Prize-Winning Abstracts From BSACI 2024 Meeting

IF 6.3 2区 医学 Q1 ALLERGY
Mohamed H. Shamji, Robert J. Boyle
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The personal experiences of seven parents who completed the hybrid webinar education model were explored using one-on-one, semi-structured interviews, with an Interpretive Descriptive approach. These accounts were synthesised into three interpretive themes which described their perceived educational needs. Parents experienced significant <i>barriers to learning</i> during their clinic visit including cognitive overload, distractions and feeling overwhelmed. <i>Multiple learning events</i> facilitated addressing knowledge gaps and improved confidence and self-efficacy. Remote learning supported <i>educating other carers</i>, reducing the burden on the attending parent to disseminate information. The hybrid webinar model supports parent learning through repeated, structured engagement in a preferred learning environment. Web-based group education facilitates dissemination of knowledge and skills to other carers. Developing a combination of synchronous and asynchronous educational strategies could further support parent needs.</p><p>Cow's milk allergy (CMA) affects ~1% of infants but is difficult to diagnose due to non-specific symptoms [<span>4</span>]. Cow's Milk-related Symptom Score (CoMiSS) is a commercially sponsored tool quantifying crying, regurgitation, stool changes, skin and respiratory issues. A score of ≥ 10 suggests high likelihood of infant CMA. This study evaluated CoMiSS' accuracy in diagnosing CMA, using symptom questionnaire data from EAT study. This involved 1295 healthy breastfed infants aged 3–12 months who underwent blinded food challenges and expert evaluation to confirm CMA. CoMiSS scores were calculated while blinded to CMA status of infants and diagnostic performance was assessed. Of 1295 infants, only 10 (0.8%) had confirmed CMA, while CoMiSS identified 492 (38.0%) as possible CMA. For each confirmed CMA case, 48 healthy infants were labelled as possible CMA. CoMiSS sensitivity was 80.0% and specificity 62.3%, with positive predictive value of 1.6% and negative predictive value of 99.8%. CoMiSS was 100% sensitive in identifying IgE-CMA, but only 50.0% sensitive in identifying non-IgE-CMA, potentially due to its emphasis on eczema. CoMiSS has high sensitivity but low specificity in identifying CMA and falsely labels high proportions of healthy young infants as having possible CMA. CoMiSS is a non-specific tool, especially in detecting non-IgE-CMA where diagnosis is most challenging.</p><p>Patch testing (PT) is helpful in the diagnosis of non-immediate cutaneous adverse drug reactions (NI-CADRs), but seldom performed in UK allergy clinics [<span>2</span>]. In our department, we established a regional tertiary referral centre for drug PT, and here we present the largest UK study of this patient cohort. We evaluated patients with NI-CADRs who were patch tested between 2019 and 2024 in our service; to evaluate safety and usefulness of drug PT. A total of 117 patients underwent drug PT. Median time interval between NI-CADR and PT was 12 months. Overall drug PT reactivity was 17.1% and positive results were detected for 22 different drugs. By phenotype, drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalised exanthematous pustulosis (AGEP) had the highest PT reactivity (66.7% each), followed by fixed drug eruption (FDE) (33.3%). PT reactivity was highest for antibiotics (68%) and iodinated contrast media (18%). Delayed intradermal testing detected only two additional positive cases (negative on PT). No patients experienced systemic reactivation. PT for NI-CADR is a safe and effective diagnostic tool, and particularly useful for DRESS, AGEP, FDE, antibiotics and iodinated contrast media. 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The ethnicity percentages (RLHIM, Non-RLHIM, NCL population) were: White (51, 54, 56); Other (14, 14, 15); Black (11, 9, 12); Asian (13, 13, 11), Mixed (5, 3, 4), Not stated (6, 5, 2). There was no statistically significant difference (Mann–Whitney <i>U</i> test) between the NCL population and either the Allergy referral sample (<i>p</i> = 0.65) or the RLHIM sample (<i>p</i> = 0.4). Conclusion: For this sample, the ethnicity of patients referred to Allergy services as a whole, and to RLHIM in particular, seems fairly well matched overall with the local population.</p><p>Long-term exposure to ambient air pollution is associated with impaired lung function in childhood [<span>6</span>]. Gas flaring is a significant cause of air pollution in the Niger Delta region of southern Nigeria. We carried out a cross-sectional study involving 774 children aged 6–15 years (382 in the community exposed to gas-flaring and 392 in the non-exposed community) to ascertain the impact of gas-flaring on lung function. Spirometry was performed using an electronic spirometer. In addition, Ozone (O<sub>3</sub>, ppm), particulate matter &lt; 2.5 μg/m<sup>3</sup> (PM<sub>2.5</sub>) and PM &lt; 10 μg/m<sup>3</sup> (PM<sub>10</sub>) were measured using hand-held air quality sensors. All air pollutants (O<sub>3</sub>, PM<sub>2.5</sub> and PM<sub>10</sub>) were significantly higher in the exposed compared to the non-exposed community (<i>p</i> = 0.03). All spirometric z-scores (FEV<sub>1</sub> [−1.68 vs. −1.27] and FEV<sub>1</sub>/FVC [−1.56 vs. −0.28]) were significantly lower in the community exposed to gas flaring (all <i>p</i> &lt; 0.001). 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引用次数: 0

