Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 37
Filter
1.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927844

ABSTRACT

RATIONALE: Over 400,000 individuals are estimated to have been exposed to the fallout of the World Trade Center (WTC) disaster. The incidence of acquired allergy and lung injury among rescue and cleanup workers exposed to the WTC fallout has been established. Briefly, rescue and cleanup workers exposed to the WTC fallout had a high incidence of allergic hypersensitivity and permanent small airways dysfunction characterized by distal airways narrowing and airway hyperresponsiveness. The current study sought to quantify the utilization of allergy/immunology services among rescue and cleanup workers exposed to the WTC fallout. METHODS: Subjects (N=65) were referred from the WTC Health Program to a multispecialty allergy/immunology and pulmonology clinic for provision of allergy-immunology specialty services. Electronic health records of all subjects were retrospectively reviewed from the date of first referral to March 2020-when routine care was interrupted due to the coronavirus disease 2019 pandemic-to quantify utilization of allergy/immunology and pulmonology services;10 subjects were excluded from analysis due to incomplete health records. RESULTS: On average, time to referral for allergy-immunology services by the WTC Health Program was 15.2 years (SD=1.7). The majority of the subjects were male (89.1%), police officers (67.3%) who never smoked (65.5%) and had no history of allergic or respiratory disease prior to being exposed to the WTC fallout. Most were found to have environmental allergies (83.6%);the most common comorbidities were allergic rhinitis (89.1%), asthma (67.3%), and chronic sinusitis (63.6%). All subjects underwent environmental allergy testing. Most subjects-35 of 55 (63.6%)-were prescribed an epinephrine autoinjector for environmental allergies. Regarding allergic immunotherapy (IT), 33 of 55 (60.0%) received IT;additionally, 7 subjects (12.7%) were determined to be IT candidates but did not receive IT. The most common monoclonal antibody therapy used in this cohort was omalizumab (18.2%). Only 11 (20.0%) and 3 (5.5%) underwent serum IgE and IgG testing, respectively. CONCLUSION: Rescue and cleanup workers referred to a multispecialty allergy/immunology and pulmonology practice from the WTC Health Program not only had a high incidence of acquired allergies to environmental allergens, but the majority were prescribed and epinephrine autoinjector and either received or were candidates to receive allergy immunotherapy. Given that hundreds of thousands of individuals were exposed to the WTC fallout and exposure is an independent risk factor for developing allergic disease, this research may have identified ways we may be falling short in providing allergy/immunology services to exposed individuals.

2.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927832

ABSTRACT

Introduction: Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystem disorder characterized by asthma, prominent peripheral blood eosinophilia, and small-vessel vasculitis. We report a case of EGPA in an adolescent with uncontrolled asthma who was receiving montelukast. Case: A 12-year-old boy who is known to have asthma and allergic rhinitis which were previously controlled on ICS, intranasal steroids, and prolonged use of montelukast for 4 years. He presented with cough and nasal blockage for 2 months. He also reported an increase in the frequency of asthma attacks and received multiple courses of systemic steroids. Subsequently, his asthma controller medications were upgraded to ICS/LABA few weeks prior to admission. His symptoms were also associated with weight loss, diarrhoea and haematochezia. He was vitally stable and maintained oxygen saturation on room air. Physical examination revealed nasal polyps, purple skin flat lesions on palms and feet (Figure1), and bilateral crackles on chest auscultation. His blood investigations were significant for leukocytosis with marked eosinophilia (11x103/uL, (51%)), high inflammatory markers and total-IgE (1975 kU/L). Initial chest XR showed bilateral interstitial thickening and small pleural effusions (Figure2). Chest CT showed centrilobular nodules and peripheral ground-glass opacities, tree-in-bud appearance with no peripheral sparing in addition to moderate pericardial effusion and bilateral mild pleural effusion (Figure3). Sinus CT showed extensive sino-nasal polyposis with pansinusitis (Figure4). Initial echocardiography showed moderate pericardial effusion with normal biventricular function. Patient was started on IV furosemide. During his hospitalization, patient developed chest pain. His serial troponin was rising and LV contractility was depressed. ECG showed ST-segment depression. Therefore, EGPA with cardiac involvement was suspected. Cardiac MR showed features of a peri-myocarditis. IVIG was commenced for suspicion of coronary artery involvement, which was later disputed by cardiac cath. He was also started on IV pulse steroids at a dose of 30 mg/kg for 3 days which resulted in dramatic decrease in troponin level, eosinophil count and CRP. Skin biopsy, which was later performed after administration of steroids, showed perivascular non-necrotizing granulomas. His ANA, ANCA and COVID-19 PCR came negative. Serum chemistries and urine microscopy were unremarkable. Patient was later started on Rituximab with significant clinical, serological and radiological (Figure5,6) improvement after 10-months of follow-up. Discussion: EGPA is rare but should be considered in children with uncontrolled asthma, eosinophilia and rhino-sinusitis. This case shows the importance of being aware that montelukast could cause EGPA, in spite of the uncertainty about its mechanism. (Figure Presented).

