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Background: Since patients admitted to the intensive care unit have a compromised im-mune system and are more prone to infection than other patients, timely diagnosis and treatment of corneal ulcers among this group of patients can prevent vision loss. Therefore, it is necessary to treat eye infections and corneal ulcers promptly and economize prohibitive costs. Objective(s): Appropriate treatment with the most effective antibiotic before the answer is available to prevent corneal ulcer complications and blindness. Method(s): This study was conducted from November 2019 to November 2020 and after approval by the ethics committee of Hamedan University of Medical Sciences with the code of ethics: IR.UMSHA.REC.1398.716. First, the corneal secretions of 121 patients admitted to the intensive care unit of Sina Hospital are prepared by an ophthalmologist (after anesthetizing the cornea with tetra-caine drops and sterile swabs) and culture in four growth mediums (blood agar, chocolate agar, thio-glycolate, and EMB). Microbial cultures are examined after 48 hours and a fungal culture is examined one week later. Disc diffusions are placed in positive microbial cultures. Antibiotic susceptibility or resistance of the antibiogram was recorded. Other demographic data, including patients' age and sex, are extracted from ICU files. Also, test results and patient identifications are recorded in a checklist designed for this purpose. Result(s): Of all the antibiotics used against common bacteria, vancomycin (84%), colistin (80.43%), cefazolin (80%), and levofloxacin (60%) had the highest sensitivity and gentamicin (93.75%), ceftazidime (86.42%) Erythromycin (85%) had the highest resistance against isolated bacteria. Conclusion(s): The data obtained from this study showed that the most common microorganisms in the age group under the age of 30 years were Acinetobacter Baumannii, in the group of 30-60 years old was Klebsiella pneumonia, and age group over 61 years old was Staphylococcus aureus, and the most sensitive antibiotics in the age group under 30 years were vancomycin and levofloxacin and the age group30-60 were colistin and vancomycin and in the age group over 61 years were vancomycin and cefazolin.Copyright © 2023 Bentham Science Publishers.
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Introduction: Coronavirus disease 2019 (COVID-19) has caused thousands of deaths since it was declared as a pandemic. Recently it continues to be one of the most followed topics in the world in terms of its course and treatment. Favipiravir is a broad-spectrum anti-viral agent that has been shown to be effective against various Coronaviruses in vitro. However, as with any drug use, side effects may develop with the use of favipravir treatment. Case Report: We reported a 55-year-old female patient with acute urticarial with angioedema whom had COVID-19 pneumonia. She had no history of allergy, atopy, previous similar episodes or family history of hereditary angioedema. There is no drug or food consumption that may be suspicious in terms of allergy described by the patient other than favipravir. Conclusion(s): As far as we know, it is the first case reported from our country. Since there is no specific examination for differential diagnosis, we cannot distinguish as a rare side effect due to favipiravir treatment or COVID-19 cutaneous manifestation. As a result, studies involving more cases of COVID-19 skin findings are needed.© Copyright 2020 by Emergency Physicians Association of Turkey.
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BACKGROUND: The pathogenesis of angioedema induced by angiotensin-converting enzyme inhibitors is based on the accumulation of bradykinin as a result of angiotensin-converting enzyme blockade. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to the angiotensin-converting enzyme 2 receptor, which may inhibit its production and thereby lead to an increase in bradykinin levels. Thus, SARS-CoV-2 infection may be a likely trigger for the development of angioedema. AIMS: This study aimed to analyze cases of hospitalizations of patients with angioedema associated with the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers during the coronavirus disease 2019 (COVID-19) pandemic. MATERIALS AND METHODS: This study retrospectively analyzed medical records of patients admitted to the Vitebsk Regional Clinical Hospital between May 2020 and December 2020 with isolated (without urticaria) angioedema while receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. In all patients, smears from the naso and oropharynx for COVID-19 were analyzed by polymerase chain reaction. RESULT(S): Fifteen inpatients (9 men and 6 women) aged 44-72 years were admitted because of emergent events, of which 53.6% had isolated angioedema. In two cases, a concomitant diagnosis of mild COVID-19 infection was established with predominant symptoms of angioedema, including edema localized in the face, tongue, sublingual area, and soft palate. All patients had favorable disease outcomes. CONCLUSION(S): Patients with angiotensin-converting enzyme inhibitor-induced angioedema may require hospitalization to monitor upper respiratory tract patency. There were cases of a combination of angiotensin-converting enzyme inhibitor-induced angioedema and mild COVID-19. Issues requiring additional research include the effect of SARS- CoV-2 infection on the levels of bradykinin and its metabolites, the triggering role of COVID-19 in the development of angioedema in patients receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, recommendations for the management of patients with angiotensin-converting enzyme inhibitor-induced angioedema, and a positive result for COVID-19.Copyright © 2020 Pharmarus Print Media All rights reserved.
