Background – While the definition of anaphylaxis is clear, its grade of severity remains a subject of debate, especially since different published classifications provide different grading score, and the same reaction may not receive the same score from different classifications. The objective of this study was to evaluate the possible discrepancies in severity scoring system for anaphylaxis in patients with a positive food challenge (OFC), using the WHO for the 11 version of the International Classification of Diseases (ICD-11) as the main reference. Methods – We conducted a retrospective observational study at the University Hospital of Montpellier, France, including patients with a positive OFC, between 2018 and 2022. We classified the severity of each reaction, as per the ICD-11 classification, but also as per four other widely used and validated classifications for grading anaphylaxis severity. Results – 235 patients presented a positive OFC between January 2018 and December 2022: 143 suffered from anaphylaxis, according to the ICD-11 classification. 76.2% of them were classified as grade 2 according to the ICD-11 classification, and 23.8% as grade 3. When comparing the different classifications, a complete concordance was recorded in 8 patients (5.6%) only. All classifications showed a good sensitivity (ranging from 99.3 to 100%), but different specificity (from 67.4 to 93.5%), and discrepancies between them were shown in most patients. Conclusion – Our work highlights the need to refine the different scoring systems, to accurately capture anaphylactic reactions and ensure appropriate management, and, in the end, to adopt a universal, intuitive, and easy-to-use classification, such as the ICD-11 one.

The authors declare no conflict of interest.

BACKGROUND:Patients suffering from allergic rhinitis seek for several therapeutic symptomatic options, including nonconventional treatments, to control their symptoms. OBJECTIVES:Through the present proof-of-concept study, we prospectively investigated the potential role of Puressentiel® nasal protection spray (SNPA) in patients suffering from cypress pollen allergic rhinitis. METHODS:In 15 adults, we performed two nasal provocation tests, with a cypress pollen extract, with a 15-day interval, with and without previous randomized administration of SNPA, and evaluated a nasal symptom score, the nasal inspiratory peak flow, and the concentration of inflammatory cytokines in the nasal lavage after the procedures. RESULTS:Comparing results in patients challenged with and without the SNPA spray before the nasal challenge, we found a 57% mean decrease in symptoms, and a 62% average difference in inspiratory peak flow, after the use of the spray. CONCLUSIONS:Puressentiel® SNPA is effective in reducing nasal symptoms, as assessed by nasal symptoms score and nasal inspiratory peak flow, and could be a valid natural non-pharmacological option in patients suffering from allergic rhinitis.

BIOTHERAPIES IN SEVERE CHILDHOOD ASTHMA. Asthma is a chronic inflammatory disease of the lower airways and is one of the most common chronic conditions during childhood. The management of severe asthmatic patients must be multidisciplinary, personalized, and holistic, especially in pediatrics. The therapeutic approach to asthmatic patients has evolved over the last years, targeting inflammatory cells and molecules. Such treatments mainly include biotherapies, and, in children, four monoclonal antibodies are presently available to treat severe asthma: omalizumab, mepolizumab, dupilumab and tezepelumab. These biotherapies have demonstrated short- and medium-term efficacy and safety in both adults and children.

Abstract Background Anaphylaxis is a serious systemic hypersensitivity reaction that requires immediate recognition and prompt administration of epinephrine/adrenaline. The present study aimed to assess the appropriateness of epinephrine/adrenaline use in children identified as allergic by physicians in the emergency department (ED) at the time of the reaction, and to identify factors that are possibly associated with epinephrine/adrenaline administration, auto‐injector prescription, and further referral to an allergist. Methods We performed a retrospective cross‐sectional study at the pediatric ED of the University Hospital of Montpellier, France. We included all consecutive children who attended the ED between 2016 and 2020 with an allergy‐related diagnosis at discharge. Results We included 1056 allergy‐related visits, including 224 (21.2%) with a diagnosis of anaphylaxis at discharge; only 17.0% of them received an epinephrine/adrenaline injection, and 57.1% consulted an allergist after the acute episode. An auto‐injector was prescribed to 63 (28.1%) patients at discharge from the ED. Besides the severity of the clinical presentation, factors associated with a guidelines‐based management of the anaphylactic reaction and with an increased administration rate of epinephrine/adrenaline included presence of asthma symptoms and presence of extended skin reactions. Conclusions Our study underlines persistent gaps in the management of pediatric anaphylaxis in ED, focusing on hereby identified levers. By disseminating current knowledge and guidelines on anaphylaxis and allergies, specialists could work together with emergency physicians to establish effective management algorithms and improve anaphylaxis management and care pathways for children experiencing allergic reactions, especially anaphylaxis. Trail Registration Clinical Trials, number NCT05112367.