3.
European Clinical Respiratory Journal ; 9(SUPPL):15-16, 2022.
Article in English | EMBASE | ID: covidwho-1915470

ABSTRACT

Background: Incidence and clinical outcomes of COVID-19 appear to differ between allergic and non- allergic asthma, but evidence for other asthma phenotypes, such as obesity-related asthma, is scarce. We sought to determine whether pre-COVID-19 obesityrelated asthma phenotypes are associated with risk of COVID-19 incidence in a Swedish populationrepresentative adult cohort. Method: Clinical examination data from 2,006 subjects aged 16-75 years collected during 2009-2012 were linked to register data of COVID-19 diagnosis, based on real-time polymerase chain reaction or ICD-10 codes set by clinicians. Obese asthma was defined as current asthma and body mass index ≥30 kg/m2. Allergic obese asthma was further based on sensitization to any aeroallergen measured by specific immunoglobulin E. Results: In total, 344 (17.1%) of the subjects had COVID-19. After adjustment for gender, age, allergy history, farm childhood, urbanization, dust exposure, smoking, education, and occupation, there was no association between having allergic obese asthma (adjusted risk ratio (aRR) 0.92, 95% CI 0.63-1.34), non-allergic obese asthma (aRR 0.94, 95% CI 0.68-1.29), or any obese asthma (aRR 0.93, 95% CI 0.72-1.19), and getting COVID-19. Stratifying by gender and age produced similar results. Conclusion: We found no association between pre- COVID-19 obesity-related asthma phenotypes and being diagnosed with COVID-19. Further analyses are needed regarding long-term outcomes and disease severity of COVID-19 in relation to obesity-related asthma phenotypes.

4.
Clinical and Translational Imaging ; 10(SUPPL 1):S42, 2022.
Article in English | EMBASE | ID: covidwho-1894689

ABSTRACT

Background-Aim: A 46 years old housewife patient with a bachelor's degree in Law contracted Covid-19 at the end of March 2021. She had a flu-like form with associated asthenia and drowsiness and no lack of sense of smell. It has been resolved in 25 days. Later, she developed progressive immediate memory loss, word-finding issues, motor and thinking slowing down. Methods: CT brain scan appeared as within the norm as well as liver enzymes, TSH, Vitamin B12, Folate and Rapid Plasma Reagine. Anti- ENA DNA ANA HIV TPO TG were negative too. In October, the patient had a further neuropsychological assessment that showed an overall picture characterized by partial orientation to space, working memory disorders, writing and comprehension (of complex tasks) issues, and immediate memory loss (possible sign both of attention span and concentration reduction). The auto-antibodies were assessed in November and they resulted negative. Moreover, the brain MRI scan and EEG (dated at the end of November) were both within the range. CSF neurodegenerative biomarkers and anti-neuronal antibodies appeared in the norm too. Results: Ultimately, in December 2021 she underwent an 18F-FDG PET brain scan and the SPM analysis showed an extensive hypometabolism in the bilateral frontal cortex and bilateral straight gyrus. Spared the cingulate cortex. Conclusions: The patient contracted Covid in March 2021. She developed neurological deterioration identified by FDG-PET. Negative autoantibodies and CSF biomarkers. PET scan was the only exam to define the brain damage in the patient above. Symmetrical bilateral frontal cortex and bilateral straight gyrus hypo-metabolism have been observed, the last one at the direct level of the olfactory bulb. In this area, in patients who died from Covid-19 it has been histologically demonstrated (data to be published) the presence of cellular inclusions named Corpore Amylacea. They would be a small hyaline mass that functions as a waste container that accumulates in the human brain in aging and in neurodegenerative and infectious processes. It is hypothesized to be that it can be involved in a sort of brain cleaning process1. Recently it has been described that they contain some neoepitopes that are recognized by natural IgMs, revealing a possible link between them and the natural immune system2. However, to now in our patient, the only diagnostic tool to evaluate the brain condition has been the 18F-FDG PET.

5.
Respirol Case Rep ; 10(7): e0979, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1881452

ABSTRACT

The coronavirus disease-2019 (COVID-19) has spread worldwide. Previous studies indicated a low prevalence of COVID-19 induced acute exacerbations of asthma. We present a 39-year-old-male obese asthmatic case who experienced acute asthma exacerbation during COVID-19. On day 8 of infection, his cough and dyspnea worsened with hypoxia and wheezing. Laboratory test results revealed elevated interleukin-6 (IL-6) and total immunoglobulin E (IgE) levels without eosinophilia. Two months since the onset, hypoxia disappeared with decreased IL-6 and IgE levels. Our case suggested that obesity and high serum IL-6 and IgE levels may have contributed to atypical asthma exacerbation in COVID-19.

