Emerging and Novel Elicitors of Anaphylaxis: Collegium Internationale Allergologicum Update 2024

Treudler R. Emerging and Novel Elicitors of Anaphylaxis: Collegium Internationale Allergologicum Update 2024. Int Arch Allergy Immunol. 2024 Mar 25:1-9. doi: 10.1159/000537958.

Abstract

Background: 

Anaphylaxis represents the most severe end of the spectrum of allergic reactions. Frequent elicitors of anaphylaxis are insects, foods, and drugs. This paper summarizes recent development with regard to emerging and novel elicitors of anaphylaxis.

Summary: 

Allergens in selected plant foods with increasing importance in anaphylaxis cases

Food allergens on the rise include pulses (like pea, chickpea), seeds (hemp, chia), nuts (cashew), pseudograins (buckwheat, quinoa), fruits, and microalgae. Novel foods are foods that were not consumed to any significant extent in the European Union before May 1997, which includes four edible insects (mealworm, migratory locust, house cricket, and buffalo worm). Recent investigations have pointed out the risk of anaphylaxis associated with the consumption of yellow mealworm for people allergic to shellfish and house dust mites.

Predicting the Outcome of Pediatric Oral Food Challenges for Determining Tolerance Development

Kim H, Jeong K, Park M et al.  Allergy Asthma Immunol Res. 2024 Mar;16(2):179-190. doi: 10.4168/aair.2024.16.2.179.

Abstract

Purpose: Despite the risk of anaphylaxis, oral food challenges (OFCs) are performed clinically for various indications, particularly to confirm tolerance development. This study aimed to assess OFCs by relevant indications and build an outcome prediction model to help determine when to perform OFCs in children who are likely to have developed immune tolerance.

Methods: In total, 432 pediatric OFCs were retrospectively analyzed according to indications. Clinical characteristics, serum total immunoglobulin (Ig) E, blood eosinophils, and specific IgE and IgG4 levels for food allergens were noted and compared. Machine learning was utilized to select the most important variables in determining the passage of the OFCs, and prediction models were constructed using the selected variables.

Distribution of oral food challenge results based on age
and food-specific immunoglobulin E for egg white and cow’s milk. 

Results: OFCs were most commonly performed to confirm tolerance development (number, %; 267, 61.8%). The most common food allergens tested were egg (191, 44.2%) and milk (135, 31.3%).

Poor rhinitis and asthma control is associated with decreased health-related quality-of-life and utilities: A MASK-air study

Vieira RJ, Leemann L, Briggs A et al. J Allergy Clin Immunol Pract. 2024 Mar 30:S2213-2198(24)00329-5. doi: 10.1016/j.jaip.2024.03.036.

Highlights box:

What is already known about this topic?

National estimates of patients' quality-of-life based on control of asthma/allergic rhinitis are lacking. Real-world data may provide insights into quality-of-life of patients with asthma/allergic rhinitis and improve the ability to provide care to these patients.

What does this article add to our knowledge?

This study provides country-specific estimates (per disease control level) for quality-of-life in patients with allergic rhinitis or asthma across multiple European countries, using EQ-5D utility index scores and EQ-5D visual analogue scale.

How does this study impact current management guidelines?

This study points to the importance of achieving a good rhinitis and asthma control.

It also provides insights into patients’ preferences regarding different control levels and comorbid status, which are essential for guideline development.

Abstract

Background

Allergic rhinitis (AR) and asthma may impact health-related quality-of-life. However, national estimates on the quality-of-life of patients with AR or asthma are lacking.

Knowledge and attitudes toward anaphylaxis to local anesthetics in dental practice

Cherrez-Ojeda I, Gallardo-Bastidas JC, Borrero GR et al. BDJ Open. 2024 Apr 4;10(1):28. doi: 10.1038/s41405-024-00210-x.

Abstract

Objective/aim

The absence of a comprehensive understanding of potential anaphylactic reactions to local anesthetics (LAs) and management can result in grave consequences. For this reason we aim to assess Latin American dentists’ knowledge, preparedness, and competency in managing anaphylactic reactions to LAs.

Materials and Methods

Design: A cross-sectional study was conducted from November 2021 to February 2022. Board-certified dentists answered a survey comprising 26 structured questions. Chi-square tests and logistic regression models were performed in Stata 17.0. Setting: Argentina, Brazil, Colombia, Costa Rica, Ecuador, Honduras, Mexico, Peru, Venezuela, and other Latin American countries.