Abstract Background Urticaria is a common condition presenting both as acute and chronic disease within primary care. To those without specialist training it is poorly understood from the points of view of diagnosis and management. It causes a considerable disease burden to sufferers with marked impact on quality of life. Purpose of this review The recent publication of the EAACI/GA²LEN/EuroGuiDerm/APAAACI Guideline for the Definition, Classification, Diagnosis and Management of Urticaria guideline prompted us to take this excellent resource and re‐configure its findings and recommendations to a non‐specialist audience with particular reference to the needs of the primary care team.

Most patients presenting with allergies are first seen by primary carehealth professionals. The perceived knowledge gaps and educational needswere recently assessed in response to which the LOGOGRAM Task Force wasestablished with the remit of constructing pragmatic flow-diagrams forcommon allergic conditions in line with an earlier EAACI proposal todevelop simplified pathways for the diagnosis and management of allergicdiseases in primary care. To address the lack of accessible andpragmatic guidance, we designed flow-diagrams for five major clinicalallergy conditions: asthma, anaphylaxis, food allergy, drug allergy andurticaria. Existing established allergy guidelines were collected anditeratively distilled to produce five pragmatic and accessible tools toaid diagnosis and management of these common allergic problems.Ultimately, they should now be validated prospectively in primary caresettings.

L'utilisation de l'urinothérapie par un patient, vu en consultation d'allergologie, nous a conduit à évaluer comment les patients s'informent sur cette pratique. L'essor de l'information de santé grand public favorise la propagation des contenus sur la médecine non conventionnelle. Celle-ci repose sur des croyances et non sur des preuves scientifiques, et n'est pas sans danger. Nous avons procédé à la recherche et à l'analyse qualitative de contenu de messages portant sur l'urinothérapie, publiés sur un forum de santé. La constitution et l'analyse du corpus ont été réalisées par un allergologue et un chercheur en sciences de l'information et de la communication. Le corpus analysé se monte à 177 messages, publiés entre 2003 et 2017. Les internautes ont recours à l'urinothérapie à la suite d'un échec de thérapie médicamenteuse, accompagné par un manque de confiance en la médecine occidentale et son système de santé. Les non-initiés demandent des informations et de la documentation. Les initiés partagent leur expérience (pathologie soignée, cause du recours à cette thérapie, procédure d'usage) et s'appuient sur les sources d'information (sites web, forums, articles scientifiques, blogs, livres, experts), visant à prouver la légitimité de la méthode. Alors qu'une partie des internautes présente les effets bénéfiques de l'urinothérapie, une autre est sceptique et souligne le manque de résultats et la dangerosité. Ces prises de position sont accompagnées par l'empirie, les citations des sources d'information, des messages malpolis et méprisants, et la rationalisation qui imite le discours scientifique. Le recours à l'urinothérapie résulte, en grande partie, d'une crise de confiance dans la médecine occidentale et le secteur de la santé, et la citation des sources d'information et des retours d'expérience dans les échanges d'internautes sont une tentative d'attribuer de la légitimité à cette pratique. Il est important de connaître l'existence de ces thérapies alternatives, fréquentes dans le domaine de l'allergologie, et implémenter la discussion scientifique entre médecin et patient.