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Since the end of 2019, the whole world has been suff ering from the Corona virus-19 (COVID-19) pandemic due to the potentially severe acute respiratory infection caused by the SARS-CoV-2 virus. To date, the infection has led to more than 4 million deaths worldwide, and>140 thousand deaths in Russia. Vaccination against COVID-19 plays a key role in stopping the pandemic. According to the existing experience in infection prevention, mass vaccination will reduce the virus's expansion and the risk of vaccine-resistant strains developing. In the context of COVID-19, the question of the feasibility and safety of vaccination for patients with primary immunodefi ciency and hereditary angioedema arises. The Russian Association of Allergists, Clinical Immunologists, and the National Association of Experts in Primary Immunodefi ciencies have developed and approved a position paper on the vaccination for patients with primary immunodefi ciency and hereditary angioedema against COVID-19. This position paper provides answers to key questions regarding vaccination for patients with these diseases.Copyright © 2020 Pharmarus Print Media License.
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Since December 2019, an outbreak of a novel coronavirus (SARS-CoV-2) infection causing COVID-19 disease has influenced the whole world. Angiotensin converting enzyme 2 (ACE2) receptors on type 2 pneumocytes in humans were determined as the entry for SARSCoV-2. Receptor binding and subsequently endocytosis of ACE2 diminish the cell membrane expression and also the function of ACE2. ACE2 is an enzyme involved in bradykinin metabolism. Lys-des-Arg9-BK occured with enzymatic cleaving of Lys-BK derived from low molecular weight kininogen is inactivated by ACE2 in tissues and it is a vasodilator agent having its own receptor named bradykinin B1. Non-metabolized Lys-des-Arg9-BK can be the reason for tissue vasodilation and increased vascular permeability in the patients with COVID-19. Increased bradykinin levels in patients with hereditary angioedema with C1-INH deficiency (C1-INH-HAE) do not cause increased SARS-CoV-2 infection or more severe disease. Although SARS-CoV-2 infection does not result in increased bradykinin levels, it can increase Lys-des-Arg9-BK levels.Copyright © 2020 Bilimsel Tip Yayinevi. All rights reserved.
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Background: Urticarial reactions following Covid-19 vaccine were rarely reported and have a short self-limited resolution. However only one case of chronic spontaneous urticaria (CSU) after mRNA vaccine was observed (1). Herein, we describe an original case series of patients who exhibited a CSU after Sars-Cov- 2 vaccination. Method(s): It was a retrospective case series of patients referred to the department of Clinical pharmacology of the University of Monastir for exploration of urticaria after Covid-19 vaccination., between January 2021 and January 2022. Result(s): Eight patients (8 F /5M) were included in this study. The median patient age was 36.5 years. None of them had a medical history of CSU. Urticaria was reported in 4 patients following mRNA vaccine (BNT162b2 and Moderna). Viral vector vaccine (Oxford/ AstraZeneca) was offended in 2 cases and inactivated virus vaccine (Sinovac, CoronaVac) was reported in 2 others cases. The mean time interval between vaccination and the onset of urticaria was 28.5 hours. The first shot of vaccine was the mostly offended dose (n = 6). Urticaria was associated with angioedema in 5 patients after Oxford/AstraZenecavaccine (n = 2) and following mRNA vaccine (n = 2). One case of urticaria was associated with angioedema and dyspnea after the CoronaVac administration. Blood tests showed polynuclear leucocytosis in 37% of patients. Positive anti-thyroperoxidase antibodies, and elevated polyclonal hypergammaglobulinemia were present in one patient 3 months after receiving BNT162b2 vaccine. Total serum IgE were high in 25% of patients following BNT162b2 and CoronaVac. All patients required antihistamines and 4 cases required intravenous betametasone. The median time to symptom resolution was 3 days but urticaria rapidly reccured throughout the entire body inspite the regular use of full dose of antihistamine. Intradermal test for the vaccine excipient as well as the offended Covid-19 vaccine was carried out in 5 patients, and were negative in all of them.Currently, all patients still has the pruritic rash daily. Conclusion(s): These cutaneous reactions seem to be particularly prolonged despite the use of symptomatic drugs, as compared with of drug induced-urticaria. Consequently, careful monitoring of urticaria over an extended period of time is needed.