Abstract

The annual British Society of Allergy and Clinical Immunology (BSACI) conference was held in Harrogate, York, UK, from 2 to 5 October 2024. This year, the Barry Kay Award, which recognises Professor Kay's national and international research contributions to the field of allergy and asthma which inspired so many young Allergists and Respiratory scientists, was awarded for the best abstracts in the Adult Clinical, Paediatric Clinical, Medical Student, Equality, Inclusivity and Diversity and Education categories. Here, we have asked the award recipients to summarise their research findings.

Immunotherapy is a widely accepted treatment for allergic conditions, designed to alter the progression of the disease by promoting immune tolerance [1]. I presented a case of a person affected by severe allergic rhinitis, eczema, asthma and multiple food allergies. Investigations revealed Der p 23 sensitisation, indicating house dust mite allergy. Rhinitis symptoms failed to respond to multiple interventions, including biologics. However, addition of dust mite immunotherapy to biologic treatment resulted in significant symptom improvement. Der p 23, a minor HDM allergen, is not always present in high concentrations in commercially available immunotherapy extracts. Studies show that many HDM extracts from different manufacturers mainly contain Der p 1 and Der p 2, lacking Der p 23. However, other studies using mass spectrometry have shown a broader range of allergen representation, including Der p 23, in products from Allergy Therapeutics and ALK-Abelló A/S. The case underscores the importance of clinicians having a thorough understanding of the allergen content in immunotherapy products, as well as conducting specific allergen component assessments before initiating treatment. This ensures that immunotherapy is tailored to the patient's individual sensitization profile, enhancing its effectiveness.

Educating parents on the recognition and management of allergic reactions is a central part of all paediatric allergy services [2, 3]. However, individual, in-person education has implications on resource management and consistency in delivery. Our institution utilises a two-part hybrid model comprising condensed in-person training followed by an online group webinar. We aimed to explore the parent experience of this model to inform our understanding of their information and education needs. The personal experiences of seven parents who completed the hybrid webinar education model were explored using one-on-one, semi-structured interviews, with an Interpretive Descriptive approach. These accounts were synthesised into three interpretive themes which described their perceived educational needs. Parents experienced significant barriers to learning during their clinic visit including cognitive overload, distractions and feeling overwhelmed. Multiple learning events facilitated addressing knowledge gaps and improved confidence and self-efficacy. Remote learning supported educating other carers, reducing the burden on the attending parent to disseminate information. The hybrid webinar model supports parent learning through repeated, structured engagement in a preferred learning environment. Web-based group education facilitates dissemination of knowledge and skills to other carers. Developing a combination of synchronous and asynchronous educational strategies could further support parent needs.