6.
Topics in Antiviral Medicine ; 30(1 SUPPL):118, 2022.
Article in English | EMBASE | ID: covidwho-1880283

ABSTRACT

Background: Coronavirus disease 2019 (COVID19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has varied clinical presentations from mild subclinical to severe disease with high mortality. Our aim was to determine whether examining immune-related gene expression early in infection could predict progression to severe disease. Methods: In subjects of the All Ireland Infectious Diseases Cohort study, we analysed expression of 579 genes with the NanoString nCounter Immunology panel in peripheral blood mononuclear cells in those with confirmed SARS-CoV-2 infection collected within 5 days of symptom onset and matched SARS-CoV-2 negative controls with respiratory infection. Subsequent maximum COVID19 disease severity was classified as mild or severe. Read counts were normalized using panel housekeeping genes. Expression changes in severity groups were estimated against control baseline. Results: Between April and July of 2020, we recruited 120 subjects, 62 with COVID19 and 58 controls, with average age 59 y.o. (IQR 34-88), 66% males and 69% Caucasian ethnicity. Maximal disease severity was used to separate COVID19 cases into mild (n=31) and severe (n=31). We identified 20 significantly deregulated genes between those with COVID19 and controls (;log2 fold;>0.5, p<0.05, Benjamin-Yekutieli p-adjustment). Function of 12 of these genes related to cytokine signaling, 9 upregulated genes to type I interferon signaling (MX1, IRF7, IFITM1, IFI35, STAT2, IRF4, PML, BST2, STAT1), while 7 downregulated genes mapped to innate immune function (IRF7, ICAM2, SERPING1, IFI16, BST2, FCER1A, PTK2). Expression in the severe group showed downregulation of FCER1A (innate immunity regulation), IL1B and TNF (inflammatory cytokines), and PTGS2 (inflammatory mediator) and greater upregulation of TNFSF4 (cytokine signaling) and PTK2 (innate immunity). Mild cases presented higher upregulation of IFIT2 (type I interferon signaling). Conclusion: Observed early downregulation of regulators and mediators of inflammation in those who developed severe COVID19, suggested dysregulation of inflammation. Specifically, IFIT2 upregulation in mild cases and FCER1A downregulation in severe cases, points to early differences in host responses centered on deregulation of the interferon and inflammation responses. Whether these patterns reflect delayed interferon involvement in pathways to control the infection and contribute to pathological inflammation and cytokine storms observed in severe COVID19 requires further research.

7.
Rassegna di Patologia dell'Apparato Respiratorio ; 37(1):57-60, 2022.
Article in Italian | EMBASE | ID: covidwho-1870302

ABSTRACT

The basophil activation test (BAT) is a flow cytometric assay that evaluates the percentage of activation or degranulation of peripheral blood basophils, after “in vitro” exposure to specific allergens. In sensitized patients, the stimulation of peripheral blood basophils with a specific allergen induces or up-regulates the expression of molecules, such as CD63 and CD203c, which represent, markers of degranulation and activation of basophils, respectively. The validity of the BAT requires a negative control (sterile saline) and a positive control (anti-IgE molecules). Several studies have demonstrated the role of the BAT in supporting the diagnosis of drug, food and hymenoptera venom allergy. The BAT has shown a low sensitivity but good specificity in diagnosing allergy to drugs such as NSAIDs, beta-lactam antibiotics, quinolones and muscle relaxants. In food allergy, the sensitivity and specificity of the BAT depends on the food;in the case of peanut allergy the sensitivity reaches 96% while the specificity the 100%. In addition, the BAT is an useful tool to monitor the natural resolution of allergies and the clinical effects induced by either immunotherapy or anti-IgE treatment. Finally, the BAT has been utilized to study the pathogenetic mechanisms underlying several IgE-mediated diseases. For example, in patients affected by severe bronchial asthma, the BAT has demonstrated the ability of Staphylococcus aureus enterotoxins to induce the activation of basophils supporting the role of these enterotoxins as “triggers” of the inflammatory cascade in bronchial asthma. In patients with cystic fibrosis the BAT can be used to dis-criminate allergic bronchopulmonary aspergillosis from Aspergillus colonization. More recently, the BAT has been demonstrated as a potential diagnostic tool to evaluate allergy to the polyethylene glycol (PEG) present in the anti-SARS-CoV-2 BNT162b2 mRNA vaccine.

