Search

Background: cold urticaria (ColdU), that is, the occurrence of wheals or angioedema in response to cold exposure, is classified into typical and atypical forms. The diagnosis of typical ColdU relies on whealing in response to local cold stimulation testing (CST). It can also manifest with cold-induced anaphylaxis (ColdA). We aimed to determine risk factors for ColdA in typical ColdU. Methods: an international, cross-sectional study COLD-CE was carried out at 32 urticaria centers of reference and excellence (UCAREs). Detailed history was taken and CST with an ice cube and/or TempTest(R) performed. ColdA was defined as an acute cold-induced involvement of the skin and/or visible mucosal tissue and at least one of: cardiovascular manifestations, difficulty breathing, or gastrointestinal symptoms. Results: of 551 ColdU patients, 75% (n = 412) had a positive CST and ColdA occurred in 37% (n = 151) of the latter. Cold-induced generalized wheals, angioedema, acral swelling, oropharyngeal/laryngeal symptoms, and itch of earlobes were identified as signs/symptoms of severe disease. ColdA was most commonly provoked by complete cold water immersion and ColdA caused by cold air was more common in countries with a warmer climate. Ten percent (n = 40) of typical ColdU patients had a concomitant chronic spontaneous urticaria (CSU). They had a lower frequency of ColdA than those without CSU (4% vs. 39%, p = .003). We identified the following risk factors for cardiovascular manifestations: previous systemic reaction to a Hymenoptera sting, angioedema, oropharyngeal/laryngeal symptoms, and itchy earlobes. Conclusion: coldA is common in typical ColdU. High-risk patients require education about their condition and how to use an adrenaline autoinjector., GA(2)LEN UCARE Network

The search for new and effective strategies to reduce bacterial biofilm formation is of utmost importance as bacterial resistance to antibiotics continues to emerge. The use of anti-biofilm agents that can disrupt recalcitrant bacterial communities can be an advantageous alternative to antimicrobials, as their use does not lead to the development of resistance mechanisms. Six MAR4 Streptomyces strains isolated from the Madeira Archipelago, at the unexplored Macaronesia Atlantic ecoregion, were used to study the chemical diversity of produced hybrid isoprenoids. These marine actinomycetes were investigated by analysing their crude extracts using LC-MS/MS and their metabolomic profiles were compared using multivariate statistical analysis (principal component analysis), showing a separation trend closely related to their phylogeny. Molecular networking unveiled the presence of a class of metabolites not previously described from MAR4 strains and new chemical derivatives belonging to the napyradiomycin and marinone classes. Furthermore, these MAR4 strains produce metabolites that inhibit biofilm formation of Staphylococcus aureus and Marinobacter hydrocarbonoclasticus. The anti-biofilm activity of napyradiomycin SF2415B3 (1) against S. aureus was confirmed.

