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Allergic rhinitis and asthma are highly related to indoor and outdoor allergens. A common weed, Chenopodium album is one of these outdoor aero-allergens. In the literature, data about specific characteristics of children with C. Album sensitization is limited. In this study, we aimed to evaluate demographic and clinical characteristics of patients with Chenopodium album sensitization in a cross-sectional study. The patients and two control groups included in the study were found to be sensitized to Chenopodium album following skin prick tests in an allergy clinic over a period of one year. The patients and control groups completed a questionnaire consisting of items regarding demographics and clinical characteristics. The frequency of Chenopodium album sensitizationwas 9.4% (47/502). The distribution of these patients diagnoses was: 48.9% allergic rhinoconjunctivitis (ARC), 19.1% allergic rhinitis (AR), 12.8% ARC + asthma, 8.5% asthma, 4.3% asthma + AR. Allergic rhinoconjunctivitis was statistically higher than in the control groups (P: 0.008, P: 0.001). Allergic rhinitis symptoms and ocular symptoms occurred together in 51% during the pollination period of Chenopodium album, whereas 17% of the patients were asymptomatic between August-September. Forty percent of the patients had accompanying sensitization to animal dander (cat and/or dog dander), which was statistically high compared to control group 1 (P: 0.001). In conclusion, Chenopodium album sensitization is highly related to rhinoconjunctivitis. Children with ocular symptoms must be evaluated for Chenopodium album sensitization. These children can also be expected to have a high animal dander sensitization rate.

Background Differences in the qualitatively-perceived burden of food allergy based on economic disadvantages have not been previously described. Objective To describe the perceptions of food allergy–related social and financial issues of families who have a child with food allergy, considering the similarities and differences between economically advantaged and disadvantaged families. Methods From March to July 2019, we interviewed parents of children being followed up for food allergy at a tertiary allergy clinic in central Canada. Interviews were recorded, transcribed, and analyzed thematically. Economic groups were categorized on the basis of the national cutoffs for low-income after-tax dollars. Results We interviewed 18 parents (17 [94.4% mothers]) of whom 6 (33.3%) were economically disadvantaged, and who represented 25 children (10 [40.0%] girls) with food allergy. We identified 3 common themes: food allergy had (1) resulted in the need to teach others in addition to contributing to tensions in relationships; (2) increased time costs for food shopping and preparation; and (3) contributed to concerns securing qualified child care. We also identified 2 divergent themes that underscored how this burden was perceived between economic groups: (1) medications and medical appointments are costly or inconvenient; and (2) allergy-friendly food choices: single vs several sources and servings. Conclusion Despite some qualitative similarities in the social and financial burdens of food allergy, there are some notable differences between economic groups that underscore the need for further discussions surrounding the related policy.

BackgroundThe Coronavirus disease 2019 (COVID‐19) has evolved as a pandemic infectious disease transmitted by the severe acute respiratory syndrome coronavirus (SARS‐CoV‐)2. Allergists and other health care providers (HCPs) in the field of allergies and associated airway diseases are in the front line, taking care of patients potentially infected with SARS‐CoV‐2. Hence, strategies and practices to minimize risks of infection for both HCPs and treated patients have to be developed and followed by allergy clinics.MethodThe scientific information on COVID‐19 was analyzed by a literature search in Medline, Pubmed, national and international guidelines from the European Academy of Allergy and Clinical Immunology (EAACI), the Cochrane Library and the Internet.ResultsBased on diagnostic and treatment standards developed by EAACI, on international information regarding COVID‐19, on guidelines of the World Health Organization (WHO) and other international organizations as well as on previous experience, a panel of experts including clinicians, psychologists, IT experts and basic scientists along with EAACI and the “Allergic Rhinitis and its Impact on Asthma (ARIA)” inititiative have developed recommendations for the optimal management of allergy clinics during the current COVID‐19 pandemic. These recommendations are grouped into nine sections on different relevant aspects for the care of patients with allergies.ConclusionsThis international Position Paper provides recommendations on operational plans and procedures to maintain high standards in the daily clinical care of allergic patients whilst ensuring necessary safety in the current COVID‐19 pandemic.

Introduction and objectives: Suspected hypersensitivity reactions (HRs) associated with vaccines are frequently reported, but confirmed cases of vaccine-triggered HRs are rare. Suspected HRs should be distinguished from actual HRs. The aims of this study are to identify the rate of actual vaccine-triggered hypersensitivity in patients who were referred to the paediatric allergy clinic due to a suspected HR and to explore the rate of revaccination in a real clinical setting. Materials and methods: A retrospective study was performed with a group of preschool children who were evaluated by skin and/or provocation tests (PTs) for the suspected HRs following vaccination. Results: A total of 26 paediatric patients (61.5% male; median age 9 months) with a previous history of suspected vaccine-triggered HR were included. In this group, 69.2% and 38.5% of the patients had a pre-existing atopic disease and an immediate reaction (emerging

To assess knowledge regarding symptoms and treatment of anaphylaxis, a vignette of a child having an allergic reaction to a peanut was presented to residents in an allergy clinic. Twelve sets of clinical outcomes ranging from severe multi-organ to mild single organ involvement were described, and residents were asked if each symptom set met criteria for diagnosis of anaphylaxis, whether epinephrine should be administered acutely and prescribed at follow-up, and whether peanuts should be avoided in the future. Of cases that met the definition of anaphylaxis 28.8% were incorrectly diagnosed, in 13.6% of cases they would allow peanuts to be eaten again, and in 23.9% of cases they would not prescribe epinephrine at follow-up. In 26.1% of cases meeting criteria for acute anaphylaxis residents would not administer epinephrine. Deficits regarding the diagnosis and treatment of anaphylaxis by residents were identified, and increased educational efforts are needed.