8.
Drug Topics ; 165(11):9-12, 2021.
Article in English | EMBASE | ID: covidwho-1866103
9.
Hematology, Transfusion and Cell Therapy ; 43:S212-S213, 2021.
Article in English | EMBASE | ID: covidwho-1859609

ABSTRACT

Descrição do caso: Paciente masculino, 76 anos, sem comorbidades, transferido de unidade básica de saúde por choque hipovolêmico devido a lesão vascular após punção arterial. O mesmo tinha sido levado por tosse, febre e alteração do estado de consciência. Foi iniciado antibiótico, reposição volêmica, afastado Covid e angioTc de membros inferiores com extravasamento do contraste em artéria femoral direita e infiltração difusa na medula óssea. Exame físico: Taquicardia, SO2 95% com O2 2 litros/min, Glasgow 11 sem déficit focal, roncos pulmonares bilaterais e presença de hematoma em região inguinal à direita com extensão para área lombar, glútea e escrotal sem palpação de frêmito. Exames: Hb 6.2 g/dL, plaquetas 67.000/uL, leucócitos totais 17.810/uL, creatinina 4.42 mg/dL, cálcio 10.6 mg/dL, albumina 2.6 g/dL, TP 63%, TTPa 50.9s, D-dímeros 3.34 ug/mL, LDH 443 U/L, fibrinogênio 240 mg/dL. RNM do neuroeixo com infiltração difusa na medula óssea da coluna vertebral e fraturas em T3, L1 e L3. Eletroforese de proteínas com imunofixação sérica e urinária sem banda monoclonal, cadeias leves Lambda 2.66 mg/L, cadeias leves kappa 2.62 mg/L, relação Kappa/Lambda 0.98, IgG 269 mg/dL, IgM 13 mg/dL, IgA mg/dL e B2-microglobulina 6.441 ng/mL. Demais exames sem alterações significativas: perfil hepático, reumatológico, metabólico, punção lombar, tomografias crânio, tórax e abdominal. Mielograma com infiltração por plasmócitos de aspecto neoplásico (78%), imunofenotipagem 57.51% de células plasmáticas totais (57.5% compatíveis com plasmócitos neoplásicos). BMO hipercelular (80%), infiltração difusa e multifocal por plasmócitos. IHQ CD138+, CD38+, ciclina+, CD3+, CD20-, CD56-, Kappa-, Lambda-, vermelho congo negativa, sugerindo Mieloma múltiplo (MM) não secretor, não produtor - ISS III. Ante ECOG de 4 e idade foi optado por paliação. Na alta hospitalar o paciente estava com resolução da coagulopatia, melhora da anemia e normalização da função renal. Discussão: O MM é uma neoplasia de células plasmocitárias caracterizada pela produção de imunoglobulina monoclonal, representa 10 a 15% das malignidades hematológicas com predomínio no sexo masculino. Incidência aumenta com idade, sendo 90% em pacientes > 50 anos. Critérios diagnósticos são resumidos no acrônimo SLiM CRAB. A distribuição da proteína monoclonal sérica ou urinária identifica-se em 97%: 50% IgG, 20% IgA, 20% cadeias leves e < 10% entre IgD, IgE, IgM ou pico biclonal. O restante 3% corresponde à variante não secretora, e, se os plasmócitos clonais são incapazes de produzir imunoglobulina, configura-se além, como não produtor. O MM não secretor (MMNS) verdadeiro baseia-se na presença de 30% de células plasmocitárias monoclonais OU plasmocitoma confirmado por biópsia, tem sido descrita associação com t(11,14)(q13;q32). Dentro das manifestações clínicas estão a imunoparesia secundária, ausência de insuficiência renal e hipercalcemia. Na apresentação do paciente a avaliação foi prejudicada decorrente do choque hipovolêmico e insuficiência renal aguda pré-renal. O prognóstico do MMNS é melhor na vigência de tratamento que inclua imunomodulador e inibidor de proteassoma quando comparado ao do MM com proteína M detectável, embora o desfecho dos pacientes que foram a TCTH autólogo não teve diferença significativa. Conclusão: MMNS é um subtipo raro com pouca literatura disponível, sendo um desafio realizar o diagnóstico, avaliação da resposta e recaída ante a falta de quantificação do pico monoclonal.

10.
Asthma Allergy Immunology ; 19(3):174-182, 2021.
Article in English | EMBASE | ID: covidwho-1856522

ABSTRACT

Objective: The clinical features of COVID-19 range from asymptomatic disease to severe pneumonia or even death. Therefore, many researchers have investigated the factors that could affect the severity of COVID-19. We aimed to assess the impact of aero-allergen sensitization and allergic diseases on the severity of COVID-19. Materials and Methods: We included 60 adult patients with symptomatic COVID-19 and allocated them into two groups equal in number as having severe and non-severe COVID-19. We evaluated the demographic features and allergic diseases in addition to clinical, laboratory and radiological findings of COVID-19. Skin prick tests (SPTs) with common aero-allergens, serum total IgE levels and blood eosinophil counts were evaluated 3 months after the patient's recovery from COVID-19. Results: The mean age of the patients was 52 ± 11 years and 73.3% of the patients were male. There was no significant difference between the two groups in terms of age, gender, smoking habits, obesity and comorbidities. Although the frequency of sensitization to aeroallergens and the allergic diseases were similar, the history of allergic diseases in the family was higher in the severe group (p<0.001). The polysensitization in SPTs was associated with the presence of a cytokine storm during the infection (p=0.02). Total IgE levels and blood eosinophil counts were not significantly different between the two groups. Conclusion: The presence of atopy or allergic diseases does not seem to be related to the severity of COVID-19. However, polysensitization and a family history of allergic diseases are more prominent in those having a cytokine storm and severe COVID-19, respectively.

