Seven days in medicine: 6-12 May 2020

In a report summarising the feedback it had received,2 the charity noted a litany of "horrendous” safety concerns, as workers were concerned about a lack of personal protective equipment and about their mental health. NICE: assess covid patients for kidney injury Patients with suspected or confirmed covid-19 should be assessed for acute kidney injury (AKI) on hospital admission or transfer, said the National Institute for Health and Care Excellence (NICE). In a new guideline aimed at healthcare professionals who are not kidney specialists, the institute said that patients with suspected or confirmed covid-19 should be monitored for AKI throughout their stay in hospital and managed appropriately if it develops.

Remdesivir Efficacy and Tolerability in Children with COVID-19-Associated Allergic Comorbidities such as Asthma, Allergic Rhinitis, and Atopic Dermatitis.

In children, coronavirus disease 2019 (COVID-19) starts as a minor illness compared to adults, but during the ongoing COVID-19 pandemic, distinct SARS-CoV-2 variants and subvariants have changed options for therapies in both adults and children, especially for those with comorbidities such as allergies. On 25 April 2022, Remdesivir (RDV), a viral RNA-dependent RNA polymerase inhibitor, was approved by the Food and Drug Administration (FDA) for the treatment of pediatric patients 28 days and older, weighing ≥3 kg, hospitalized or non-hospitalized, who are at high risk of progression to severe forms of COVID-19. While RDV has been shown to have favorable effects in numerous types of research conducted on adults, such as shortening hospital stays, and has shown it has antiviral effects on various RNA viruses, there is a lack of findings regarding safety, tolerability, and efficacy of RDV in allergic pediatric patients since its initial FDA approval. This study aims to assess RDV's efficacy and tolerability in treating pediatric patients with mild and severe forms of COVID-19-associated allergies such as asthma, allergic rhinitis, and atopic dermatitis and how RDV affects the duration of hospitalization, especially for these comorbidities. The most recent pandemic wave among children rose due to the high transmissibility of the Omicron variant, and this study analyzed changes between July 2020 and September 2022 at the National Institute of Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania. Our retrospective study included 250 children <18 years old, 42 (16.8%) had allergies, 132 were males (52.8%), age group 0-5 years old (80%), with a positive viral test for SARS-CoV-2. Severity was categorized as mild (43.6%), moderate (53.2%), and severe (1.6%) COVID-19, and treatment with RDV was administered in 50.4% (126/250) of children included in the study. The presence of comorbidities, asthma (7.2%), allergic rhinitis (4.4%), and atopic dermatitis (4.4%), was associated with an increased risk of developing severe COVID-19 infection in children, p < 0.05. We did not register deaths and severe complications; all cases evolved favorably under the instituted treatment. Laboratory abnormalities in transaminase levels 53.97% (ALT) and 61.9% (AST) were grades 1 or 2 and did not require discontinuation of the antiviral treatment, p < 0.05. RDV in children reduced the duration and evolution of COVID-19 and decreased the length of hospitalization in group-associated allergies; p < 0.05. This article summarizes RDV's efficacy among children with COVID-19 and allergies when the clinical result was improved and reports positive effects on tolerability and reduced duration of hospitalization, especially in children with asthma, atopic dermatitis, and allergic rhinitis. More studies are needed to confirm our findings.

Best practices for pediatricians in diagnosing and treating asthma

Additionally, they can treat atopic comorbidities such as atopic dermatitis, chronic urticaria, nasal polyps, eosinophilic esophagitis, and hypereosinophilic syndrome, resulting in improved quality of life for our patients. Parents should be made aware of its updated black box warning for possible effects on mental health and behavior changes,3 including but not limited to suicidal ideation. FDA requires boxed warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair);advises restricting use for allergic rhinitis.