Introduction: Food protein-induced enterocolitis syndrome (FPIES) is a gastrointestinal syndrome due to a non-IgE mediated food hypersensitivity. The most common triggers are cow's milk and soy. Fish is one of the most frequently reported causes in Spain.The objective of this study is to describe the clinical characteristics of patients diagnosed with (FPIES) in a paediatric allergy clinic. Material and methods: A retrospective descriptive study was carried out by reviewing medical records of patients diagnosed with FPIES in the Paediatric Allergy Unit of the Miguel Servet Children's Hospital from the years 2007 to 2017. Results: A total of 135 patients were diagnosed during the study period, of whom 45% were male and 55% were female. The mean age at diagnosis was 11 ± 1.5 months and the mean age of improvement was 2 years and 6 months ± 2.5 years (n = 83). A personal history of atopy was observed in 31.9%. The main trigger foods were: white fish (41.4%), cow's milk (25.1%), and egg (15.5%). A conversion to IgE-mediated allergy was seen in 4.4% of patients.There was vomiting in 81.5% of the cases, with a mean of 1.75 ± 1.1 h of latency, as well as diarrhoea in 41.5%, with a mean of 7.86 ± 15.16 h of latency, and decline in 30.4% with a mean latency of 3.81 ± 11.57 h. Discussion: In our series, the most frequent trigger of the FPIES was fish. It was manifested mainly by late vomiting and a tolerance was reached mostly at 2 years 6 months. Resumen: Introducción: La enterocolitis inducida por proteínas de la dieta, o también conocida como food protein-induced enterocolitis syndrome (FPIES), es un síndrome gastrointestinal de hipersensibilidad alimentaria no mediada por IgE. Los desencadenantes más comunes son la leche de vaca y de soja. El pescado es una de las causas reportadas con más frecuencia en España.El objetivo de esta investigación es describir las características clínicas de los pacientes diagnosticados de FPIES en nuestra consulta de alergología pediátrica. Material y métodos: Estudio descriptivo retrospectivo, realizado mediante revisión de historias clínicas de los pacientes diagnosticados con FPIES en la Unidad de Alergología Pediátrica del Hospital Infantil Miguel Servet desde 2007 a 2017. Resultados: Desde enero de 2007 hasta diciembre de 2017 fueron diagnosticados 135 pacientes: 45% hombres y 55% mujeres. La edad media al diagnóstico fue de 11 ± 1,5 meses y la edad media de superación 2 años y 6 meses ± 2,5 años (n = 83). Un 31,9% presentó antecedentes personales de atopia. Los principales alimentos desencadenantes fueron: pescado blanco (41,4%), leche de vaca (25,1%) y huevo (15,5%). Un 4,4% presentó conversión a alergia IgE mediada.El 81,5% de los casos presentó vómitos, con una media de 1,75 ± 1,1 horas de latencia; diarreas en un 41,5%, con una media de 7,86 ± 15,16 horas de latencia; decaimiento en el 30,4% con una media de 3,81 ± 11,57 horas de latencia. Discusión: En nuestra serie el desencadenante más frecuente fue el pescado. Se manifestó principalmente por vómitos tardíos, y alcanzó una tolerancia en su mayoría hacia los 2 años 6 meses.

Background China and Spain are world leaders in the consumption of edible bulbs (garlic and onion), but there are few references to their capacity to cause allergic symptoms. The target was to study allergic sensitization and clinical symptoms associated with garlic and onion consumption in a large sample of allergic patients. Methods An observational cross-sectional study was conducted, testing garlic and onion extracts in 8109 patients of all ages seen by our allergy clinic in 2018. Forty-four aeroallergens and foods were tested, including garlic and onion, with prick test and determination of specific IgE. Oral provocation and contact tests were performed if a delayed reaction was suspected. Western Blot was performed in the serum of patients positive to garlic and onion. Results We conducted 356,798 skin tests and 4254 specific IgE determinations. Of the 8109 patients tested, 2508 (30.92%) presented with symptoms associated with food intake and, in these patients, food hypersensitivity was detected by skin test, positive specific IgE or provocation in 924 patients, and was caused by garlic or onions in 27, indicating a prevalence of 2.92%. Immunodetection showed an association between the symptoms and a specific LTP to these bulbs, without cross-reactivity with other LTPs in the Mediterranean diet (peach, wheat). Conclusions Allergic hypersensitivity to garlic and onions should not be underestimated and, given their high consumption, should be included in the diagnostic food allergy battery.

Background: Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the sinonasal mucosa and with strong associations to other immune-mediated comorbidities. Patients often require referral to both an otolaryngologist and an allergist/immunologist. This study is the first in the literature to describe a multidisciplinary clinic that offers patient care by subspecialists in rhinology and in allergy/immunology. Methods: One hundred twenty-nine patients were seen in the Comprehensive Sinus and Allergy Clinic (CSAC) between January 2016 and June 2017 and 43 selected patients were seen in both the standalone allergy and rhinology clinics over the same time period. Patient satisfaction was retrospectively assessed using a modified Press-Ganey satisfaction survey. Time to evaluation and time to follow up appointment were compared between the CSAC and both the standalone rhinology and allergy/immunology clinics. Results: Patients seen in the CSAC reported high satisfaction with the amount of time spent with the physicians (98.3%), quality of medical care (9.3 ± 1.0), and most importantly, the convenience of seeing two physicians in one day (9.5 ± 1.2). Time from referral placement to clinic evaluation ( P ≤ .02) and time to follow up appointment ( P ≤ .002) was significantly shorter for the CSAC than for the standalone Rhinology or Allergy clinics. Conclusion: Patients reported high satisfaction with the medical care provided and were also seen much faster in our multidisciplinary clinic as compared to standalone rhinology or allergy/immunology clinics. Overall, a multidisciplinary approach may be beneficial to patients presenting to tertiary referral centers with CRS and atopic conditions.

Background Food allergy is defined as an immune reaction to proteins in the food and can be immunoglobulin (Ig)E-mediated or non–IgE-mediated. IgE-mediated food allergy is a worldwide health problem that affects millions of persons and numerous aspects of a person’s life. Allergic reactions secondary to food ingestion are responsible for a variety of symptoms involving the skin, gastrointestinal tract, and respiratory tract. While all other non-allergic food reactions are categorized as “food intolerance”. Aims to assess prevalence of Food allergy among Egyptian patients complaining of food adverse events attending Allergy clinic at Ain Shams University Hospital. Methods This was a randomized cross sectional study involving 200 patients complaining of food adverse events attending Allergy clinic at Ain Shams University Hospitals between the first of February 2019 till the end of January 2020, 90 patents had confirmed food allergy Results The Total patients who were presented to the Allergy outpatient clinic at Ain Shams University hospital between the first of February 2019 and the end of January 2020 were 200 patients presented complaining of food adverse events with the percentage (9.5%). Among the 200 patients presented complaining of food adverse events, there were 90 patients who were confirmed food allergy. Conclusion food allergy may be over estimated along patient with food adverse events.

