Allergen Component Testing: Key in Diagnosing Atypical Pollen-Food Allergy Syndrome

Lee Qiyu M, Dawson T, Moulsdale P.  Cureus 16(4): e58722. doi:10.7759/cureus.58722

Abstract

This case report details the complex presentation, diagnosis, and management of a teenager with pollen-food allergen syndrome (PFAS), formerly known as oral allergy syndrome. PFAS, mediated by immunoglobulin E (IgE) antibodies, stems from the cross-reactivity between pollens and uncooked plant-based foods, leading to a spectrum of symptoms, such as itching or tingling of the oral cavity. A UK survey indicated an average PFAS prevalence of 2%, with apples, hazelnuts, and kiwifruit commonly implicated. The presented case involved a 15-year-old girl referred from the respiratory clinic to the allergy clinic due to episodes of sore throat and urticaria rash following Nutella (chocolate paste containing hazelnut) and peanut consumption. 

Summary of the allergen component testing results.

Extensive diagnostic measures, including specific IgE testing, skin prick tests, and allergen component testing, revealed cross-reactivity between Bet v 1 and hazelnut allergens.

Patients' values and preferences for health states in allergic rhinitis-An artificial intelligence supported systematic review

Brozek J, Borowiack E, Sadowska E et al. Allergy. 2024 Mar 29. doi: 10.1111/all.16100.

Abstract

Background

Allergic rhinitis (AR) impacts patients' physical and emotional well-being. Assessing patients' values and preferences (V&P) related to AR is an essential part of patient-centered care and of the guideline development process. We aimed to systematically summarize the information about patients' V&P on AR and its symptoms and impact on daily life.

Methods

We conducted systematic review in a MEDLINE, Embase, PsychInfo, and CINAHL databases. We included studies which quantitatively assessed patients' V&P for specific outcomes in AR by assessing utilities, applying discrete choice approaches, or rating and ranking outcomes. We grouped outcomes as AR symptoms, functional status, and care-related patient experience. Study selection and data extraction were supported by the Laser AI tool. We rated the certainty of evidence (CoE) using the GRADE approach.

Global assessment of the knowledge and confidence in managing allergic disorders among primary care pediatricians across Europe: An EAACI task force report

 Cabrera M, Ryan D, Erlewyn-Lajeunesse M et al. Pediatr Allergy Immunol. 2024 Apr;35(4):e14116. doi: 10.1111/pai.14116. 

Abstract

Background: Pediatricians are often the first point of contact for children in Primary Care (PC), but still perceive gaps in their allergy knowledge. We investigated self-perceived knowledge gaps and educational needs in pediatricians across healthcare systems in Europe so that future educational initiatives may better support the delivery of allergy services in PC.

Method: A multinational survey was circulated to pediatricians who care for children and adolescents with allergy problems in PC by the EAACI Allergy Educational Needs in Primary Care Pediatricians Task Force from February to March 2023. A 5-point Likert scale was used to assess the level of agreement with questionnaire statements. Thirty surveys per country were the cut-off for inclusion and statistical analysis.

Proportion of responders and reasons for referral to an allergist.

Results: In this study, 1991 respondents were obtained from 56 countries across Europe and 210 responses were from countries with a cut-off below 30 participants per country. Primary care pediatricians (PCPs) comprised 74.4% of the respondents. The majority (65.3%) were contracted to state or district health services. 61.7% had awareness of guidelines for onward allergy referral in their countries but only 22.3% were aware of the EAACI competencies document for allied health professionals for allergy.

Increased prevalence of autoimmune thyroid disease after COVID-19: A single-center, prospective study

Rossini A, Cassibba S, Perticone F et al. Front Endocrinol (Lausanne). 2023 Mar 8;14:1126683. doi: 10.3389/fendo.2023.1126683. 

Abstract

Introduction: Thyroid dysfunctions associated with SARS-CoV-2 acute infection have been extensively described since the beginning of COVID-19 pandemics. Conversely, few data are available on the occurrence of thyroid autoimmunity after COVID-19 resolution. We assessed the prevalence of autoimmune thyroid disease (ATD) and thyroid dysfunctions in COVID-19 survivors three months after hospital admission.

Design and methods: Single-center, prospective, observational, cohort study performed at ASST Papa Giovanni XXIII Hospital, Bergamo, Italy. 599 COVID-19 survivors were prospectively evaluated for thyroid function and autoimmunity thyroperoxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb). When a positive antibody concentration was detected, thyroid ultrasound was performed. Multiple logistic regression model was used to estimate the association between autoimmunity and demographic characteristics, respiratory support, and comorbidities. Autoimmunity results were compared to a cohort of 498 controls referred to our Institution for non-thyroid diseases before the pandemic onset.

Patient-Reported Outcome Measures in Atopic Dermatitis and Chronic Urticaria are Underused in Clinical Practice

Cherrez-Ojeda I, Bousquet J, Giménez-Arnau A et al.  J Allergy Clin Immunol Pract. 2024 Apr 9:S2213-2198(24)00349-0. doi: 10.1016/j.jaip.2024.03.050. 

