Real life study of the use of omalizumab for pediatric patients with multiple food allergies

Background Multiple food allergies (MFAs) affect 30% of the child population with food allergy. The current treatment is the exclusion diet, which frequently affects the quality of life for these patients. The objective of the study was to describe the effect of omalizumab treatment in children diagnosed with MFAs who experienced frequent anaphylactic reactions and the impact on their quality of life. Material and methods A descriptive observational study. Patients with severe food restrictions and high-risk due to multiple episodes of anaphylaxis were included. The allergy was confirmed by compatible clinical, skin tests, positive specific IgE and oral food challenges (OFCs). Omalizumab treatment was initiated and the impact on the life quality of patients and their families was assessed using the validated Food Allergy Quality of Life Questionnaire-Parent Form. Results Five patients with an average age at diagnosis of 3.58 years (range between 1.5–7.9 years), were diagnosed with MFAs. All patients presented with anaphylaxis. All patients were treated with omalizumab between 2013 and 2019. Omalizumab treatment was initiated at a mean age of 6.05 years (range between 4.5–8.25 years). All patients have undergone OFC to reintroduce food successfully. 2 patients had their dose of omalizumab reduced by half, and 1 patient has had the time interval extended between administrations due to the maintenance of food tolerance. No immediate local or systemic adverse reactions were documented. Two patients have commenced omalizumab administration at home without incident. Conclusions Children with MFAs who are treated with omalizumab do not show reactions in response to most of the foods to which they previously had anaphylaxis. Consequently, these patients were able to significantly expand the variety of their diet, improving the life quality and avoid anaphylaxis following the inadvertent intake of these foods (AU)

Management of Allergic Diseases During COVID-19 Outbreak.

PURPOSE OF REVIEW: The coronavirus disease 2019 (COVID-19) has challenged healthcare system capacities and safety for health care workers, reshaping doctor-patient interaction favoring e-Health or telemedicine. The pandemic situation may make difficult to prioritize patients with allergies diseases (AD), face-to-face evaluation, and moreover concern about the possible COVID-19 diagnosis, since COVID-19 shared many symptoms in common with AD. Being COVID-19 a novel disease, everyone is susceptible; there are some advances on vaccine and specific treatment. We evaluate existing literature on allergic diseases (AD): allergic rhinitis, asthma, food allergy, drug allergy, and skin allergy, and potential underlying mechanisms for any interrelationship between AD and COVID-19. RECENT FINDINGS: There is inconclusive and controversial evidence of the association between AD and the risk of adverse clinical outcomes of COVID-19. AD patients should minimize hospital and face-to-face visits, and those who have used biologics and allergen immunotherapy should continue the treatment. It is essential to wear personal protective equipment for the protection of health care workers. Social distancing, rational use of facemasks, eye protection, and hand disinfection for health care workers and patients deserve further attention and promotion. Teleconsultation during COVID-19 times for AD patients is very encouraging and telemedicine platform can provide a reliable service in patient care.

Real life study of the use of omalizumab for pediatric patients with multiple food allergies.

BACKGROUND: Multiple food allergies (MFAs) affect 30% of the child population with food allergy. The current treatment is the exclusion diet, which frequently affects the quality of life for these patients. The objective of the study was to describe the effect of omalizumab treatment in children diagnosed with MFAs who experienced frequent anaphylactic reactions and the impact on their quality of life. MATERIAL AND METHODS: A descriptive observational study. Patients with severe food restrictions and high-risk due to multiple episodes of anaphylaxis were included. The allergy was confirmed by compatible clinical, skin tests, positive specific IgE and oral food challenges (OFCs). Omalizumab treatment was initiated and the impact on the life quality of patients and their families was assessed using the validated Food Allergy Quality of Life Questionnaire-Parent Form. RESULTS: Five patients with an average age at diagnosis of 3.58 years (range between 1.5-7.9 years), were diagnosed with MFAs. All patients presented with anaphylaxis. All patients were treated with omalizumab between 2013 and 2019. Omalizumab treatment was initiated at a mean age of 6.05 years (range between 4.5-8.25 years). All patients have undergone OFC to reintroduce food successfully. 2 patients had their dose of omalizumab reduced by half, and 1 patient has had the time interval extended between administrations due to the maintenance of food tolerance. No immediate local or systemic adverse reactions were documented. Two patients have commenced omalizumab administration at home without incident. CONCLUSIONS: Children with MFAs who are treated with omalizumab do not show reactions in response to most of the foods to which they previously had anaphylaxis. Consequently, these patients were able to significantly expand the variety of their diet, improving the life quality and avoid anaphylaxis following the inadvertent intake of these foods.