A 4-year-old boy presents at the allergy clinic with severe refractory allergic rhinitis. Antihistamine therapy has not satisfactorily improved his symptoms, and he has not tolerated a trial of intranasal corticosteroids. You wonder if montelukast monotherapy might be effective in managing his symptoms. In a child with allergic rhinitis [patient] is montelukast monotherapy [intervention], compared with other treatments or placebo [comparison], effective in reducing symptoms [outcome]? MEDLINE and Embase up to April 2021 were searched using the following search terms: ( allergic rhinitis) AND (montelukast) AND (paediatric OR child* [child, children] ). Reference lists were subsequently searched to identify additional studies. A total of 419 abstracts with keywords as described in the search criteria were identified. Three literature reviews were identified,1–3 with none considering all the available evidence to April 2021. Studies that did not include a montelukast monotherapy group were excluded. Seven studies were considered as being relevant to the clinical question. These studies are summarised in table 1. View this table: Table 1 Summary of included studies Allergic rhinitis (AR) is a chronic condition that is reported to affect one in eight children worldwide.4 In AR, inhaled allergens (such as pollen, pet dander or dust mites) irritate the …

Background Delayed hypersensitivity reactions (DHRs) to radiocontrast media (RCM) occur in approximately 0.5–23.0% of patients and are thought to be caused by T cell-mediated mechanisms. However, an optimal pharmacological preventive strategy is not yet established in patients with histories of delayed reactions to RCM. Objective We aimed to evaluate the efficacy of pharmacological prevention in patients with histories of delayed reactions to non-ionic low-osmolar RCM when re-exposed to RCM. Methods A retrospective review of electronic medical records of 117 patients with previous histories of DHRs to RCM who visited an allergy clinic for the prevention of reactions after the re-exposure to RCM was conducted. The effects of pharmacological prevention were compared according to the symptom scores of previous reactions based on their intensities and durations with electronic medical records (EMRs). Results Of the 117 patients who experienced DHRs after RCM injection, we confirmed the outcomes of RCM re-exposure in 101 patients. For pharmacological prevention, 92 patients (91.1%) received steroids before RCM injection and among them, 50 patients (49.5%) received additional steroids after RCM injection. With this pharmacological prevention, patients of symptoms improved or no recurrence, recurrence of similar previous symptoms, and recurrence of worse symptoms were 98 (97.0%), 2 (2.0%), and 1 (1.0%), respectively. The proportions of no recurrence after pharmacological prevention were lower in patients with severe reactions and higher symptom scores. Conclusion Pharmacological prevention showed a beneficial effect in most patients with delayed hypersensitivity to RCM. Further investigations are needed to establish an effective protocol for the prevention of delayed reactions to RCM.

Background: The majority of mixed-fed infants with non-IgE-mediated cow's milk protein allergy (CMPA) enteropathies are managed with an extensively hydrolysed cow's milk based infant formula (eHF). Given the high variability in peptide distribution of available eHFs, it is important to understand the suitability of a specific product in the management of distinct phenotypes.Objective: To assess the symptom resolution of various phenotypes of clinical manifestations of CMPA enteropathies and constipation managed by a casein-based eHF.Methods: The data of 20 full-term infants (n = 15 with non-IgE-mediated CMPA and n = 5 with constipation) attending a paediatric allergy clinic in Cyprus and managed with a casein-based eHF were retrospectively analysed.Results: Based on the clinical symptoms and history, infants were classified into the following phenotypes: (a) 11/15 (73.3%) FPIAP, (b) 3/15 (20%) FPIES, and (c) 1/15 (6.7%) severe diarrhoea. Overall, 14 (93.3%) patients were successfully managed with the casein-based eHF and 1 (6.7%) required an AAF. This formula was effective in 91% of patients with FPIAP, in 100% with FPIES and with diarrhoea. Three (60%) patients with constipation responded to the eHF.Conclusion: This case-series report supports the efficacy of a particular casein-based eHF for the nutritional management of non-IgE mediated CMPA enteropathies.

Background Researchers have shown that eosinophil peroxidase (EPO) is a relatively accurate marker of eosinophilia and eosinophil activity. However, its use as a marker of eosinophilic inflammation in nasal secretions is limited because the diagnostic cutoff values of EPO for use as a one-time test for allergic diseases such as allergic rhinitis have not been established. Purpose To identify the correlation between nasal eosinophil count and EPO in children and adolescents with rhinitis. Methods We recruited patients

BACKGROUND The NHS is not meeting the nation's allergy needs. There are insufficient allergy specialists, with variable care across the country. General practitioners (GPs) are lacking in allergy training. London's Whittington Hospital created a GP with Special Interest (GPwSI) community paediatric allergy clinic, running alongside pre-existing hospital clinics, to address local unmet needs, aiming to provide equity for patients, improve patient experience and decrease secondary care burden. OBJECTIVES To establish whether improvements have occurred within the service by introducing a GPwSI-led community paediatric allergy clinic alongside providing GP education and referral pathways. This study asks: (a) Have allergy-related hospital attendances decreased with the provision of the community service? (b) Are patients seen in the appropriate clinic? (c) What proportion of patients require GPwSI follow-up? (d) Is there good patient satisfaction? (e) Have allergy clinic waiting times changed? METHODS Numbers of allergy-related hospital attendances and waiting times in 2013, 2014 and 2016 were assessed. Data were analysed regarding proportions of patients requiring GPwSI follow-up or referral from the GPwSI community clinic to hospital. Patient satisfaction was assessed. RESULTS Since introducing the GPwSI community service the burden on secondary care has decreased, with reduced hospital attendances for allergy clinic patients, although waiting times have increased. In 2013, 65% of allergy clinic patients attended other hospital services for allergy-related complaints prior to their first allergy clinic appointment. This was reduced to 27.3% (community) and 36.9% (hospital) in 2014 and maintained in 2016 (27.5% community and 37.5% hospital), P

