Cow's milk protein allergy is an important clinical and social problem and remains a source of considerable controversy among physicians, patients, parents, and healthcare payers. To date, the Polish Society of Allergology has not issued an official position regarding standards of management in this area. Therefore, we decided to develop recommendations that may serve as a starting point for diagnosis and therapy. Given the numerous controversies related to reimbursement, the standards also address this issue. The document was prepared by a group of practicing physicians who are involved in the daily care of children. The recommendations are intended for physicians of all specialties. To ensure clarity and usability, a question-based format supported by the Delphi methodology was applied.
Superior vena cava syndrome (SVCS) is a rare and life-threatening condition caused by the obstruction or compression of the superior vena cava, commonly due to malignancies, such as lung cancer. Diagnosing SVCS can be challenging due to its nonspecific symptoms that overlap with other conditions, such as angioedema. Making accurate differentiation may be critical for timely and appropriate patient treatment. This case report presents a 60-year-old female patient who was initially misdiagnosed with angioedema. However, after her condition showed no improvement despite implementation of multiple treatments, further investigation led to the accurate diagnosis of superior vena cava syndrome (SVCS). The presented delay in diagnosis highlights the difficulty in recognising SVCS, a condition that mainly presents as facial and upper body oedema. This case emphasises the need for thorough differential diagnosis, careful clinical examination, and heightened awareness of SVCS, to avoid misdiagnosis and ensure proper management.
Mast cells are a heterogeneous population of immune effector cells derived from haematopoietic progenitors in the bone marrow that undergo final differentiation in peripheral tissues. Their strategic localisation within barrier tissues, such as the skin and the mucosal surfaces of the respiratory and gastrointestinal tracts, underlies their critical role in the initiation and modulation of immune responses. As key components of innate immunity, mast cells recognise pathogen-associated molecular patterns (PAMPs) through pattern recognition receptors (PRRs), leading to their activation and the release of pro-inflammatory mediators. Furthermore, mast cells exert important immunoregulatory functions through interactions with other immune cells, including T lymphocytes, dendritic cells, and macrophages, thereby shaping inflammatory processes and immune responses. Mast cells play a central role in the pathogenesis of allergic diseases, where they act as primary effector cells in IgE-mediated type I hypersensitivity reactions. Cross-linking of Fc epsilon RI receptors induces rapid activation and degranulation, resulting in the release of mediators responsible for the development of clinical symptoms. In contrast, in cancer, mast cells represent a key component of the tumour microenvironment (TME) and exhibit a context-dependent role in tumour progression. They may promote tumour development through the induction of angiogenesis, extracellular matrix (ECM) remodeling, and modulation of immune responses, but they can also contribute to anti-tumour immunity. This review summarises current evidence on shared molecular and cellular mechanisms of mast cell function in allergic diseases and cancer, with a focus on their clinical relevance as potential therapeutic targets.
Munchausen syndrome is a rare and difficult to diagnose psychiatric condition that falls within the spectrum of factitious disorders. Patients engage in various behaviours with the conscious intention of producing symptoms, dramatizing existing symptoms, and maintaining medical attention. Dermatological symptoms are among the most commonly observed physical manifestations of this syndrome and often complicate differential diagnosis. Here, a 16-year-old female adolescent presented with a one-week history of progressively spreading, ill-defined, macular, eroded, and crusted lesions. A detailed clinical evaluation revealed no systemic findings or pathological laboratory abnormalities except for leukocytosis and mild anaemia. Autoimmune, infectious, and allergic causes were thoroughly ruled out. The patient's history included a dramatic course, attacks associated with food intake but not clinically confirmed, and frequent visits to different healthcare centres. During hospitalisation, the lesions increased and decreased daily; systemic and local treatments provided limited and temporary relief. During the change of the patient's intravenous line, the arm was wiped with alcohol and pigment transferred to the cotton. Inconsistencies in the patient's history a diagnosis of Munchausen syndrome was made. This case highlights the importance of considering artificial disorders in the differential diagnosis of unexplained, treatment-resistant, and atypically distributed skin lesions, particularly during adolescence. Delayed diagnosis can lead to unnecessary tests and treatments and even iatrogenic harm, so these cases should be carefully managed with a multidisciplinary approach.