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Background: Adverse reaction's reported after COVID 19 vaccination had a negative impact on public opinion. These adverse reactions may be or may be not be mediated by hypersensibility reactions. The proper assesment and the manegament of adverse reactions are crucial in order to offer a safer inmunitation and also to reduce the misinformation and the growing rejection to COVID 19 vaccination. Objective(s): To describe clinical characteristics and the allergological study done in different patients who had an adverse event right after COVID 19 vaccine administration Method: Descriptive study in patients who have experienced an adverse event after one single dose of the SARS CoV2's vaccine. Sex, age, atopy, drug allergies, anaphylaxis reaction (according to EEACI), syntoms, timing, vaccine and dose are described on this study. Skin test were done in every patient (Prick-Test and intradermo reaction) with ARN vaccine samples (Pfizer and Moderna), Adenovirus vaccine extract (Astrazeneca) and a battery of excipients (Polietilenglicol, Polisorbato80 and Trometamol). Result(s): The study included 44 patients with an average of 48,76 +/- 12,23 years, (93% women-29% atopic). 29% of the patients reported to be allergic to other drugs (AINES especially). The most frequent reaction according to EEACI anaphilaxy's classification was Grade 1 with a 61%. Grade 2: 18%, Grade 3: 21%. Urticaria and/or angioedema were the most frequent syntoms (60%) followed by disnea (20%) and being late syntoms (50%) the most usual ones. Pfizer was the most implicated vaccine (64%) with the first dose (84%). Skin tests with Polietilenglicol, Trometamol and Polisorbato80 at different concentrations were negative in all patients but two, one positive to Polisorbato80 0.004mg/ml with a previous sensitization to Prontosan (contains Polisorbato) and another one positive to Trometamol 0.1mg/ml. Conclusion(s): Allergists play a main role to offer the maximum befenits to their patients and to improve the vaccine's safety. Skin tests were the most efective tool to diagnose hypersensibility reactions. The 93,17% of the patients with a negative test result tolerated the second dose. The others did not get the second dose due to their own will. Avoiding the COVID 19 vaccine was recommended in those patients with a hypersensibility to the vaccine components diagnose.
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Background: Coronavirus disease 2019 (COVID-19) was suspected to trigger angioedema attacks, or cause more severe COVID-19 disease in patients with Hereditary angioedema (HAE). Our objective was to evaluate the severity of COVID-19 and its impact on disease control in patients with severe HAE in long-term prophylaxis(LTP) with subcutaneous C1-inhibitor( SC C1-INH). Method(s): We p erformed a retrospective s tudy of p atients w ith s evere course of HAE who maintained LTP with SC C1-INH during the pandemic. Date were collected under conditions of daily clinical practice. Patients were evaluated at least 2 times after switching to LTP with SC C1-INH. We analyzed COVID19 vaccine application and tolerance, COVID19 infection, disease control after COVID19 infection and the quality-of- life. Result(s): We evaluated 18 patients(12 female) who switched from LTP with IV C1-INH to LTP with SC C1 INH. Switching was followed by a significant decrease in the number of attacks, visits to the emergency department, and use of rescue dose of IV C1-INH or icatibant, as well as improved disease control (Angioedema Control Test). All patients were vaccinated against COVID19 (37 doses of mRNA vaccine and 4 doses of viral vector vaccine). Nor severe neither moderate adverse reactions were observed. 5 patients were infected with COVID19 (one 30 years-old female patient was infected twice) and had mild symptoms. None of the patients needed a hospital admission. Only one of the patients had worsening of the disease control after COVID19 infection and long -term post COVID repercussion (persistent headache and depressive mood). One of the infected patients was pregnant (7 gestational weeks) and had asymptomatic COVID19 infection with no impact on pregnancy. Conclusion(s): In our cohort of patients LTP with SC C1 INH and correct vaccination against COVID19 have shown that can maintain severe HAE patients with good clinical control even when infected with the virus.