11.
Oman Med J ; 37(1): e330, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1841613

ABSTRACT

OBJECTIVES: Anaphylaxis is an acute and potentially fatal allergic reaction. No studies have yet been conducted to evaluate the spectrum of anaphylactic reactions among Omani patients. As such, this study aimed to describe the clinical features, causes, investigation, and management of anaphylaxis among patients presenting to a tertiary care center in Oman. METHODS: This retrospective study took place between August 2005 and June 2020 at the allergy and immunology clinic of Sultan Qaboos University Hospital, Muscat, Oman. All patients diagnosed with anaphylaxis during the study period were included. Data were collected from electronic medical records. RESULTS: One hundred patients were diagnosed with anaphylaxis during the study period. Of these, 52.0% were male. The mean age was 15.9±16.2 years, with 70.0% aged < 18 years old. The eosinophil count ranged from 0.0-16.9 × 109/L, with a mean of 0.8±2.2 × 109/L and a median of 0.3 (0.1-0.6) × 109/L. Total immunoglobulin (Ig) E levels ranged from 25-8706 kIU/L, with a mean of 935.1±1369.5 kIU/L and a median of 500.4 (186.0-972.5) kIU/L. The majority of patients had a family history of allergies (72.0%), and other had concomitant allergic conditions (66.0%). All were prescribed epinephrine (100%). The most common cause of anaphylaxis was food (65.0%). The second most frequent trigger was insect venom (32.0%). Most patients had one category cause (81.0%); two or more causes were present in 12.0% of patients. Clinical symptoms manifested most frequently as cutaneous (92.0%) and respiratory (85.0%). The majority of patients (87.0%) demonstrated the involvement of more than one bodily system. Mean total IgE levels were significantly higher in patients with concomitant presence of other allergic conditions (1193.8 kIU/L) than patients without another concomitant allergic disease (503.6 kIU/L; p =0.030). In addition, concomitant allergic disease is significantly higher in patients < 18 years of age (75.4%) compared to patients > 18 years of age (45.2%; p =0.010). CONCLUSIONS: Due to its life-threatening nature, knowledge of the epidemiology and clinical features of anaphylaxis in different populations is necessary to deliver rapid treatment. This study found that the clinical features of anaphylactic patients in Oman were similar to those reported elsewhere. Further research is needed to determine the true incidence of anaphylaxis in Oman to minimize associated morbidity and mortality.

12.
Applied Sciences ; 12(9):4584, 2022.
Article in English | ProQuest Central | ID: covidwho-1837664

ABSTRACT

Aptamers represent the next frontier as biorecognition elements in biosensors thanks to a smaller size and lower molecular weight with respect to antibodies, more structural flexibility with the possibility to be regenerated, reduced batch-to-batch variation, and a potentially lower cost. Their high specificity and small size are particularly interesting for their application in optical biosensors since the perturbation of the evanescent field are low. Apart from the conventional plasmonic optical sensors, platforms based on silica and plastic optical fibers represent an interesting class of devices for point-of-care testing (POCT) in different applications. The first example of the coupling between aptamers and silica optical fibers was reported by Pollet in 2009 for the detection of IgE molecules. Six years later, the first example was published using a plastic optical fiber (POF) for the detection of Vascular Endothelial Growth Factor (VEGF). The excellent flexibility, great numerical aperture, and the large diameter make POFs extremely promising to be coupled to aptamers for the development of a sensitive platform easily integrable in portable, small-size, and simple devices. Starting from silica fiber-based surface plasmon resonance devices, here, a focus on significant biological applications based on aptamers, combined with plasmonic-POF probes, is reported.

13.
Children (Basel) ; 9(4)2022 Mar 28.
Article in English | MEDLINE | ID: covidwho-1809735

ABSTRACT

Fruit is a kind of plant food which is rich in nutrients and immune-regulating ingredients. A meta-analysis has demonstrated that fruits have a protective effects against asthma. On the other hand, clinical syndromes of allergic reactions to fruits manifest as an oral allergy syndrome. We aimed to investigate the patterns and associated factors of fruit allergen-specific IgE (sIgE) sensitization among patients with suspected clinical symptoms. Data were extracted from the Chang Gung Research Database. Fruit sensitization in Taiwan was evaluated using the presence of IgE antibodies against specific fruits. The overall prevalence of positive sIgE responses to fruit allergens in Taiwan, in order of decreasing importance, was pineapple, kiwi, banana, and papaya. Children aged 0-18 had a higher positive rate of allergic responses to pineapple, kiwi, banana, and papaya than adults over the age of 18. Positive specific IgE for kiwi, banana, or papaya was more frequent in younger than in older children and children with a higher total IgE of both logarithmic (log) and arithmetic values. The analysis of log IgE for pineapple positive vs. negative children determined an optimal cutoff value, log IgE 2.2, with both sensitivity (0.9) and specificity (0.5). Dermatitis was significantly more prevalent in children with positive IgE for pineapple, kiwi, banana, and papaya than negative specific IgE. The highest positive rate of sIgE against fruits was pineapple among children. Even in older children, the positive rate of pineapple allergens was high. IgE discriminates with and without sIgE for pineapple, with an optimal cutoff of 158.5 U/mL.