Introduction: Air pollution is a significant global public health problem, affecting the cardiovascular system, causing heart and lung disease, lung cancer, food and skin allergies, chronic obstructive pulmonary disease, and asthma. Over 90% of children worldwide breathe polluted air, and 300 million of them live in areas with air pollution six times higher than the norm. Aim: The aim of this study is to examine the relationship between the prevalence of food and skin allergies among children and adolescents and ambient air quality in Poland. Material and methods: Data on the incidence of food allergies (K52.2) and skin allergies (L27.2) in Poland among children and adolescents aged 0 to 18 years were obtained from the Ministry of Health, as well as data from the Chief Inspectorate of Environmental Protection on average annual atmospheric air concentrations (sulphur dioxide, nitrogen dioxide, benzo[a]pyrene, PM2.5 particulate matter, and PM10 particulate matter) for the period 2018 to 2024. The study used Statistica 13.6.0.064 (0616) and Pearson correlation coefficients. Results: During the analysed period, average annual air pollution levels in Poland decreased. For PM10 particulate matter, these concentrations were 32.1 mu m3 in 2018 and 20.2 mu m3 in 2024, and for benzo(a)pyrene, 4.3 ng/m3 in 2018 and 1.3 ng/m3 in 2024. The incidence rate of food and skin allergies is decreasing, reaching 103.8/10,000 and 97.1/10,000 in 2018, and 87.4/10,000 and 71.1/10,000 in 2024, respectively. Conclusions: The analysis of average annual selected air concentrations showed that air quality has been improving since 2018. Along with the decrease in atmospheric air pollution concentrations, there has also been a decrease in the incidence of food and skin allergies among children and adolescents.
Introduction: Autoimmune diseases (AID) are associated with immune dysregulation, raising concerns about the safety and effectiveness of allergen immunotherapy (AIT) and venom immunotherapy (VIT). Patients with AID are frequently excluded from clinical trials, and current guidelines remain cautious despite limited real-world evidence. Aim: The aim of this study was to evaluate and compare the safety and clinical effectiveness of AIT and VIT in patients with and without AID. Material and methods: We retrospectively reviewed patients treated with AIT or VIT between 2014 and 2024 at a tertiary allergy center. AID diagnoses were confirmed via specialist records. Treatment effectiveness was defined as documented patient-reported improvement - reduction of allergy medication (AIT) or tolerance of field stings (VIT). Safety was based on reported adverse events. Group comparisons used the c2 test or Results: In the AIT group, clinical improvement was observed in 51.4% of AID vs. 38.9% of non-AID patients (p = 0.2012). Adverse events occurred in 27.0% and 38.9% (p = 0.163). In the VIT group, 86.7% of AID and 88.7% of non-AID patients tolerated field stings without systemic reactions (p = 0.6847). Using a stricter definition (no local or systemic reactions), rates were 60.0% vs. 57.6% (p = 0.8571). Adverse events occurred in 56.1% and 54.7% (p = 0.8683). Conclusions: In this real-world cohort, both AIT and VIT were found to be safe and effective in patients with stable AID. The presence of autoimmune comorbidities did not significantly affect clinical outcomes. These findings challenge longstanding concerns and support the use of immunotherapy in appropriately selected patients with AID.
The aim of this paper is to provide a critical analysis of histamine intolerance (HIT) in children and adolescents, with a focus on proposed mechanisms, diagnostic limitations, and realistic therapeutic options. Symptoms attributed to HIT are nonspecific and therefore require a broad differential diagnosis, including functional and psychosomatic disorders, allergies, other food intolerances, and inflammatory diseases. Measurement of serum diamine oxidase activity has limited diagnostic utility. If dietary intervention is considered, it should be short-term and accompanied by an assessment of the risk of nutritional deficiencies and the potential development of pediatric feeding and eating disorders. The overarching goal should remain the maintenance of dietary diversity and the improvement of quality of life for the child and their family. This paper also highlights the need for high-quality research and effective patient and family education to reduce misdiagnosis and prevent unnecessary dietary restrictions.
This document presents the 2026 update of the expert position statement issued by the Polish Society of Allergology and the Polish Respiratory Society on the use of single-inhaler triple therapy (SITT) in asthma management. It builds upon previous statements and incorporates new evidence from randomized controlled trials, real-world studies, and pharmacoeconomic analyses. The updated recommendations reaffirm and expand the role of SITT in specific clinical scenarios, including patients with small airway disease, those at high risk of exacerbations, and patients with asthma who smoke. Key elements of the Polish approach include the use of SITT with a medium dose of inhaled corticosteroids (ICS) at Step 4B in cases of inadequate response to Step 4A therapy (MART or ICS/LABA with a medium dose of ICS), and the use of SITT with a high dose of ICS at Step 5 in the majority of patients before considering biologic therapy. The document emphasizes that treatment selection should reflect the clinical characteristics of asthma and incorporate all available therapeutic and diagnostic options. Avoiding a rigid, algorithmic approach is essential, with therapy tailored to the individual patient.