Safety of omalizumab in chronic urticaria during pregnancy: a real-life study

Cataldo Patruno, Fabrizio Guarneri, Eustachio Nettis et al.  Clinical and Experimental Dermatology, Volume 49, Issue 4, April 2024, Pages 344–347, https://doi.org/10.1093/ced/llad386

Abstract

Background

Managing a pregnant patient with chronic spontaneous urticaria (CSU) is often challenging. Recent data have shown that most CSU treatments in pregnant patients are second-generation H1 antihistamines (sgAHs), while data on the safety of omalizumab are scant.

Objectives

To evaluate, in a routine clinical practice setting, the efficacy and safety of omalizumab in patients with severe CSU refractory to sgAHs who either became pregnant during treatment or who started the drug during pregnancy.

Population-based cohort study to investigate the changes in prevalence, severity profile, and treatment modalities used in Korean atopic dermatitis patients

Lee, H.J., Oh, H.J., Lee, G.N. et al. Sci Rep 14, 7979 (2024). https://doi.org/10.1038/s41598-024-57777-6

Abstract

A) Change of annual prevalence of atopic dermatitis according to age group from 2002 to 2019,
(B) distribution of atopic dermatitis patients by age group in 2002 and in 2019.

In this retrospective study spanning from 2002 to 2019, we analyzed data from 355,277 Korean patients diagnosed with atopic dermatitis (AD) through the National Health Insurance System. Our objective was to comprehensively analyze the trends in prevalence, severity profiles, and treatment approaches for AD in Korea over this 18-year period. Initially, AD prevalence stood at 3.88% in 2002 but notably rose to 5.03% by 2019. During the same period, while AD prevalence decreased in the 0–1-year-old group (from 34.52% to 24.83%), it remained relatively stable in the 1–11-year-old group. Conversely, the 12–19-year-old and 20 years or older age groups witnessed substantial increases in AD prevalence, climbing from 2.55 to 6.02% and 1.44% to 3.53%, respectively.

Filaggrin loss-of-function variants are associated with atopic dermatitis phenotypes in a diverse, early life prospective cohort

Virolainen SJ, Satish L, Biagini JM et al. JCI Insight. 2024 Apr 2:e178258. doi: 10.1172/jci.insight.178258.

Abstract

Graphical Abstract

Loss-of-Function (LoF) variants in the filaggrin (FLG) gene are the strongest known genetic risk factor for atopic dermatitis (AD), but the impact of these variants on AD outcomes is poorly understood. We comprehensively identified genetic variants through targeted region sequencing of FLG in children (n = 438) participating in the Mechanisms of Progression of Atopic Dermatitis to Asthma in Children (MPAACH) cohort. Twenty FLG LoF variants were identified, including one novel variant and nine variants not previously associated with AD. FLG LoF variants were found in 13.6% of the cohort. Among these children, the presence of one or more FLG LoF variants was associated with moderate/severe AD (odds ratio (OR) = 2.00 (95% CI, 1.23-3.68) compared to those with mild AD.

Human Leukocyte Antigens and Sulfamethoxazole/Cotrimoxazole-Induced Severe Cutaneous Adverse Reactions: A Systematic Review and Meta-Analysis

Wu PC, Chen WT, Huang IH, Chen CB, Wang CW, Tai CC, Chung WH, Chi CC. JAMA Dermatol. 2024 Apr 3. doi: 10.1001/jamadermatol.2024.0210. 

Key Points

Question  Is there an association between human leukocyte antigen (HLA) and sulfamethoxazole (SMX)/cotrimoxazole (CTX)–induced severe cutaneous adverse reactions (SCARs)?

Findings  In this systematic review and meta-analysis of 6 studies involving 322 patients with SCARs, significant associations were identified between the HLA-A*11:01, HLA-B*13:01, HLA-B*15:02, HLA-B*38:02, and HLA-C*08:01 genotypes and SMX/CTX-induced SCARs. The HLA-B*15:02 and HLA-B*38:02 genotypes were significantly associated with SMX/CTX-induced Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), while the HLA-A*68:01 and HLA-B*39:01 genotypes were associated with SMX/CTX-induced drug reaction with eosinophilia and systemic symptoms; the HLA-B*13:01 allele showed an association with SMX/CTX-induced SJS/TEN and drug reaction with eosinophilia and systemic symptoms.

Meaning  The results of this review suggest that multiple HLA alleles were associated with SMX/CTX-induced SCARs.

Abstract

Importance  Sulfamethoxazole (SMX) and cotrimoxazole (CTX), a fixed-dose combination of SMX and trimethoprim in a 5:1 ratio, are antibacterial sulfonamides commonly used for treating various diseases.