Clinical and Experimental Allergy最新文献

{"title":"Evaluation of a Novel Automated Allergy Intradermal Skin Test Reader: A Diagnostic Accuracy Study","authors":"M. P. Morales-Palacios, J. M. Núñez-Córdoba, E. Tejero, O. Matellanes, C. M. D'Amelio, G. Gastaminza","doi":"10.1111/cea.14553","DOIUrl":"10.1111/cea.14553","url":null,"abstract":"<p>The intradermal test (IDT) and skin prick test (SPT) represent the primary diagnostic tool [<span>1</span>], and most common used in vivo biomarker in the study of immediate hypersensitive reactions [<span>2</span>]. IDT is used in the study of drug and hymenoptera venom allergy [<span>1</span>], consisting in a manual procedure (MP) that involves different measurement techniques and criteria with the consequent variability between health professionals [<span>3</span>], being the lack of their standardisation still a pending task [<span>4</span>]. The current positive criteria (an increase of 3 or more millimetres in maximum diameter (MD) of the initial wheal and surrounding erythema) [<span>3</span>] depends on a manual measurement, where it is difficult to obtain such a small measurement in a reproducible and reliable way. After all, the final decision on whether a test is positive or negative will depend on the judgement of the professional doing the study.</p><p>Nexkin DSPT (Digital Skin Prick Test) is a medical device that automatically assess the wheal size in SPT. This device, based on 3D-laser technology, reconstructs the geometry of the arm of the patient, followed by an algorithm-based methodology that locates the wheals and calculates their shape and size (area in mm<sup>2</sup>, and MD and orthogonal diameters in mm) automatically [<span>5</span>]. In 2021, our group conducted a clinical trial to validate the use of Nexkin DSPT for the measurement of SPT; our results showed higher reliability for the device in comparison to MP, correlations between the MP and Nexkin DSPT showed a relatively strong association (area: <i>r</i> = 0.742, <i>p</i> < 0.001; MD: <i>r</i> = 0.700, <i>p</i> < 0.001; OD: <i>r</i> = 0.644, <i>p</i> < 0.001) and the consistency of Nexkin DSPT readings were greater than those of the MP in the test–retest: reading variations in Nexkin DSPT area (2.02 mm<sup>2</sup>; SD = 3.42) were lower than those of the MP (4.94 mm<sup>2</sup>; SD = 4.14) (<i>p</i> < 0.001) [<span>6</span>].</p><p>A prospective study, company-sponsored, was conducted at Clínica Universidad de Navarra (PI_2021/155), IDTs were performed in 194 participants with positive (histamine) and negative (saline solution) controls. Two readings were executed (immediate and after 20 min) both automatically, with Nexkin DSPT and by the MP (performed by the same allergology specialist in all cases). We aimed to determine sensitivity and specificity, agreement between both methods as well as a potential cut-off point for diagnosis.</p><p>For the estimation of sensitivity, specificity, discrimination capability and the identification of potential cut-off points we randomly selected 97 wheals from each of both groups (histamine and saline solution). The complete sample was used for the evaluation of the agreement between the MP and the device, and for the comparisons between the immediate and second reading of the device. Characteristics of the part","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 12","pages":"1006-1009"},"PeriodicalIF":6.3,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Preoperative Nasal Mucus Thymic Stromal Lymphopoietin and Decreased Quality of Life in Chronic Rhinosinusitis With Nasal Polyps.","authors":"Jiani Chen, Li Hu, Juan Liu, Qianqian Zhang, Fuying Cheng, Yizhang Wang, Yingqi Gao, Yumin Zhou, Chen Zhang, Le Shi, Yufei Yang, Gesang, Guoyu Cai, Danzeng, Haiyue Zhang, Fan Shi, Kai Xue, Dehui Wang, Huan Wang, Xicai Sun","doi":"10.1111/cea.14552","DOIUrl":"https://doi.org/10.1111/cea.14552","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Onset and Offset of Early Dupilumab Response Using Domiciliary Monitoring in Type 2 High Unified Airway Disease","authors":"Kirsten Stewart, Chris RuiWen Kuo, Rory Chan, Brian Lipworth","doi":"10.1111/cea.14550","DOIUrl":"10.1111/cea.14550","url":null,"abstract":"<p>Few studies have prospectively looked in detail at concomitant upper and lower airway outcomes in patients with Type 2 (T2) high unified airway disease (UAD); severe asthma and chronic rhinosinusitis with nasal polyposis (CRSwNP). Remote follow-up of the clinical burden of upper and lower airway disease in response to treatment, including biologics, can be challenging. There is an unmet need for a portable mobile phone-connected device which records both upper and lower airway outcomes. Useful measures of clinical improvement include assessment of airflow obstruction as peak expiratory flow (PEF) for asthma and peak nasal inspiratory flow (PNIF) for CRSwNP, visual analogue scale (VAS) symptom scores and inhaler use. We evaluated a novel hand-held device (Smart peak flow, Smart Respiratory Products Ltd, Imperial College, London, UK), which connects to android or iOS mobile phones via wireless Bluetooth or headphone jack.