Chemosensory dysfunction in COVID-19 out-patients.

BACKGROUND: Since the outbreak in China due to coronavirus disease 2019 (COVID-19) various studies have been published describing olfactory and gustatory dysfunction (OGD). OBJECTIVE: The aim was to investigate the frequency and severity of OGD in SARS-CoV-2 (+) out-patients compared to controls with common cold/flu like symptoms and two negative RT-PCR. METHODS: A multicenter cross-sectional study on SARS-CoV-2-positive out-patients (n = 197) and controls (n = 107) from five Spanish Hospitals. Severity of OGD was categorized by visual analogue scale (VAS). Frequency and severity of the chemosensory impairment were analyzed. RESULTS: The frequencies of smell (70.1%) and taste loss (65%) were significantly higher among COVID-19 subjects than in the controls (20.6% and 19.6%, respectively). Simultaneous OGD was more frequent in the COVID-19 group (61.9% vs 10.3%) and they scored higher in VAS for severity of OGD than controls. In the COVID-19 group, OGD was predominant in young subjects 46.5 ± 14.5 and females (63.5%). Subjects with severe loss of smell were younger (42.7 years old vs 45.5 years old), and recovered later (median = 7, IQR = 5.5 vs median = 4, IQR = 3) than those with mild loss of smell. Subjects with severe loss of taste, recovered later in days (median = 7, IQR = 6 vs median = 2, IQR = 2), compared to those with mild loss. CONCLUSION: OGD is a prevalent symptom in COVID-19 subjects with significant differences compared to controls. It was predominant in young and females subjects. Stratified analysis by the severity of OGD showed that more than 60% of COVID-19 subjects presented a severe OGD who took a longer time to recover compared to those with mild symptoms.

Translation and validation of the short version of the Questionnaire of Olfactory Disorders-Negative Statements to Spanish.

INTRODUCTION: There are more than 400 million of native Spanish speakers around the world, being the second most spoken language in regard to the number of native speakers. For this reason, a valid questionnaire to access the olfaction of our patients is necessary. MATERIAL AND METHODS: Validation and cross-cultural adaptation of the svQOD-NS questionnaire to the Spanish language. Internal consistency of svQOD-NS measured with Cronbach α. RESULTS: 40 patients met the inclusion criteria. 41 ± 153 (range 21-82), and 32 (80%) were female. 20 patients (57,1%) were male and 15 (42,9%) were female. There was a normal distribution among patients included according to the Shapiro-Wilk test (p = 0.175). Internal consistency of svQOD-NS measured with Cronbach α was 0.861. The intraclass correlation coefficient was 0.849 (confidence interval [CI] 95%: 0.766-0.911). CONCLUSION: The Spanish Language is the second most spoken language with regard to the number of native speakers and the svQOD-NS translation represents a valid option for the Spanish-speaking medical community, from which a large number of patients can benefit.

Pérdida del sentido del olfato durante la pandemia COVID-19 / Olfactory dysfunction during COVID-19 pandemic

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The Loss of Smell and Taste in the COVID-19 Outbreak: a Tale of Many Countries.

PURPOSE OF REVIEW: Olfactory dysfunction in upper airway viral infections (common cold, acute rhinosinusitis) is common (> 60%). During the COVID-19 outbreak, frequency of sensory disorders (smell and/or taste) in affected patients has shown a high variability from 5 to 98%, depending on the methodology, country, and study. RECENT FINDINGS: A sudden, severe, isolated loss of smell and/or taste, in the absence of other upper airway inflammatory diseases (allergic rhinitis, chronic rhinosinusitis, nasal polyposis), should alert individuals and physicians on being potentially affected by COVID-19. The evaluation of smell/taste disorders with a visual analogue scale or an individual olfactory or gustatory test, at the hospital or by telemedicine, to prevent contamination might facilitate an early detection of infected patients and reduce the transmission of SARS-CoV-2. During the COVID-19 outbreak, patients with sudden loss of smell should initiate social distancing and home isolation measures and be tested for SARS-CoV-2 diagnostic test when available. Olfactory training is recommended when smell does not come back after 1 month but can be started earlier.