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Background: The Spanish COVID-19 vaccination program commenced in December 2020. Some patients were excluded due to background pathologies, ever changing vaccination protocols and the risk of the secondary effects. Some were allergy patients with previous non-vaccine- related anaphylactic episodes, mastocytosis, and food or drug allergies. There were concerns that patients with secondary effects after the first or second doses would be reluctant to have further doses. The Allergy department at the Hospital Universitario Central de Asturias created a COVID-19 pre-and post-vaccination in-person program in which allergy excipient testing and vaccination were carried out when necessary. As far as we are aware, this is the first ever allergy-led testing and vaccination centre protocol of this kind. Method(s): 110 consecutive patients received at least one vaccine dose under the program in the Allergy Department from January 2021 to February 2022. Result(s): Females were more likely to be referred to the Allergy Department (90% of the total). The mean patient age was 53 years and ranged from 18 to 92 years. 27% were existing patients referred internally by the Allergy department, with the remainder from elsewhere. Angioedema (9%), mastocytosis (4%) and anaphylaxis (17%) were some of the patients' preconditions. A third of patients had two or more doses administered in the department. 61% of patients who received one dose of vaccine in the Allergy department went on to complete the full vaccination course as per national Spanish protocol. Only 16% could not continue with immunizations due to a severe allergic reaction to their first or second doses. None of the patients in the Allergy department program required emergency care after vaccination. Conclusion(s): The majority of patients at high risk of secondary effects were able to complete their vaccination course after the Allergy department input. The Allergy department can work as a successful vaccination centre when required.
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Background: Covid 19 is a global epidemic. One of the most important steps in the fight against this epidemic is vaccination. mRNA vaccines are used in vaccination in our country. Among the additives in the vaccine, the substance with the highest allergenic risk is polyethylene glucose (PEG). There are different molecular weights of PEG. Another additive that has a high risk of cross-reaction with PEG as an additive is POLISORBAT 80. Skin tests with drugs containing PEG and POLISORBAT 80 and, if available, tests with vaccines are instructive. Among the drugs containing PEG: Moxifloxacin tablet, ciprofloxacin tablet, Amoxicillin clavulanic acid tablet;Medicines containing polysorbate include: Omalizumab vaccine, Mepolizumab vaccine. The results of the skin test with PEG-containing methylprednisolone (DEPO-MEDROL) and POLYSORBAT-containing triamcinolone (KENACORT-A) in order to be evaluated in terms of vaccine in our 2 patients who had multiple drug sensitivities before were shared. Method(s): Case 1: 33 y, F *There are diagnoses of urticaria and angioedema. Urticaria 30 minutes after taking aspirin, levofloxacin, cefdinir tablet;5 minutes after taking ciprofloxacin tablets, he has anaphylaxis. *Applies before Biontec vaccine. *The patient had a history of anaphylaxis with PEG-containing ciprofloxacin. In the skin tests performed with DEPO-MEDROL and KENACORT-A, 1/100 intradermal test was positive. *The patient for whom Biontec vaccine was not recommended received Synovac vaccine without any problems. Case 2: 52 years, F * He has a diagnosis of urticaria. 5 minutes after general anesthesia and local anesthesia;The patient who had cardiac arrest 3 times was evaluated. The patient, who had Synovac for 2 times without any problems, wanted to have the 3rd dose of Biontec vaccine. *Tested with general -local anesthetic agents. *Ciprofloxacin skin tests are negative;Urticaria plaques developed after 30 minutes of 1/4 tb in oral provocation. In the skin tests performed with DEPO-MEDROL and KENACORT-A, 1/100 intradermal test was positive. *Biontec vaccine is not recommended. Result(s): A safer vaccination is ensured by testing with additives in Covid 19 vaccines. Conclusion(s): Drug additives should also be kept in mind in patients with multiple drug allergies.
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Background: Since the introduction of COVID-19 vaccines, many reports have focused on adverse reactions. However, there is no global agreement on how to manage those patients. We aim to assess the management of adverse reactions by an immunoallergology department and its outcomes. Method(s): Retrospective analysis of the patients sent to our centre from January to October 2021 for adverse reactions to a COVID-19 vaccine, and who were considered ineligible for a 2nd dose by general practitioners. We collected data on the reported reactions, allergological study and outcomes. Result(s): 123 patients with adverse reactions were included (77% women, n = 95), mean age 55 years-old (min 12;max 92). Pfizer/ BioNTech Vaccine was inoculated in 64 patients (52%);Moderna in 15 (12%);AstraZeneca in 44 (36%). 65 patients (53%) presented symptoms compatible with allergic reactions: 86% (n = 56) with mucocutaneous symptoms, mainly urticaria-like lesions and/or angioedema;17% (n = 11) with suspected anaphylaxis and 5% (n = 3) with Steven-Johnson Syndrome. 19 patients performed skin testing with: PEG2000 (n = 17);polysorbate 80 (n = 15);COVID-19 vaccines (n = 21). Four patients had at least one positive test. 58 patients (47%) presented with non-allergic reactions. They showed great variability of symptoms. Most mild: 47% reported non-specific symptoms (such as malaise, headache, myalgia, fever, or fatigue) and 26% reported local reactions on the inoculation site. Some severe: 6 with deep vein or pulmonary thrombosis, 4 with myocarditis, 2 with stroke or myocardial infarction, and 1 with VITT. Patients with positive skin tests or severe previous reactions (n = 36, 29%) were referred for an alternative vaccine. Those with suspected allergic reaction but negative skin tests were premedicated with antihistamines before the 2nd dose. Follow-up showed: of the 81 patients (66%) who received an additional dose, 25% (n = 20) reported an adverse reaction, which was mild, and no case of anaphylaxis was reported. 16 (13%) refused a 2nd dose, and for 26 (21%) the information could not be obtained. Conclusion(s): The intervention of an allergologist had a significant positive impact on vaccination rates, with 2/3 of patients being reclassified as eligible for a 2nd dose. Allergological study and intervention identified vaccine-allergic patients and guided the decision on vaccine change and premedication, which resulted in a considerably lower number of adverse reactions to the 2nd dose, or at least its severity.
