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Keywords: allergy prevention; infant weaning; peanut allergy EN allergy prevention infant weaning peanut allergy 372 375 4 03/15/23 20230301 NES 230301 Key messages Peanut allergy is lower in the Irish CORAL cohort than infants born before early peanut exposure recommendations. Egg allergy incidence at 2 years may reflect the use of baked egg ladders in all infants with egg allergy.[[1]] Food Frequency Questionnaire data on egg and peanut consumption are outlined in Table 1. Peanut sensitization doubled between 12 and 24 months of age in the BASELINE cohort.[3] While AD has been higher in the CORAL pandemic cohort,[2] peanut sensitization and peanut and egg allergy are much lower at 24 months. [Extracted from the article]

Thus, even if it does not seem to be mandatory sending to an allergy workup all these patients, it can still be useful to make an allergy evaluation as even a low % detection rate can help patients' management (since test specificity if often close to 100%) in order to give indication about avoiding drugs in the future. Keywords: children; erythema multiforme; hypersensitivity drug reaction; lymphocyte transformation test; Mycoplasmapneumoniae; Mycoplasma-induced rash and mucositis; paediatrics; Stevens-Johnson syndrome EN children erythema multiforme hypersensitivity drug reaction lymphocyte transformation test Mycoplasmapneumoniae Mycoplasma-induced rash and mucositis paediatrics Stevens-Johnson syndrome 740 744 5 05/08/21 20210501 NES 210501 To the Editor, I Mycoplasma pneumoniae i (MP) infection is a common cause of community-acquired pneumonia in children sometimes associated with intriguing mucocutaneous manifestations variable in severity such as erythema multiforme (EM) or Stevens-Johnson syndrome (SJS).1 Various papers attempted to distinguish the clinical features of MP-associated diseases, but the topic is still confusing, ending in conflicting classifications.2-6 A systematic review suggested that they should be considered as distinct entities from the genuine drug-induced SJS, introducing the term ' I Mycoplasma i -induced rash and mucositis' (MIRM).7 Other authors used the expression ' I Mycoplasma pneumoniae i -associated mucositis' (MPAM) to distinguish a variant with isolated mucosal involvement without rash.8 Recently, MIRM have been included in a larger group called RIME (reactive infectious mucocutaneous eruption).9 Erythema multiforme is a cutaneous rash characterized by typical target lesions. Children, erythema multiforme, hypersensitivity drug reaction, lymphocyte transformation test, Mycoplasmapneumoniae, Mycoplasma-induced rash and mucositis, paediatrics, Stevens-Johnson syndrome. [Extracted from the article]

A152 Patient-responsive paediatric allergy care pathways: Creating safe and efficient acceptance,... Serena Braccio 1; Penny Salt 1; Natalie Bishop 2; Louise Long 1; Sean Harrison 1; Dalbir... 1 University College London Hospital, London, UK; 2 University College London, London, UK B Objectives: b Due to our long waiting list, we have lost our ability to be responsive to patients who are at risk of severe allergic reactions due to delay in diagnosis or those with multi-allergic disease affecting their quality of life. A043 Development of a regional paediatric egg allergy management pathway Anna Rucker 1; Cherry Alviani 2; Penny Barnard 3; Isabelle Brady 2; Rachel Freer 4; Lucy... 1 Royal Surrey County Hospital, Guildford, UK; 2 University Hospital Southampton, Southampton... B Objectives: b I Aims i : The BSACI 2021 guideline for the management of egg allergy recommends managing mild egg allergy in infants with education and gradual egg reintroduction at home, without prior allergy tests or referral to secondary care. A055 Using electronic patient records to identify IgE-mediated milk allergy patients who have not... William Tan 1,2; Andrew Clark 2; Amruta Fulmali 2; Zaraquiza Zolkipli 2; Rebecca Tibbott... 1 University of Cambridge, Cambridge, UK; 2 Cambridge University Hospitals, Cambridge, UK B Objectives: b Early-life milk reintroduction, following diagnosis of IgE-mediated milk allergy, may protect against persistent milk allergy and thereby reduce risk and improve quality of life. A084 Two cases of lipid transfer protein allergy in a tertiary paediatric allergy centre Felicity Norris; Briony Stone; David Luyt; Gary Stiefel Leicester Children's Hospital, Leicester, UK B Objectives: b I Background i : LTP allergy is anecdotally increasingly common within paediatric allergy clinics which presents clinical challenges particularly for management. [Extracted from the article]

