cutaneous calciphylaxis is a puzzling disease, with a challenging diagnosis, and a complex treatment, which requires a multidisciplinary team and expertise. [ABSTRACT FROM AUTHOR]

IL-15 has emerged as a potentially relevant target in the IL-17 response in psoriasis. However, its mechanism is poorly characterized in humans. IL-15 and IL-23 are constitutively expressed in the psoriatic lesion. Also, IL-15 is considered a susceptibilityassociated gene in psoriasis, as are IL-23R, and HLACW6. Here, we studied the effect of IL-15 and IL-23 stimulation on the cytokine response of CLA+/CLA- T cells from 9 psoriasis patients and 3 healthy control subjects. To this end, CLA + and CLA- T cells from blood samples were cultured with epidermal cells from skin biopsies and treated with IL-15 and IL-23. After five days of culture, cytokines in supernatant were measured by ELISA or fluorescent bead-based immunoassay. There was a statistically significant increase in IL-17F and IL-17A production (P < .001) in cocultures of psoriasis skin-homing CLA + T cells with epidermal cells when stimulated with IL-15 and IL-23, but this effect was not observed in the cells of healthy controls. Interestingly, this response was reduced by around 50 to 80% by blocking HLA class I and II molecules. Our results point to the synergic action of IL-15 and IL-23 selectively for CLA + cells in psoriasis, leading to the induction of Th17 cell-related cytokines. [ABSTRACT FROM AUTHOR]

A recent survey of the European Academy of Allergy and Clinical Immunology (EAACI) Drug Allergy Interest Group (DAIG) on how European allergy specialists deal with beta‐lactam (BL) hypersensitivity demonstrated a significant heterogeneity in current practice, suggesting the need to review and update existing EAACI guidelines in order to make the diagnostic procedures as safe and accurate, but also as cost‐effective, as possible. For this purpose, a bibliographic search on large studies regarding BL hypersensitivity diagnosis was performed by an EAACI task force, which reviewed and evaluated the literature data using the GRADE system for quality of evidence and strength of recommendation. The updated guidelines provide a risk stratification in BL hypersensitivity according to index reaction(s), as well as an algorithmic approach, based on cross‐reactivity studies, in patients with a suspicion of BL hypersensitivity and an immediate need for antibiotic therapy, when referral to an allergist is not feasible. Furthermore, the update addresses availability and concentrations of skin test (ST) reagents, ST and drug provocation test (DPT) protocols, and diagnostic algorithms and administration of alternative BL in allergic subjects. Specifically, distinct diagnostic algorithms are suggested depending on risk stratification of the patient into high and low risk based on the morphology and chronology of the reaction, immediate (ie, occurring within 1‐6 hours after the last administered dose) or nonimmediate (ie, occurring more than 1 hour after the initial drug administration), and the reaction severity. Regarding the allergy workup, the main novelty of this document is the fact that in some low‐risk nonimmediate reactions ST are not mandatory, especially in children. For DPT, further studies are necessary to provide data supporting the standardization of protocols, especially of those regarding nonimmediate reactions, for which there is currently no consensus. [ABSTRACT FROM AUTHOR]

Introduction: Hypersensitivity to nonsteroidal anti‐inflammatory drugs (NSAIDs) is of great concern because they are frequently encountered in daily clinical practice. Drug provocation tests (DPTs) are particularly needed for NSAIDs. Methods: The aim of this retrospective study was to detect eliciting dose thresholds during NSAIDs DPT in order to suggest optimal step doses, using the survival analysis method. Our secondary objective was to describe subgroups at higher risk during DPT and evaluate the safety of our 30 minutes incremental 1‐day protocol. The study comprised all the patients attended the Allergy of the University Hospital of Montpellier (France), between 1997 and 2017 for a suspicion of drug hypersensitivity reaction to NSAIDs. Results: Throughout the study period, 311 positive DPT were analyzed (accounting for 285 hypersensitive patients). We identified eliciting thresholds (dose and time), and we suggest the following steps for future DPT: for the rapid absorption group (acetylsalicylic acid, ibuprofen, ketoprofen, and tiaprofenic acid), every 30 minutes: 20%‐30%‐50% of daily therapeutic dose, for the moderate absorption group, every 30 minutes: for diclofenac 5%‐15%‐30%‐50%, and for celecoxib, 20%‐80%. For the slow absorption group, piroxicam, 25%‐75%, was separated by a 3‐hours interval. A surveillance period of 3 hours after the last dose is mandatory for patients. Conclusion: Drug provocation test protocols for NSAID are empirical, driven by the knowledge on patterns of DHR, cross‐reactivity between NSAID and pharmacological effects of these all drugs. This is the second experience in improving DPT protocols, after BL (B‐lactam) antibiotics. [ABSTRACT FROM AUTHOR]