Prize-Winning Abstracts From BSACI 2024 Meeting

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 (PM_2.5) and PM < 10 μg/m³ (PM₁₀) were measured using hand-held air quality sensors. All air pollutants (O₃, PM_2.5 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.