</p><p>Thirteen participants were prospectively assessed who completed e-diary recordings, of 21 enrolled subjects with uncontrolled T2 high UAD as part of a study where patients received open-label dupilumab 300 mg every 2 weeks [<span>1, 2</span>] for 12 weeks (EudraCT 2021-005593-25), with the primary endpoint of mannitol challenge (reported elsewhere). Patients used maintenance and reliever therapy [<span>3</span>] (MART 2–8 actuations daily) extra-fine beclometasone/formoterol 100/6 μg as their inhaled corticosteroid (ICS) along with their usual intranasal corticosteroid (INCS) and entered a 4-week run-in period. Rescue albuterol could be used beyond the maximum MART dose of 8 actuations/day. Electronic diary recordings were made in the morning, including inhaler use (actuations/day) and the best of three readings for PNIF and PEF. VAS symptom scores for hyposmia, nasal congestion and global asthma symptoms were made by selecting a point on a 0–10 electronic scale. The study had local research ethics committee approval 21/WS/0151 and all participants gave their informed consent. Participants e-diaries were assessed for 2 weeks prior to, and for 2 weeks following, the first dose of dupilumab. The e-diaries were then assessed for 4 weeks following the final dose of dupilumab. Initial repeated measures analysis of variance (ANOVA) was performed followed by pairwise Student's <i>t</i>-test with a two-tailed alpha error of 0.05 to compare the two-weekly mean results from 2 weeks prior to the first dose to 2 weeks following the first dose (Weeks −2 and −1 vs. Weeks 1 and 2), baseline to end of treatment (Weeks −2 and −1 vs. Weeks 11 and 12) and the 4 weeks following the final dose of dupilumab (Weeks 11 and 12 vs. Weeks 13 and 14). e-Diary results were assessed in relation to the minimal clinical important difference values (MCID) [<span>4-9</span>].</p><p>Thirteen patients completed 12 weeks of e-diary recordings; eight had aspirin exacerbated respiratory disease (AERD) and six were males. The mean age was 53 years, mean (SEM) I","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 12","pages":"1010-1012"},"PeriodicalIF":6.3,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Digital Health Interventions for Asthma or COPD: Systematic Review","authors":"Marta Alexandra Martins Ferreira, Adalberto Fernandes dos Santos, Bernardo Sousa-Pinto, Luís Taborda-Barata","doi":"10.1111/cea.14547","DOIUrl":"10.1111/cea.14547","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Digital interventions such as remote monitoring of symptoms and physiological measurements have the potential to reduce the economic burden of asthma and chronic obstructive pulmonary disease (COPD) but their cost-effectiveness remains unclear. This systematic review of randomised controlled trials (RCT) aims to assess whether digital health interventions can be cost-effective in these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Systematic review of RCTs. Study quality was assessed using RoB2 tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources</h3>\u0000 \u0000 <p>Systematic search in three databases: PubMed, Scopus and Web of Science.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Eligibility Criteria</h3>\u0000 \u0000 <p>Studies were eligible if they were RCTs with health economic evaluations assessing participants with asthma and/or COPD and comparing a digital health intervention to standard of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 35 RCTs, of which 21 were related to COPD, 13 to asthma and one to both diseases. Overall, studies assessed four categories of digital health interventions: (i) Electronic patient diaries (<i>n</i> = 4), (ii) real-time monitoring (<i>n</i> = 19), (iii) teleconsultations (<i>n</i> = 6) and (iv) others (<i>n</i> = 6). Eleven studies performed a full economic evaluation analysis, while 24 studies performed a partial economic analysis. Most studies involving real-time monitoring or teleconsultations presented economic results in favour of digital health interventions (indicating them to be cost-effective or less expensive than the standard of care). Mixed results were obtained for electronic patient diaries. In the studies that conducted a full economic analysis, the incremental cost-effectiveness ratio (ICER) ranged from 3530,93€/QALY and 286,369,28€/QALY. In the studies that conducted a partial economic analysis, the cost differences between the intervention group and the control group ranged from 0,12€ and 85,217,86€. Half studies with low risk of bias concluded that the intervention was economically favourable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although costs varied based on intervention type, follow-up period and country, most studies report digital health interventions to be affordable or associated with decreased costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>PROSPERO: CRD42023439195</p>\u0000 ","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 9","pages":"651-668"},"PeriodicalIF":6.3,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BSACI Nut Allergy Guideline Audit by National Survey: A Summary of Findings","authors":"Felicity Norris, Amrit Dhesi, Shifa Shaikh, Andrew T. Clark, Gary Stiefel","doi":"10.1111/cea.14549","DOIUrl":"10.1111/cea.14549","url":null,"abstract":"<p>Since the publication of the BSACI guideline on the management of nut allergy (NA) in 2017 [<span>1</span>], little is known regarding current practice across the United Kingdom (UK). Between 07 December 2022 and 03 February 2023, an online survey was disseminated through the BSACI and local allergy networks to BSACI members and non-members. Respondents completed a survey (available via link below) covering resources and case vignettes to assess approaches to diagnosis and management of NA. Aims of the survey included to audit compliance with the published diagnostic pathways, and to establish current dietary and medical management. Finally, we assessed regional differences in service provision and management of NA.</p><p>A total of 249 healthcare professionals (HCPs) responded to the survey. Of respondents, 190 (76%) were BSACI members and 59 (24%) were non-members. The response rate amongst BSACI members was 19% (190/979). 219/249 (88%) of respondents exclusively managed paediatric patients; 105/190 (55%) of the BSACI members were paediatric allergists/paediatricians with allergy interest.</p><p>Amongst respondents from the different UK regions, at least 92% had access to skin prick testing (SPT), 95% to specific IgE (sIgE) testing and 93% to written allergy plans. Overall, ≥99% respondents had access to a dietitian via a referral process except in the North (<i>referring to Health Education England's</i> North East and North West regions). There was a large observed disparity in access to a dietitian in clinic; 74% in London compared to 35% in the North. Only respondents from 3 NHS trusts (Ireland, Wales and London) reported psychologist access in clinic.</p><p>Diagnostic accuracy to three case vignettes was determined by correct interpretation and application of the published diagnostic algorithm [<span>1</span>]. Only BSACI member responses were audited (<i>n</i> = 190). Responses resulting in diagnostic accuracy for primary peanut allergy (PA) were 140/149 (94%) and 142/148 (96%) for pollen food syndrome (PFS). Despite typical histories of PA and PFS, 43/149 (29%) and 105/148 (71%), respectively, suggested component resolved diagnostics (CRD), which are not recommended. Only 89/146 (61%) suggested CRD for a case of PFS/primary hazelnut allergy (diagnostic uncertainty), although the algorithm supports its use.</p><p>Medical and dietary management was evaluated in BSACI members (<i>n</i> = 190). Prescribing AAIs for cases of anaphylaxis to peanut (147/149 (99%)) and PFS with no asthma (17/153 (11%)) were consistent across respondents. In example cases 1, 3 & 4 (Figure 1) there was large variation with 98/154 (64%), 82/154 (53%) and 94/154 (61%), respectively, recommending AAIs. Over 90% of respondents in all regions except the Midlands & East (62%) would advise patients to carry two AAIs at all times in a case of anaphylaxis to peanut.