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Objective To explore the status and influencing factors of latent tuberculosis infection among high school students in Chongqing and to provide technical support for the prevention and control of tuberculosis in schools in Chongqing. Methods Stratified cluster sampling method was used to select the students of the first and second years of high school in Chongqing in 2023, as the study subjects to detect latent tuberculosis infection with recombinant Mycobacterium tuberculosis fusion protein skin test, to collect the information related to latent tuberculosis infection, and to analyse the influencing factors using Logistic regression model. Results A total of 9161 students in the first and second years of high school in Chongqing were included, and 543 latent tuberculosis infections were detected, with a latent tuberculosis infection rate of 5. 93%. Multifactorial logistic regression analysis showed that history of previous tuberculosis (0R: 4, 244, 95%Cf: 2. 239 - 8. 044), history of close contact with tuberculosis (OR:2. 096, 95% CI: 1, 123 -3.914), smoking (OR: &819, 95% Cf: 3. 562 - 13. 053), and staying up late (<92,: 1. 665, 95% CI: 1. 154 - 2. 402) were risk factors for latent tuberculosis infection in students. Conclusion The rate of latent tuberculosis infection among students in the first and second years of high school in Chongqing is low. Not smoking, not staying up late, avoiding close contact with tuberculosis patients, taking good personal protective measures, strengthening physical exercise, and improving immunity can reduce the risk of students being infected with Mycobacterium tuberculosis. [ABSTRACT FROM AUTHOR]

Background: Hypersensitivity to beta-lactam (BL) antibiotics is one of the most frequent reported drug allergies. In our population, it is common to find labels of BL allergy in electronic medical records (EMRs) that have not been assessed. The objective of our study was to detect patients with beta-lactam allergy labels in their EMRs and to assess how many of them are false after a correct diagnostic evaluation. Methods: A multicentre prospective study was performed with patients labelled as allergic to BLs in their EMRs in the previous 5 years. Demographical and clinical data, as well as variables regarding the BL allergy label and the characteristics of the index reaction from clinical history and EMRs, were recorded. Then, diagnostic assessments including clinical history, skin tests (STs), and drug provocation tests (DPTs) were conducted in order to confirm or exclude the diagnosis of BL allergy. Results: A total of 249 patients completed the study, of which 160 (64.3%) were women with a median age of 57 years (interquartile range [IQR], 45-68). The most frequent BL allergy labels detected were for penicillin (124), amoxicillin/clavulanic acid (61), and amoxicillin (54). Of the 204 patients who underwent STs, 20.1% were positive. DPTs were performed in 224 patients, showing good tolerance in 87.1% of cases. After the allergy diagnosis work-up, 186 patients (74.7%) were diagnosed as non-allergic to BL antibiotics. Conclusion: In our study population, the number of patients labelled as allergic to BLs in their EMRs was similar to that in previously published studies, with proportions near to 75%-80% being falsely labelled as allergic to BLs. [ABSTRACT FROM AUTHOR]

A rare case of food-dependent exercise-induced anaphylaxis caused by potato snacks is reported. Specific food triggers for anaphylaxis were identified by using the skin prick test, antigen analysis, and serum IgE assays. Four potato proteins were considered candidate antigens for food-dependent exercise-induced anaphylaxis.

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

Tuberculosis (TB) is a disease caused by members of the M. tuberculosis complex (MTC) that affects numerous species. M. caprae, a member of the complex which is close to M. bovis, is emerging and affects several different hosts that include goats, cattle, sheep, pigs, rabbits, wild boar, red deer, foxes and also humans. A new M. caprae spoligotype (SB2737) was isolated from an outbreak of sheep tuberculosis affecting a mixed sheep (323)-goat (29) farm in 2021. The index case was detected by the La Rioja slaughterhouse veterinary inspection. Tracing back to the farm of origin, both species were submitted to Comparative Intradermal Tuberculin Test (CITT) and M. bovis-specific antibody ELISA tests. A subsample was also examined by IFN-γ release assay (IGRA) and all positives were slaughtered and pathologically and microbiologically investigated. Only 1.2% of sheep and no goat were positive in the CITT, and 11.4% in the IGRA sheep subsample, while up to 36.8% were positive in two consecutive M. bovis-specific antibody ELISA tests. Goats had always tested negative in annual intradermal follow-up since 2013. Upon confirmation of the immunologically positive sheep at slaughter, all the remaining negative animals were killed and 29.2% of sheep were still found infected. This raised the final overall prevalence to 37.5%. Antibody ELISA was the most sensitive (81.4%) in vivo detection method still showing a 85.0% specificity relative to pathological and microbiological tuberculosis status. It was nearly 10 times more sensitive than skin test and had an 86.8% positive predictive value. Notwithstanding a possible singular pathogenesis of the new spoligotype, this outbreak adds up to previous reports suggesting that sheep tuberculosis could be huge reservoir of infection worldwide overlooked by skin test low sensitivity or simply lack of investigation. This makes it urgent to extend the use antibody tests to address the Trojan horse of hidden M. tuberculosis complex infections on bovine TB control programs. [ABSTRACT FROM AUTHOR]

