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This guidance updates 2021 GRADE (Grading of Recommendations Assessment, Development and Evaluation) recommendations regarding immediate allergic reactions following coronavirus disease 2019 (COVID-19) vaccines and addresses revaccinating individuals with first-dose allergic reactions and allergy testing to determine revaccination outcomes. Recent meta-analyses assessed the incidence of severe allergic reactions to initial COVID-19 vaccination, risk of mRNA-COVID-19 revaccination after an initial reaction, and diagnostic accuracy of COVID-19 vaccine and vaccine excipient testing in predicting reactions. GRADE methods informed rating the certainty of evidence and strength of recommendations. A modified Delphi panel consisting of experts in allergy, anaphylaxis, vaccinology, infectious diseases, emergency medicine, and primary care from Australia, Canada, Europe, Japan, South Africa, the United Kingdom, and the United States formed the recommendations. We recommend vaccination for persons without COVID-19 vaccine excipient allergy and revaccination after a prior immediate allergic reaction. We suggest against >15-minute postvaccination observation. We recommend against mRNA vaccine or excipient skin testing to predict outcomes. We suggest revaccination of persons with an immediate allergic reaction to the mRNA vaccine or excipients be performed by a person with vaccine allergy expertise in a properly equipped setting. We suggest against premedication, split-dosing, or special precautions because of a comorbid allergic history.

Background: Adverse reactions, including anaphylaxis, to messenger RNA coronavirus disease 2019 (COVID-19) vaccines rarely occur. Because of the need to administer a timely second dose in subjects who reported a reaction to their first dose, a panel of health-care professionals developed a safe triage of the employees and health care providers (EHCP) at a large health-care system to consider administration of future dosing. Methods: There were 28,544 EHCPs who received their first dose of COVID-19 vaccines between December 15, 2020, and March 8, 2021. The EHCPs self-reported adverse reactions to a centralized COVID-19 command center (CCC). The CCC screened and collected information on the quality of reaction, symptoms, and timing of the onset of the reaction. Results: Of 1253 calls to the CCC, 113 were identified as requiring consideration by a panel of three (American Board of Allergy and Immunology) ABAI-certified allergists for future dosing or formal in-person assessment. Of the 113 EHCPs, 94 (83.2%) were recommended to get their second dose. Eighty of 94 received their second planned dose without a severe or immediate reaction. Of the 14 of 113 identified as needing further evaluation, 6 were evaluated by a physician and subsequently received their second dose without a serious adverse reaction. Eight of 14 did not receive their second dose. Only 5 of the 113 EHCPs reported reactions (4.4%) were recommended to not take the second dose: 3 (2.6%) because of symptoms consistent with anaphylaxis, and 2 because of neurologic complications (seizure, stroke). Conclusion: The panel demonstrated that, by consideration of reaction history alone, the ECHPs could be appropriately triaged to receive scheduled second dosing of COVID-19 vaccines without delays for in-person evaluation and allergy testing. [ABSTRACT FROM AUTHOR]

The effects of density and other situational factors on perceptions of and responses to crowding in classroom learning environments were examined in three separate and concurrent investigations. Implications based on the pattern of results for all three experiments are discussed. (Author/GK)

In order to reconstruct the plasma boundary directly and independently, a new method based on visible imaging diagnostics is developed for experimental advanced superconducting tokamak (EAST); its effectiveness has been verified by conducting offline experiments based on EAST’s historical data. The offline boundary reconstruction results, including X-points, are compared to offline equilibrium fitting code (offline EFIT), which is a commonly used reconstruction method. With an average error of 1.5 cm, the total processing time for one frame is less than 2 ms by current software and hardware. When the camera sensor is not saturated, the algorithm is robust for different image intensities of the plasma discharge. The results of the boundary reconstruction by visible imaging diagnostics also show potential for real-time plasma control in a tokamak. [ABSTRACT FROM AUTHOR]

