Allergological study in patients vaccinated against COVID-19 with suspected allergic reactions.

BACKGROUND: One of the main barriers to vaccination against SARS-CoV-2 is the fear of developing hypersensitivity reactions to any of its components. Although these reactions are very rare, it is necessary to establish an effective protocol to detect patients at risk of developing them. The aim of this study was to evaluate hypersensitivity reactions in vaccinated patients in order to allow or not to complete the vaccination protocol. METHODS: Descriptive and cross-sectional study in which patients with suspected hypersensitivity to SARS-CoV-2 vaccines were evaluated. All patients underwent skin prick test (SPT) and/or intradermal test (IDT) with the vaccines and their excipients. In patients with positive IDT with the vaccine, a histopathological and immunohistochemical study was performed by skin biopsy. A basophil activation test (BAT) and a lymphoblastic transformation test (LTT) were also performed. RESULTS: Sixteen patients with suspected hypersensitivity to SARS-CoV-2 vaccine (12 received Comirnaty®, 3 received Vaxzevria®, and 1 received Spikevax®) were evaluated. Half had immediate hypersensitivity reactions and half had delayed reactions. All SPTs to excipients and vaccines were negative. IDTs with all excipients were negative. IDTs with vaccines were positive in 11 patients and negative in 5. The histological and immunohistochemical study of the two selected patients with positive IDT with vaccine showed T-lymphocyte involvement. BAT and LTT were negative in both cases. The vaccination protocol could be completed in 7 of 16 patients (44%) studied. The remaining 9 patients did not receive the second dose: 5 because vaccination was not required and 4 because they refused to be vaccinated. CONCLUSIONS: Thanks to the allergological and immunohistochemical study, the vaccination protocol could be completed in about half of the patients who presented suspected hypersensitivity reactions to SARS-CoV-2 vaccines. IDTs with vaccines could be a valuable method for assessing the immunogenicity of the vaccines.

Enfermedad pulmonar intersticial linfocítica granulomatosa: descripción de una serie de 9 casos / Granulomatous lymphocytic interstitial lung disease: description of a series of 9 cases

Introducción: La enfermedad pulmonar intersticial linfocítica granulomatosa (GLILD) es una de las complicaciones no infecciosas más graves de los pacientes con inmunodeficiencia común variable (IDCV). Su diagnóstico y tratamiento suponen un reto.ObjetivoAnalizar las características de los pacientes con IDCV y GLILD del Hospital General Universitario de Alicante.Material y métodosEstudio descriptivo de los pacientes con IDCV y GLILD diagnosticados desde 2000 a 2020.ResultadosDe los 42 pacientes con IDCV 9 presentaban GLILD (21%). La edad media al diagnóstico fue de 39 años. El 66% de IDCV fue de tipo MB0. El 55% tenía los linfocitos LB disminuidos. Se observó una disminución de la capacidad de transferencia del monóxido de carbono en un 89%. La biopsia pulmonar quirúrgica (BPQ) se realizó en el 78%. La manifestación extrapulmonar más frecuente fue adenopatías (78%). Una paciente presentó mutación patológica en heterocigosis en el gen CTLA4. El 67% de los pacientes recibió tratamiento combinado de corticoides con rituximab.ConclusionesLa GLILD es una complicación infrecuente de las IDCV cuyo diagnóstico y tratamiento es un reto. Su diagnóstico requiere un alto índice de sospecha, por lo que el enfoque diagnóstico multidisciplinar y el tratamiento combinado podrían proporcionar un buen resultado en la población adulta. (AU)

Introduction: Granulomatous-lymphocytic interstitial lung disease (GLILD) is one of the most serious non-infectious complications in patients with common variable immunodeficiency (CVID). Its diagnosis and treatment are challenging.ObjectiveTo analyse the characteristics of Hospital General Universitario de Alicante patients with CVID and GLILD.Material and methodsDescriptive study of patients with CVID and GLILD diagnosed from 2000 to 2020.ResultsOf the 42 patients with CVID, 9 had GLILD (21%). Mean age at diagnosis of 39 years. Sixty-six percent of the CVID was type MB0. Fifty-five percent had decreased BLs. There was a decrease in DLCO by 89%. Surgical lung biopsy (SLB) was performed in 78%. The most frequent extrapulmonary manifestation was adenopathy (78%). One patient had a heterozygous pathological mutation in the CTLA4 gene. Of the patients, 67% received combined corticosteroid treatment with Rituximab.ConclusionsGLILD is a rare complication of CVID whose diagnosis and treatment are a challenge. Its diagnosis requires a high index of suspicion, therefore a multidisciplinary diagnostic approach and combined treatment could provide a good result in the adult population. (AU)

[Granulomatous lymphocytic interstitial lung disease: description of a series of 9 cases]. / Enfermedad pulmonar intersticial linfocítica granulomatosa: descripción de una serie de 9 casos.

INTRODUCTION: Granulomatous-lymphocytic interstitial lung disease (GLILD) is one of the most serious non-infectious complications in patients with common variable immunodeficiency (CVID). Its diagnosis and treatment are challenging. OBJECTIVE: To analyse the characteristics of Hospital General Universitario de Alicante patients with CVID and GLILD. MATERIAL AND METHODS: Descriptive study of patients with CVID and GLILD diagnosed from 2000 to 2020. RESULTS: Of the 42 patients with CVID, 9 had GLILD (21%). Mean age at diagnosis of 39 years. Sixty-six percent of the CVID was type MB0. Fifty-five percent had decreased BLs. There was a decrease in DLCO by 89%. Surgical lung biopsy (SLB) was performed in 78%. The most frequent extrapulmonary manifestation was adenopathy (78%). One patient had a heterozygous pathological mutation in the CTLA4 gene. Of the patients, 67% received combined corticosteroid treatment with Rituximab. CONCLUSIONS: GLILD is a rare complication of CVID whose diagnosis and treatment are a challenge. Its diagnosis requires a high index of suspicion, therefore a multidisciplinary diagnostic approach and combined treatment could provide a good result in the adult population.

Immediate hypersensitivity to polyethylene glycols in unrelated products: when standardization in the nomenclature of the components of drugs, cosmetics, and food becomes necessary.

BACKGROUND: Polyethylene glycols (PEGs) and their derivatives are non-ionic polymers of ethylene oxide commercially available with numerous synonyms, such as macrogol, oxyethylene polymer, and laureth-9. Although these polymers are usually safe, mild to life-threatening immediate-type hypersensitivity reactions have been reported. Nevertheless, awareness about their allergic potential is minimal due to the non-standardization of their nomenclature. CASE PRESENTATION: We present the case of a 29-years-old woman who developed several local and systemic type I hypersensitivity reactions including a severe anaphylactic reaction to different pharmacologic and cosmetic products whose excipients included PEG. Prick tests and basophil activation tests were performed to several pharmacological and cosmetic products, but only those containing PEGs and their derivatives were positive. The patient was diagnosed with immediate hypersensitivity IgE-mediated to PEGs and its derivatives. CONCLUSIONS: Standardization of the terminology used to describe the presence of PEGs in products would help patients to identify them clearly and unequivocally and thus avoid the development of hypersensitivity reactions. It is also recommended studying PEG allergy in reactions to products containing PEGs, once allergy to the active ingredients has been excluded and in reactions to multiple unrelated drugs.Clinical study protocol number PI2018/29 (registered on 24 September 2018).