Background: The incidence of missed appointment of the patients who were waiting more than 1 month was 22.0%. Therefore, this study was designed to identify factors associated with missed appointment which may lead to better system development. Objective: To study factors that affect missed appointments. Methods: This was a survey research using the questionnaire demonstrated factors associated with missed appointments. This study included 330 patients who had been serving from October 2016 to March 2017 in allergy clinic at Ramathibodi Hospital. Results: Of the 330 patients, 71.5% were female, 57.0% graduated a bachelor degree, 76.7% lived in Bangkok and nearby provinces, and 37.9% used civil servant medical benefit. Among 75.5% of patients had general appointments, 24.5% had intervention appointment, 72.1% experienced missed appointments, and only 27.9% never been defaulted. Factors associated with never been defaulted appointments were degree graduation higher than bachelor degree, appointment for intervention, conveniency of commuted methods, and lesser waiting time at the hospital. While factors affecting missed appointments were error checking for dates, forgotten the dates, the good condition of the illness, remission of disease activities, still exist much of medicine, and boring with the service system of the hospital. Approximately 83.3% of patients did not use Rama Appointment, a mobile application for appointment management. Conclusions: There are many factors associated with missed appointments which provide opportunity for quality improvement.

BACKGROUND/OBJECTIVES The TOPICOP scale is an easy-to-use scale for assessing topical corticosteroid (TCS) phobia in atopic dermatitis (AD) patients and their caretakers. TCS phobia is a common problem among AD patients and their caretakers. The aim of this study was to examine the relationship between TCS phobia in caretakers of children with AD and the characteristics of patients using the TOPICOP scale. METHODS Caretakers of AD patients who visited the allergy clinic at the National Center for Child Health and Development in Tokyo between February 2014 and May 2014 were recruited. Caretakers of patients in follow-up had already attended an education session on treatment at the institution. All participants completed an anonymous questionnaire on the characteristics of the respondents and patients using the Patient-Oriented Eczema Measure (POEM) and the Japanese version of TOPICOP. RESULTS In total, 243 participants (88.9% female) completed the survey. The average TOPICOP score was 40.3 and the median POEM score was 4. The TOPICOP score was significantly higher for patients younger than 12 months old with moderate to very severe AD (POEM ≥ 8) whose caretaker had not attended an educational session (P

Jun Zuo,1,2 Ruisong Gong,1,2 Xiaowen Liu,2 Jing Zhao1,2 1Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, People’s Republic of China; 2Department of Anesthesiology, China-Japan Friendship Hospital, Beijing 100029, People’s Republic of ChinaCorrespondence: Jing ZhaoDepartment of Anesthesiology, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Beijing 100029, People’s Republic of ChinaEmail zhaojing1009@aliyun.comBackground: Local anesthetics (LAs) have been widely used throughout the healthcare settings, especially in local anesthesia and pain management. The incidence of allergic reactions to LAs remains uncertain. The danger of allergic reactions to the use of LAs in every day of clinical practice is a matter of great concern. Therefore, it is necessary to investigate the risk of true allergy to LAs.Methods: This study retrospectively evaluated the medical records of patients who were referred to an anesthesia allergy clinic in China and underwent allergy tests with LAs over a 10-year period from 2009 to 2019. The following information was collected from medical records: demographics of the patients, reasons for referral, clinical features of drug hypersensitivity reaction (DHR), and test results with LAs. Skin tests combined with an in vitro method, basophil activation test (BAT), were used to investigate allergic reactions to LAs.Results: A group of 109 patients were included in the analysis. The main reason for referral was the presence of a suspected DHR after procedures with LAs (n=68, 62%), the second most common reason for referral was a history of DHR to other drugs and the need to use LAs for upcoming procedures (n=41, 38%). Of the 68 patients with a suspected DHR to LAs, only six cases presented true allergy and showed positive results in skin tests and/or BAT. And all 41 patients who had a history of DHR to other drugs presented negative in all tests.Conclusion: Risk of true allergy to LAs may be very low. However, patients with a suspected history of DHR to LAs should be considered for allergy tests. Skin tests and BAT may be useful in the investigation and diagnosis of true allergy to LAs in clinical practice.Keywords: adverse drug reactions, local anesthetics, allergy, skin tests, BAT

Objectives We aimed to identify the percentage inaccuracy in classifying asthma severity as severe asthma based on the 2019 Global Initiative for Asthma (GINA) guidelines criteria, at Cleveland Clinic Abu Dhabi, and make recommendations to improve the assessment of asthma severity. Methods All asthma patients that attended the Pulmonology clinic or the Allergy clinic from May 2015 to December 2019 were retrospectively analyzed to identify which asthma patients classified as having severe asthma according to the 2019 GINA guidelines criteria. We then calculated the percentage inaccuracy associated with giving diagnoses of severe asthma. Results We retrospectively analyzed a total of 902 patients, and out of those, we identified 334 as patients with severe asthma according to the 2019 GINA guidelines criteria. Of those 334 patients, 218 were given an incorrect asthma severity of either mild (N=14), moderate (N=203), or unspecified asthma severity (N=1) in the hospital’s electronic records. This represents a percentage inaccuracy of 65.3% in classifying asthma severity as severe asthma. Fluticasone propionate-salmeterol was the most used ICS-LABA (inhaled corticosteroid and long-acting beta-agonist) medication in the severe asthma group (58.1%). Fluticasone furoate-vilanterol was identified as the most incorrectly prescribed ICS-LABA medication (68.2%). Conclusion We identified an inaccuracy of 65.3% in classifying asthma severity as severe at our hospital. This inaccuracy is associated with a lack of understanding of the GINA guidelines by clinicians, as well as a lack of acceptance of some of the criteria in the GINA guidelines by patients. We have made recommendations to help improve the accuracy of asthma severity assessment, in order to be fully adherent to the GINA guidelines criteria.

