CASE REPORT: Immigrants and evolving food allergies

Case report Background: We present a case of coconut allergy as a rare evolving food allergy among immigrants. Case presentation: A 3-year-old girl, on treatment for asthma, was referred to the allergy clinic due to possible reactions to salmon and coconut. Due to COVID restrictions, the initial consultation was conducted by telephone. Reportedly, she developed hives and wheeze after eating salmon and coconut products. During the face-to-face review, it was noted that the child's paternal side of the family was of ethnic minorities. The patient had cradle cap as a baby, and coconut oil was applied for treatment as advised by family back home. During a hospital-based coconut challenge, she developed puffy eyes, and on subsequent consumption of coconut macaroon, she developed hives. The child was diagnosed with coconut allergy. Face-to-face assessment and food cultural awareness are essential for clinical diagnosis. Discussion(s): Allergy is a multifactorial illness affected by epigenetic, environmental factors, eczema during infancy and food culture. Studies suggest that the risk of allergy can be highest in immigrants to culturally stable food, particularly with delayed early taste during weaning. The dual allergen hypothesis proposes that early cutaneous exposure to food protein through damaged skin barrier can lead to sensitisation and allergy and that early oral exposure to food induces tolerance. Conclusion(s): Further research on understanding the interaction between epigenetics of the allergic disease and the environment is needed as is an understanding of how the movement of populations and different culture habits can affect the incidence of food allergy. In the meantime, is promoting healthy skin barrier and early food introduction enough to prevent food allergies.

Appearance and management of COVID-19 laryngo-tracheitis: Two case reports

We present two cases of coronavirus disease 2019 (COVID-19)-related laryngotracheitis in good-prognosis, ventilated patients who had failed extubation. As the pandemic continues to unfold across the globe and better management of those with respiratory failure develops, this may be an increasingly common scenario. Close ENT-intensivist liaison, meticulous team preparation, early consideration of rigid endoscopy and prospective data collection and case sharing are recommended.

Multidisciplinary guidance for safe tracheostomy care during the COVID-19 pandemic: the NHS National Patient Safety Improvement Programme (NatPatSIP).

The COVID-19 pandemic is causing a significant increase in the number of patients requiring relatively prolonged invasive mechanical ventilation and an associated surge in patients who need a tracheostomy to facilitate weaning from respiratory support. In parallel, there has been a global increase in guidance from professional bodies representing staff who care for patients with tracheostomies at different points in their acute hospital journey, rehabilitation and recovery. Of concern are the risks to healthcare staff of infection arising from tracheostomy insertion and caring for patients with a tracheostomy. Hospitals are also facing extraordinary demands on critical care services such that many patients who require a tracheostomy will be managed outside established intensive care or head and neck units and cared for by staff with little tracheostomy experience. These concerns led NHS England and NHS Improvement to expedite the National Patient Safety Improvement Programme's 'Safe Tracheostomy Care' workstream as part of the NHS COVID-19 response. Supporting this workstream, UK stakeholder organisations involved in tracheostomy care were invited to develop consensus guidance based on: expert opinion; the best available published literature; and existing multidisciplinary guidelines. Topics with direct relevance for frontline staff were identified. This consensus guidance includes: infectivity of patients with respect to tracheostomy indications and timing; aerosol-generating procedures and risks to staff; insertion procedures; and management following tracheostomy.