Multiple Monitoring Stations in Big Cities: First Example of Three Spore Traps in Rome

(1) Background: Rome is a municipality with an area of 1287 km2 and presents floristic-vegetational complexity that is reflected in the composition of aerospora, which are responsible for pollinosis. The presence of airborne pollen can be detected by pollen monitoring. The large extent of the city's territory makes it possible to verify possible changes in pollen composition in different sites of the city. With this in mind, a study was conducted to assess the differences in airborne pollen concentration, considering phenological and production indicators at three different sites in the city. (2) Methods: Pollen data of eight taxa were considered, Alnus spp., Castanea sativa Miller, Cupressaceae-Taxaceae, Olea europaea L., Platanaceae, Poaceae, Quercus spp., and Urticaceae, during 2020 and 2021, using three monitoring samplers. The airborne pollen concentration and the seasons of the three centers were calculated and compared with each other. (3) Results: The diversity between the three samplers shows a phenological succession in accordance with the microclimatic diversity present in the city. The heterogeneity of the airborne pollen concentration reflects the floristic-vegetational diversity, while qualitative and quantitative parameters indicate a homogeneous flowering trend reflecting the seasonality of the various species. (4) Conclusions: The present work and the Italian geographic context suggest the need for a greater number of sampling points to guarantee a true localization of the data. Having several sampling stations also contributes to the protection of health and green areas, which are difficult to manage, conserve, and maintain.

The school nurse talks about how to keep your body healthy. Doesn't really talk about food allergies. I'd like to change that

Food allergies are increasingly common and affect approximately one in thirteen students in the United States (US). Anaphylactic reactions can be unpredictable, severe, and sometimes life-threatening if not treated quickly and appropriately. School health policies and education surrounding food allergies vary substantially within and between states, as do guidelines that influence policy, and influence students' experiences of school with food allergies. Additionally, the COVID-19 pandemic has influenced students' experiences of their school communities. There is a limited research exploring student perspectives regarding food allergy policies, and none published to-date reflecting perspectives during the pandemic. Students' voices are not always included in food allergy management and policy research. The current study was conducted to elicit elementary students' voices during a unique moment in world history, the beginning of the COVID-19 pandemic. Elementary school students' stories, attitudes, and perspectives regarding food allergy management and school policies in New England were explored through semistructured, individual interviews (n = 7). A descriptive phenomenological approach was applied to the conceptualization of this project and thematic analysis of views shared. Parent (n = 29) and student (n = 11) questionnaire data were collected to supplement interview findings. Questionnaire results reflected student and parent experiences of variability in school-based food allergy policies and attitudes. Interview findings reflected that many students experienced COVID-19 precautions as protective against opportunities for exposure to allergens in school, wished that others knew more about food allergies, and reflected the general sense that food allergies were usually met with respect in school. Some called for increased education to promote awareness and practical knowledge within their school communities. Student impressions of food allergy management have diverse implications for policy. Student openness to improvements to education, in combination with the shared comfort expressed in others knowing about their unique food allergies, suggests that elementary school could be an appropriate place to integrate food allergy education. Additionally, food-allergy related comfort afforded by COVID-19 precautions indicates room for development in food allergy policy development and education to enhance perceptions of safety at school among students with food allergies. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Exploring the impacts of FDA temporary food labeling flexibility among the food allergy community during the Covid-19 pandemic

In an attempt to improve access to food distribution systems during the Covid-19 pandemic, the United States Food and Drug Administration (FDA) issued temporary flexibility in food labeling requirements. This requirement affects the Top 8 allergens and could lead to accidental allergen ingestion. The purpose of this study was to utilize a qualitative method to collect and analyze comments to FDA that were available via Allergic Living's website from May 22, 2020, to June 18, 2020, following the release of the food labeling change. In total, 3,033 comments were analyzed using the thematic analysis six-phase framework approach. Various themes were extracted relating to the emotional responses of the new labeling including fear, safety concerns, and trust of certain food product brands among the food allergy community. This research has implications for a broad spectrum of the U.S. food industry including restaurants, grocery stores, specialty food associations, and consumers. Stakeholders and experts in the food allergy community should be consulted when a policy change is occurring, especially during a pandemic affecting access to safe food.

Exploring the impacts of FDA temporary food labeling flexibility among the food allergy community during the COVID-19 pandemic. (Special Issue: The impact of the covid-19 pandemic and the foodservice industries.)