</p><p>Dietary advice for avoidance of the index nut was consistent using a case of PA and tree NA","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 11","pages":"936-938"},"PeriodicalIF":6.3,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14549","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Childhood Anaphylaxis in Asia","authors":"Raymond James Mullins","doi":"10.1111/cea.14533","DOIUrl":"10.1111/cea.14533","url":null,"abstract":"<p>Whether childhood food allergy (FA) has increased in recent years continues to be a potential source of debate [<span>1</span>]. Demand for allergy-related medications and anaphylaxis-related hospital services have steadily increased in recent decades in many high-income countries [<span>2, 3</span>]. By contrast, population-based studies of food sensitization, fatal food anaphylaxis rates or challenge-confirmed FA demonstrate inconsistent evidence of increase [<span>1-3</span>]. The perception that childhood FA incidence may have increased over the last three decades is largely underpinned by data derived from changes in hospital emergency room use and admission rates for treatment of anaphylaxis, and to a lesser extent, demand for outpatient services [<span>2, 3</span>]. Most studies show an acceleration in anaphylaxis hospital presentation and/or admission rates in the last two decades, with the highest burden falling on young children aged 0–4 years. Significant country-to-country differences in estimated FA and anaphylaxis prevalence rates and common food triggers have been described, with lower rates previously observed in Asia compared to other regions [<span>4</span>].</p><p>That situation, however, may be changing. In this issue, Goh et al. describe an approximate doubling in hospital presentations coded as anaphylaxis in those aged 0–19 years in Singapore from 2015 to 2022 [<span>5</span>]. Rates quadrupled in those aged 0–4 years, mirroring patterns previously reported from high-income countries outside of Asia. There was a parallel increase in anaphylaxis admission rates but no overall increase in severity, as assessed by the presence of shock, doses of adrenaline required or the need for higher levels of care [<span>5</span>]. The authors also reported no overall increase in attendances for total “allergy-related” presentations from 2015 to 2019; the rise was only seen for presentations coded as anaphylaxis. There were also no changes in total emergency room attendances for all medical or trauma cases, suggesting the trends observed were not an artefact of higher presentation rates overall. Adrenaline was administered in 88% of cases. Ethnic variation was observed, with higher presentation rates noted in the 24% of the population without Chinese/Malay ethnic background. Consistent with studies from high-income countries outside of Asia, the highest rates occurred in children aged 0–4 years, with the increase predominantly driven by allergy to egg, peanut, tree nuts, dairy products and shellfish. Their most recent rates of 38.8/10<sup>5</sup> population is comparable with those described in Europe, and Northern America/South West Pacific countries [<span>3, 4</span>], albeit this increase occurring a decade after similar observations in these other regions.</p><p>A small number of studies suggest that FA/anaphylaxis presentations may be increasing in Asia in line with other countries. Even within Asia, there is significant heteroge","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 8","pages":"532-533"},"PeriodicalIF":6.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14533","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overcoming Barriers to Remission in Severe Eosinophilic Asthma: Two-Year Real-World Data With Benralizumab","authors":"David J. Jackson,&nbsp;Hassan Burhan,&nbsp;Hitasha Rupani,&nbsp;Paul E. Pfeffer,&nbsp;Ian J. Clifton,&nbsp;Shoaib Faruqi,&nbsp;Jaideep Dhariwal,&nbsp;Pujan Patel,&nbsp;Tamsin Morris,&nbsp;Joseph Lipworth,&nbsp;Michael Watt,&nbsp;Charlotte Lupton,&nbsp;Sabada Dube,&nbsp;Joe Hickey,&nbsp;Alexandra M. Nanzer","doi":"10.1111/cea.14544","DOIUrl":"10.1111/cea.14544","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Benralizumab has been reported to lead to clinical remission of severe eosinophilic asthma (SEA) at 1 year in some patients. However, whether this is maintained over a longer term remains unclear. Additionally, the impact of pulmonary and extrapulmonary comorbidities on the ability to meet remission is poorly understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Clinical outcomes including remission of SEA with benralizumab at 1 and 2 years were assessed retrospectively in a real-world UK multi-centre severe asthma cohort. The presence of clinically relevant pulmonary and extrapulmonary comorbidities associated with respiratory symptoms was recorded. Analyses to identify factors associated with the ability to meet remission were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 276 patients with SEA treated with benralizumab including 113 patients who had switched