14.
Annals of Allergy, Asthma and Immunology ; 127(5):S13, 2021.
Article in English | EMBASE | ID: covidwho-1748295

ABSTRACT

Introduction -Currently, IgE blood testing requires phlebotomy that can be painful and leads to a delay in accurate diagnosis of allergies. An opportunity exists for in-office point-of-care (POC) testing to quantify patient IgE from a low-volume fingerstick blood sample. A system has been developed that performs up to 20 tests for whole protein and components in approximately 30 minutes by Kenota Health. Methods - Preliminary platform performance validation is required and Total IgE quantification (fingerstick) has been used to compare the system against a commonly used lab method (phlebotomy). 59 subjects & 10 contrived samples were tested for Total IgE on both systems. Whole blood, and plasma were analyzed using the POC and ImmunoCAP systems, respectively. The IgE measurements were compared using a Passing-Bablok regression analysis. Results - The 59 subjects were between 14-65 years old (a young population has been used successfully, but due to COVID lockdown, fewer younger subjects were available). The IgE ranged from 1 kU/L to 3500 kU/L. The Log of the IgE measurements were plotted against each other to evaluate the POC system accuracy, precision and fit. The systems aligned very well with the slope (1.015) and y-intercept (0.923) being within the Confidence interval of the data. The r2 value for the fit was 0.98. Conclusions - The data confirms that the Kenota POC system demonstrates substantially equivalent performance to ImmunoCAP. This conclusion sets the stage for a future with specific IgE quantification (whole allergen and component testing) in allergists’ offices used to guide rapid and convenient patient diagnosis. [Formula presented]

15.
Annals of Allergy, Asthma and Immunology ; 127(5):S43, 2021.
Article in English | EMBASE | ID: covidwho-1748293

ABSTRACT

Introduction: A single tertiary care center has offered oral immunotherapy (OIT) as a clinical service since 2018 using commercial products and subsequently has offered FDA-approved Peanut (Arachis- hypogaea) Allergen Powder-dnfp (PNAP) since July 2020. Shared decision making regarding OIT was based on previous IgE testing, history, and family preference. Methods: A retrospective chart review was performed in REDCap database. Results: A total of 37 patients initiated OIT (21 commercial products and 16 PNAP). The mean age was 9.25 for commercial product and 7.25 for PNAP with more males than females participating. Co-morbid conditions included allergic rhinitis, asthma, and eczema. Mean peanut IgE prior to starting was 49.75 and Ara h2 was 32.73. Prior reactions to peanut included skin, GI and anaphylaxis. Three children failed an oral challenge prior to starting OIT. There were 5 children that had never ingested peanuts but completed OIT. Minor intermittent side effects including stomach upset and itchy mouth were reported during escalation of both products. Dose adjustment was required for 1 PNAP patient for complaint of dysphagia and pain. There were 4 patients who dropped out of OIT: refusal to eat (1), unrelated GI disease (1) and the COVID-19 pandemic (2). All patients upon reaching maintenance are daily dosing with peanuts or chocolate-covered peanut candy. Lifestyle changes reported since reaching maintenance include eating in restaurants previously avoided and ingesting foods with labels stating: “may contain peanuts,” and “foods processed in a facility with peanuts.” Conclusions: Peanut OIT is safe and well tolerated in our patient population.

16.
Annals of Allergy, Asthma and Immunology ; 127(5):S88, 2021.
Article in English | EMBASE | ID: covidwho-1748291

ABSTRACT

Introduction: Hypersensitivity pneumonitis is an interstitial lung disease caused by lymphocytic response to inhalant exposures such as molds or avian excreta. Given its complexity and variation in presentation, the diagnosis of hypersensitivity pneumonitis requires obtaining a detailed exposure history and thorough workup. Case Description: A 17-year-old previously healthy female without asthma history developed cough, fever, and shortness of breath. A week later, she was intubated for acute respiratory failure. Her initial imaging revealed pneumomediastinum and pneumopericardium with ground glass opacities. The etiology of her respiratory failure remained unclear. Infectious workup, including multiple COVID tests, was negative. Given that she cares for horses, a hypersensitivity pneumonitis panel was done and revealed elevated aspergillus fumigatus IgG level >200 mcg/mL and total IgE of 571 kU/L. BAL showed elevated neutrophil count and lung biopsy was not obtained. She was extubated after a week and subsequently revealed that she vapes marijuana. This introduced e-cigarette and vaping associated lung injury (EVALI) as another etiology for her presentation. She ultimately completed an extended course of steroids and was discharged on supplemental oxygen. Discussion: Our patient presented with acute respiratory failure and negative infectious workup. Initial social history revealed frequent exposure to horse barns, leading to a diagnosis of hypersensitivity pneumonitis. However, it was subsequently revealed that she vaped, which introduced EVALI as another possibility. While her final diagnosis remains nebulous, this case highlights the importance of maintaining a broad differential during assessment of acute respiratory failure and the critical role that astute history taking plays in the diagnostic process. [Formula presented]