Cow's milk allergy (CMA) affects ~1% of infants but is difficult to diagnose due to non-specific symptoms [4]. Cow's Milk-related Symptom Score (CoMiSS) is a commercially sponsored tool quantifying crying, regurgitation, stool changes, skin and respiratory issues. A score of ≥ 10 suggests high likelihood of infant CMA. This study evaluated CoMiSS' accuracy in diagnosing CMA, using symptom questionnaire data from EAT study. This involved 1295 healthy breastfed infants aged 3–12 months who underwent blinded food challenges and expert evaluation to confirm CMA. CoMiSS scores were calculated while blinded to CMA status of infants and diagnostic performance was assessed. Of 1295 infants, only 10 (0.8%) had confirmed CMA, while CoMiSS identified 492 (38.0%) as possible CMA. For each confirmed CMA case, 48 healthy infants were labelled as possible CMA. CoMiSS sensitivity was 80.0% and specificity 62.3%, with positive predictive value of 1.6% and negative predictive value of 99.8%. CoMiSS was 100% sensitive in identifying IgE-CMA, but only 50.0% sensitive in identifying non-IgE-CMA, potentially due to its emphasis on eczema. CoMiSS has high sensitivity but low specificity in identifying CMA and falsely labels high proportions of healthy young infants as having possible CMA. CoMiSS is a non-specific tool, especially in detecting non-IgE-CMA where diagnosis is most challenging.

Patch testing (PT) is helpful in the diagnosis of non-immediate cutaneous adverse drug reactions (NI-CADRs), but seldom performed in UK allergy clinics [2]. In our department, we established a regional tertiary referral centre for drug PT, and here we present the largest UK study of this patient cohort. We evaluated patients with NI-CADRs who were patch tested between 2019 and 2024 in our service; to evaluate safety and usefulness of drug PT. A total of 117 patients underwent drug PT. Median time interval between NI-CADR and PT was 12 months. Overall drug PT reactivity was 17.1% and positive results were detected for 22 different drugs. By phenotype, drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalised exanthematous pustulosis (AGEP) had the highest PT reactivity (66.7% each), followed by fixed drug eruption (FDE) (33.3%). PT reactivity was highest for antibiotics (68%) and iodinated contrast media (18%). Delayed intradermal testing detected only two additional positive cases (negative on PT). No patients experienced systemic reactivation. PT for NI-CADR is a safe and effective diagnostic tool, and particularly useful for DRESS, AGEP, FDE, antibiotics and iodinated contrast media. We highlight the benefits of establishing a regional tertiary drug allergy service.

Objectives: To identify the ethnicity of patients referred to Allergy services as a whole, and to RLHIM in particular, by GPs in North Central London Integrated Care Board and compare this with ethnicity data for the local population, to investigate any possible systematic difference [5]. Methods: All referrals by NCL GPs to Allergy Services made between April 1, 2023, and March 31, 2024, were extracted from the Electronic Referral Service (ERS) database. Patient and aggregated population ethnicities were obtained from multiple data sources, resulting in an ethnicity coverage of over 95%. Results: 3133 Allergy referrals were identified in the period stated, of which 2194 (66%) were made to RLHIM, from a population of 1,272,927. The ethnicity percentages (RLHIM, Non-RLHIM, NCL population) were: White (51, 54, 56); Other (14, 14, 15); Black (11, 9, 12); Asian (13, 13, 11), Mixed (5, 3, 4), Not stated (6, 5, 2). There was no statistically significant difference (Mann–Whitney U test) between the NCL population and either the Allergy referral sample (p = 0.65) or the RLHIM sample (p = 0.4). Conclusion: For this sample, the ethnicity of patients referred to Allergy services as a whole, and to RLHIM in particular, seems fairly well matched overall with the local population.

Long-term exposure to ambient air pollution is associated with impaired lung function in childhood [6]. Gas flaring is a significant cause of air pollution in the Niger Delta region of southern Nigeria. We carried out a cross-sectional study involving 774 children aged 6–15 years (382 in the community exposed to gas-flaring and 392 in the non-exposed community) to ascertain the impact of gas-flaring on lung function. Spirometry was performed using an electronic spirometer. In addition, Ozone (O3, ppm), particulate matter < 2.5 μg/m3 (PM2.5) and PM < 10 μg/m3 (PM10) were measured using hand-held air quality sensors. All air pollutants (O3, PM2.5 and PM10) were significantly higher in the exposed compared to the non-exposed community (p = 0.03). All spirometric z-scores (FEV1 [−1.68 vs. −1.27] and FEV1/FVC [−1.56 vs. −0.28]) were significantly lower in the community exposed to gas flaring (all p < 0.001). The community exposed to gas flaring had a markedly higher proportion of participants with the obstructive phenotype than the non-gas flaring community (81 [21.2%] vs. 22 [5.6%]; p < 0.001), with no differences in the restrictive phenotype. In conclusion, living in a community exposed to gas flaring is associated with impaired lung function at school age.