Background Food protein-induced enterocolitis (FPIES), an entity previously thought to only affect children, has been increasingly described in adults. In this study, we report a Canadian cohort of 19 adolescents and adults with recurrent non-immunoglobulin E (IgE)-mediated gastrointestinal symptoms after crustacean ingestion, consistent with FPIES. Methods We conducted a retrospective chart review of patients in an outpatient allergy clinic from January 2005 to May 2020. Electronic records were searched using keywords for crustaceans and for symptoms consistent with FPIES. We included patients with gastrointestinal symptoms specifically to crustaceans on more than one occasion, who were 14 years or older at the time of index reaction. Exclusion criteria included symptoms suggestive of an IgE-mediated anaphylactic reaction or a likely alternative diagnosis. We identified 19 patients for our cohort who met the criteria. Results Our cohort was 68.4% female (13) and 32.6% (6) male. The average age at first reaction to crustaceans was 34 years old with a range of 14–68 years (median = 28 years; IQR = 32 years). Time from ingestion to beginning of symptoms ranged from 3 min to 6.5 h, with an average of 2.8 h (median = 2 h; IQR = 3.25 h). Duration of reaction ranged from less than a minute to over 48 h, with a mean of 9.4 h (median = 4 h; IQR = 7.75 h). Patients had 4.8 reactions on average; however, number of reactions ranged from 2 to 12.5 (median = 3, IQR = 3). All patients identified a “trigger” food in the crustacean group, and 12 subjects identified additional reactions to other seafood. Conclusions This case series will better characterize and advance our understanding of this disease entity in adults. There are key differences in the presentation of FPIES in adults compared to children, namely female predominance, difference in solid food trigger, and unpredictable time course. Future studies are needed to examine the pathophysiology and natural history of adult FPIES. Specific guidelines should be developed for the diagnosis and management in adults. Trial registration: retrospectively registered.

Dear Editor, We were interested to read the letter by Kakleas and colleagues.1 They report three findings. The first is that of 89 children referred to an allergy clinic, diagnoses made in the Emergency Department (ED) clinical notes matched the Emergency Care Data Set (ECDS) diagnosis in 60% of cases (43 children with ‘other allergic reaction’ and 10 children with ‘anaphylaxis’). The second is that in the ED clinical notes, clinicians made two allergy diagnoses that are not available in ECDS (cow’s milk protein allergy and non-IgE allergy, occurring in 10 and 2 cases respectively). Their final finding is that diagnoses made in an allergy clinic were, in descending order of frequency: food allergy, urticaria, cow’s milk protein allergy and food/skin allergy. They note that the diagnosis of urticaria made in the allergy clinic is not usually a diagnosis associated with allergy. ‘Urticaria’ is in fact available in ECDS, in the ‘Skin and soft tissues’ subgroup, not the ‘Allergy’ subgroup. This implies that in those cases at least, …

Allergic rhinitis (AR) is a very common condition presenting to an Otorhinolaryngologist. Prevalence of AR is on the increase and it has significant impact on quality of life of the patient. Skin prick test (SPT) is a simple test to determine allergen sensitization status in patients with AR. There is wide variation in allergen panel used in SPT among various allergy clinics and many centres use a large panel of allergens which requires multiple skin pricks for the patient undergoing the test. Our aim was to identify a minimum panel of allergens among patients with symptoms of AR undergoing SPT which could be used as a screening panel for AR. The present study is a cross sectional study in patients with symptoms of AR undergoing SPT at Allergy clinic of Bangalore Baptist hospital over a period of 18 months from January 2018. 149 patients were included in the study and 26 patients who had negative SPT for all allergens tested were excluded. Prevalence of sensitization for individual allergens was calculated. House dust mite (Dermatophagoides pteronyssinus and Dermatophagoides farinae) was the most prevalent allergen to which 73.9% and 65.8% of our study population was sensitized respectively. We identified a minimum allergen panel of 3 allergens (Dermatophagoides pteronyssinus, Lambs quarter and Dermatophagoides farinae) which could identify > 90% of patients sensitized in the study group.

Background In Canada, anaphylaxis-level food allergy constitutes a legal disability. Yet, no nationwide policies exist to support families. We sought to understand what parents of children with food allergy perceive as the most pressing food allergy-related policy concerns in Canada. Methods Between March–June 2019, we interviewed 23 families whose food allergic children (N = 28mean age 7.9 years) attending an allergy clinic in Winnipeg, Canada. Interviews were audio-recorded, transcribed and analyzed using content analysis. Results Over 40% of children had multiple food allergies, representing most of Health Canada’s priority allergens. We identified four themes: (1) High prevalence. High priority?. (2) Food labels can be misleading, (3) Costs and creative ideas, and (4) Do we have to just deal with the status quo around allergies? Conclusion Food allergy ought to be a national policy priority, to improve the process for precautionary labelling, to improve funding, educational tools access to care, and knowledge of current allergy guidelines.

The advent of biologic therapies has transformed care for severe atopic disorders but their high cost poses new challenges with regards to long-term sustainability and fair allocation of resources. This article covers the basic concepts of cost-utility analyses and reviews the available literature on cost-utility of biologic drugs in atopic disorders. When used within their limits as part of a multi-dimensional assessment, economic analyses can be extremely useful to guide decision-making and prioritization of care. Despite the good quality of most cost-utility analyses conducted for the use of biologics in asthma and other atopic diseases, their conclusions regarding cost-effectiveness are extremely variable. This is mainly due to the use of inconsistent estimates of health utility benefit with therapy. Development of reliable and validated instruments to measure disutility in atopic disorders and measure of indirect costs in atopic disease are identified as a priority for future research.

Background Peanut allergy (PA) is associated with an economic and psychological burden on patients and families. Its diagnosis includes tests for peanut specific immunoglobulin E (sIgE), the values of which usually are categorized as positive or negative using a predefined cutoff (usually 0.35 kU/L). With the use of Bayes' theorem, this categorization can be replaced with a continuous interpretation of sIgE, which accounts for the prevalence of PA and history of ingestion. Objective To evaluate a method for estimating the likelihood ratio (LR) for each value of sIgE by performing a pilot investigation with the results of oral food challenges. The LR could be used to estimate the probability of PA. Methods The outcomes of oral food challenges and serum IgE values from 117 children seen in an allergy clinic between January 2017 and November 2019 were obtained. Polynomial regression of the receiver operation characteristics curve was used to determine an LR for each value of sIgE. Linear regression was used to estimate an LR for each value of sIgE. Results sIgE ranged from less than 0.1 kU/L to 35 kU/L. Bayes' theorem and a receiver operation characteristics curve were used to estimate LRs for each value of peanut sIgE. The value of IgE associated with an LR of 1 was 0.22 kU/L, which is comparable to other studies that used a value of 0.35 kU/L to separate positive from negative results. Conclusion When combined with estimates of pretest probability, this method should permit the development of computerized decision-making algorithms to estimate the probability that a patient has PA.