from a previous biologic to benralizumab were included. Overall, clinical remission was met in 17% (<i>n</i> = 31/186) and 32% (<i>n</i> = 43/133) of patients at 1 and 2 years, respectively. This increased to 28% at 1 year and 49% at 2 years once patients with pulmonary and/or extrapulmonary comorbidities were excluded. Body mass index (BMI) and maintenance OCS (mOCS) use demonstrated a negative association with clinical remission at 1 (BMI: OR: 0.89, 95% CI: 0.82–0.96, <i>p</i> &lt; 0.01; mOCS: OR: 0.94, 95% CI: 0.89–0.99, <i>p</i> &lt; 0.05) and 2 years (BMI: OR: 0.93, 95% CI: 0.87–0.99, <i>p</i> &lt; 0.05; mOCS: OR: 0.95, 95% CI: 0.89–0.99, <i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this long-term, real-world study, patients with SEA demonstrated the ability to meet and sustain clinical remission when treated with benralizumab. The presence of comorbidities including obesity, which are known to be independently associated with respiratory symptoms, reduced the likelihood of meeting clinical remission.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 10","pages":"734-746"},"PeriodicalIF":6.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14544","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lymphopenia in Chronic Spontaneous Urticaria is Linked to Basopenia and Eosinopenia","authors":"Mojca Bizjak,&nbsp;Mitja Košnik,&nbsp;Riccardo Asero,&nbsp;Emek Kocatürk,&nbsp;Ana M. Giménez-Arnau,&nbsp;Marcus Maurer","doi":"10.1111/cea.14538","DOIUrl":"10.1111/cea.14538","url":null,"abstract":"&lt;p&gt;Circulating blood numbers of lymphocytes in chronic spontaneous urticaria (CSU) have not been given sufficient attention. Histopathological analysis of wheals in CSU has demonstrated an increased number of mast cells (MCs) and a perivascular infiltrate of T lymphocytes along with variable numbers of basophils, eosinophils, monocytes and neutrophils [&lt;span&gt;1&lt;/span&gt;]. Grattan et al. reported lower blood lymphocyte counts in CSU patients than in healthy controls [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Autoimmune CSU (aiCSU), in which MCs and basophils are activated by immunoglobulin G (IgG) autoantibodies against the high-affinity receptor FcεRI for immunoglobulin E (IgE) or against IgE, is characterised by high disease activity and poor response to standard treatments [&lt;span&gt;3&lt;/span&gt;]. An early attempt to define aiCSU using three criteria (i.e. a positive basophil activation test or histamine release, a positive autologous serum skin test [ASST] and a positive immunoassay for IgG anti-FcεRI or IgE), which are not usually available in clinical practice, did not incorporate clinical features now known to be important [&lt;span&gt;4&lt;/span&gt;]. Several recently described features of aiCSU, such as blood basopenia and eosinopenia, high levels of IgG against thyroid peroxidase (anti-TPO) and low total serum IgE levels [&lt;span&gt;3, 4&lt;/span&gt;], can assist in identifying patients with aiCSU, but there is still a need for additional parameters. We aimed to search for new routinely available markers of aiCSU in a substantial cohort of patients.&lt;/p&gt;&lt;p&gt;This study involved 300 CSU patients aged 17 years and older (68% female; mean age 45.0 years, SD 15.6 years), all assessed by the same dermatologist at Clinic Golnik. CSU was diagnosed clinically [&lt;span&gt;5&lt;/span&gt;]. Exclusion criteria included prior omalizumab treatment, systemic glucocorticosteroid treatment within 7 days of venesection, predominant chronic inducible urticaria, wheals persisting more than 48 h and bradykinin-mediated angioedema. Data on demographics, patient history and laboratory tests were obtained at the initial visit as part of routine clinical care, based on the guidelines and clinical suspicion of comorbidities. The following laboratory tests were done at the Clinic Golnik laboratory: automated complete blood count (CBC) with differential (&lt;i&gt;n&lt;/i&gt; = 300; Sysmex XN 3100, Sysmex), C-reactive protein (CRP; &lt;i&gt;n&lt;/i&gt; = 292), total serum IgE (&lt;i&gt;n&lt;/i&gt; = 149), anti-TPO (&lt;i&gt;n&lt;/i&gt; = 184), antinuclear antibodies (ANA; &lt;i&gt;n&lt;/i&gt; = 86) and IgG against complement component C1q (anti-C1q; &lt;i&gt;n&lt;/i&gt; = 81). All patients were followed up for a minimum of 3 months, and responses to standard treatments were assessed. Uncontrolled CSU was defined as the Urticaria Control Test (UCT) score of 0–11 [&lt;span&gt;5&lt;/span&gt;]. The study was approved by the Slovenian National Medical Ethics Committee (KME78/09/14). These data were systematically