Retrospective questionnaires are used since decades to assess the severity and/or control of allergic diseases. Applications on smartphones have recently facilitated the use of prospective clinical diaries, based on questionnaires filled every day by the patient. Once limited to clinical trials, these e‐diaries, based on validated disease control scores and visual analogue scales, permit a quantitative day‐by‐day measure free of recall bias. Given the advantages of this procedure, its use could be extended to the daily clinical practice. E‐diaries may facilitate (1) a more precise identification of the culprit allergen in the diagnostic work‐up of poly‐sensitized patients, (2) the stratification of patients for treatment, (3) the follow‐up of the patients under treatment for optimized shared decision‐making, and (4) a careful assessment of preventive therapies. While a few apps are being used in scientific studies, consensus on their use in daily practice should be reached and guidelines for specialists should be elaborated by scientific associations. [ABSTRACT FROM AUTHOR]

Background: Previous systematic reviews have focused on associations between single time point measures of Body Mass Index (BMI) and asthma and allergic diseases. As BMI changes dynamically during childhood, examination of associations between longitudinal trajectories in BMI and allergic diseases is needed to fully understand the nature of these relationships. Objective: To systematically synthesise the association between BMI trajectories in childhood (0–18 years) and allergic diseases (asthma, eczema, allergic rhinitis, or food allergies outcomes). Design: We conducted a systematic review following the PRISMA guidelines, and two independent reviewers assessed the study quality using the ROBINS‐E and GRADE tools. A narrative synthesis was performed as the statistical heterogeneity did not allow a meta‐analysis. Data Sources: A search was performed on PubMed and EMBASE databases on 4th January 2023. Eligibility Criteria: Longitudinal cohort studies assessing the associations between childhood BMI trajectories and allergic diseases were included. Results: Eleven studies met the inclusion criteria with a total of 37,690 participants between 0 and 53 years of age. Ten studies examined asthma outcomes, three assessed association with allergic rhinitis, two assessed eczema, and one assessed food allergy. High heterogeneity and high risk of bias were observed. Overall, the quality of evidence was very low. Nevertheless, two consistent findings were identified: (1) a persistently high BMI between 6 and 10 years of age may be associated with an increased risk of asthma at 18 years and (2) a rapid increase in BMI in the first 2 years of life may be associated with subsequent asthma. Conclusions: Maintaining a normal BMI trajectory during childhood may reduce the risk of asthma. Future research that adequately addresses confounding and includes longer‐term follow‐up is needed. Moreover, additional studies examining potential associations with eczema, food allergies, and allergic rhinitis outcomes are needed. [ABSTRACT FROM AUTHOR]

Keywords: delabeling; drug allergy; drug provocation test; penicillin allergy; penicillin allergy labels EN delabeling drug allergy drug provocation test penicillin allergy penicillin allergy labels 969 973 5 09/05/23 20230901 NES 230901 Key messages Correct penicillin allergy labels are crucial for patient safety and correct patient management. Twenty-nine patients with a disproved allergy still had an incorrect penicillin allergy label in the hospital EMR, and of those, 16 (55.1%) also had an incorrect penicillin allergy label in primary care. The primary aim of this study was to investigate the degree of match/mismatch between penicillin allergy labels in hospital and primary care EMR systems in patients who had undergone penicillin allergy investigation in a hospital allergy clinic. Among patients with a disproved allergy, 93 patients (21.4%) still had an incorrect penicillin allergy label in primary care (79 GP clinics). [Extracted from the article]

In Denmark, tests for specific IgE to penicillins have been used routinely for many years in penicillin allergy investigation. Keywords: anaphylaxis; drug allergy; drug hypersensitivity; immediate type hypersensitivity; penicillin; penicillin allergy; penicillin minor determinants; specific IgE; specific IgE to penicillins EN anaphylaxis drug allergy drug hypersensitivity immediate type hypersensitivity penicillin penicillin allergy penicillin minor determinants specific IgE specific IgE to penicillins 887 890 4 08/14/23 20230801 NES 230801 Key points Specific IgE to penicillins have been recommended in the context of immediate-type allergic reactions. Our study shows that compared to the four commonly used specific IgE assays for penicillins specific IgE MD was positive in a further 29.4% of patients with suspicion of penicillin hypersensitivity, which might increase the sensitivity of penicillin sIgE testing. [Extracted from the article]