Contact DermatitisEarly View CONTACT POINT An immune reaction caused by silicone breast implants Quentin Samaran, orcid.org/0000-0002-0560-5493 Department of Dermatology, University of Montpellier, Montpellier, France Contribution: Conceptualization (equal), Data curation (equal), ​Investigation (equal), Validation (equal), Visualization (equal), Writing - original draft (lead), Writing - review & editing (equal)Search for more papers by this authorFarid Bekara, Department of Plastic and Reconstructive Surgery, Burns and Wound Healing Units, CHRU Lapeyronie, Montpellier University Hospital and Montpellier University, Montpellier, France Contribution: Data curation (equal), ​Investigation (equal), Writing - review & editing (equal)Search for more papers by this authorFaisal Aljaber, Department of Dermatology, University of Montpellier, Montpellier, France Contribution: Data curation (equal), ​Investigation (equal), Writing - review & editing (equal)Search for more papers by this authorEvangéline Clark, orcid.org/0000-0003-2056-5909 Department of Dermatology, University of Montpellier, Montpellier, France Contribution: Data curation (equal), ​Investigation (equal), Writing - review & editing (equal)Search for more papers by this authorOlivier Dereure, Department of Dermatology, University of Montpellier, Montpellier, France Contribution: Funding acquisition (equal), Resources (equal), Supervision (supporting), Writing - review & editing (equal)Search for more papers by this authorNadia Raison-Peyron, Corresponding Author n-raison@chu-montpellier.fr orcid.org/0000-0002-7991-3165 Department of Dermatology, University of Montpellier, Montpellier, France Correspondence Dr Nadia Raison-Peyron, Department of Dermatology, Hôpital Saint Eloi, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France. Email: n-raison@chu-montpellier.fr Contribution: Conceptualization (equal), Data curation (equal), Funding acquisition (equal), ​Investigation (equal), Methodology (equal), Resources (equal), Supervision (lead), Validation (equal), Writing - original draft (supporting), Writing - review & editing (equal)Search for more papers by this author Quentin Samaran, orcid.org/0000-0002-0560-5493 Department of Dermatology, University of Montpellier, Montpellier, France Contribution: Conceptualization (equal), Data curation (equal), ​Investigation (equal), Validation (equal), Visualization (equal), Writing - original draft (lead), Writing - review & editing (equal)Search for more papers by this authorFarid Bekara, Department of Plastic and Reconstructive Surgery, Burns and Wound Healing Units, CHRU Lapeyronie, Montpellier University Hospital and Montpellier University, Montpellier, France Contribution: Data curation (equal), ​Investigation (equal), Writing - review & editing (equal)Search for more papers by this authorFaisal Aljaber, Department of Dermatology, University of Montpellier, Montpellier, France Contribution: Data curation (equal), ​Investigation (equal), Writing - review & editing (equal)Search for more papers by this authorEvangéline Clark, orcid.org/0000-0003-2056-5909 Department of Dermatology, University of Montpellier, Montpellier, France Contribution: Data curation (equal), ​Investigation (equal), Writing - review & editing (equal)Search for more papers by this authorOlivier Dereure, Department of Dermatology, University of Montpellier, Montpellier, France Contribution: Funding acquisition (equal), Resources (equal), Supervision (supporting), Writing - review & editing (equal)Search for more papers by this authorNadia Raison-Peyron, Corresponding Author n-raison@chu-montpellier.fr orcid.org/0000-0002-7991-3165 Department of Dermatology, University of Montpellier, Montpellier, France Correspondence Dr Nadia Raison-Peyron, Department of Dermatology, Hôpital Saint Eloi, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France. Email: n-raison@chu-montpellier.fr Contribution: Conceptualization (equal), Data curation (equal), Funding acquisition (equal), ​Investigation (equal), Methodology (equal), Resources (equal), Supervision (lead), Validation (equal), Writing - original draft (supporting), Writing - review & editing (equal)Search for more papers by this author First published: 11 July 2021 https://doi.org/10.1111/cod.13936Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Granulomatous dermatitis following the administration of various vaccines has previously been reported. However, cases of cutaneous granulomatosis following the measles, mumps, and rubella (MMR) vaccine have not yet been reported. We report the case of a 3‐year‐old boy with a granuloma annulare‐like reaction following MMR vaccination.

The authors declare no conflict of interests.

Background Anaphylaxis is a recognized public health issue. There is no doubt that food-induced anaphylaxis (FIA) has tremendous impact on the quality of life of patients and their families and increases direct and indirect costs. FIA is associated with increasing rates of emergency department admissions and hospitalizations and implies the risk of death. Morbidity epidemiological data are a key to tailor public health actions to this non-communicable disease. The aim of this article was to review published morbidity epidemiological data relating to FIA and potential risk factors, in order to provide evidence-based recommendations to reduce the risk of severe adverse outcomes. Methods We identified published studies available in PUBMED/MEDLINE (1966-2020), EMBASE (1980-2020) and CINAHL (1982-2020). The systematic review was carried out using MeSH terms related to FIA ED admissions and hospitalizations. Results A total of 25 articles were selected, 80% published in the last 5 years. After critical analysis of methodological and clinical characteristics reported in the data selected, we were able to propose preventive strategies. Conclusion Anaphylaxis is a recognized public health issue. FIA is associated with increasing rates of ED admissions and hospitalizations and imply in risk of death. More than reviewing and critically interpreting the key patterns related to FIA morbidity published data, we proposed strategies in order to promote quality care of patients suffering from FIA. Our World Health Organization Collaborative Center is deeply involved in this process, and we believe that the proposed strategies will inform future healthcare policies on anaphylaxis. The long-term objective would be to improve clinical care and quality of life of patients and their families, and develop risk-stratified, cost-effective preventive measures.