Statement of the Spanish Society of Allergology and Clinical Immunology on provocation tests with aspirin/nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used throughout the world. They are frequently involved in hypersensitivity reactions, which range from local or mild reactions to systemic and severe reactions. Consequently, it is necessary to perform an exhaustive study of patients in order to make an accurate diagnosis, search for safe procedures in the case of severe reactions, and identify alternative treatment options. Various guidelines and protocols address the management of hypersensitivity to NSAIDs, although these vary widely from country to country. The Committees of Asthma, Rhinoconjunctivitis, and Drug Allergy of the Spanish Society of Allergy and Clinical Immunology (SEAIC) propose the present position statement on available options for provocation testing with aspirin/NSAIDs. This document is the fruit of an exhaustive review of current evidence and is based on recent publications addressing the diagnosis of patients with hypersensitivity to NSAIDs and on a consensus-oriented discussion among a group of experts from the SEAIC. The main objective was to draft an easy-toread, practical guideline for health care professionals in specialist areas who assess and manage patients with suspected hypersensitivity to NSAIDs. Furthermore, indications, contraindications, and procedures for oral, bronchial, and nasal provocation tests with aspirin/NSAIDs have been updated

Los antiinflamatorios no esteroideos (AINE) son medicamentos ampliamente utilizados a nivel mundial y frecuentemente implicados en reacciones de hipersensibilidad que pueden comprender desde reacciones locales y/o leves a reacciones sistémicas y graves. La complejidad del diagnóstico ante la falta de pruebas cutáneas o de laboratorio estandarizadas y/o validadas, hace que en muchos casos debamos realizar pruebas de provocación de alto riesgo. Por ello, es necesario un exhaustivo estudio de estos pacientes en los que tienen gran importancia el correcto diagnóstico y la búsqueda de procedimientos más seguros ante pacientes con reacciones graves, así como también la búsqueda de opciones alternativas de tratamientos antiinflamatorios. Actualmente existen diversas guías y protocolos de actuación que describen el manejo de la hipersensibilidad a los AINE aunque con importante variabilidad entre diferentes países. Desde los distintos comités de Asma, Rinoconjuntivitis y Alergia a Fármacos de la Sociedad Española de Alergología e Inmunología Clínica (SEAIC) proponemos un documento de posicionamiento sobre las opciones en las pruebas de provocación con aspirina/ AINE. Este documento es el resultado de una revisión exhaustiva de la evidencia actual, basada en publicaciones recientes sobre el diagnóstico de pacientes con hipersensibilidad a AINE, y de la discusión consensuada de un grupo de expertos de la SEAIC. El objetivo fundamental ha sido elaborar una guía práctica de fácil lectura dirigida a profesionales sanitarios de atención especializada implicados en el estudio y manejo de pacientes con sospecha de hipersensibilidad a AINE. Además, se ha realizado una actualización sobre las indicaciones, contraindicaciones y procedimientos de las pruebas de provocación oral, bronquial y nasal con aspirina/AINE

Olfactory dysfunction in the COVID-19 outbreak

The first cases of coronavirus 2019 disease (COVID-19) occurred in Wuhan, China, and the disease rapidly become a public health emergency of international proportions. COVID-19 can cause mild-to-severe acute respiratory syndrome (SARS) and is caused by the SARS-CoV-2 coronavirus. The clinical manifestations of COVID-19 include fever, dry cough, fatigue, sputum production, shortness of breath, sore throat, and headache. We performed this narrative review to analyze the current literature on postviral olfactory dysfunction related to the SARSCoV- 2 pandemic. Since the initial anecdotal reports from China, increasingly frequent international reports on COVID-19 indicate that 5% to 85% of affected patients lose their sense of smell, thus highlighting the very heterogeneous nature of the literature in this area. Therefore, we advise home isolation measures and/or social distancing, as well as tests to detect SARS-CoV-2 when possible, in patients with sudden and severe loss of smell who cannot be promptly evaluated

