ABSTRACT
Objective: To identify trends of contact allergy and patch testing amendments at the Contact Dermatitis Clinic, Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University. Materials and Methods: Medical records of 6,862 patients referred to our clinic between January 1992 and December 2021 for patch testing were reviewed. Results: The number of patients patch tested increased and reached a peak of 600 patients/year in 2019 before the COVID-19 pandemic. The most frequently used series was baseline, while the most used specific series was cosmetics. The overall positivity rate was 69%. The highest positivity rate was in the cosmetics series (70.2%). Nickel sulfate was the most common contact allergen found (24.2%). Conclusion: Our patch test service has been growing in the last 30 years. The series of allergens used for patch testing has been amended every few years to be up-to-date with current global trends of contact allergies. Continual surveillance of contact prevalence and periodic updating of those series are necessary to enhance our ability to detect culprit contact allergens, which could help us improve care of our patients © All material is licensed under terms of the Creative Commons Attribution 4.0 International (CC-BY-NC-ND 4.0) license unless otherwise stated
ABSTRACT
Background. Penicillins and cephalosporins (PCN/CEPH) are considered firstline antibiotics for numerous infections for their efficacy, tolerability, and cost effectiveness. Unfortunately, their use may be precluded in approximately 10% of the general adult population who self-report 'allergy'. As a result, suboptimal antimicrobials are substituted which may increase toxicities, length of hospitalizations, and antimicrobial resistance with subsequent expense and morbidity. Multiple organizations endorse beta-lactam allergy skin testing (BLAST) as an essential component of antimicrobial stewardship programs.In an attempt to better describe this patient population as well as to protocolize and improve rates of referral to allergy/immunology clinic, a quality initiative was undertaken at our institution. Methods. Adult inpatients for whom an infectious disease consult was placed over a 6-month period were chart-reviewed for PCN/CEPH allergy. Inappropriately charted allergies were reconciled and patients were recommended referral to allergy/immunology for formal evaluation with BLAST when appropriate. Referrals were placed for agreeable patients who were then evaluated for appropriateness through history and then scheduled for BLAST. Patients who tolerated oral exposures without adverse effects had the allergy removed from their chart and were educated. Results. 322 patients met inclusion criteria for allergy referral. Of those, 103 agreed to further evaluation, and referrals were placed for 100%. Unfortunately, 7 patients died before referrals could be completed, and 88 referred patients did not complete BLAST for other reasons. In total 8 patients completed BLAST, and allergy was de-labeled in 75% (N= 6) of those cases. Conclusion. Our data indicated similar prevalence of reported PCN/CEPH allergy between our institution and the general population. We achieved our aim of improving allergy referral rates among this population, however there was a high rate of attrition in the transitions of care. Qualitative review of selected patients highlights common thematic barriers including the COVID-19 pandemic, fiscal concerns, and acuity of condition. Future directions should include BLAST at the point of care or making referrals from the primary care setting.
ABSTRACT
Introduction: Mechanisms underlying allergic reactions to the new BNT162b2 (Pfizer) and AZD1222 (AstraZeneca) COVID-19 vaccinations are poorly understood. Polyethylene glycol (PEG) is implicated for BNT162b2;and polysorbate 80 (PS80) and disodium edetate (EDTA) for AZD1222. Methods: Patients referred to our service were investigated with standardised vaccine skin-prick testing (SPT) and intradermal testing (IDT) protocols. Basophil activation testing (BAT) was performed in patients with history highly suggestive of excipient or vaccine allergy. Results: Reason for referral was suspected excipient allergy in 16/23 (70%), previous other vaccine reaction in 4/23 (17%), and reaction to the BNT162b2 vaccine in 3/23 (13%). In patients with suspected excipient allergy, SPT was only positive in 1/16 (6%). In 12/16 patients with suspected PEG allergy, IDT and BAT were positive in 5 (42%) for the BNT162b2 vaccine but not PEG. 3/5 have subsequently undergone successful vaccination with AZD1222, while 1/5 had cross-reactivity with AZD1222 on BAT and has not been vaccinated. 2/16 patients with suspected PS80 allergy were negative on SPT, IDT, and BAT, and have undergone successful AZD1222 vaccination. In the 2/16 patients with EDTA allergy IDT was positive to EDTA but neither vaccine, correlating with BAT. 1 has been successfully vaccinated with the EDTA-containing AZD1222 vaccine. 2 patients (1 reaction to BNT162b2, 1 other vaccine reaction) developed systemic reactions during testing without tryptase elevation. Both were associated with local flare response to the BNT162b2 vaccine, both have undergone successful vaccination with the AZD1222 vaccine. All other patients with negative SPT, IDT, and BAT results have subsequently tolerated vaccination. Conclusion: Most patients can be successfully vaccinated with available COVID-19 vaccines. SPT has low sensitivity and a combined protocol of SPT, IDT, and BAT provides confidence in allergy delabelling. Not all excipient allergies correlate to vaccination allergy and BAT provides a powerful diagnostic tool in these cases.
ABSTRACT
PURPOSE OF REVIEW: The coronavirus disease 2019 (COVID-19) has challenged healthcare system capacities and safety for health care workers, reshaping doctor-patient interaction favoring e-Health or telemedicine. The pandemic situation may make difficult to prioritize patients with allergies diseases (AD), face-to-face evaluation, and moreover concern about the possible COVID-19 diagnosis, since COVID-19 shared many symptoms in common with AD. Being COVID-19 a novel disease, everyone is susceptible; there are some advances on vaccine and specific treatment. We evaluate existing literature on allergic diseases (AD): allergic rhinitis, asthma, food allergy, drug allergy, and skin allergy, and potential underlying mechanisms for any interrelationship between AD and COVID-19. RECENT FINDINGS: There is inconclusive and controversial evidence of the association between AD and the risk of adverse clinical outcomes of COVID-19. AD patients should minimize hospital and face-to-face visits, and those who have used biologics and allergen immunotherapy should continue the treatment. It is essential to wear personal protective equipment for the protection of health care workers. Social distancing, rational use of facemasks, eye protection, and hand disinfection for health care workers and patients deserve further attention and promotion. Teleconsultation during COVID-19 times for AD patients is very encouraging and telemedicine platform can provide a reliable service in patient care.