Safety of omalizumab administration in chronic spontaneous urticaria during COVID-19 infection: a case report.Marisa Paulino1, Celia Costa1, Elisa Pedro11Immunoallergology department, Hospital de Santa Maria – Centro Hospitalar Universitario Lisboa Norte, PortugalDr. Marisa Paulino has nothing to disclose.Dr. Celia Costa has nothing to disclose.Dr. Elisa Pedro has nothing to disclose.Keywords : Omalizumab, COVID-19, urticariaTo the Editor:COVID-19 pandemic affected millions of people worldwide since was first reported in December 20191. As the pandemic expanded around the world medical practice suffered substantial changes. Healthcare systems worldwide had to adapt to provide the best and safest care for patients as well as ensure the safety of medical personnel. Patients with severe allergic disease provide the major challenge for allergists2. Biologicals are widely used in the management of severe allergic diseases and have long become part of our daily practice, however, SARS-CoV-2 infection risks in these patients lacks evidence2. Recent reports regarding Dupilumab (anti-IL3 and IL-4) administration in infected patients with chronic rhinosinusitis with nasal polyps3 and severe atopic dermatitis4,5 showed no increase in risk of severe COVID-19.Omalizumab is a monoclonal antibody targeting IgE approved for the treatment of severe asthma, chronic spontaneous urticaria (CSU)6. We report a case of a 45-year-old female with CSU treated with omalizumab that contracted COVID-19.Urticaria symptoms began at 42 years-old, 1 year prior to the first appointment, initially with only symptomatic dermographism: wheeling and itching 5-10 minutes after scratching the skin or in areas of friction from clothes. After six months she had an episode of generalized maculopapular, itching lesions with individual duration of less than 24hours that worsened after sun exposure developing areas of angioedema. She recurred to her general practitioner that prescribed bilastine 20mg/day, topical corticosteroid and referred her to our urticaria Unit.At first appointment she was medicated with bilastine 20mg/day maintaining daily wheals with a weekly urticaria activity score (UAS7) between 24-25 for the following 12 weeks. H1-Antihistamine dosage was increased until a maximum dosage of 4/day was achieved. Skin prick tests for aeroallergens and food allergens were negative. Autologous serum skin test (ASST) was negative. Blood workup was clear. She had a positive respiratory test for Helicobacter pylori that required two eradication treatments to achieve a negative result but without influence on the urticaria activity.The patient quality of life deteriorated further as the disease progressed with an increased absenteeism from work (health care assistant), strained personal and social relationships and reduced self-esteem.After failure of the second line of treatment (H1-Antihistamine 4/day), omalizumab was proposed. She started treatment in November 2019 with 300mg subcutaneously every 4 weeks at our day care unit. At first administration she was medicated with bilastine 20mg 4/day. The UAS7 was 21, urticaria control test (UCT) was 7 and Dermatology Life Quality Index (DLQI) was 7. At the fourth administration she had her CSU controlled: UAS7 0, UCT 16 and DLQI 0, and reduced the dose of bilastine 20mg to 2/day.Due to the COVID-19 pandemic, the patient chose not to take omalizumab in March 2020, imposing an 8-week interval between administrations. At that time she reported only a slight increase in pruritus (UAS7 7). Omalizumab was resumed on April 28th. Triage was performed before administration excluding COVID-19 symptoms, fever or contact with infected individuals.Her husband started exhibiting COVID-19 symptoms on May 3rd (fever, cough, dyspnea, diarrhea) and 1 day later she noticed anosmia and arthralgia, both were positive to SARS-CoV-2 (RT-PCR of nasopharyngeal exudate) on May 5th. CSU was controlled and she reported only a slight increase in pruritus with the need for increasing H1-Antihistamine dosage from 2 to 4/day. She maintained mild symptoms and tested negative after 3.5 weeks. Only anosmia persisted but with a slight improvement. As she was quarantined at the time, she was unable to attend treatment in May but maintained the scheduled treatments in June 23rd as CSU was controlled.No worsening of CSU symptoms or increase in COVID-19 severity was observed in this case despite the administration of omalizumab in the week prior to SARS-CoV-2 infection.Viral infections are known as triggers or eliciting factors for chronic urticaria6, SARS-CoV-2 infection as also been reported to manifest with acute urticaria7. The effects of COVID-19 in CSU control are unknown, in the reported case, no worsening of symptoms was observed.According to the EAACI consensus on biologicals, patients with severe allergic disease should maintain treatment with biologicals if there is a safe environment, and at-home administration should be encouraged. Regardless of disease severity, patients with COVID-19 should interrupt treatment until recovery is established2.More evidence is needed to assert the safety of biologicals during COVID infection and effect of the disease in severe allergic patients.1. Zhang J jin, Dong X, Cao Y yuan, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy Eur J Allergy Clin Immunol . Published online 2020. doi:10.1111/all.142382. Vultaggio A, Agache I, Akdis CA, et al. Considerations on Biologicals for Patients with allergic disease in times of the COVID‐19 pandemic: an EAACI Statement. Allergy Eur J Allergy Clin Immunol . Published online 2020. doi:10.1111/all.144073. Forster-Ruhrmann U, Szczepek AJ, Claus Bachert habil, Heidi Olze habil. COVID-19 infection in a patient with severe chronic rhinosinusitis with nasal polyps during therapy with dupilumab. J Allergy Clin Immunol . Published online 2020. doi:10.1016/j.jaci.2020.05.0054. Carugno A, Raponi F, Locatelli AG, et al. No evidence of increased risk for COVID-19 infection in patients treated with Dupilumab for atopic dermatitis in a high-epidemic area - Bergamo, Lombardy, Italy.J Eur Acad Dermatol Venereol . Published online 2020. doi:10.1111/jdv.165525. Ferrucci S, Romagnuolo M, Angileri L, Berti E, Tavecchio S. Safety of dupilumab in severe atopic dermatitis and infection of Covid-19: two case reports. J Eur Acad Dermatol Venereol . Published online 2020. doi:10.1111/jdv.165276. Zuberbier T, Aberer W, Asero R, et al. 7. The EAACI/GA2LEN/EDF/WAO guideline for the definition,classification, diagnosis and management of urticaria.Allergy Eur J Allergy Clin Immunol . 2018;73(7):1393-1414.7. Galvan Casas C, Catala A, Carretero Hernandez G, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol . Published online 2020. doi:10.1111/bjd.19163