Today the educational community as a whole faces a universal challenge: to ensure equitable and quality education as well as effective and efficient evaluation of student learning in hybrid, flexible or 100% distance modalities for their students. In addition, we must also plan for the post-COVID-19 pandemic era. Centres for Teaching and Learning play a pivotal function in addressing and overcoming this challenge. In the midst of the pandemic, the centres, the equivalent services, and their teams of instructional designers, teaching and learning experts and multimedia developers became the first responders to support the pedagogical and digital transformation of all courses. The Centres became the academic heroes of COVID-19. They exceeded all expectations for what they could handle in this kind of emergency. The urgent requirement for these centres and their teams will persist until the war against the COVID19 pandemic is won, and the core of education is transformed. This white paper illuminates how Centres for Teaching and Learning, and equivalent entities addressed and plan to address trends and issues in digital learning in the context of educational disruption caused by COVID-19.

Contact DermatitisVolume 82, Issue 6 p. 395-397 CONTACT POINT Airborne allergic contact dermatitis caused by artichoke Quentin Samaran, Quentin Samaran orcid.org/0000-0002-0560-5493 Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, FranceSearch for more papers by this authorEvangeline Clark, Evangeline Clark Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, FranceSearch for more papers by this authorOlivier Dereure, Olivier Dereure Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, FranceSearch for more papers by this authorAgnès Sparsa, Agnès Sparsa Department of Internal Medicine, Clinique Mutualiste Catalane, Perpignan, FranceSearch for more papers by this authorAurélie Du-Thanh, Aurélie Du-Thanh Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, FranceSearch for more papers by this authorNadia Raison-Peyron, Corresponding Author Nadia Raison-Peyron n-raison@chu-montpellier.fr orcid.org/0000-0002-7991-3165 Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, France Correspondence Nadia Raison-Peyron, Department of Dermatology, Hôpital Saint Eloi, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France. Email: n-raison@chu-montpellier.frSearch for more papers by this author Quentin Samaran, Quentin Samaran orcid.org/0000-0002-0560-5493 Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, FranceSearch for more papers by this authorEvangeline Clark, Evangeline Clark Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, FranceSearch for more papers by this authorOlivier Dereure, Olivier Dereure Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, FranceSearch for more papers by this authorAgnès Sparsa, Agnès Sparsa Department of Internal Medicine, Clinique Mutualiste Catalane, Perpignan, FranceSearch for more papers by this authorAurélie Du-Thanh, Aurélie Du-Thanh Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, FranceSearch for more papers by this authorNadia Raison-Peyron, Corresponding Author Nadia Raison-Peyron n-raison@chu-montpellier.fr orcid.org/0000-0002-7991-3165 Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, France Correspondence Nadia Raison-Peyron, Department of Dermatology, Hôpital Saint Eloi, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France. Email: n-raison@chu-montpellier.frSearch for more papers by this author First published: 04 February 2020 https://doi.org/10.1111/cod.13480Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume82, Issue6June 2020Pages 395-397 RelatedInformation

Hilger C1, Clark E2, Swiontek K1, Chiriac AM3,4, Caimmi DP3,4, Demoly P3,4,5, Bourrain JL2,3 1Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg 2Department of Dermatology, CHU Montpellier, University of Montpellier I, Montpellier, France 3Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University, Hospital of Montpellier, Montpellier, France 4Sorbonne Université, INSERM UMR-S 1136, IPLESP, Equipe EPAR, Paris, France 5WHO Collaborating Centre on Scientific Classification Support, Montpellier, France