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Background: COVID-19 virus vaccines are associated with adverse events. We aim to characterize and compare adverse reactions to different COVID-19 vaccines in a Portuguese centre. Method(s): Retrospective analysis of patients with adverse reactions to COVID-19 vaccines referred to our Immunoallergology Department between January and October 2021. The patients were divided according to the vaccine used: Pfizer/BioNTech (Pf), Moderna (M), or AstraZeneca (AZ). Result(s): 123 patients were included. 64 patients (52%) reacted to the Pf vaccine (77% women, mean age 49 years old);15 (12%) to the M vaccine (87% females, mean age 50 years old);and 44 (36%) to the AZ vaccine (75% women, mean age 64.8 years old). All groups showed a higher number of non-immediate reactions (>6h after inoculation): 59% for Pf, 60% for M, and 91% for AZ. Reactions to Pf and M were more frequently allergic-like (63% and 60%, respectively). Reactions to AZ were predominantly non-allergic (64%). The most frequently reported reactions for Pf and M were: sensation of throat tightness (Pf 31%, M 20%), urticaria (Pf 30%, M 27%), angioedema (Pf 17%, M 33%), constitutional non-specific symptoms (Pf 25%, M 27%), and local reactions on the inoculation site (Pf 20%, M 33%). There were 8 (13%) patients with suspected anaphylaxis with Pf, 3 (20%) with M, and none with AZ. The most frequently reported reactions for AZ were cardiovascular events (30%): myocardial, cerebral or pulmonary thromboembolic events (n = 6), phlebitis (n = 5), myocarditis (n = 1), and vaccine-induced immune thrombotic thrombocytopenia (n = 1). Other common reactions were constitutional non-specific symptoms (32%), local reactions on the inoculation site (18%), urticaria (23%), angioedema (14%), and non-urticaria rash (14%). Conclusion(s): Adverse reactions were more common in women. The mRNA vaccines were more frequently associated with allergic-like reactions, including anaphylaxis. In contrast, AZ vaccine was associated with nonallergic cardiovascular reactions. Up to 1/3 of patients in each group reported constitutional non-specific symptoms and local reactions on the inoculation site.
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Background: Hereditary (HAE-C1- INH) and acquired (AAE C1-INH) angioedema with C1 inhibitor (C1 INH) deficiency are rare but potentially life-threatening conditions associated with bradykinin overproduction and recurrent episodes of angioedema without wheals. Increased susceptibility to infections or infection-associated fatal outcomes has not been previously described in this condition. However, in 2020 novel theories suggesting bradykinin as a potential mediator involved in lung injury in COVID-19 disease have been proposed. Therefore, a more severe course of COVID-19 infection in C1 INH deficient should be considered. Method(s): In September 2021, we performed a retrospective analysis of COVID-19 disease courses in HAE C1-INH and AAE C1-INH patients from Czech referral centers for the treatment of hereditary angioedema with C1 INH deficiency. Collected data involved basic demography, comorbidities, previous immunosuppressive treatment, COVID-19 symptoms and treatment, HAE symptoms during infection. Result(s): We identified 17 patients (10 females, 7 males) with C1 INH deficiency with COVID-19 positivity from March 2020 until September 2021 with median age of 45 years (10-80 years). Our cohort consisted of 16 HAE C1-INH patients (94%, HAE-1 15/ 16 -94%, HAE-2 1/16 -6%) and 1 AAE C1-INH patient (6%). Only 8 (47%) of the patients were receiving HAE prophylaxis. Most common comorbidity was obesity (4/17, 24%) followed by autoimmune disease (3/17, 18%), hypertension (3/17, 18%), immunodeficiency (3/ 17, 18%), prior immunosuppressive treatment (3/ 17, 18%) and malignancy (2/17, 12%). COVID-19 infection was asymptomatic in 3 of them (18%). Symptomatic patients reported most commonly fever (10/14, 67%), anosmia and ageusia (8/14, 53%) and headache (3/14, 20%). Only 2 symptomatic patients (14%) had pneumonia treated with antibiotics. None of our patients were treated with monoclonal antibodies or referred to the hospital. All the patients recovered. Two patients reported long-lasting symptoms more than 3 months after infection. Five patients (29%) experienced HAE attacks and in two of them, increased attack frequency lasted several weeks after recovery. Conclusion(s): According to our findings, we do not assume C1 INH deficiency to be a risk factor for a severe course of COVID-19 disease. However, as other infections, COVID-19 might trigger angioedema attacks and may cause increased attack frequency after recovery.