In an attempt to improve access to food distribution systems during the Covid-19 pandemic, the United States Food and Drug Administration (FDA) issued temporary flexibility in food labeling requirements. This requirement affects the Top 8 allergens and could lead to accidental allergen ingestion. The purpose of this study was to utilize a qualitative method to collect and analyze comments to FDA that were available via Allergic Living's website from May 22, 2020, to June 18, 2020, following the release of the food labeling change. In total, 3,033 comments were analyzed using the thematic analysis six-phase framework approach. Various themes were extracted relating to the emotional responses of the new labeling including fear, safety concerns, and trust of certain food product brands among the food allergy community. This research has implications for a broad spectrum of the U.S. food industry including restaurants, grocery stores, specialty food associations, and consumers. Stakeholders and experts in the food allergy community should be consulted when a policy change is occurring, especially during a pandemic affecting access to safe food.

Abdominal Pain in the Female Patient: Always Consider Your Differentials

Steadman, L., Coles, K., & Kopf, S. (2023). Abdominal pain in the female patient: Always consider your differentials. Pediatric Nursing, 49(1), 45-47.

Practice Notes from the AAAI

99441 – [Telephone evaluation and management service by a physician or other qualified healthcare professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment;Five-10 minutes of medical discussion.] Cellular Partners of Mast Cells and Basophils in Homeostasis and Allergic Disease You can find a full list of 2020 Virtual Annual Meeting sessions, including pricing for special sessions, by visiting the AAAAI Continuing Education Center at education.aaaai.org.Earn CME Credit with Select AAAAI Podcast Episodes The AAAAI is excited to offer free CME credit for members who listen to select episodes of our podcast, Conversations from the World of Allergy. Episodes offering CME credit will be identified with a CME icon and CME language in the podcast description.Lay Organizations The AAAAI places a high value on its relationships with patient advocacy organizations in support of our mutual concern for the needs of people with allergy, asthma and immunologic disease and their families. Allergy & Asthma Network allergyasthmanetwork.org American Partnership for Eosinophilic Disorders (APFED) apfed.org Asthma & Allergy Foundation of America (AAFA) aafa.org Alaska Chapter: aafaalaska.com California Chapter: aafa-ca.com Greater Kansas City Chapter: aafakc.org Maryland/Washington DC Chapter: aafa-md.org Michigan Chapter: aafamich.org New England Chapter: asthmaandallergies.org Texas Chapter: aafatexas.org St. Louis Chapter: aafastl.org Campaign Urging Research for Eosinophilic Disease (CURED) curedfoundation.org Food Allergy and Anaphylaxis Connection Team (FAACT) foodallergyawareness.org Food Allergy Research & Education (FARE) foodallergy.org Immune Deficiency Foundation (IDF) primaryimmune.org International FPIES Association fpies.org The Mastocytosis Society (TMS) tmsforacure.org US Hereditary Angioedema Association (HAEA) haea.org You Can Now Use Our Internet Point-of-Care Activity to Earn MOC The COVID-19 pandemic has altered the way we see patients and conduct research.

Is SARS-CoV-2 Vaccination of Subjects with a Prior History of Allergies Dangerous? Experiences in the Veneto Region of Italy.

Adverse events after SARS-CoV-2 vaccinations have caused alarm to some individuals with previously diagnosed allergies. The aim of this study was to investigate whether the risk of adverse reactions was actually higher in this subgroup. To this end, we carried out an observational descriptive analysis of vaccines administered in a "protected setting" in the Veneto region of Italy between December 2020 and December 2022. Reactions were classified using systemic organic classification (SOC), and their severity was assessed using the criteria of the Italian Drug Agency (AIFA). A total of 421 subjects were vaccinated with 1050 doses, 95.0% of which were administered without adverse events. In all, 53 subjects reported 87 SOC reactions (1.6 reactions/person), and 18.3% of these reactions were severe. One person was hospitalized, but all subjects enjoyed complete remission. Reporting rates were 9.0%, 3.1%, and 1.2% for first, second, and third doses, respectively. The most frequent reactions involved the respiratory system (2.3%), the cutaneous and subcutaneous systems (2.1%), and the nervous system (1.7%). Multivariate analyses (adjOR (95% CI)) revealed that the probability of experiencing at least one reaction significantly declined with increases in age [0.95 (0.94-0.97)] and in the number of doses received, i.e., 75% [0.25 (0.13-0.49)] for second doses and 88% [0.12 (0.04-0.39)] for third doses. These results indicated that vaccinations could be safely administered; few reactions were reported, and there were no permanent adverse outcomes.