Los primeros casos de la enfermedad por coronavirus 2019 (COVID-19) ocurrieron en Wuhan, China, y se propagaron rápidamente para convertirse en una emergencia de salud pública y de preocupación internacional. La enfermedad puede manifestarse desde una forma leve a un síndrome respiratorio agudo grave (SARS) y es causada por el coronavirus SARS-CoV-2. Las manifestaciones clínicas de COVID-19 incluyen fiebre, tos seca, fatiga, expectoración, dificultad respiratoria, odinofagia y cefalea. El objetivo de este estudio es revisar la literatura actual sobre la disfunción olfatoria (DO) posviral en lo que respecta a la pandemia de SARS-CoV-2. Se han publicado un creciente número de estudios a nivel mundial desde los casos anecdóticos iniciales en China, en los que se ha demostrado una prevalencia variable de pérdida de olfato en pacientes COVID-19 que va desde un 5 a un 85%. Hasta la fecha, la literatura es ampliamente heterogénea respecto a la pérdida de olfato, por lo que podemos advertir y recomendar a aquellos pacientes con pérdida del olfato súbita y grave que no puedan ser evaluados rápidamente, seguir medidas de aislamiento domiciliario y/o distanciamiento interpersonal, así como realizar pruebas de diagnóstico para el SARS-CoV-2 cuando sea posible

Multiple chemical sensitivity worsens quality of life and cognitive and sensorial features of sense of smell.

Multiple chemical sensitivity (MCS) is characterized by a loss of tolerance to a variety of environmental chemicals. Multiple chemical sensitivity is frequently triggered by exposure to chemical agents, especially insecticides. The aim of the study was to measure the sense of smell and quality of life in patients with MCS compared to the control group. We studied the sense of smell, both sensitive and sensorial characteristics, in female patients with MCS (n = 58, mean 50.5 ± 8.5 years) and healthy female volunteers without rhinosinusal pathologies (n = 60, mean age 46 ± 10.2 years). Olfactometry (Barcelona Smell Test 24/BAST-24), sinonasal symptoms (visual analogue scale/VAS 0-100 mm), and quality of life (Quick Environmental Exposure and Sensitivity Inventory/QEESI) were assessed. Multiple chemical sensitivity patients showed a significant impairment in smell identification (19 ± 12 %; p > 0.05) and forced choice (62 ± 18 %; p > 0.05), but not in smell detection (96 ± 4 %) compared to the control group. Multiple chemical sensitivity patients reported more odours as being intense and irritating and less fresh and pleasant when compared with the control group. Patients scored a high level (40-100) on QEESI questionnaire (symptom severity, chemical intolerances, other intolerances, life impact). In MCS patients, total symptom intensity (VAS/0-700 mm) score was 202 ± 135, while disease severity score was 80 ± 23. The most frequent symptoms were itching and posterior rhinorrhea. Multiple chemical sensitivity patients have an impairment in smell cognitive abilities (odour identification and forced choice, but not for detection) with increased smell hypersensitivity and poor quality of life.

Comparative analysis of allergic rhinitis in children and adults.

Allergic rhinitis (AR) is a worldwide health problem that generates a significant healthcare burden in adults, adolescents, and children. Epidemiological studies have indicated that the prevalence of AR has progressively increased over the last three decades in developed and industrialized countries. AR currently affects up to 40 % of the worldwide population, with differences between adults and children and different countries of the World. Although not life-threatening, AR symptoms are frequently bothersome, adversely affecting work and quality of life of the affected patients, and causing a significant burden on both the individual and society. The symptoms have the potential to lead to both physical and mental complications, with sleep-disordered breathing in childhood and adolescence being associated with disorders in learning performance, behavior, and attention. Clinical features and comorbidities are very important for the "allergic march", and in both adults and children there is some evidence of association between AR and asthma. ARIA classifications of both symptom duration (intermittent, persistent) and severity (mild, moderate, severe) have been validated in both adult and pediatric populations. Based on the duration and severity of patient's disease, an appropriate treatment strategy has been issued for both adults and children, which consists of patient's education, allergen avoidance, and pharmacological as well as allergen-specific immunotherapy treatment. The present review will attempt to compare the characteristics of AR between children and adults, either in the epidemiology, clinical features, impact on QOL, and management of the disease.