We read with deep interest the report by Tepasse et al.1 concerning two cases of persisting viraemia in coronavirus disease 2019 (COVID-19) with fatal outcome. Whilst severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in the early stages of infection has been well described, less is known about the development of antibodies to SARS-CoV-2, clearance of RNA shedding and clinical outcome of COVID-19. In addition, the impact of immunosuppressive treatments on disease severity is not yet established, but several reports suggest a more prolonged disease in patients under rituximab, a B-cell depleting drug.2-4 Here we report a case of persisting COVID-19, following combined treatment with rituximab and bendamustine for lymphoma, which immediately recovered after convalescent plasma transfusion. We think that this case raises promising perspectives for immunocompromised patients with persisting COVID-19. A 76-year-old woman was diagnosed in 2019 with orbital and meningeal marginal zone lymphoma in the context of probable unrecognised Sjögren's syndrome with positive salivary gland biopsy (focus score = 2). Bendamustine and rituximab were administrated on 12 February (70 mg/m2 of bendamustine) and 16 March 2020 (90 mg/m2), inducing a decay of lymphocyte count from 1410/µl on 11 February to 160/µl on 17 March 2020. Granulocyte-colony stimulating factor prophylaxis was started thereafter. She consulted her general practitioner on 26 March 2020 (Day 1) with fever, diarrhoea and deep fatigue. Home surveillance was initially decided. On 1 April (Day 7), she was referred to our hospital for severe pneumonia (tachypnoea, fever and desaturation requiring oxygen). Blood testing revealed lymphopenia (550/µl) in all lymphocytic subtypes: 88 lymphocyte T CD4 cells/µl (16·0%), 385 lymphocyte T CD8 cells/µl (69·6%), 3 lymphocyte B cells/µl (0·6%), 59 natural killer cells/µl (10·7%), associated with thrombocytopenia (65 × 109/l) and an inflammatory syndrome [neutrophilic leucocytosis of 25·11 × 103/µl and a C-reactive protein (CRP) of 24 mg/l]. Ground-glass bilateral opacities and consolidations were observed on chest computed tomography (CT). SARS-CoV-2 infection was confirmed by RNA reverse transcriptase-polymerase chain reaction (RT-PCR) on a nasopharyngeal swab. A combination of lopinavir/ritonavir was given between days 9 and 24. Faced with worsening of clinical symptoms (confusion and increased oxygen requirement) and extension of the opacities on chest CT, a treatment with prednisone (50 mg/day) for 7 days was introduced on day 27. Apyrexia and oxygen withdrawal ensued. However, symptoms relapsed within 48 h of prednisone withdrawal, and persisted during the sixth week of admission, requiring oxygen administration due to desaturation, relapse of fever. Follow-up chest CT on day 36 and day 44 showed an increase in ground-glass and consolidation opacities. SARS-CoV-2 RNA remained positive on 10 repeated nasopharyngeal swab tests (Fig 1). By contrast, SARS-CoV-2 antibodies remained undetectable at Day 47. Intravenous convalescent plasma obtained from SARS-CoV-2 survivors was administered starting at day 50 over 2 days, after obtaining the patient's informed consent, (2 units of 200 ml/day). No adverse events occurred. The patient tested positive for SARS-CoV-2 anti-nucleocapsid and anti-Spike immunoglobulin G (IgG) after the two first plasma units. Her health condition quickly improved, allowing definitively withdrawing oxygen, apyrexia ensued, and a decrease in CRP level within 24 h was objectified. SARS-CoV-2 RNA became undetectable on Day 57 and remained negative on Day 62. She returned home on Day 69 and completely recovered after 17 additional days of follow-up. To date, treatment of COVID-19 is still challenging and there is no specific recommended therapy. Despite the sequential introduction of different treatments, our patient experienced an unusual delayed clinical worsening, a persisting clinical infection and a prolonged viral shedding. Such a course is unusual, as the median time to clinical worsening is approximately 8–10 days. Furthermore, the median time until viral RNA clearance attested by PCR on a nasopharyngeal swab, is estimated around 17–24 days in hospitalised patients.5 Prolonged viral RNA shedding over 15 days is not infrequent, especially in elderly and severe COVID-19 cases.6 In patients with prolonged viral shedding, the symptoms had retrieved whilst SARS-COV-2 RNA remained detectable in pharyngeal swabs at day 54. Furthermore, in our patient, persistent pneumonia, abnormalities in the CT scan, and the levels of PCR cycle threshold values suggested a persisting viral replication and possible infectiousness. Seroconversion occurs after 7 days in 50% of patients and IgG are detected in >90% of patients after day 14·7 High viral loads are reported during the first week of COVID-19, when viral isolation of SARS-CoV-2 is possible. In the present case, spontaneous seroconversion never occurred, suggesting that the combination of bendamustine and rituximab induced an impairment of humoral and cellular response against SARS-CoV-2 due to persisting depletion of circulating CD4+ T and B cells. Indeed, bendamustine preferentially inhibits CD4+ lymphocytes,8 while rituximab deeply depletes humoral and B-cell responses to infections.9 Despite its reputation for good tolerance, rituximab may even induce severe life-threatening infections.10 Although rituximab does not directly affect CD20– plasma cells producing antibodies, the antibody production can be impaired, as well as the antibody response after vaccination. Other B-cell functions may be altered by rituximab, notably the antigen presentation and cellular interactions with T cells and monocytes/macrophages through interleukin 6 production.4 Thus, B-cell depleting drugs may delay the inflammatory response in COVID-19, which is tragically illustrated by a cytokine storm in the most severe cases, as illustrated by those reported by Tepasse et al.1 We think that hyperimmune plasma from convalescent patients could provide a valuable input against SARS-CoV-2 infection in patients' immunosuppressed with rituximab. In the present case, the rapid clinical improvement followed by viral clearance after administration of hyperimmune plasma argue that passively transferred antibodies played a key role in COVID-19 recovery. Convalescent plasma extracted from patients recovering from diverse infections contains neutralising antibodies against specific agents, and its efficacy has been diversely evaluated in patients with severe and acute COVID-19 infection.11 In the present case, the transfusion was well tolerated and no transfusion-related acute lung injury was observed.12 To the best of our knowledge, we describe the first case of favourable outcome following convalescent plasma transfusion, in an immunocompromised patient with persisting COVID-19. Administration of neutralising antibodies may be a possible therapeutic approach in patients with persisting COVID-19 symptomatology in the context of deep immunosuppression. Research reported in this publication included work performed in Montpellier University. The authors declare no competing financial interests. Evangéline Clark, Ionut L. Filip and Philippe Guilpain designed and wrote the paper. Edouard Tuaillon extracted virology data. All the authors revised the paper.