Protocols for Managing Food Allergies in Elementary and Secondary Schools.

The prevalence of food allergies is on the rise; nearly 8% of children worldwide are affected. The most common allergens-milk, eggs, peanuts, tree nuts, shellfish, fish, and wheat-account for 90% of serious allergic reactions. A literature review of online databases in CINAHL, PubMed Central, Education Resources Information Center (ERIC), Google Scholar, Health Resource Center Academic, and archival searching was performed to identify evidenced-based practices for managing food allergies in schools. There is no cure for food allergies. The current management standard is to avoid the allergen, treat a mild reaction with antihistamine and observation, and treat anaphylaxis with an intramuscular injection of epinephrine. Due to COVID-19 social distancing recommendations, food consumption in schools has moved from cafeterias and lunchrooms into classrooms and other spaces. This in turn necessitates strict adherence to hand washing and disinfecting all surfaces that come in contact with food. Managing food allergies in schools requires cooperation among school administrators, nurses, teachers, staff, families, and health care providers. Resources for managing food allergies in schools are presented offering information for parents, school administrators, nurses, teachers, and staff for planning and implementing strategies for preventing and reducing allergic reactions and treating life-threatening food allergy reactions.

Antibodies as drugs-a Keystone Symposia report.

Therapeutic antibodies have broad indications across diverse disease states, such as oncology, autoimmune diseases, and infectious diseases. New research continues to identify antibodies with therapeutic potential as well as methods to improve upon endogenous antibodies and to design antibodies de novo. On April 27-30, 2022, experts in antibody research across academia and industry met for the Keystone symposium "Antibodies as Drugs" to present the state-of-the-art in antibody therapeutics, repertoires and deep learning, bispecific antibodies, and engineering.

The quantity of unheated milk tolerated as a predictor of tolerance to baked milk

Background: Tolerance of baked milk indicates a good prognosis in IgE-mediated cow's milk allergy. Objective: The present study aims to investigate the predictors of baked milk tolerance, particularly the amount of milk tolerated in the first oral food challenge (OFC) test, in children with IgE-mediated cow's milk allergy. Methods: The study included 35 cases who were diagnosed with IgE-mediated cow's milk allergy upon open OFC testing in the Pediatric Allergy Clinic. Four weeks after the diagnosis, skin prick test (SPT) and OFC were performed with baked milk. Cases who did and did not develop reactions during OFC with baked milk were compared regarding clinical and laboratory parameters. Results: Twelve cases (33.3%) did not develop a reaction during OFC with baked milk. Those who had low levels of casein sIgE, ß-lactoglobulin sIgE, and a-lactoalbumin sIgE;small SPT wheal diameter for baked milk and a-lactoalbumin;and a large amount of unheated milk tolerated in the first OFC were found to be tolerant to baked milk (p < 0.05). For predicting baked milk tolerance, a cut-off level of the amount of unheated milk tolerated in OFC was calculated as 620 mg [with the area under the curve (AUC) 0.88 (95% confidence interval 0.77-0.99) in ROC curve analysis]. Conclusion: If a child with cow's milk allergy is able to tolerate more than 620 mg of milk protein during challenge with unheated milk, this may show that this child will tolerate baked milk, meaning that the child will be able to tolerate cow's milk in the future.

Digital Literacy-Based User Experience Design for Medication-Allergy Patients Care

Digital literacy is not based solely on an understanding of technology, but is highly influenced by social and cultural context. This study focused on developing mobile applications for medication allergy care for respiratory-related patients in daily life, which is based on inclusiveness and digital literacy. With COVID-19, there are growing needs to share the role of primary care hospitals, with, for example GPs, and self-care symptom records applications, in order to supplement the saturated medical service of general hospitals. The mobile application of ‘medication-allergy record for respiratory-related patients’ which is developed in this study considers cultural digital literacy and provides the solutions to the local people’s needs. For these objectives this study has conducted field research and analyzed the influential factors and needs in digital interaction, by interviewing 120 outpatients of respiratory and allergic internal medicine department in general hospital in Cheongju. Based on this, the direction of the mobile application has developed new information architecture and relevant wire-frames. This study will contribute to the future direction of non-face communication in health-care service by suggesting a self-data-producing digital health care service by bridging the personal culture and user-centered technology. © Springer Nature Switzerland AG 2021.

