Shellfish‐allergic patients show high sensitization rates to edible insects, but clinically relevant allergy is less frequent and usually mild. Current diagnostic markers have limited predictive value, highlighting the need for further allergen characterisation before broader dietary recommendations.
BACKGROUND:Digital symptom monitoring via e-Diary apps can support the diagnosis and management of chronic diseases with trigger-induced exacerbations such as pollen allergies. Attrition is a major challenge for continuous e-Diary usage with an unsupervised approach. OBJECTIVE:To investigate adherence to e-Diary reporting, its early determinants and predictors in a blended care setting among pollen allergic patients with heterogeneous cultural backgrounds. METHODS:The @IT.2020 observational multicenter study recruited patients with diagnosed seasonal allergic rhinitis from seven Southern European/Mediterranean countries. Baseline characteristics were investigated through questionnaires, skin prick tests and serum specific IgE measurements. The study doctors asked patients to record their allergy symptoms via e-Diary (AllergyMonitor, TPS) daily during the clinically relevant season of pollination and increased mould concentrations. RESULTS:Among 815 patients (467 adults, 348 children), the average prescribed e-Diary recording period was 106 (SD 47.1) days, with an average completion rate of 75.2% (SD 21.2%). Children (≥ 10 years) filled 73.8% (95% CI 68.1-79.4) of prescribed days without parental support. We identified a stable 'higher' and a more variable 'lower' adherence cluster. Adherence was weakly associated with disease severity, but not with age, gender, country, education or digital literacy. Short-term (first 3 weeks) adherence was strongly associated with long-term adherence (partial R2 = 0.387, p < 0.001), with 87.6% of lower adherent patients remaining poorly adherent beyond 3 weeks. CONCLUSION:In a blended care setting, adherence to e-Diary compilation among pollen allergic patients is high, irrespective of age and cultural background. Early identification of lower adherence is possible and might inform early interventions to improve patient adherence.
Laws surrounding the management of allergies and anaphylaxis in American schools vary by state, and there is limited information regarding the effectiveness of school allergy response policies both between and within states. The objective of this study was to qualitatively compare allergy preparedness within a sample of six Oregon public school districts and to further understand the possible impact of community poverty on school allergy management. A questionnaire was sent to one school nurse in each district and collected information regarding allergy preparedness and response protocols within their district‘s elementary schools. Via a heat map, we observed heterogeneity in multiple aspects of allergy preparedness between districts including differences in access to undesignated adrenaline autoinjectors, staff training frequency, and types of staff undergoing allergy training. We found that less than 50% of students with severe allergies kept their own adrenaline autoinjector or an allergy action plan from a healthcare provider at school. Our study suggests variability in allergy management between districts which raises concerns surrounding health equity. Elementary schools in lower-resource communities may be particularly vulnerable to under preparedness.
STP with plasma‐derived C1 inhibitor in patients with HAE‐nC1INH can reduce the risk of post‐procedure attacks. Efficacy in preventing attacks in patients with HAE‐FXII was higher than in those with HAE‐UNK.
BACKGROUND:The Australasian Society of Clinical Immunology and Allergy (ASCIA) Guideline: Infant Feeding for Food Allergy Prevention is an update of the 2016 ASCIA guideline. This updated guideline provides recommendations specifically in relation to infant feeding for food allergy prevention. METHODS:A review of the guideline began in 2024, informed by a systematic evidence review process and using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) framework. Where evidence was lacking, a formal Delphi process was used to develop recommendations based on expert consensus. An Expert Writing Group comprising representation from ASCIA, the National Allergy Council, Allergy & Anaphylaxis Australia the National Allergy Centre of Excellence and the Centre for Food Allergy Research was established. Key stakeholder meetings were held. RESULTS:A systematic review of evidence resulted in 16 recommendations: eight based on published evidence; eight based on expert consensus. ASCIA recommends: In Australia and New Zealand, infants should be introduced to solid foods when they are showing signs of developmental readiness. This is usually around 6 months and not before 4 months of age. Soon after infants have started solid foods, well cooked egg and appropriate forms of peanut are included in the infant's diet. Other common food allergens included in the family diet should be offered to the infant. Once introduced, common food allergens should be offered around once a week. Breastfeeding is encouraged, with no maternal dietary modifications. Breastmilk substitutes based on hydrolysed milk protein, soy or other proteins are not recommended for allergy prevention. Mild perioral rashes which appear around food consumption (redness or contact urticaria with no other symptoms of allergy) may not be a sign of an allergic reaction, and the food should be offered again. CONCLUSION:Key changes from the 2016 ASCIA guideline include specific recommendations regarding the timing of peanut and egg introduction, alongside a recommendation regarding perioral rashes to support primary healthcare providers. These guidelines require ongoing review and updating as new evidence emerges.
BACKGROUND:During the grass flowering season, fungal spores are abundant in outdoor air. We tested for co-sensitisations to grass pollen and fungal spores, assessed the degree of co-exposure, and studied its impact on the nasal mycobiome and immune responses. METHODS:Fungi-specific IgE-levels were studied in 277 individuals with and without grass pollen sensitisation. In a small cohort (n = 7), exposure to grass pollen and fungal spores was monitored during 5 consecutive indoor and outdoor stays in a flowering meadow and correlated with changes in the nasal mycobiome. Cytokines of nasal epithelial cells were studied under stimulation with recombinant grass pollen allergens, with and without fungal spores derived from outdoor isolates. RESULTS:IgE-sensitisation against the studied fungi was significantly more frequent among individuals with grass pollen sensitisation than among those without grass pollen sensitisation. Outdoor exposure resulted in changes in the nasal mycobiome, with a transitory enrichment of environmental fungi, for example, Cladosporium species. Most of the fungi cultivated from outdoor air samples belonged to the genera Fusarium, Cladosporium and Penicillium. Apical co-stimulation of nasal epithelial cells with grass pollen allergens and Fusarium, Cladosporium or Penicillium spores led to an increased loss of transepithelial electrical resistance and induction of pro-inflammatory cytokine release compared to mono-stimulation. CONCLUSION:Frequent co-exposure to fungal spores and grass pollen may increase the chance of acquiring a co-sensitisation to both allergens. Environmental fungi interact with and transitorily change the local mycobiome. Under co-exposure, fungal spores induce nasal inflammation and foster immune responses to otherwise poorly immunogenic pollen allergens.