Oral Immunotherapy (OIT) to peanuts has been associated with an increased risk of anaphylaxis, with a risk ratio above 3 and need for epinephrine in about 25% of treated patients.[1] Main protocols start at a median dose of 0.5 mg of peanut proteins.[1] We are presenting preliminary data on a low-dose delayed dose increase OIT for peanuts, performed at the Allergy Unit of the University Hospital of Montpellier (France). We included 19 consecutive patients with a diagnosis of peanut allergy, reached through oral food challenge (OFC). We then decided to treat them with an OIT protocol, starting at the dose of 0.02 mg of peanut proteins. Doses were increased every 4 to 12 weeks, depending on the severity of the reported allergic reaction or of the results of the OFC (shorter delay in less severe patients). Patients had a median age of 12.7 years (min-max 5-31), 8 of them were females (42.1%). 6 of them had a clinical history of eczema (31.6%), 11 suffered from concomitant asthma (57.9%), 14 of them were atopic (73.7%), and 12 of them presented an allergy to another food (63.2%). 2 patients reported a clinical history of anaphylaxis (1 shock), 3 others had a clinical history of anaphylaxis and presented an anaphylactic reaction during the OFC (1 shock); 5 others presented an anaphylactic reaction during the OFC (1 shock. In total, 10 patients had a history or an OFC concluded because of anaphylaxis (52.6%) and 3 experienced an anaphylactic shock (15.8%). Patients underwent our local OIT protocol. Overall, they reached the average dose of 600 mg of peanut protein (median 400 mg). 10 patients (52.6%) tolerate now 400 mg of peanut, and 4 (21.1%) tolerate more than 1000 mg. No patient experienced any allergic reaction during the whole procedure, neither at the hospital, when doses were increased, nor at home, during maintenance phases. The present pilot study shows that peanut OIT starting at very low doses and with delayed doses increases, as proposed by our protocol, seems an effective and safe procedure even in patients having experienced peanut anaphylaxis.

Corticosteroids (CS) are among the most prescribed drugs in pediatrics. In allergy, CS are prescribed for several different conditions. If CS show clear benefits when adequately prescribed, CS are also associated with several side effects, well known by pediatricians. As for asthma exacerbations, the oral route is always the preferred one in pediatrics. Several authors debated if the use of a single dose of dexamethasone is better in terms of efficacy, compared with a 3‐ to 5‐day course of prednisone or prednisolone. Another interesting issue that has not been fully clarified concerns whether oral corticosteroids should be prescribed in preschoolers presenting with acute wheezing. The present review aims to review the most recent publications on this topic and to try to clarify which may be the best option in children suffering from asthma exacerbations.