Post-COVID impact on skin allergies

The pandemic raises several concerns for medical providers. Speedy screening and therapy, susceptibility categorization, effective utilization of acute medical utilities, proper drugs, observation, and quick release are vital for protecting as many victims as feasible. We discussed several ML (machine learning) classification strategies for analyzing skin-related concerns. This chapter tries to give appropriate skin specialists a strategy plan to comprehend its potential and difficulties. In this study, we employ several classification approaches and multi-model classification methods-design autonomous assessment assistance to reliably detect a specific type of allergic rhinitis ailment for deployment. © 2022 Nova Science Publishers, Inc. All rights reserved.

Navigating patients with atopic dermatitis or chronic spontaneous urticaria during the COVID-19 pandemic.

A rapid spread of different strains of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an unprecedented pandemic. Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, the medical body has encountered major obstacles concerning disease management at different levels. Even though patients infected with this virus mainly present with respiratory symptoms, it has been associated with a plethora of well-documented cutaneous manifestations in the literature. However, little investigations have been conducted concerning COVID-19 and its impact on skin disorders mediated by type 2 inflammation leaving multiple dermatologists and other specialists perplexed by the lack of clinical guidelines or pathways. This review focuses on the effects of this pandemic in patients with skin disorders mediated by type 2 inflammation, specifically atopic dermatitis and chronic spontaneous urticaria. In addition, it will provide clinicians a guide on treatment and vaccination considerations for this stated set of patients.

Original Article Highlights From This Issue

Administration of biologics is not necessary to be postponed due to SARS-CoV-2 infection.Constant-Load Exercise Versus High-Intensity Interval Training on Aerobic Fitness in Moderate-to-Severe Asthma: A Randomized Controlled Trial Aparecido da Silva et al 2596 What is already known about this topic? Bronchiectasis is expected to worsen the clinical and functional outcomes in patients with asthma, but limited data are available regarding the long-term effects of bronchiectasis on the clinical course of asthma. Data from this large, prospective study translate the OCS-sparing effect of mepolizumab in patients with severe asthma reported across randomized, placebo-controlled trials into real-world clinical effectiveness when used alongside standard of care. [...]these risk factors are not of sufficient magnitude to warrant special measures regarding their vaccination.Assessment of Immediate Allergic Reactions After Immunization With the Pfizer BNT162b2 Vaccine Using Intradermal Skin Testing With the COVID-19 Vaccines Shavit et al 2677 What is already known about this topic?

Cross-Reactivity between Pfizer/BioNTech and Johnsson Vaccines: A Case Report: An International Journal of Medical Toxicology and Drug Experience

Introduction: Polyethylene glycol (PEG) is one of the ingredients in the Pfizer/BioNTech COVID 19 vaccine (mRNA vaccine) and has been known to cause hypersensitivity [1-3]. Polysorbate is an ingredient in the Johnson vaccine (adenovirus vaccine) which may crossreact with PEG. Objective: We report a case of cross-reactivity between Pfizer/ BioNTech and Johnsson vaccines. Methods: This observation was notified in the pharmacovigilance center of Sfax, Tunisia (faculty of medicine of Sfax). The study of drug imputability was carried out according to the WHO method. Results: We report the case of a 32-year-old Tunisian woman with a history of atopy and intolerance to non-steroidal anti-inflammatory drugs (NSAIDs) but no history of SARS-CoV-2 infection. On August 15, 2021 (at 08:30), she developed sweating, vomiting and dizziness immediately after receiving the initial dose of Johnson COVID-19 vaccine. Her blood pressure became lower (less than 90/60 mmHg). She had to stay at the vaccination centre for one hour, and the clinical signs improved spontaneously after one hour. In the evening of the same day, the patient presented a febrile maculopapular eruption in the abdomen, trunk, and face. The rash resolved spontaneously over a week. The patient was referred to the pharma-covigilance center of Sfax (Tunisia). The messenger RNA vaccine was advocated for the second vaccine. On December 2021, she was received the second dose of the Pfizer/BioNTech COVID 19 vaccine (mRNA vaccine). Six hours later, she experienced a pruritic maculopapular rash on the abdomen, trunk, neck, and face. These clinical signs improved spontaneously after two days. the diagnosis of cross-allergy between these two vaccines was retained for this patient Conclusion: To our knowledge, this is the first cross-allergy between mRNA and adenovirus COVID-19 vaccines notified in Tunisian population. Healthcare professionals should be aware that hypersen-sitivity can occur with COVID-19 vaccines containing macrogols/ PEGs and those containing polysorbates. Its recognition may be challenging and often require skin testing. Per CDC guidance, con-sultation with an allergist-pharmacologist should be considered to help determine if the patient can safely receive vaccination [4].