Thymic stromal lymphopoietin (TSLP) and IL-7 are cytokines that signal via the IL-7 receptor alpha (IL-7Rα) to exert both overlapping and unique functions during early stages of mouse B-cell development. In human B lymphopoiesis, the requirement for IL-7Rα signaling is controversial and the roles of IL-7 and TSLP are less clear. Here, we evaluated human B-cell production using novel in vitro and xenograft models of human B-cell development that provide selective IL-7 and human TSLP (hTSLP) stimulation. We show that in vitro human B-cell production is almost completely blocked in the absence of IL-7Rα stimulation, and that either TSLP or IL-7 can provide a signal critical for the production and proliferation of human CD19+ PAX5+ pro-B cells. Analysis of primary human bone marrow stromal cells shows that they express both IL-7 and TSLP, providing an in vivo source of these cytokines. We further show that the in vivo production of human pro-B cells under the influence of mouse IL-7 in a xenograft scenario is reduced by anti-IL-7 neutralizing antibodies, and that this loss can be restored by hTSLP at physiological levels. These data establish the importance of IL-7Rα mediated signals for normal human B-cell production. [ABSTRACT FROM AUTHOR]

I was very disappointed to read the article 'Allergy treatment nothing to sneeze at,' which encouraged physicians to consider practicing allergy as a revenue source. For those who would 'play [...]

Patients with urticaria and/or angioedema have several reasons to have a poor quality of life (QoL). The intensity of pruritus and density of involvement compromise a patient's lifestyle as well as aggravate stressors that affect physical and psychiatric conditions. The burden of illness is significant in not only costs for emergent practitioner visits, but, often, unnecessary laboratory testing and medication expenses. Questionnaires that assess a patient's QoL serve to document benefit to therapies. Objectively documenting changes that are important to patients with urticaria and/or angioedema allows the patients and clinician to accurately assess effectiveness of therapies over long periods of time. Specific surveys that address urticaria (CU-Q2oL and UAS) and angioedema (AE-QoL questionnaire) allow simplified and sensitive assessments for patients with the corresponding condition. Common components of appropriate surveys assess not only intensity of pruritus and wheals but also impact on sleep, interpersonal relationships, and appearances. In considering the most important aspects of several surveys, an example of a survey is provided that focuses on the patient's perception of how their urticaria and/or angioedema impacts their QoL. [ABSTRACT FROM AUTHOR]

Employers hope that this is the year that things finally return around, and that includes increases in hiring and compensation. Still, budgets are tight and companies need to get the most productivity possible from their compensation programs. That is fueling an increased interest in total compensation management, in which compensation is used as a carrot to drive desired behavior. The goals are to identify top performers, create more like them, and have employee performance best meet business goals. [ABSTRACT FROM AUTHOR]

Pruritus is synonymous with itching. Many medical conditions are complicated by chronic pruritus compromising the patient's quality of life. The majority of pruritic stimuli are transmitted through C fibers into the lateral spinothalamic tract and then into the somatic sensory cortex where the itching is detected. Histamine, substance P, and tumor necrosis factor α play significant roles in the perception of pruritus. Medical conditions in adults with significant pruritus will be defined in this review. [ABSTRACT FROM AUTHOR]

The dilemma of treating chronic sinusitis continues to confuse clinicians. When mucosal thickening does not respond to aggressive antibiotic therapy, other etiologies should be considered. Perhaps the most likely is the inflammatory response. In comparison with asthma, chronic sinusitis exhibits amazing similarities. Atopic dermatitis also exhibits similar inflammatory responses that lead to thickening of the skin in a manner not dissimilar to mucosal thickening. The interactions amid eosinophils, lymphocytes, leukotrienes, interleukins, and epithelial cells serve as a reminder that there is one immune response and similarities exist in the pathophysiology of these conditions. [ABSTRACT FROM AUTHOR]

Patients with chronic urticaria have a poor quality of life (QOL). Chronic pruritus with variable appearance of urticaria and/or angioedema are typical of the uncertainty that compromise their QOL. Other issues such as fatigue, cost of therapy, and social isolation further contribute to the frustration that patients experience. Various instruments are available to measure the quality of life of patients with urticaria and can be adjunctive in the continued assessment of patients with this variable condition. In comparison with other dermatological and medical conditions, patients with chronic urticaria have a significantly worse QOL. [ABSTRACT FROM AUTHOR]

The causes of coughing are multiple. Research into the physiology of coughing has established that interactions amid C-fibers and rapidly activating receptors in humans have the most significant effect on stimulation of coughing. Precipitants of coughing include gastroesophageal reflux and sinusitis. Stimulation of vagal afferents by esophageal irritation and aspiration of acidic gastric contents or vapors are the most frequently cited causes of cough associated with gastroesophageal reflux or laryngopharyngeal reflux. Sinusitis may precipitate coughing from other mechanisms including aspiration of postnasal drainage and sinopulmonary reflex. Taking a lesson on how these conditions affect asthmatic patients, this article will review how these two conditions may also influence cough in normal patients. [ABSTRACT FROM AUTHOR]