Abstract

Background: Patient-reported outcome measures (PROMs) are validated and standardized tools that complement physician evaluations and guide treatment decisions. PROMs are crucial for monitoring atopic dermatitis (AD) and chronic urticaria (CU) in clinical practice, but there are unmet needs and knowledge gaps regarding their use in clinical practice.

Objective: We investigated the global real-world use of AD and CU PROMs in allergology and dermatology clinics as well as their associated local and regional networks.

Methods: Across 72 specialized allergy and dermatology centers and their local and regional networks, 2,534 physicians in 73 countries completed a 53-item questionnaire on the use of PROMs for AD and CU.

Results: Of 2,534 physicians, 1,308 were aware of PROMs. Of these, 14% and 15% used PROMs for AD and CU, respectively. Half of physicians who use PROMs do so only "rarely" or "sometimes". AD and CU PROM usage is associated with being female, younger, and a dermatologist. POSCORAD and UAS were the most utilized PROMs for AD and CU, respectively.

An integrated molecular risk score early in life for subsequent childhood asthma risk

Böck A, Urner K, Eckert JK et al.  Clin Exp Allergy. 2024 Mar 31. doi: 10.1111/cea.14475. 

Abstract

Background

Numerous children present with early wheeze symptoms, yet solely a subgroup develops childhood asthma. Early identification of children at risk is key for clinical monitoring, timely patient-tailored treatment, and preventing chronic, severe sequelae. For early prediction of childhood asthma, we aimed to define an integrated risk score combining established risk factors with genome-wide molecular markers at birth, complemented by subsequent clinical symptoms/diagnoses (wheezing, atopic dermatitis, food allergy).

Methods

Three longitudinal birth cohorts (PAULINA/PAULCHEN, n = 190 + 93 = 283, PASTURE, n = 1133) were used to predict childhood asthma (age 5–11) including epidemiological characteristics and molecular markers: genotype, DNA methylation and mRNA expression (RNASeq/NanoString). Apparent (ap) and optimism-corrected (oc) performance (AUC/R2) was assessed leveraging evidence from independent studies (Naïve-Bayes approach) combined with high-dimensional logistic regression models (LASSO).

Results

Asthma prediction with epidemiological characteristics at birth (maternal asthma, sex, farm environment) yielded an ocAUC = 0.65. Inclusion of molecular markers as predictors resulted in an improvement in apparent prediction performance, however, for optimism-corrected performance only a moderate increase was observed (upto ocAUC = 0.68).

COVID-19 and Asthma Onset in Children

James P. Senter, Laura K. Aisenberg, Jesse W. Dudley, Xianqun Luan, Jing Huang, Chén C. Kenyon, David A. Hill. Pediatrics 2024; e2023064615. 10.1542/peds.2023-064615

ABSTRACT

BACKGROUND AND OBJECTIVES:

Respiratory viral infections increase risk of asthma in infants and children. Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus can cause severe lung inflammation and prolonged respiratory symptoms. We sought to determine whether SARS-CoV-2 infection modified pediatric incident asthma risk.

METHODS:

This retrospective cohort study examined children ages 1 to 16 within the Children’s Hospital of Philadelphia Care Network who received polymerase chain reaction (PCR) testing for SARS-CoV-2 between March 1, 2020 and February 28, 2021. Multivariable Cox regression models assessed the hazard ratio of new asthma diagnosis between SARS-CoV-2 PCR positive and SARS-CoV-2 PCR negative groups within an 18-month observation window. Models were adjusted for demographic characteristics, socioeconomic variables, and atopic comorbidities.

RESULTS:

Kaplan-Meier survival curves comparing adjusted asthma-free survival between
SARS-CoV-2 positive and SARS-CoV-2 negative groups.

There were 27 423 subjects included in the study. In adjusted analyses, SARS-CoV-2 PCR positivity had no significant effect on the hazard of new asthma diagnosis (hazard ratio [HR]: 0.96; P = .79). Black race (HR: 1.49; P = .004), food allergies (HR: 1.26; P = .025), and allergic rhinitis (HR: 2.30; P < .001) significantly increased the hazard of new asthma diagnosis. Preterm birth (HR: 1.48; P = .005) and BMI (HR: 1.13; P < .001) significantly increased the hazard of new asthma diagnosis for children <5 years old.

Preventive allergen immunotherapy with inhalant allergens in children

Dwivedi V, Kopanja S, Schmidthaler K, Sieber J et al. Allergy. 2024 Apr 8. doi: 10.1111/all.16115. 

REVIEW - Open Access

Abstract

The efficacy and safety of preventive allergen immunotherapy (pAIT) in children are currently under investigation. Here, we provide an overview of pAIT with respiratory allergens concerning the prevention of new sensitizations, allergic disease onset and progression as well as further immunomodulatory effects.

Process of study selection

Three databases were searched for clinical pAIT studies in children. Selected publications were reviewed for preventive outcomes according to prevention level (primary, secondary, and tertiary), allergen type, administration route, dose, and treatment duration. The primary prevention approach appears safe but showed no allergen-specific effect on new sensitizations. Secondary prevention seems feasible and may induce regulatory T cell-mediated immunotolerance. The number of studies at these prevention levels is limited.