Background: Fungal infections are the primary cause of skin diseases. Topical application of antifungal drugs is the most preferred treatment which is associated with key limitations viz. need for high doses and frequency of application. By considering the limitations of current topical treatment, the present study involves the formulation and characterization of luliconazole nanogel. Materials and Methods: The luliconazole nanoparticles were prepared by using biodegradable polymer PLGA 50:50 and dispersed in polymeric dispersion prepared by Carbopol 940 and HPMC K4M. For optimization of nanoparticles as well as their polymeric dispersion a factor-three level (32) design was implemented. Optimized nanoparticles were characterized for various parameters viz. particle size, PDI, entrapment efficiency, XRD, SEM, whereas the nanogel was investigated for viscosity, cumulative drug release, spreadability, extrudability, skin irritation test, and antifungal activity. Results: The nine batches of nanoparticles as well as nanogel were prepared. Nanoparticles prepared by using 100 mg PLGA at 6 HPH cycles showed size, PDI, and % entrapment as 406 nm and 87% respectively was the desired batch. The XRD and SEM study ensured the encapsulation of drug with satisfactory surface morphology. Nano-gel formulated with 0.3% Carbopol and 1.0% HPMC was selected as optimized; it showed viscosity and % cumulative drug release as 3650 cP and 54% respectively. Nanogel showed significant sustained luliconazole release (54.12%) in comparison to simple nanoparticles (65.22%). The formulation showed improved antifungal activity than standard treatment without any skin irritation signs. Conclusion: Prepared nano-gel is a promising alternative to the current treatment. [ABSTRACT FROM AUTHOR]

Background: Hypersensitivity to beta-lactam (BL) antibiotics is one of the most frequent reported drug allergies. In our population, it is common to find labels of BL allergy in electronic medical records (EMRs) that have not been assessed. The objective of our study was to detect patients with beta-lactam allergy labels in their EMRs and to assess how many of them are false after a correct diagnostic evaluation.Methods: A multicentre prospective study was performed with patients labelled as allergic to BLs in their EMRs in the previous 5 years. Demographical and clinical data, as well as variables regarding the BL allergy label and the characteristics of the index reaction from clinical history and EMRs, were recorded. Then, diagnostic assessments including clinical history, skin tests (STs), and drug provocation tests (DPTs) were conducted in order to confirm or exclude the diagnosis of BL allergy.Results: A total of 249 patients completed the study, of which 160 (64.3%) were women with a median age of 57 years (interquartile range [IQR], 45–68). The most frequent BL allergy labels detected were for penicillin (124), amoxicillin/clavulanic acid (61), and amoxicillin (54). Of the 204 patients who underwent STs, 20.1% were positive. DPTs were performed in 224 patients, showing good tolerance in 87.1% of cases. After the allergy diagnosis work-up, 186 patients (74.7%) were diagnosed as non-allergic to BL antibiotics.Conclusion: In our study population, the number of patients labelled as allergic to BLs in their EMRs was similar to that in previously published studies, with proportions near to 75%–80% being falsely labelled as allergic to BLs.

Empty mast cell syndrome, also named post anaphylaxis mast cell anergy (PAMA), is a temporary state of loss of mast cell responsiveness after a severe immediate hypersensitivity reaction. In this study, we describe a case of PAMA after accidental re-exposure to amoxicillin in a patient who developed severe anaphylaxis to this drug three days earlier in the operating room. To our knowledge, this report is the second to document this phenomenon.