Eosinophilic Gastrointestinal Diseases (EGID) are uncommon to rare gastrointestinal eosinophilic infiltrated clinicopathological conditions, ranging from the esophagus to the sigmoid colon. Outside of the near immediate newborn period, associated with milk or soy protein colitis ( Food protein-induced allergic proctocolitis) 1 the presence of exaggerated gastrointestinal eosinophilia is clinically relevant and has long-term concerns. In this review the separate clinical EGID conditions will be briefly reviewed, with added clinical pearls, based on an extensive Pediatric Allergy-Immunology experience.

Yazıcı, Selçuk (Balikesir Author), Aim: Allergic sensitization in infancy generally develops against food allergens. We aimed to investigate the frequency of aero-allergens sensitization at older ages in infants with food allergy. Material and Methods: This retrospective cross-sectional study was conducted in Dr. Behcet Uz Children's Allergy Clinic. Infants with confirmed IgE-mediated food allergy between January 1st, 2004, and December 31st, 2016, were evaluated for aero-allergen sensitivities through skin prick tests (SPT) after at least two years after diagnosis, and the data were compared with a healthy control group. Results: A total of 187 cases, 87 of which were patients, were included in the study. The cause of food allergies was cow's milk only in 24 (27.6%) cases, egg only in 26 (29.9%) cases, both cow's milk and egg in 33 (37.9%) cases, fish only in two cases (2.3%), and both fish and egg in two (2.3%) cases. The mean age at which the aero-allergen SPT was performed was 65 (46-180) months in the patient group and 72 (48-132) months in the healthy control group. In the patient group, 39 (44.8%) had aero-allergen sensitization, whereas, in the healthy control group, five (5%) had aero-allergen sensitization. Aero-allergen sensitization was more frequent in the patient group (p0.05). Conclusion: In infants with food allergies, sensitization may develop with aero-allergens at an early age. Clinical follow-up of these patients may be important in terms of allergic respiratory diseases., Amaç: İnfant dönemde alerjik duyarlanma genellikle besin alerjenlerine karşı gelişir. Amacımız besin alerjisi olan infantlarda ileri yaşlarda aero-allerjenlere duyarlılık gelişimini araştırmaktır. Gereç ve Yöntemler: Geriye dönük kesitsel bu çalışmada Dr. Behçet Uz Çocuk Hastanesi Çocuk Alerji Kliniği’mizde 01.01.2004 ile 31.12.2016 tarihleri arasında başvuran IgE aracılı besin alerjisi tanısı doğrulanan infantlar en az 2 yıl sonra deri prick testi ile aero-alerjen duyarlanmaları değerlendirildi. Aero-alerjen duyarlılıkları sağlıklı kontrol grubu ile karşılaştırıldı. Bulgular: Çalışmaya 87’si hasta olmak üzere toplam 187 olgu alındı. Olguların 24’ü (%27,6) sadece süt, 26’sı (%29,9) sadece yumurta, 33’ü (%37,9) süt ve yumurta, 2’si (%2,3) balık, 2’si (%2,3) balık ve yumurta alerjisi saptanmıştı. Aero-alerjen deri prick testin yapıldığı ortalama yaş hasta grubunda 65 (46–180) ay, kontrol grubunda 72 (48–132) ay saptandı. Hasta grubunda 39 (%44,8) olguda aero-alerjen duyarlılığı saptanırken kontrol grubunda 5 (%5) olguda aero-alerjen duyarlılığı saptandı. Aero-alerjen duyarlılık hasta grubunda daha sık saptandı (p0,05). Çıkarımlar: Besin alerjisi olan infantlarda erken yaşlarda aero-alerjenlerle duyarlanma gelişebilmektedir. Gelişebilecek alerjik solunum yolu hastalıkları açısından bu hastaların klinik izlemi önemlidir.

In the United Kingdom, there are acknowledged short comings in allergy care provision for patients seen in primary care. There is a lack of allergy training for healthcare professionals and this leads to inappropriate referrals to the limited number of allergy specialists. The primary aims of this study are to assess the feasibility of delivering and evaluating a new nurse-led allergy service in primary care, measured by recruitment, retention and quality of life. This is a single arm feasibility trial in which up to 250 participants referred to the nurse-led allergy clinic will receive the intervention and complete 6–12 weeks follow-up before being referred back to their usual care. Primary outcomes for this study will be establishment of clinics, recruitment and retention rates, and estimates of change in disease-specific quality of life measures. Secondary outcomes will be acceptability of the new service to participants/carers and healthcare professionals. A sample of participants and professional stakeholders will take part in more in-depth semi-structured qualitative interviews. Data from this feasibility trial will be used to inform plans for a pilot randomised controlled trial of nurse-led allergy clinics.

BACKGROUND: Asthma is the most prevalent chronic disease in the pediatric age group. The disease affects different aspects of the children's lives, such as physical, emotional, social and educational aspects. Thus, more focus has been on the quality of life in these patients rather than the duration of their illness in recent years.AIM: This study examined the different aspects of quality of life in asthmatic children for the first time in this geographic area.METHODS: The study was cross-sectional conducted in 2015-2016. The asthmatic group was 100 patients aged 8 to 12 admitted to the Asthma and Allergy Clinic of Ghaem Hospital (as) in Mashhad with the control group composed of 100 healthy children of the same age and gender. The standard questionnaire pedsQLTM was used for comparing the quality of life of children in the two groups. Statistical analysis was SPSS23 with P-value less than 0.05, which was statistically significant.RESULTS: In each group, 58 patients were boys, and 42 were girls. In a comparison of the quality of life of children, the asthma group with a mean total score of Peds QL 20.99 ± 12.54 compared to the healthy children with a mean total score of Peds QL of 8.8 ± 5.41 had a lower quality of life (P < 0.001). Moreover, regarding various aspects of quality of life asthma group had a lower quality of life in physical performance, emotional performance and performance in school (P < 0.001). Nonetheless, there was no significant difference between the two groups considering social function (P = 0.267). Examining the relationship between Peds QL score of patients with asthma with various variables was indicative of the fact that Peds QL scores were significantly correlated with the gender of the patients, showing better quality of life in the girls (P = 0.001).CONCLUSION: The results indicated that children with asthma have a significantly lower quality of life compared with healthy children of the same age. Also, in examining the different aspects of quality of life, these children had a lower quality of life in physical performance, emotional performance, and performance at school, and were at the level as that of healthy children only in social performance.

