Ocular allergy comprises a range of inflammatory conditions affecting the ocular surface, with allergic conjunctivitis (AC) representing a common clinical manifestation. Despite the availability of several therapeutic options, effective long-term management remains challenging because of the heterogeneous clinical presentation and complex underlying mechanisms of the disease. This narrative review summarizes the etiology, clinical manifestations, immunopathogenesis, and current and emerging therapeutic strategies for AC, emphasizing their clinical relevance and implications for disease management. Mild disease is generally managed with allergen avoidance, supportive measures, and topical antihistamines or dual-action agents, whereas severe or persistent disease may require topical corticosteroids or immunomodulators, depending on the phenotype and severity. Allergen-specific immunotherapy (AIT) may provide longer-term disease modification in selected patients. Emerging therapies, including biologics and targeted small-molecule inhibitors, offer additional treatment possibilities; however, clinical evidence for most remains limited, and further studies are needed to establish their efficacy, safety, and appropriate use. Important challenges include disease heterogeneity, limited availability of validated biomarkers, and difficulties translating experimental findings into clinical practice. Ultimately, treatment tailored to disease phenotype and severity, based on the underlying inflammatory mechanisms, can improve long-term disease control and ocular-surface outcomes. Continued research into the biological complexity of AC is essential for developing safer and more effective treatments that improve ocular health and quality of life.
Background/Objectives: Although cefazolin is the recommended antibiotic for surgical prophylaxis, patients with a penicillin allergy label (PAL) frequently receive second-line antibiotics due to misconceptions regarding β-lactam cross-reactivity. Despite robust evidence supporting risk-stratified cefazolin use, implementation remains inconsistent. We evaluated the effect of a behaviour-informed, multidisciplinary implementation strategy on appropriate cefazolin utilisation among PAL patients undergoing surgery. Methods: A before-and-after quality improvement study was conducted at Singapore General Hospital. Following revision of the institutional surgical prophylaxis guidelines, a hospital-wide implementation strategy informed by the Capability–Opportunity–Motivation Behaviour (COM-B) framework was implemented through clinician education, workflow redesign, point-of-care prescribing prompts, multidisciplinary governance and organisational endorsement. The primary outcome was the median weekly proportion of eligible PAL patients receiving cefazolin. Secondary outcomes included perioperative allergic reactions and surgical site infections (SSIs). Results: A total of 126 patients in the pre-intervention period and 133 patients in the post-intervention period were included. The median weekly proportion of PAL patients receiving cefazolin increased from 22% to 50% (p < 0.01), with sustained improvement throughout the intervention period. Three patients (2.3%) developed suspected allergic reactions following cefazolin administration; one reaction was mild (urticaria), one was moderate (rash and chest tightness without haemodynamic instability), and one was suspected anaphylaxis. Significantly, no cases resulted in intensive care admission or cancellation of surgery. No statistically significant difference in SSI incidence was detected between patients receiving cefazolin and those receiving alternative antibiotics (0/96 vs. 5/163, p = 0.161); however, the small number of events limits interpretation of this exploratory safety outcome. Conclusions: A behaviour-informed implementation strategy combining COM-B-guided intervention design, multidisciplinary governance and anaesthesiologist-led implementation was associated with a safe increase in cefazolin use for surgical prophylaxis in PAL patients. These findings suggest that interventions addressing behavioural and organisational barriers may support the implementation of evidence-based recommendations and improve cefazolin uptake in routine perioperative practice, although the impact on clinical outcomes requires further evaluation.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially life-threatening type IV immune reactions characterized by systemic inflammation mediated by cytotoxic T lymphocytes resulting in epidermal detachment and extensive necrosis. Although infrequent, the main concern across the SJS/TEN spectrum is its mortality, morbidity and associated financial burden. To date, there are no definitive recommendations regarding optimal treatment regimens; therefore, early diagnosis, prompt withdrawal of the culprit drug, and interdisciplinary consultations are vital to avoid disease progression. It is hard to assess the efficacy of novel therapies when the “conventional”, well-founded therapies with corticosteroids and cyclosporine are still under investigation. However, optimal posology is still under debate, as well as possible combined therapies. Other drugs that have shown to have a possible beneficial effect, like etanercept and n-Acetylcysteine, are still under investigation, given the insufficient number of investigations and small samples. New pharmacological approaches have been proposed in the last decade to improve outcomes across the SJS/TEN spectrum. This review aims to analyze novel approaches for SJS/TEN and assess their efficacy and safety compared to currently available treatments.
Background: Cefazolin is recommended for surgical prophylaxis in most patients with penicillin allergy labels (PALs) but concerns over beta-lactam cross-reactivity often limit use. We evaluated a behaviourally informed, multidisciplinary antimicrobial stewardship strategy on cefazolin utilisation among patients with PALs undergoing joint arthroplasty. Methods: Behavioural change frameworks identified determinants influencing perioperative antibiotic prescribing, which guided multidisciplinary antimicrobial stewardship strategy implementation over two phases: (1) department-level advocacy within Orthopaedics and then (2) hospital-wide advocacy. We retrospectively evaluated the strategies among adults with PALs undergoing primary total knee or hip arthroplasty. The primary outcome was cefazolin utilisation over time. Secondary outcomes included perioperative hypersensitivity reactions, surgical site infections (SSIs), and prosthetic joint infections (PJIs). Results: The proportion of patients receiving perioperative cefazolin increased significantly and sustainably over time (p < 0.001), rising from approximately 20% (baseline) to 92.9% (peak). Among 606 patients, 356 and 250 received cefazolin and alternative antibiotics, respectively. Suspected perioperative hypersensitivity reactions were uncommon, mild, and self-limiting (0.8% vs. 2.0%, cefazolin vs. alternative). SSIs and PJIs were similar between groups. Conclusions: A behaviourally informed, multidisciplinary stewardship strategy successfully increased cefazolin use in joint arthroplasty patients with PALs. Similar behavioural frameworks may be adopted to guide the design of other antimicrobial stewardship interventions to drive sustainable practice change.
Food allergies are a growing public health problem during childhood, significantly affecting the health and quality of life of children and their families. The aim of this study was to investigate parent-reported food allergic reactions among preschool children in Greece. A cross-sectional survey was conducted using an anonymous online questionnaire completed by parents or legal guardians of 151 preschool children aged 3–6.5 years. Fifty-seven percent of participating parents reported that their child had experienced a food allergic reaction-related. The most commonly reported symptoms were skin rash, eczema and itching, while cow’s milk and dairy products were the most frequently reported allergenic foods. Among children with parent-reported food allergic reactions (n = 86), 8.1% had a reported diagnosis of asthma and 7.0% had experienced a food-induced anaphylactic reaction requiring adrenaline administration. No statistically significant associations were found between gender, age and the occurrence of parent-reported food allergic reactions. The findings indicate that parent-reported food allergic reactions were frequently reported within the study sample. However, because the results were based exclusively on parental reports and were not clinically confirmed, they should not be interpreted as estimates of the prevalence of food allergy in the general population. Future nationwide studies using representative sampling strategies and standardized diagnostic methods are warranted.