Asthma is a chronic inflammatory disease of the airways, the severe forms of which can lead to severe exacerbations and significant deterioration in quality of life. One of the key mediators of the eosinophilic inflammation characteristic of severe asthma is interleukin 5 (IL-5). IL-5 stimulates the maturation, activation, and migration of eosinophils into the airways, where they cause epithelial damage and exacerbate disease symptoms. Given the important role of IL-5 in the pathogenesis of severe eosinophilic asthma, novel biologic therapies using the monoclonal antibodies mepolizumab, reslizumab, and benralizumab have been developed. Mepolizumab blocks free IL-5, reducing the number of eosinophils and reducing the need for oral corticosteroids. Reslizumab neutralizes IL-5, improving lung function and reducing the frequency of exacerbations. Benralizumab binds to the IL-5 receptor, leading to almost complete elimination of eosinophils. These therapies significantly improve asthma control, reducing symptoms and the risk of exacerbations. However, their use is associated with potential problems, such as allergic reactions, increased risk of infection, and the high cost of therapy, which may limit its availability. Nevertheless, IL-5 blockade represents a breakthrough in the treatment of severe asthma, offering patients an effective alternative to standard corticosteroid therapy.
Introduction: Drug allergy is a significant concern in paediatric clinical practice, yet studies suggest that healthcare providers may have limited knowledge regarding drug hypersensitivity reactions, particularly severe subtypes. Evaluating the knowledge and attitudes of paediatric physicians in this area is essential for improving patient safety. Aim: This study aimed to assess the knowledge and attitudes of paediatric residents and specialists regarding drug allergies, specifically in paediatric patients, focusing on both basic drug allergy knowledge and severe reaction recognition. Material and methods: Conducted at Umraniye Training and Research Hospital, the study included 86 paediatric residents and specialists, who completed a 34-question survey addressing demographic data, general knowledge of drug allergies, response to severe reactions, and alternative drug choices. Data were statistically analysed to evaluate correct response rates and their association with demographic factors. Results: The average correct response rate was 71.3%, with a higher accuracy in general drug allergy knowledge (77.6%) than in severe reaction recognition (61.0%). Participants demonstrated substantial knowledge about basic drug allergy facts but showed gaps in understanding severe reaction subtypes. Experienced specialists scored higher than residents, particularly in recognizing signs of severe drug reactions and choosing alternative medications. Conclusions: While paediatric healthcare providers possess foundational knowledge of drug allergies, they exhibit limited familiarity with severe drug reactions. Enhanced training in this area is essential to improve patient safety and optimize clinical care for paediatric patients with potential drug allergies.
Introduction: Cold urticaria is a rare subtype of physical urticaria, typically of unknown origin, and is defined by the development of hives, angioedema after sustained exposure to cold stimuli. Exposure to cold drinks, low temperatures, or contact with cold objects can trigger cold urticaria. Anaphylactic reactions may occur if a large area of skin is exposed to cold. Material and methods: Our study involved 45 patients over the age of 17 who were diagnosed with cold urticaria. The diagnosis was based on a history of skin reactions such as urticaria, angioedema, anaphylaxis triggered by cold exposure, in addition to a positive result on the ice cube test. Demographic, diagnostic, and therapeutic data were collected. The study participants' complete blood count, mean platelet volume, erythrocyte sedimentation rate, total immunoglobulin E, C-reactive protein and tryptase levels were measured. Results: The patient group consisted of 36 (80%) female participants with a mean age of 35 +/- 14 years. The majority of patients (over 50%) experienced localized symptoms in response to cold exposure, categorized as grade/type 1. In comparison, 44.4% exhibited more widespread skin reactions, such as urticaria, angioedema (grade/type 2), while 4.4% suffered from systemic involvement, including anaphylaxis (grade/type 3). Laboratory values were: baseline tryptase level was 4.6 +/- 3.8 & micro;g/l, total immunoglobulin E level was 271 +/- 267 IU/ml. Conclusions: Cold urticaria occurs in adults and may be associated with anaphylaxis. In our study, no secondary causes were found. All individuals diagnosed with cold urticaria should be informed about the potential risk of anaphylaxis and advised to carry an adrenaline autoinjector.