At the end of the 18th Century, the history of immunology began in Mexico, with Francisco Xavier Balmis, who initiated the process of vaccination against smallpox. By doing this, he established the bases for research and clinical practice in this field of medicine. Among the pioneers of immunology in Mexico stand out Eduardo Licega, Maximiliano Ruiz Castaneda and Mario Salazar Mallen. This last one founded the first allergy laboratory located in the Hospital General de Mexico, becoming the first one of its nature in the entire nation as well as being recognized by Universidad Nacional Autonoma de Mexico (UNAM) as the first course of allergy. The Unique Plan of Medical Specializations (PUEM it's the acronym in Spanish) is a curricular plan organized in a functional conceptual construction, destined to conduct medical educational actions and designed by Faculty of Medicine UNAM, health institutes and the Mexican counsels of specialists; having as the main purpose that medical residents acquire knowledge, ability, skills, and ethical values to practice medicine with quality and efficiency. The specialty of Allergy and Clinic Immunology is part of PUEM since 1994 for adult patients and since 1998 in pediatrics. At the present it's being held in 8 different institutions of health conformed by six courses for adult patients and two for pediatric ones. The UNAM evaluates the quality of the specialty courses through diverse processes, all coordinated by the Postgraduate Department from the Faculty of Medicine, through the coordination of academic subcommittees who's also helped by the members of the Academic Subcommittees of Allergy and Clinic Immunology with the objective of guaranteeing quality in the formation of human resources.

Aim We aimed to identify the frequency, magnitude and risk factors of salbutamol-induced hypoxia in children with acute asthma. Methods This study was conducted at Hacettepe University on children who presented to the paediatric allergy clinic or the paediatric emergency room with acute asthma between July 2014 and June 2015. Vital signs, pulse oximetry-defined oxygen saturation and modified pulmonary index scores were evaluated before and after the first, second and third doses of nebulised salbutamol and repeated one and 10 days later. Results We included 304 patients (65.7% male) from median age of 5.3 years (range 1-18 years). Salbutamol-induced hypoxia was detected in 14.7%, 3.9% and 1.3%, respectively, after the first, second and third doses of salbutamol. The risk factors for hypoxia were younger age and a higher modified pulmonary index score, but the risk factors for salbutamol-induced hypoxia were the number of salbutamol doses given in the last six hours and the presence of aeroallergen sensitisation. The maximum decrease in oxygen saturation after salbutamol was %5. Conclusion Although bronchodilators are the first-line treatment for acute asthma, they caused modest hypoxaemia, especially at repeated doses and, or, in patients with aeroallergen sensitisation.

JM Miller, AC Blackman, HT Wang. Ann Allerg Asthma Immunol . 2020:124(4):379–384 The authors investigated the effect of food allergy on quality of life (FAQoL), factors associated with worse FAQoL, and the differences in FAQoL between adolescents versus younger children with food allergy. Children aged 0 to 17 years with a food allergy were recruited from the Allergy Clinic at Texas Children’s Hospital from June 2017–June 2019. 150 children (aged 0–12) and 24 adolescents (13–17) participated. Patients who had outgrown their food allergy were excluded. Eighty-eight percent of children and 95.8% of adolescents were peanut allergic. Forty-seven percent of children and 79.2% of adolescents had experienced anaphylaxis. Parents completed the food allergy quality of life questionnaire (FAQLQ)-Parent form as a proxy for children 0–12 years. Adolescents, age 13 to 17 years, completed the FAQLQ-teenager form. The FAQLQs use a 7-point Likert scale and higher scores reflect worse QoL. The FAQLQs measure …

Objectives: To detect common skin-sensitizing agents among patients experiencing allergic contact dermatitis (ACD). Methods: This was a retrospective study of 152 patients with clinically suspected ACD who underwent patch testing in an allergy clinic at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between January 2012 and February 2015. Of these patients, only 74 (48%) patients reacted to one or more contact allergens. This group of patients included 58 (78.4%) women and 16 (21.6%) men (mean age: 37.8±13.8 years). Patch testing was performed using the thin-layer rapid-use epicutaneous patch test panels. Results: Nickel sulfate was the most common sensitizing agent, with 26 (35.1%) patients yielding a positive result; followed by p-phenylenediamine in 17 (22.9%), butyl-tetra-phenol formaldehyde in 12 (16.2%), gold sodium thiosulfate in 10 (13.5%), and thimerosal in 6 (8.1%) patients. Nickel reactivity was significantly higher among women (41.4%) than among men (12.5%) ( p less than 0.0001). Similarly, gold reactivity among women (15.5%) was also higher than among men (6.2%) ( p ≤0.02). Conclusion: The high level of skin sensitization due to nickel, PPD, and gold in patients with ACD emphasizes the need for measures to decrease exposure to these sensitizing agents. Saudi Med J 2017; Vol. 38 (9): 922-927 doi: 10.15537/smj.2017.9.19864 How to cite this article: Shakoor Z, Al-Mutairi AS, Al-Shenaifi AM, Al-Abdulsalam AM, Al-Shirah BZ, Al-Harbi SA. Screening for skin-sensitizing allergens among patients with clinically suspected allergic contact dermatitis. Saudi Med J . 2017 Sep;38(9):922-927. doi: 10.15537/smj.2017.9.20505.