The following case was presented at the Eastern Allergy Conference May 2005 to each of four small group sessions in an attempt to incorporate problem-based learning (PBL) into the curriculum of the conference for the first time in its 18-year history. Before this, the format had always been non-stop lectures for four days. The attempt to use PBL in breakout sessions was due to the well-documented improved learning experience with PBL demonstrated by multiple studies in the literature of PBL for CME. This PBL case on an adult who presents with a "chronic cough" was linked to a series of three didactic lectures to reinforce the differential diagnoses in this patient. The three lectures followed the PBL breakout sessions (during the morning of the conference) and were entitled Laryngeal Pharyngeal Reflux (LPR), Chronic Sinusitis: A Surgical Perspective and Chronic Cough. Although the best learning scenario for this case occurs when there is interaction with one's peers, review of this case and answering the questions that were posed by the facilitators can still provide a great learning experience. [ABSTRACT FROM AUTHOR]

There are many endocrine conditions that can present with allergic symptoms and signs. Thyroid conditions ranging from fatigue to orbitopathy associated with Grave's disease can be confused with allergic conjunctivitis and angioedema. Autoimmune thyroid disease is commonly associated with idiopathic urticaria. Symptoms of orthostatic hypotension and intolerance often present when least expected and should be considered ahead of time to avoid confusion in treating possible systemic allergic reactions. Flushing is a frequent sign and differentiating from complaints commonly associated with allergic reactions, rosacea, and endocrinopathies is helpful in sorting out some of the more complex conditions associated with this symptom. [ABSTRACT FROM AUTHOR]

Coughing that lasts >3 weeks is generally considered chronic. The causes of chronic cough are many. Most often, chronic cough is due to postnasal drainage, asthma, and/or gastroesophageal disease. However, other causes such as laryngopharyngeal reflux, vocal cord dysfunction, occult sinusitis, pertussis, and angiotensin-converting enzyme inhibitor should be considered. Even rarer entities will be discussed as well as some of the pathophysiology associated with the cough reflex. [ABSTRACT FROM AUTHOR]

When patients present with itching and the perception that they have hives, what other processes can mimic urticaria? With the exception of urticarial vasculitis, urticaria typically lasts less than 24 to 36 hours at one site. A rash that persists longer should raise the suspicion of another inflammatory process. When the hive-like rash does not respond to antihistamines, a biopsy may reveal an alternative diagnosis. All biopsies should also be submitted for immunofluorescence to exclude atypical presentations of inflammatory bullous disease presenting with urticaria. However, even biopsies can be subject to misinterpretation and if the clinical picture does not support the biopsy, an alternative consultation with a dermatopathologist may be required. The extent of the laboratory and radiologic evaluation should be dictated by the clinician's suspicion of alternative causes for the hive(s) because rarely malignancies may present with urticaria. Common things are indeed common with urticaria and the more urticaria does not appear to be typical, the more often the clinician should consider alternative diagnoses. [ABSTRACT FROM AUTHOR]

Fishbein's model was extended to female occupational choice. Normative beliefs and the attitudinal components of the model, as applied to female career choices, were expected to predict subjects' behavioral intentions better than would attitude alone. Eighty-eight sophomore women filled out and returned field survey questionnaires consisting of scales to measure the necessary components of the model. Additional measures were also taken. The normative beliefs component of the model was found to be the major predictor of behavioral intentions. The attitudinal component was relatively unimportant. Other findings were consistent with the model. Implications of the results are discussed. [ABSTRACT FROM PUBLISHER]

We studied the phase-transition induced texture changes and strengthening mechanism for zirconium metal under quasi-hydrostatic compression and uni-axial deformation under confined high pressure using the deformation-DIA (D-DIA) apparatus. It is shown that the experimentally obtained texture for ω-phase Zr can be qualitatively described by combining a subset of orientation variants previously proposed in two different models. The determined flow stress for the high-pressure ω-phase is 0.5-1.2 GPa, more than three times higher than that of the α-phase. Using first-principles calculations, we investigated the mechanical and electronic properties of the two Zr polymorphs. We find that the observed strengthening can be attributed to the relatively strong directional bonding in the ω phase, which significantly increases its shear plastic resistance over the α-phase Zr. The present findings provide an alternate route for Zr metal strengthening by high-pressure phase transformation. [ABSTRACT FROM AUTHOR]