17.
Anaesthesia ; 77(SUPPL 2):44, 2022.
Article in English | EMBASE | ID: covidwho-1666279

ABSTRACT

Allergy to excipients used in drug formulations is an often overlooked issue, recently highlighted by cases of severe reaction to the Pfizer-Biontech COVID-19 vaccination. Sulphites, including metabisulphites, are antioxidant preservatives found in many foods but also in certain drugs used by anaesthetists, including metaraminol, catecholamines, metoclopramide and some forms of propofol. Patients may present with a variety of intolerances to sulphites. Anaesthetists need to know how to counsel them, which drugs to avoid, and whether to administer sulphite-containing adrenaline in an emergency scenario. Description A patient with reported sulphite allergy following previous reactions to metabisulphite-containing local anaesthetic presented for an elective operation. The hospital pharmacist took several weeks to confirm the sulphite content of key anaesthetic drugs and to find alternatives. In particular, sulphite-free adrenaline had to be sourced from France. General anaesthesia proceeded uneventfully, and a 'green bag' of safe emergency drugs stayed with the patient until her discharge. The patient was referred for further allergy testing, but as the allergy centre could not provide sulphite-free adrenaline, she declined challenge with metabisulphites and with preparations of adrenaline available in the UK. This will clearly pose a challenge in the future should she present with anaphylaxis or for emergency surgery or critical care. Discussion Documented reactions to parenteral sulphites are uncommon, varied and cover a variety of suggested pathophysiologies, of which IgE-mediated allergy is rare [1]. Additionally, asthmatics may report bronchospasm related to sulphite containing foodstuffs, but this results from direct irritation from sulphur dioxide and is not immune mediated. Establishing the diagnosis is difficult, requiring challenge testing in specialist allergy centres;skin prick testing can be unreliable. Challenge with sulphite-containing adrenaline, thus establishing safety of use in case of anaphylaxis, is one pragmatic option. Sensible precautions include close liaison with the hospital pharmacist, an easily accessible list of sulphite-free alternatives and a policy on adrenaline use in anaphylaxis. Although evidence is scant, expert opinion suggests that in anaphylaxis the benefit of administering sulphite-containing adrenaline outweighs the risks [2].

18.
Int J Mol Sci ; 22(24)2021 Dec 20.
Article in English | MEDLINE | ID: covidwho-1595807

ABSTRACT

The IL-4 and IL-13 cytokine pathways play integral roles in stimulating IgE inflammation, with the IL-4 cytokine being a major cytokine in the etiology of thunderstorm asthma, atopic dermatitis, and allergic rhinitis. The increasing prevalence of thunderstorm asthma in the younger population and the lessening efficacy of corticosteroids and other anti-inflammatories has created a need for more effective pharmaceuticals. This review summarizes the IL-4 and IL-13 pathways while highlighting and discussing the current pathway inhibitors aimed at treating thunderstorm asthma and atopic dermatitis, as well as the potential efficacy of peptide therapeutics in this field.


Subject(s)
Allergens/adverse effects , Asthma/immunology , Dermatitis, Atopic/immunology , Interleukin-4/metabolism , Allergens/immunology , Asthma/drug therapy , Dermatitis, Atopic/drug therapy , Gene Expression Regulation/drug effects , Humans , Interleukin-13/metabolism , Molecular Targeted Therapy , Signal Transduction/drug effects
19.
Internal Medicine Journal ; 51(SUPPL 4):12, 2021.
Article in English | EMBASE | ID: covidwho-1583539

ABSTRACT

Background: Chlorhexidine is an antiseptic widely used in healthcare settings. There are increasing reports of significant hypersensitivity reactions associated with its use. While severe reactions have been reported predominantly in patients in perioperative situations, some small case reports have indicated significant reactions in healthcare workers exposed to chlorhexidine in the workplace. Development of chlorhexidine allergy has been identified as an important occupational risk to healthcare workers. We sought to evaluate the prevalence of sensitisation to chlorhexidine amongst healthcare workers at a large tertiary hospital in order to assess the potential allergic safety risks associated with chlorhexidine exposure amongst staff. Method: Sensitisation to chlorhexidine was evaluated by measurement of serum specific IgE in samples collected from staff assessed after a sharps injury incident and laboratory staff collected for quality assurance procedures. This test method has been shown to have high sensitivity and specificity in the diagnosis of chlorhexidine allergy. Prevalence of sensitisation was additionally evaluated with reference to changes in exposure to chlorhexidine-based hand hygiene products as a result of infection control procedures and the COVID-19 pandemic. Results: A total of 320 samples were examined. The prevalence of positive chlorhexidine-specific IgE was 2.1%. Prevalence of sensitisation in samples collected prior to onset of the COVID-19 pandemic was 1.4% and 2.8% in samples collected post onset. This did not represent a statistically significant difference. Conclusions: Increased exposure to chlorhexidine-based hand hygiene products was not demonstrated to increase sensitisation in this study. However, the prevalence figures for chlorhexidine sensitisation are higher than estimated for similar cohorts in previous studies. This highlights the importance of testing for chlorhexidine allergy when investigating occupational allergy, particularly given the risk of severe reactions in sensitised individuals.