collected from patients' charts with their consent, in a retrospective manner, and analysed using IBM SPSS","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 10","pages":"770-773"},"PeriodicalIF":6.3,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14538","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Tolerance in Patients With Allergy to Patent Blue V—A 20-Year Single Centre Experience","authors":"Simon Schneekloth,&nbsp;Mogens Krøigaard,&nbsp;Johannes K. Boysen,&nbsp;Holger Mosbech,&nbsp;Birgitte B. Melchiors,&nbsp;Lene H. Garvey","doi":"10.1111/cea.14534","DOIUrl":"10.1111/cea.14534","url":null,"abstract":"&lt;p&gt;Blue dyes are a common cause of perioperative hypersensitivity (POH) reactions, with studies reporting 1:300 patients having reactions ranging from localised urticaria to circulatory collapse [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Sentinel lymph node biopsy (SLNB) is the gold standard in early-stage breast cancer detection, using the combination of blue dye and isotope tracing with an identification rate of 98.8% [&lt;span&gt;2&lt;/span&gt;]. The mode of sensitisation to patent blue V (PBV) is unknown as patients typically react on their first subcutaneous exposure. PBV is also used to colour products such as textiles, food and cosmetics, and exposure to PBV is almost inevitable in daily life. However, no information is available regarding potential risks of allergic reactions to PBV, through such exposure, after confirmed allergy to subcutaneous exposure. After a suspected POH reaction, it is important to refer patients for allergy investigation to identify the culprit drug and find a safe alternative [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The aims of this single-centre retrospective study were to identify patients investigated for suspected POH to PBV, characterise reactions, determine the proportion of patients with confirmed allergy to PBV and to evaluate the frequency of oral tolerance among patients with confirmed allergy to subcutaneously administered PBV.&lt;/p&gt;&lt;p&gt;Data were collected from the Danish Anaesthesia Allergy Centre (DAAC) database from 2004 to 2023 and included clinical history, symptoms from the POH reaction, results of skin tests, in-vitro tests and drug provocation in 843 patients.&lt;/p&gt;&lt;p&gt;In total, 843 patients had been investigated and 75 (8.9%) had been exposed to PBV prior to the suspected POH reaction and were included in the study. Included patients were predominantly women (&lt;i&gt;n&lt;/i&gt; = 68, 91%, mean age: 56 years) with breast cancer. Of the 75 patients, 54 (72%) were diagnosed with PBV hypersensitivity. Symptoms occurred &lt;30 min after injection in 30 cases (67%) and &gt;30 min after injection in 15 cases (33%), unknown in 9 patients. Of the 21 patients testing negative to PBV, two tested positive to dicloxacillin and chlorhexidine, respectively. Of patients testing positive to PBV 28 (52%) suffered grade III reactions (modified Ring and Messmer classification [&lt;span&gt;3&lt;/span&gt;]), meeting the criteria for anaphylaxis; 19 had grade I reactions, of which 6 had localised urticaria and 10 had generalised urticaria.&lt;/p&gt;&lt;p&gt;Diagnosis of allergy to PBV were made by skin prick test (SPT) in concentrations of 0.25, 2.5 and 25 mg/mL and intradermal test (IDT) in concentrations of 0.025 and 0.25 mg/mL. In total, 52 out of 54 patients with proven hypersensitivity to PBV underwent titrated sublingual and oral provocation up to 30 mg of PBV. This was tolerated by all patients. The protocol used for oral challenge with PBV is shown in Figure 1.&lt;/p&gt;&lt;p&gt;To our knowledge, this retrospective single-centre study presents the largest series of patients with PBV allergy so far and prov","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 10","pages":"763-765"},"PeriodicalIF":6.3,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14534","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IgE Antibody Associations With Allergic Disease Phenotypes Using ISAC and ALEX Assays","authors":"Enrico Scala,&nbsp;Valeria Villella,&nbsp;Damiano Abeni,&nbsp;Mauro Giani,&nbsp;Emma Cristina Guerra,&nbsp;Maria Locanto,&nbsp;Giorgia Meneguzzi,&nbsp;Lia Pirrotta,&nbsp;Donato Quaratino,&nbsp;Alessandra Zaffiro,&nbsp;Tonia Samela,&nbsp;Elisabetta Caprini,&nbsp;Lorenzo Cecchi,&nbsp;Danilo Villalta,&nbsp;Riccardo Asero","doi":"10.1111/cea.14551","DOIUrl":"10.1111/cea.14551","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 12","pages":"1013-1015"},"PeriodicalIF":6.3,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}