Summary Specificity of sIgE was lower than previously reported; the sIgE‐to‐tIgE ratio performs better and offers excellent specificity. The sIgE‐to‐tIgE ratio can be used as an alternative diagnostic if BAT is unavailable.
Birch pollen related food allergy is mild in most patients, but 12.9% have severe reactions. Home‐based OFCs are safe for well‐selected patients, sparing time‐consuming procedures in the hospital.
Summary The G allele in rs111911698 is strongly associated with BST ≥ 8 ng/mL and could serve as a genetic proxy for the detection of HαT in patients with Hymenoptera venom anaphylaxis. The G allele in rs111911698 is a highly sensitive and specific identifier of HαT, with high positive and negative likelihood ratios.
Early egg introduction guidelines have not reduced food allergy emergency visits in Japan. Tree nut allergy attendances increased, highlighting gaps in current prevention strategies.
Summary Allergy evaluations are important for delabeling non‐hypersensitive patients and diagnosing and treating concomitant skin conditions. Rapid drug desensitisation enables patients to continue treatment with critical biologics, but treatment is complicated.
INTRODUCTION:The recommended first-line treatment for anaphylaxis in the community is intramuscular injection of adrenaline. The treatment is a standardised dose of either a 150 μg or a 300 μg adrenaline auto-injector (AAI) device depending upon the patient's weight. Currently, no standardised mechanisms exist to transition patients onto the higher 300 μg dose when they reach 25-30 kg (depending upon the manufacturer). METHODS:We undertook analysis of NHS prescriptions data dispensed in the community in England to identify rates of non-standard AAI dose prescribing. Non-standard prescribing is defined as patients who are likely to have exceeded the 25-30 kg threshold but still received a 150 μg dose. Data were limited to the most recent AAI prescription for an individual patient that occurred in the last 2 years (December 2022-2024). Patient weight at the time of prescribing was approximated using an age-to-weight correlation model. AAI recommended switching weights, based on device metadata, were compared to the patients' approximated weight to identify non-standard prescribing. Statistical comparison between rates of non-standard prescribing and patient deprivation was computed using Kendall's Tau correlation coefficient. A complementary analysis to identify patients who received a 300 μg dose but were likely under the 25-30 kg threshold was also carried out. RESULTS:Overall, 46,999 patients were identified as having received a 150 μg strength injector in their most recent AAI prescription; of these, over 95% received two or more devices in line with national guidance. Estimates based on age for weight growth centiles show that between 9480 (20.2%) and at least 1747 (3.7%) of those prescribed a 150 μg autoinjector were likely to exceed the weight threshold for this dose. Using a Resuscitation Council UK guideline of age 6 years for switching to a 300 μg dose, the estimated proportion prescribed a non-standard AAI dose increases to 23,059 patients (49.1%). Estimated rates of non-standard AAI prescribing were found to be higher in areas of England with the most deprivation. Conservative estimates found only 67 children likely under 25 kg and 330 children likely under 30 kg who received a 300 μg dose. CONCLUSIONS:This analysis of community AAI prescriptions in England suggests that underdosing of AAI prescriptions in children and adults is not uncommon. Healthcare professionals with patients at risk of anaphylaxis should review whether patients prescribed AAI devices have the appropriate device for their weight.
BACKGROUND:Allergic bronchopulmonary aspergillosis (ABPA) requires screening in adults with asthma using Aspergillus fumigatus-specific IgE (Af-IgE). The current Af-IgE threshold of 0.35 kUA/L has low specificity, leading to unnecessary downstream testing. OBJECTIVES:To determine an optimal Af-IgE threshold that maintains high sensitivity while improving specificity for ABPA screening in adults with asthma. METHODS:We performed a diagnostic accuracy study of prospectively collected data using distinct derivation and validation cohorts in a tertiary care setting. The index test was ImmunoCAP Af-IgE at thresholds of 0.35, 0.70 and 0.90 kUA/L. The reference standard was the 2024 ISHAM-ABPA criteria applied by investigators aware of all test results. RESULTS:We included 543 consecutive asthmatic subjects investigated for possible ABPA in the derivation cohort (July 2017-September 2018) and 375 subjects with established asthma and ABPA in the validation dataset (January 2020-December 2023). ABPA prevalence was 19.5% (106/543) in derivation and 69.6% (261/375) in validation cohorts. Bayesian latent class analysis estimated a 0.3 kUA/L cut-off but did not improve specificity; frequentist analysis showed model misfit. In the validation cohort, increasing the threshold from 0.35 to 0.70 kUA/L improved specificity from 66.7% (95% CI, 57.6-74.7) to 72.8% (95% CI, 64.0-80.1; p = 0.016) without significant sensitivity reduction (100% to 98.9%; 95% CI, 96.7-99.6; p = 0.25). No patients with bronchiectasis were missed. At 0.90 kUA/L, sensitivity significantly decreased (97.7%; 95% CI, 95.1-98.9; p = 0.031). CONCLUSIONS:ImmunoCAP Af-IgE threshold of 0.70 kUA/L optimised diagnostic performance for ABPA screening in adults with asthma, potentially reducing unnecessary confirmatory testing.