Abstract Image

BSACI 2024年会议获奖摘要
英国过敏与临床免疫学学会(BSACI)年度会议于2024年10月2日至5日在英国约克郡哈罗盖特举行。今年,Barry Kay奖授予了成人临床、儿科临床、医学生、平等、包容性和多样性以及教育类别的最佳摘要,该奖项表彰了Kay教授在过敏和哮喘领域的国家和国际研究贡献,激励了许多年轻的过敏症专家和呼吸系统科学家。在这里,我们请获奖者总结他们的研究成果。免疫疗法是一种被广泛接受的治疗过敏性疾病的方法,旨在通过促进免疫耐受来改变疾病的进展。我提出了一个病例,一个人的影响严重过敏性鼻炎,湿疹,哮喘和多种食物过敏。调查显示Der p23致敏,表明屋尘螨过敏。鼻炎症状对多种干预无效,包括生物制剂。然而,在生物治疗的基础上加入尘螨免疫治疗可显著改善症状。derp23是一种次要的HDM过敏原,在市售的免疫治疗提取物中并不总是高浓度存在。研究表明,许多不同厂家的HDM提取物主要含有Der p1和Der p2,缺乏Der p23。然而,其他使用质谱法的研究表明,过敏治疗公司和ALK-Abelló a /S公司的产品中含有更广泛的过敏原,包括Der p23。该病例强调了临床医生全面了解免疫治疗产品中过敏原含量的重要性,以及在开始治疗前进行特定过敏原成分评估的重要性。这确保了免疫疗法是量身定制的病人的个人致敏概况,提高其有效性。教育家长认识和管理过敏反应是所有儿科过敏服务的核心部分[2,3]。然而,个别的、面对面的教育对资源管理和交付的一致性有影响。我们的机构采用两部分混合模式,包括浓缩的面对面培训,然后是在线小组网络研讨会。我们的目的是探索这种模式的家长经验,以告知我们对他们的信息和教育需求的理解。本研究采用一对一、半结构化访谈的方式,采用解释性描述的方法,对完成混合网络研讨会教育模式的七位家长的个人经历进行了探讨。这些说法被综合成三个解释主题,描述了他们感知到的教育需求。家长们在诊所访问期间经历了重大的学习障碍,包括认知超载、分心和感到不知所措。多种学习活动有助于解决知识差距,提高信心和自我效能。远程学习有助于教育其他照料者,减轻照料者父母传播信息的负担。混合网络研讨会模式支持家长通过在首选的学习环境中重复、结构化的参与来学习。网上小组教育有助向其他护理人员传播知识和技能。制定同步和非同步教育战略的结合可以进一步支持家长的需要。牛奶过敏(CMA)影响约1%的婴儿,但由于其非特异性症状而难以诊断。牛奶相关症状评分(CoMiSS)是一种商业赞助的量化哭泣、反流、粪便变化、皮肤和呼吸问题的工具。得分≥10分提示婴儿CMA的可能性高。本研究利用EAT研究的症状问卷数据,评估CoMiSS诊断CMA的准确性。该研究涉及1295名3-12个月的健康母乳喂养婴儿,他们接受了盲法食物挑战和专家评估以确认CMA。在不知道婴儿CMA状态的情况下计算CoMiSS评分,并评估诊断表现。在1295例婴儿中,只有10例(0.8%)确诊为CMA,而CoMiSS鉴定492例(38.0%)为可能的CMA。对于每一个确诊的CMA病例,48个健康婴儿被标记为可能的CMA。CoMiSS敏感性为80.0%,特异性为62.3%,阳性预测值为1.6%,阴性预测值为99.8%。CoMiSS对IgE-CMA的敏感性为100%,但对非IgE-CMA的敏感性仅为50.0%,这可能是由于其对湿疹的重视。CoMiSS在识别CMA方面具有高灵敏度但低特异性,并且错误地将高比例的健康婴儿标记为可能患有CMA。CoMiSS是一种非特异性工具,特别是在检测非ige - cma时,诊断最具挑战性。斑贴试验(PT)有助于诊断非立即皮肤药物不良反应(NI-CADRs),但在英国过敏诊所很少进行。 在我们的部门,我们建立了一个区域性的三级转诊中心,用于药物PT,在这里我们展示了英国最大的该患者队列研究。我们评估了2019年至2024年间在我们服务中进行贴片测试的ni - cadr患者;共117例患者接受了药物PT, NI-CADR和PT的中位时间间隔为12个月。总药物PT反应性为17.1%,22种不同药物检测出阳性结果。从表型上看,有嗜酸性粒细胞增多和全身症状的药物反应(DRESS)和急性全发性脓疱病(AGEP)的PT反应性最高(各为66.7%),其次是固定药疹(FDE)(33.3%)。PT反应性最高的是抗生素(68%)和碘造影剂(18%)。