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Background: The pandemic of Coronavirus disease 19 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2), has become a global challenge in the last two years. SARS-CoV- 2 enters the cells of the infected subjects through angiotensin converting enzyme 2 (ACE-2), leading to its depletion on cell surface. ACE-2 activity is involved in the catabolism of des-Arg( 9)-bradykinin and increases the expression of angiotensin converting enzyme (ACE) in animal models. ACE in turn inactivates bradykinin. The infection has therefore the potential to cause a deregulation of the contact system and its pro-inflammatory activity, which could also contribute to the pathogenesis of COVID-19. Since bradykinin-mediated angioedema is generally thought to be the result of a poorly regulated contact system, it has been speculated that these patients are prone to severe SARS-CoV- 2 infection and that COVID-19 can in turn elicit angioedema attacks. We examined these hypotheses in a large group of bradykinin-mediated angioedema patients. Method(s): W e c onducted a m ulticenter r etrospective s tudy t argeting all the patients with hereditary angioedema (HAE) or acquired angioedema due to C1 inhibitor deficiency followed up by the centers of the Italian Network for Hereditary and Acquired Angioedema (ITACA). All accessible patients underwent a telephone interview between January 1st and March 31st 2021;we collected data about demographic and angioedema features, the occurrence of SARS-CoV- 2 positivity and COVID-19 outcomes from the beginning of the pandemic until March 31st 2021. A digital diary of attacks developed by ITACA helped us to collect attacks data. 15 centers participated in the survey. Result(s): 677 patients were included;52/677 reported SARS-CoV- 2 positivity (48 with hereditary and 4 with acquired C1 inhibitor deficiency). The incidence was 7.68% (confidence interval 5,79-9,95%), similar to the general population (6.04%). 4/52 patients (7.7%) reported severe COVID-19;the median disease duration was 15 days. One patient suffered a pulmonary thromboembolism;no deaths were reported. 27/52 patients (51,9%) had angioedema attacks during the infection, with a median of 1 attack per patient;severity of COVID-19 predicted more frequent and more severe angioedema attacks in a multivariate analysis (p < 0.001). Conclusion(s): COVID-19 does not seem more severe in bradykinin-mediated angioedema than in the general population. SARS-CoV- 2 infection can elicit angioedema attacks.
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Case report: Chronic urticaria is defined as the presence of urticaria for a period exceeding six weeks. Infections are known as possible triggers for urticaria manifestations, and, as such, SARS-CoV- 2 infection can be recognized as causative. An 8-year- old boy, with a previous history of idiopathic chronic urticaria, came to the Emergency Department for the appearance of generalized urticaria and lips angioedema associated with vomit and shortening of breath normal vital signs by age. Thus, due to the significant reaction, intravenous corticosteroids and antihistamines were promptly administered, with a rapid improvement of symptoms. Since the systemic reaction, the tryptase dosage was performed with the identification of an elevation at the time of the arrival and a complete normalization after the twelfth hour from the beginning of the reaction. Figure 1 shows the kinetic of the tryptase over time. SARS-CoV2 swab was performed before hospitalization and a positive test was identified. To investigate the etiopathogenesis of reaction, the patient was submitted to the extensive clinical, laboratory, and instrumental investigations that revealed only a positive in vitro basophil activation test (BAT) as evidence of functional serum histamine-releasing autoantibodies that are directed against IgE or high-affinity IgE receptors. The viral infection did not need any medication, and the urticaria was resolute in a couple of days. Daily treatment with oral antihistamines was then prescribed, and no further urticarious episodes occurred. A negative SARS-CoV- 2 swab was detected within 12 days of beginning symptoms. Approximately 40% of patients with idiopathic chronic urticaria have circulating antibodies versus IgE epitopes or the IgE receptor, but as it occurs in many autoimmune conditions, the presence of autoantibodies does not necessarily result in a disease phenotype. It is demonstrated that infections can elicit an autoimmune condition, and as our report shows, SARS-CoV2 could explain the reaction observed in our patient. The autoimmune precondition could have been the primer of the systemic reaction, pre-activating the mastocyte degranulation, as the tryptase elevation demonstrated. On the other hand, the SARS-CoV2 virus reducing the ACE2 expression, due to virus endocytosis, could create an imbalance in the RAS system, increasing the bradykinin levels. Bystander activation of pre-activated mastocytes caused by an inflammatory environment could explain the systemic reaction described above.