This article discusses the occurrence of injection-site reactions (ISR) in patients receiving tralokinumab, a medication used to treat moderate-to-severe atopic dermatitis. The prevalence of ISR with tralokinumab in real-life studies was higher than in clinical trials. The article presents a case study of a 17-year-old male who experienced pruritic and painful ISR after self-injections of tralokinumab. Skin biopsy and testing ruled out an allergic reaction and suggested that incorrect injection procedure may have been the cause. Educating the patient on the correct procedure resulted in a decrease in the frequency and intensity of ISR. [Extracted from the article]

Anaphylaxis is a potentially life-threatening systemic allergic reaction that can result in fatal outcomes if not promptly and appropriately treated. The diagnosis of the cause of anaphylaxis during anesthesia can be challenging due to the complexity of the perioperative environment. Propofol-induced perioperative anaphylaxis is uncommon, occurring in perioperative anaphylactic shock cases. We present a case of perioperative anaphylactic shock in a patient with no known allergies who had been exposed to the same anesthetic agents, propofol, rocuronium, and remifentanil, three times previously without incident. Cardiac arrest occurred 50 min after induction, which showed pulseless electrical activity with decreasing saturation without bronchial spasm and skin erythema or edema. After prompt and appropriate management including cardiopulmonary resuscitation, the patient recovered without complications. The diagnosis was confirmed as propofol-induced anaphylactic shock by an elevated serum tryptase level, measured in a timely manner, and by skin tests (skin prick test and intradermal test), which revealed strong hypersensitivity to propofol. This case is notable for the cardiovascular collapse that occurred without respiratory symptoms or skin manifestations, as well as the delayed onset of anaphylaxis (>50 min). This case underscores the importance of vigilance for anaphylaxis, even with repeated exposure to previously well-tolerated drugs, as sensitization can lead to more severe reactions. It also highlights the potential for anaphylaxis to occur outside the acute phase and without typical clinical features.

Limitations in diagnostic test performance are one of the major challenges hampering the eradication of bovine tuberculosis (bTB). Non-tuberculous mycobacteria (NTM) are considered one of the main causes of non-specific reactions in the intradermal tuberculin test, the most widely used bTB diagnostic test. To determine the role of NTMs in bTB misdiagnosis in Spain, an experimental study including the NTM species most commonly found in bTB-positive animals from bTB-free farms in the country (M. avium subsp. avium (Maa), "Mycobacterium avium subsp. hominissuis" (Mah), M. bourgelatii, M. intermedium, M. kansasii and M. nonchromogenicum) was carried out on guinea pigs and cattle. First, guinea pigs were sensitized with the selected NTMs, and six weeks post-sensitization four antigen mixtures (bovine-PPD, avian-PPD, P22 and ESAT6-CFP10) were inoculated intradermally and their effect was measured 24- and 48-h post-inoculation. Larger erythematous reactions were observed in guinea pigs sensitized with Mah, M. kansasii, and Maa, with significant differences in the reactions measured at the bovine-PPD inoculation site for the two first bacteria compared with other NTMs. The sensitization process was repeated in cattle, and five months post-sensitization the same antigen mixtures were inoculated in the cervical region and responses were measured at 48- and 72-h post-inoculation. A significantly higher increase in the skinfold thickness measured at the bovine-PPD inoculation site was observed in calves sensitized with Mah, Maa, M. intermedium and M. kansasii. These results demonstrate that certain NTM species may play a more significant role in bTB diagnostic interferences and show that results obtained in guinea pig and bovine models do not always coincide., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Vancomycin infusion reaction (VIR), reportedly mediated through Mas-Related G Protein-Coupled Receptor-X2, is the primary vancomycin-induced immediate drug reaction. Clinically, distinguishing the underlying drug-induced immediate drug reaction mechanisms is crucial for future treatment strategies, including drug restriction, re-administration, and pretreatment considerations. However, the lack of validated diagnostic tests makes this challenging, often leading to unnecessary drug restriction., Objective: To determine whether intradermal tests (IDTs) and, separately, the basophil activation test (BAT) differentiate VIR from vancomycin-tolerant subjects., Methods: This was a cross-sectional study of vancomycin-exposed adults with and without a history of VIR. Data on demographics, allergy-related comorbidities, history of vancomycin exposures, and VIR characteristics were collected. IDT with vancomycin was performed. IDT dose-response EC 50 , IDT-related local symptoms, and BAT results were compared between groups., Results: A total of 11 VIR and 10 vancomycin-tolerant subjects were enrolled. The most reported VIR symptoms were pruritus (82%), flushing (82%), hives (46%), angioedema (27%), and dyspnea (19%). The IDT dose-response mean EC 50 was 328 μg/mL (95% CI, 296-367) in the VIR versus 1166 μg/mL (95% CI, 1029-1379) in the tolerant group (P < .0001). All VIR subjects reported IDT-related local pruritus compared with 60% of tolerant subjects (P = .0185). The %CD63 + basophils were consistently less than 2%, without significant differences between groups (P < .54)., Conclusions: Variations in skin test methodologies could help identify other immediate drug reaction mechanisms beyond IgE. This skin test protocol holds the potential for identifying VIR, particularly in cases where patients have received multiple drugs while BAT is insufficient. Future studies will validate and delineate its predictive value, assessing the risk of VIR., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Objectives: To investigate the incidence and influencing factors of allergic reactions to cephalosporins., Methods: A cross-sectional study of 29 medical institutions in Zhejiang Province was conducted from April 2021 to June 2021. The incidence of allergic reactions to cephalosporins was investigated. The influencing factors of cephalosporin-induced allergic reactions were analyzed by Poisson regression., Results: A total of 56 155 patients were included in this study. The total incidence of allergic reactions to cephalosporin was 1.67 ‰, the highest incidences of anaphylaxis occurred in ceftizoxime (4.27‰), followed by ceftriaxone (3.49‰) and cefotaxime (2.40‰). There was no significant difference in the incidence of allergic reactions between patients with negative skin tests and those without skin tests (1.75‰ vs. 1.63‰, RR =1.07, 95% CI :0.70-1.63, P > 0.05). Poisson regression showed that body mass index (BMI) <18.5 kg/cm 2 ( RR =2.43, 95% CI : 1.23-4.82, P <0.01) and history of β-lactam antibiotics allergy ( RR =33.88, 95% CI : 1.47-781.12, P <0.05) increased cephalosporin-induced anaphylaxis. Compared with cefuroxime, the risk of allergic reactions was increased for ceftriaxone ( RR =3.08, 95% CI : 1.70-5.59, P <0.01), ceftazidime ( RR =1.89, 95% CI : 1.03-3.47, P <0.05), and ceftriaxone ( RR =3.74, 95% CI : 1.64-8.50, P <0.01)., Conclusions: Lower BMI and history of β-lactam antibiotics allergy increase the risk of cephalosporin allergic reactions, and the routine skin test may not reduce the occurrence of allergic reactions to cephalosporins.