Allergic History and Anaphylaxis in COVID-19 Vaccines: A Disproportionality Analysis in the FDA Vaccine Adverse Event Reporting System: An International Journal of Medical Toxicology and Drug Experience

Introduction: Many pre- and post-marketing studies on Covid-19 vaccines investigated their safety in the overall population. Little information is available on cohorts with specific comorbidities. Few studies evaluate the safety in allergic subjects, in particular as related to the anaphylaxis risk. Objective: To investigate the association between anaphylaxis after Covid-19 vaccines and the history of hypersensitivity reactions to the most common allergens. Methods: The Vaccine Adverse Event Reporting System (VAERS, January 2020-December 2021) was downloaded and cleaned. We focused on reports of Adverse Events Following Immunization (AEFIs) following COVID-19 vaccination in subjects > 12 years old with history of allergy. We performed a descriptive analysis and calculated the Reporting Odds Ratio (ROR) to identify demographic characteristics and allergic histories disproportionally reported with anaphylaxis for each Covid-19 vaccine and the most recorded allergens. Results: We retrieved 183,860 AEFI reports recording any allergic history (864 anaphylaxis reports among cases vs 6,162 in Covid-19 reports without history of allergy). They concerned mostly women (81.3%) and adults (74.0%). Almost all reports were submitted in the US (99.7%) and 38.3% of them resulted in hospitalization. Covid-19 vaccines administered were Spikevax (49.3%), Comirnaty (42.1%), and Janssen (8.4%). The antigens most recorded as allergens were penicillins (49,407), sulfa drugs (37,365), opioids (26,398), seafood (12,039), latex (11,442), NSAIDs (11,319), cephalosporins (8,379), quinolones (8,023), macrolides (7,586). Seafood allergy resulted associated with anaphylaxis for Comirnaty (ROR = 2.80;95% CI 2.20-3.56), Spikevax (2.57;1.88-3.51), and Janssen (2.67;1.39-5.11). Latex allergy was associated with anaphylaxis for Comirnaty (ROR = 1.92;95% CI 1.45-2.55). Conclusion: We gathered evidence pointing towards a preferential development of anaphylaxis in patients with an history of hypersensitivity to seafood (for all Covid-19 vaccines) or latex (restricted to Comirnaty). Whether confirmed by further studies, this knowledge may drive a more practical anamnesis and a prompt management of anaphylactic reactions.

Obesity and the brain. Winter Conference 2021, 7-8 December 2021

This journal issue includes 48 articles that discuss development and validation of a novel quality assessment tool to measure the quality of nutrition information online;longitudinal association between takeaway food environment and secondary school adolescents BMI and body fat percentage;dietary practices, beliefs, and behaviours among adults with inflammatory bowel disease;postpartum depression in Irish mothers and associations with infant feeding practices;the impact of dietary saturated fat replacement with unsaturated fat on the plasma lipidome and cardiometabolic disease risk;ole of brain serotonin in age-related decline in physical activity in mice;ey stakeholder perceptions of food allergies within the airline industry;sleep quality of higher education students during COVID-19 and its association with diet quality and lifestyle behaviours.