The undesired attachment of micro and macroorganisms on water-immersed surfaces, known as marine biofouling, results in severe prevention and maintenance costs (billions €/year) for aquaculture, shipping and other industries that rely on coastal and off-shore infrastructures. To date, there are no sustainable, cost-effective and environmentally safe solutions to address this challenging phenomenon. Therefore, we investigated the antifouling activity of napyradiomycin derivatives that were isolated from actinomycetes from ocean sediments collected off the Madeira Archipelago. Our results revealed that napyradiomycins inhibited ≥80% of the marine biofilm-forming bacteria assayed, as well as the settlement of Mytilus galloprovincialis larvae (EC50 &lt, 5 µg/ml and LC50/EC50 &gt, 15), without viability impairment. In silico prediction of toxicity end points are of the same order of magnitude of standard approved drugs and biocides. Altogether, napyradiomycins disclosed bioactivity against marine micro and macrofouling organisms, and non-toxic effects towards the studied species, displaying potential to be used in the development of antifouling products.

Hypersensitivity reactions to antineoplastic agents may lead to discontinuation of first-line treatments. Rapid drug desensitization (RDD) allows for a safe reintroduction in patients who are allergic to them.To evaluate the safety and efficacy of the Brigham and Women's Hospital's 12-step RDD in a Portuguese patient population with cancer and to identify markers associated with breakthrough reactions (BTRs) to platins.We conducted a retrospective review of desensitizations undertaken at the Immunoallergology Day-Care Unit of the Santa Maria Hospital in Lisbon, Portugal, from July 2008 to July 2019. Adult patients with cancer and with immediate hypersensitivity reactions were included. Skin testing was performed to platins, trastuzumab, and cetuximab. The 12-step protocol was used for most patients, and a shorter protocol was used in 9 patients who were taxane-reactive to resume regular infusions.A total of 1471 RDDs were performed in 272 patients to 136 platins, 124 taxanes, 13 monoclonal antibodies, and 10 other drugs. Skin test results were positive in 127 of patients who were platin-reactive (95.3%) and negative in patients who were cetuximab- and trastuzumab-reactive. There were 141 BTRs during RDD (9.6% of infusions), 79.4% induced by platins with the majority having mild reactions (68.8%). There were 8 patients who were paclitaxel-reactive, and who completed a shorter protocol and resumed regular infusions successfully. Multiple platin infusions (cutoff: ≥10) and total immunoglobulin E greater than or equal to 100 U/mL were identified as independent risk factors for BTRs in patients who were platin-reactive.This large single-center study confirmed the safety and efficacy of the 12-step RDD protocol in a diverse cancer population, providing evidence of its universal applications. Total immunoglobulin E is a potentially useful biomarker to identify high-risk patients who are platin-reactive.

Background Hypersensitivity reactions to antineoplastic agents may lead to discontinuation of first-line treatments. Rapid drug desensitization (RDD) allows for a safe reintroduction in patients who are allergic to them. Objective To evaluate the safety and efficacy of the Brigham and Women's Hospital’s 12-step RDD in a Portuguese patient population with cancer and to identify markers associated with breakthrough reactions (BTRs) to platins. Methods We conducted a retrospective review of desensitizations undertaken at the Immunoallergology Day-Care Unit of the Santa Maria Hospital in Lisbon, Portugal, from July 2008 to July 2019. Adult patients with cancer and with immediate hypersensitivity reactions were included. Skin testing was performed to platins, trastuzumab, and cetuximab. The 12-step protocol was used for most patients, and a shorter protocol was used in 9 patients who were taxane-reactive to resume regular infusions. Results A total of 1471 RDDs were performed in 272 patients to 136 platins, 124 taxanes, 13 monoclonal antibodies, and 10 other drugs. Skin test results were positive in 127 of patients who were platin-reactive (95.3%) and negative in patients who were cetuximab- and trastuzumab-reactive. There were 141 BTRs during RDD (9.6% of infusions), 79.4% induced by platins with the majority having mild reactions (68.8%). There were 8 patients who were paclitaxel-reactive, and who completed a shorter protocol and resumed regular infusions successfully. Multiple platin infusions (cutoff: ≥10) and total immunoglobulin E greater than or equal to 100 U/mL were identified as independent risk factors for BTRs in patients who were platin-reactive. Conclusion This large single-center study confirmed the safety and efficacy of the 12-step RDD protocol in a diverse cancer population, providing evidence of its universal applications. Total immunoglobulin E is a potentially useful biomarker to identify high-risk patients who are platin-reactive.