A rare case of food-dependent exercise-induced anaphylaxis caused by potato snacks is reported. Specific food triggers for anaphylaxis were identified by using the skin prick test, antigen analysis, and serum IgE assays. Four potato proteins were considered candidate antigens for food-dependent exercise-induced anaphylaxis., Competing Interests: Disclosure of potential conflict of interest: K. Matsunaga is an endowed chair from Hoyu Co, Ltd, and has received research funding from Hoyu Co, Ltd. M. Nakamura, T. Kawabe, and N. Sato are employees of Hoyu Co, Ltd. The rest of the authors declare that they have no relevant conflicts of interest., (© 2024 The Author(s).)

Summary: Background. International guidelines suggested skin tests with Polyethylene-glycol (PEG) and polysorbate 80 (PS-80), to investigate a possible hypersensitivity to these excipients either to identify subjects at risk of developing allergic reactions to Covid-19 vaccines, or in patients with suspected IgE mediated hypersensitivity reactions (HR) to the Covid-19 vaccine. The main purpose of this study was to investigate the prevalence of PEG and PS sensitization in patients with a clinical history of HR to drugs containing PEG/PS and in patients with a suspected Covid-19 vaccine immediate HR. Methods. This was a multicenter retrospective study conducted by allergists belonging to 20 Italian medical centers. Skin testing was performed in 531 patients with either a clinical history of suspected hypersensitivity reaction (HR) to drugs containing PEG and/or PS-80 (group 1:362 patient) or a suspected HR to Covid-19 vaccines (group 2: 169 patient), as suggested by the AAIITO/SIAAIC guidelines for the "management of patients at risk of allergic reactions to Covid-19 vaccines" [1]. Results. 10/362 (0.02%) had positive skin test to one or both excipients in group 1, 12/169 (7.1%) in group 2 (p less than 0.01). In group 2 HRs to Covid-19 vaccines were immediate in 10/12 of cases and anaphylaxis occurred in 4/12 of patients. Conclusions. The positivity of skin test with PEG and or PS before vaccination is extremely rare and mostly replaceable by an accurate clinical history. Sensitization to PEG and PS has to be investigated in patients with a previous immediate HR to a Covid-19 vaccine, in particular in patients with anaphylaxis.