Background Occupational diseases involving the immune system are considered to be occupational allergic diseases (OAD); 15% of occupational diseases are allergic. The social consequences of OAD are significant for both workers and employers. Objectives To describe demographic and clinical characteristics of patients with OAD and their social outcomes. Methods Descriptive and retrospective study of the medical records of patients diagnosed with OAD cared at the occupational allergy clinic of a university hospital in Sao Paulo, Brazil. Results A total of 72 patients exhibited OAD, with age 21 to 89 years old; 52% were male. Atopic antecedents were described for 35% of patients. Most patients worked in the chemical industry (17%), cleaning (15%), construction (11%) and health care (8%). Occupational rhinitis was found in 26% of the patients, work-related asthma in 18%, asthma and rhinitis in 25%, and allergic contact dermatitis in 13%. In regard to the social outcomes, 36 (50%) workers remained in their jobs, 19 (26%) changed function, 7 (10%) changed occupation, 7 (10%) were fired and 3 (4%) retired. Conclusions In the present study, OAD prevailed among males and within the economically active age; cases of occupational rhinitis were the most frequent. Half of the employees remained in the same job position even after diagnosis.

Chronic spontaneous urticaria (CSU) is a disease that seriously disturbs the quality of life of the patient. Currently there is no prognostic marker of the disease. Our aim in this study was to determine possible prognostic markers of CSU in children.All patients younger than 18 years of age who were followed by the Pediatric Immunology and Allergy Clinic of Diyarbakir Children's Hospital with a diagnosis of CSU between June 2017 and February 2019 were included in the study. Clinical and laboratory findings were compared between the symptomatic patient group and the patient group that remained in remission for at least three months without use of medication.Of the 52 cases included in the study, 32 (61.5%) were male. Mean age at time of diagnosis was 9.4 ± 4.4 years. Twenty-four cases (46.2%) went into remission. Young age at the time of diagnosis and being in the initial months of the disease were found to be associated with good prognosis (p 0.05). Among laboratory results, elevation in absolute neutrophil count and neutrophil/lymphocyte ratio (NLR) were found to be associated with poor prognosis (p 0.05). NLR was positively correlated with disease duration (p 0.05).For childhood CSU, younger age and initial months of the disease are good prognostic indicators, while only neutrophil/lymphocyte count can be used as a remission marker.

Aims To asses short term compliance with advice to introduce SKIN TEST NEGATIVE foods after clinic. To asses barriers to commencing advised consumption. Methods Allergy-related dietary restrictions are often too broad, and are not based on clinical evidence of allergy or sensitisation. In CUH allergy clinic parents are advised to introduce foods after full allergy focused history, usually negative SPT and occasionally IgE testing. Parents are given a written list of foods to be introduced and are advised that they will be contacted in exactly one week to inquire about (non-)completion of the introductions. Results 75 parents were contacted 1 week after their clinic visit. 10 parents (13%) failed to commence food as instructed with reasons such as ‘child refusal’, ‘forgot’ and child vomiting immediately post ingestion. 65 (87%) commenced foods as planned, most were asked to try tree nuts with only 6 parents 13%) asked to start the egg or milk ladder. 55 of these parents were asked to introduce more than one food (up to 6 foods), 10 of the 55 parents failed to introduce more than one food (18%) and 45 completed all advised introductions (82%). Reasons given for incomplete multiple introductions were ‘not enough time since clinic’ and fear of introducing more than one food would cause a reaction.47 parents (72%) gave the advised foods more than once/regularly in the week, (18) 27% parents gave the advised foods just once so far , but 13 of these 18 were willing to offer the foods again. Conclusion 87% of parent introduced advised food(s) within 1 week, but only 72% were offering the foods regularly. Reasons for non-compliance were usually not allergy-related and can be worked around, including giving a wider time window for multiple introductions. Introduction of unduly avoided foods is a key part of modern allergy care.

BackgroundDermatological services in Laos, South East Asia are limited mainly to the capital and patch testing is currently not available, so no data exists regarding the common cutaneous allergens in this population.ObjectivesThe aim of this study was to document common allergens in paediatric patients with atopic dermatitis attending the allergy clinic in the capital, Vientiane.Patients/Materials/MethodsFifty paediatric patients with atopic dermatitis were patch tested using TRUE Test® panels 1 to 3 (35 allergens). Readings were taken at Days 2 and 4.ResultsTwenty-six positive patch tests were recorded on Day 4 in 15 children (30%). The most common allergens were: gold (18%), nickel (10%), formaldehyde (6%) and p-Phenylenediamine (6%). Other positive allergens were potassium dichromate (2%), cobalt dichloride (2%), Bronopol (2%), paraben mix (2%), fragrance mix 1 (2%) and neomycin (2%). The majority of the patients with positive reactions were female.ConclusionsThis study represents the first documented patch test results in the Lao population. It is hoped that these findings will help clinicians to advise the families of children with atopic dermatitis on common allergens to avoid and inform future work on contact dermatitis in this population.

We looked after 2 young people with allergy who were unable to pursue their intended careers in the military. These patients raised our awareness that we didn’t routinely discuss career and led us to source useful patient information. Allergy UK produce a useful patient information leaflet on allergies and the Military. Further information is available on Army website, Aim To explore whether career discussion forms part of the consultation with young people in Paediatric Allergy clinics and assess awareness of available career information for young people with allergies. To highlight the relevance of career advice regarding military careers. Methodology Survey in a Regional Allergy Forum – a 9 question SurveyMonkey with 17 responses from Doctors, Clinical Nurse Specialists (CNS) working in Paediatric allergy, and 1 CNS in adult allergy. Results 45% of survey participants were aware of specific careers which exclude children with allergies, 25% were aware that some careers excluded children with allergies, with 30% of responses unaware. 53% sometimes discussed potential problems with future careers in clinic, 23% replied that they always did and 23% didn’t. There was a mixed picture regarding where the responsibility to discuss future careers lay with regards to allergy. 40% of respondents felt the responsibility did lie with the health professional, 28% in conjunction with school and care givers and 18% felt the role was outside the health care professional remit, and 10% only when specifically asked. Conclusion We concluded that there is good awareness that children with allergies meet exemptions in some careers and a positive sense that it is within the remit of the health Professional in allergy to explore career choice with patients, in conjunction with family and school. The survey demonstrates to us that an increase in career discussion is required with increased awareness of the availability of relevant leaflets about exclusions within the Military, to further enhance our support for our young people as they move through and transition from the Allergy Clinic into the world of work.