延迟皮内检测仅发现另外两例阳性病例(PT阴性)。没有患者出现全身再激活。PT诊断NI-CADR是一种安全有效的诊断工具,尤其适用于DRESS、AGEP、FDE、抗生素和碘造影剂。我们强调建立区域性三级药物过敏服务的好处。目的:通过伦敦中北部综合护理委员会的全科医生确定过敏服务患者的种族,特别是RLHIM,并将其与当地人口的种族数据进行比较,以调查任何可能的系统差异[5]。方法:从电子转诊服务(ERS)数据库中提取2023年4月1日至2024年3月31日期间NCL全科医生向过敏服务部门转诊的所有病例。从多个数据源获得患者和总体人口种族,使种族覆盖率超过95%。结果:在此期间发现了3133例过敏转诊,其中2194例(66%)是RLHIM,来自1,272,927人。种族百分比(RLHIM, Non-RLHIM, NCL人群)为:白人(51,54,56);其他(14,14,15);黑色(11,9,12);亚洲(13,13,11),混合(5,3,4),未陈述(6,5,2)。NCL人群与过敏转诊样本(p = 0.65)或RLHIM样本(p = 0.4)之间没有统计学上的显著差异(Mann-Whitney U检验)。结论:对于这个样本,过敏服务的患者的种族,特别是RLHIM,似乎与当地人口相当匹配。长期暴露于环境空气污染与儿童bbb肺功能受损有关。天然气燃烧是尼日利亚南部尼日尔三角洲地区空气污染的一个重要原因。我们进行了一项横断面研究,涉及774名6-15岁的儿童(382名来自暴露于天然气燃烧的社区,392名来自未暴露于天然气燃烧的社区),以确定天然气燃烧对肺功能的影响。肺活量测定采用电子肺活量计。此外,使用手持式空气质量传感器测量臭氧(O3, ppm)、PM2.5和PM10 μg/m3 (PM10)。所有空气污染物(O3、PM2.5和PM10)在暴露人群中均显著高于未暴露人群(p = 0.03)。在暴露于天然气燃烧的社区中,所有肺活量z分数(FEV1 [- 1.68 vs. - 1.27]和FEV1/FVC [- 1.56 vs. - 0.28])均显著降低(p均为0.001)。暴露于天然气燃烧的社区中,阻塞性表型的参与者比例明显高于非天然气燃烧社区(81人[21.2%]对22人[5.6%]);P &lt; 0.001),在限制性表型上没有差异。总之,生活在一个暴露于天然气燃烧的社区与学龄期肺功能受损有关。
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来源期刊
CiteScore
10.40
自引率
9.80%
发文量
189
审稿时长
3-8 weeks
期刊介绍: Clinical & Experimental Allergy strikes an excellent balance between clinical and scientific articles and carries regular reviews and editorials written by leading authorities in their field. In response to the increasing number of quality submissions, since 1996 the journals size has increased by over 30%. Clinical & Experimental Allergy is essential reading for allergy practitioners and research scientists with an interest in allergic diseases and mechanisms. Truly international in appeal, Clinical & Experimental Allergy publishes clinical and experimental observations in disease in all fields of medicine in which allergic hypersensitivity plays a part.
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