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Background: Few studies demonstrating the involvement of the complement system in COVID-19 pathogenesis have been published, suggesting its role in pulmonary symptoms and endothelial permeability, which is known to be crucial in the origin of Hereditary Angioedema (HAE).1 Post-morten tissue of COVID-19 patients reported depots of complement, activated by the lectin pathway, in type I and II alveolar epithelial cells.2 After this evidence and the link that infectious processes have as triggers of angioedema episodes, in patients with HAE, we propose to study the implication of both the infection and de doses of the COVID vaccine, in the appearance of episodes of angioedema in our population with a diagnos is of HAE. Method(s): Telemedicine interventions (telephone consultations) were carried out by trained Allergists from Hospital Universitario de Canarias, reaching out patients with a confirmed diagnosis of HEA by Skin Allergy Unit (SAU) within the local health district. Result(s): A total of 17 (11 females) were finally screened, and 2 (11.76%) passed a confirmed COVID-19 disease in January 2022 associating no acute attacks or need for rescue medication. Both subjects were fully vaccinated (3 doses-schedule) prior to the infection and suffered from a COVID-19 mild disease only. Only an individual dose of COVID-19 vaccination (Vaxzevria, Astra-Zeneca) -out of 40 overall given doses in 15 subjects and 3 different brands-was associated to an acute episode of abdominal swelling demanding immediate self-administered rescue therapy (icatibant) thus, preventing the patient from rushing to the Emergency Department. The subsequent 2 doses of the COVID-19 vaccination were safely scheduled in the same patient. Conclusion(s): In accordance with former reports4, only mild COVID-19 symptoms were associated in subjects with a confirmed diagnosis of HAE.
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Case report Background: Hereditary angioedema (HAE) is a rare disease that usually manifests during childhood and is characterized by recurrent swelling episodes in various body tissues. Effective treatment options, including replacement therapy with C1 inhibitor (C1-INH) concentrate, are available for acute attacks and, for patients with high disease burden, for prophylaxis. More convenient than intravenous (IV) injections, and better suitable for patients with difficult venous access, is subcutaneous (SC) administration. However, treatment with SC prophylactic C1-INH is not yet approved in Europe for children < 12 years of age. Case Description: The boy presented to our clinic in 2014 at the age of 3, with a diagnosis of HAE due to C1-INH deficiency. During the last 3 months, he had been given IV C1-INH concentrate on-demand for HAE attacks. During the following year, the boy experienced monthly attacks at different body sites and had to be hospitalized several times for edema of the extremities and face, and abdominal colicky pain. At 5 to 6 years of age, attack frequency increased to once weekly and a first swelling of the trachea with dyspnea occurred. Over time, this led to repeated occurrence of panic attacks and psychological problems, which were exacerbated by social distancing during the coronavirus disease-19 pandemic. To mitigate disease burden, his therapy was switched to weekly prophylaxis with IV C1-INH, and the bradykinin receptor inhibitor icatibant was kept on hand as emergency medicine. Less than half a year later, attack frequency increased again and the regimen was changed to twice weekly. This led to drastic deterioration of venous access, so that a switch to SC prophylaxis became inevitable. The patient, now 10 years old, and his mother were trained in SC injection techniques and since June 2021, they administer twice weekly SC C1-INH (2000 International Units) at home, with no breakthrough attacks and significant improvement of quality of life. Conclusion(s): Because of high disease burden and impairment of quality of life due to high edema frequency, routine prophylaxis was chosen. In patients receiving frequent IV prophylaxis, occurrence of breakthrough attacks and deterioration of venous access warrants a switch to SC treatment. In the present case, this switch was unavoidable, although this treatment option is not approved for children. It allows the boy to self-administer his C1-INH and has improved his quality of life significantly.