20.
Blood ; 138:4220, 2021.
Article in English | EMBASE | ID: covidwho-1582199

ABSTRACT

BACKGROUND: Immune thrombocytopenia purpura (ITP) has a complex pathogenesis and may be a primary diagnosis or secondary to an underlying condition 1. Evaluation for underlying diagnoses in patients presenting with atypical features of classic ITP is key, as this can impact treatment decisions, therapy response, and prognosis. Genetic variants that predispose patients to ITP are especially important to investigate as patients may be at risk for additional autoimmune phenomenon or malignancy. The SARS CoV-2 pandemic has added further complexity as reports suggest the infection can lead to autoimmunity in those with genetic predispositions 2,3. Loss of the suppressor of cytokine signaling 1 (SOCS1) function has been described to manifest with autoinflammatory syndrome, with or without immunodeficiency 4,5. Reports of autoimmunity developing in patients with SOCS1 haploinsufficiency after SARS CoV-2 infection are documented, including multi-system inflammatory syndrome (MIS-C) 2. A proposed mechanism of this virus-triggered autoimmunity includes a transient innate and adaptive immunodeficiency 3. This raises the question whether patients harboring genetic variants with risk of autoimmunity are placed at an even higher risk for ITP in the wake of SARS-CoV2 infection. CASE PRESENTATION: We present a 6-year-old female with isolated thrombocytopenia of 4,000/uL identified during evaluation for severe arthralgias unresponsive to corticosteroid treatment (maximum dose 1mg/kg/day) over a 6-month period. Laboratory results at presentation were consistent with ITP, including presence of platelet autoantibodies. Evaluation revealed hypocellularity for age (~50%) on bone marrow evaluation as well as elevated IgE (2080 kU/L), with IgA, IgM, and IgG levels within reference range. She had a remote history of SARS CoV-2-like illness and SARS CoV-2 antibodies were found present in serologic assay, without a history of vaccination. Genetic testing, including chromosomal microarray from peripheral blood and marrow, was included in the diagnostic workup given concern for a history of developmental delays with macrocephaly and necessity to rule-out malignancy with the patient noted to have a 5 mega-base deletion at 16p13.2p13.11, which includes the SOCS1 gene. Comprehensive next generation sequencing for additional immune dysregulation/primary immunodeficiency associated variants was unremarkable. Functional studies of surface expression of interferon-inducible genes (CD169 (SIGLEC-1)) and STAT1 phosphorylation via analysis of CD14+ monocytes revealed excess interferon signaling previously described in patients with SOCS1 haploinsufficiency (Figure 1). Measurements of B-cell-activating factor were also found to be extremely elevated at 6432 pg/mL. The patient's ITP course was complicated by hematuria, melena and refractory platelet response to first line therapy consisting of intravenous immunoglobulin 1 g/kg x2 doses and 2 mg/kg/day prednisolone. She required escalation to high dose methylprednisolone (30mg/kg), rituximab 375 mg/m 2/weekly x4 doses, and concurrent romiplostim (2 doses) for control of thrombocytopenia and bleeding manifestations. Her rheumatologic symptoms subsided with initiation of corticosteroids, and she has subsequently completed a prolonged corticosteroid taper. She currently has a normal platelet count with non-steroidal anti-inflammatory therapy utilized for arthralgia management with plan to transition to JAK inhibition for maintenance therapy. CONCLUSION: This case highlights the potential impact of investigating for susceptibility genes for ITP with consideration for broader testing including targeted next generation sequencing panels or microarray analysis in patients with atypical ITP presentations or response to therapy, as knowledge of this patient's underlying genetics led to earlier treatment and use of alternative agents. Additionally, the case adds the novel finding of bone marrow hypocellularity to the clinical phenotype of SOCS1 haploinsufficiency, as this has not yet been reported and contributes to the literature on the relationship of autoimmunity and SARS CoV-2 infections in patients with predisposing genetic variants. [Formula presented] Disclosures: Walkovich: Horizon Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees;Pharming: Honoraria, Membership on an entity's Board of Directors or advisory committees;Swedish Orphan Biovitrum AB (Sobi): Consultancy, Honoraria;X4 Pharmaceuticals: Other: Local PI for clinical trial involving mavorixafor and patients with neutropenia.

SELECTION OF CITATIONS
SEARCH DETAIL