ABSTRACT
Background: During Covid-19 pandemic, the massive use of Personal Protective Equipment could provoke severe adverse reactions in latex allergy patients and could negatively affect their quality of life. Method(s): The observational single-centre present study was carried out on 67 adult subjects with a latex allergy diagnosis followed by Allergy Unit of Fondazione Policlinico Universitario A. Gemelli IRCCS of Rome. All data were collected from January 2020 to December 2020. All patients underwent to a survey focused on their clinical and psychological conditions during Covid-19 pandemic. For the evaluation of the degree of well-being, we used SF-36 questionnaire (Short-Form 36-Item Health Survey). The aim of our study is: (a) to evaluate the incidence of allergic reactions in patients with latex allergy during the SARS-CoV- 2 pandemic;(b) to evaluate the protective role of continuous latex ITS during this period;(c) to evaluate quality of life of natural rubber latex allergy (NRLA) patients during the pandemic. Result(s): 67 patients (9 males and 58 females, mean age of 45.9 +/- 11.4 years) suffered from latex allergy were included in the present study. We recorded among our patients 13 cases (34.2%) of urticarial/ angioedema (U/A), 9 cases (23.6%) of respiratory symptoms (RS;dyspnoea, shortness of breath, wheezing) and 7 cases (18.4%) of anaphylaxis. In patients undergone continuous ITS, we observed less cases of U/A (p < 0.001), RS (p < 0.001), anaphylaxis (p = 0.003), hospitalizations (p = 0.014) and a lower therapy administration. We compared the results of SF-36 questionnaire in patients undergone continuous and not continuous latex ITS with a significance differences score between these two groups. Conclusion(s): The pandemic challenged the capacity of healthcare systems to provide adequate management of NRLA patients and in this context, we performed a survey to monitor their health status. During the pandemic, the risk of latex exposure was significant increased considering the possibility of direct skin contact, airborne exposure, contamination of food and medical evaluations. Our study is the first that investigated the clinical and quality of life effects of Covid-19 pandemia in NRLA patients demonstrating the importance of SLIT adherence also in this complex period. (Table Presented).
ABSTRACT
Background: Drug hypersensitivity reactions (DHRs) of the immediate type are diagnosed in approximately 1-2% per 100 thousand people. During the COVID-19 pandemic, the use of antibiotics increased, and cases of immediate reactions to these drugs became more frequent. However, due to the lack of medical centers which have the necessary conditions for carrying out provocation tests, the use of in vitro diagnostic methods for hypersensitivity reactions to antibiotics is becoming even more relevant during the pandemic. Flow CAST Basophil Activation Test (BAT) Flow Cytometry can be used for the in vitro detection of immediate type allergic reactions and hypersensitivities to suspected allergens in patients at risk for DHRs. The purpose is to study the possibility of diagnosing hypersensitivity reactions to antibiotics using BAT to antibiotics. Method(s): The Patient Questionnaire Card and the Patient Review Card were used to survey 32 (8.7%) individuals (f -56.3%, m -43.7%) who met the inclusion criteria (the presence of hypersensitivity reactions to beta-lactam antibiotics during the last 3 years). We used Flow CAST to identify the DHRs to beta-lactam antibiotics (Ceftriaxone (conc. 4 mg/ml);Cefuroxime (conc. 2.5 mg/ml);Amoxicillinum (conc. 2.5 mg/ml) from CAST Allergens for CASTFlow CAST) BUHLMANN LABORATORIES AG, Switzerland) in whole blood. Flow cytometric acquisition was performed on a flow cytometer BD FacsCalibur (USA), and 300 basophilic cells were analyzed. Result(s): The most common clinical manifestations included acute urticaria + angioedema (40.6%), generalized urticaria (28.1%), anaphylactic shock (21.9%), bronchospasm (9.4%). The percentage of patients diagnosed with an immediate reaction based on the time of its occurrence was 62.5%, whereas the percentage of patients diagnosed with an immediate reaction based on the clinical manifestations was 81.25%, which was confirmed by positive BAT results (p > 0.05). 68.75% of people with clinical manifestations of reactions to one antibiotic (ceftriaxone or amoxicillin) showed increased values on the BAT test to other beta antibiotics, which may indicate the presence of cross-reactivity between these groups of drugs. Conclusion(s): Diagnostics of immediate hypersensitivity reactions to antibiotics based on in vitro BAT is a highly accurate method. However, in cases of possible cross-reactivity between antibiotics and in cases of delayed reactions, in-depth studies are required.