India is the home of nearly 20% of the global population with 1.35 billion people. Of all non‐communicable diseases, allergic diseases such as allergic rhinitis (AR) and asthma appear to have increased in India over the past decades. Approximately 22% of adolescents currently suffer from AR in India. However, owing to the lack of adequate epidemiological studies in India, particularly in rural and suburban areas, this number may misrepresent the true burden of this disease. While the risk factors for AR are mainly environmental exposures or genetic factors, several new environmental, social, and behavioural risk factors such as the presence of dumpsters near residences, movement of vehicles near homes, and exposure to artificial light at night have been found to be associated with AR. However, despite international guidelines, the diagnosis and management of AR in India are often suboptimal, for multiple reasons such as the lack of specialized training in allergy and immunology among Indian clinicians, the lack of diagnostic facilities, and the high cost of medications. This review aims at highlighting the current scenario of AR in India and how it differs from the rest of the world. It also highlights the need for developing a strategic approach to enhance the quality of care for allergic diseases by upgrading education and training for healthcare professionals, creating awareness among clinicians and patients, and involving stakeholders and policymakers in making treatments accessible and affordable to patients. [ABSTRACT FROM AUTHOR]

Allergic diseases such as bronchial asthma, rhinitis and eczema are an important public health issue globally in 21st century. Their prevalence and impact in India is high, in terms of total numbers of people affected. Due to diverse climate and lifestyle, the Indian population is exposed to a rich and varied range of aerobiological particles. In the last two decades in India, 83 pollens, 34 fungi, six dust mite and 19 insect species were reported as allergenic, often contributing to heavy allergenic exposure in indoor and outdoor environments. There are currently few practitioners who offer allergy diagnosis and treatment in India, but there is active basic and molecular research aiming to improve the health of allergic patients. This review explores the field of aero‐allergy in India during the last two decades, with special emphasis on prevalence across various centres and relevant scientific advances such as genetic associations and new therapeutics. This review will be helpful for clinicians to select aero‐allergens for sensitisation testing in patients suffering from symptoms in different regions of India, and to support patients undertaking prophylaxis of allergic symptoms in India according to local environmental conditions. This study also helps to define patient selection for allergy testing and the role of test results in guiding allergic disease management in the Indian context. Finally, we summarize genetic findings relevant to aero‐allergy in India and discuss the development of novel therapeutics for investigation and management of aero‐allergy in India. [ABSTRACT FROM AUTHOR]

Dual intracellular staining of CD154 (CD40L) and cytokines at single-cell level: A novel aid to document immediate hypersensitivity to amoxicillin Actually, 11/15 (73%) patients demonstrated a positive CD154/IL-4 LAT (e.g. a net expression of CD154 and/or IL-4 higher than the respectively maximal values observed in tolerant controls). Keywords: amoxicillin; CD154; cytokines; flow cytometry; IFN- ; IL-4; immediate drug hypersensitivity EN amoxicillin CD154 cytokines flow cytometry IFN- IL-4 immediate drug hypersensitivity 679 682 4 06/09/23 20230601 NES 230601 Key messages Multichromatic flow cytometry enables simultaneous analysis of intracellular CD154, IL-4 and IFN- in drug-reactive T lymphocytes. In conclusion, flow-based combined analysis of intracellular expression of CD154, IL-4 and IFN- by AXE-reactive T lymphocytes is an attractive approach for safe diagnosis of immediate amoxicillin hypersensitivity reactions. [Extracted from the article]

Reports on the British Society of Allergy and Clinical Immunology's position paper on latex allergy. Types of allergic reaction to latex; Allergenicity of dry rubber.

The association between Hymenoptera venom‐triggered anaphylaxis (HVA) and clonal mast cell‐related disorders (cMCD) has been known for decades. However, recent breakthroughs in peripheral blood screening for KIT p.D816V missense variant have revealed the true extent of this clinical association whilst adding to our understanding of the underlying aetiology. Thus, recent large studies highlighted the presence of KIT p.D816V among 18.2% and 23% of patients with severe Hymenoptera venom‐triggered anaphylaxis. A significant proportion of those patients have normal serum basal tryptase (BST) levels, with no cutaneous findings such as urticaria pigmentosa or other systemic findings such as organomegaly that would have suggested the presence of cMCD. These findings of an increased prevalence suggest that the impact of cMCD on anaphylaxis could be clinically underestimated and that the leading question for clinicians could be changed from 'how many patients with cMCD have anaphylaxis?' to 'how many patients with anaphylaxis have cMCD?'. The discovery of hereditary α‐tryptasemia (HαT)—a genetic trait caused by an increased copy number of the Tryptase Alpha/Beta 1 (TPSAB1) gene‐, first described in 2016, is now known to underlie the majority of cases of elevated BST outside of cMCD and chronic kidney disease. HαT is the first common heritable genetic modifier of anaphylaxis described, and it is associated with increased risk for severe HVA (relative risk = 2.0), idiopathic anaphylaxis, and an increased prevalence of anaphylaxis in patients with cMCD, possibly due to the unique activity profile of α/β ‐tryptase heterotetramers that may potentiate immediate hypersensitivity reaction severity. Our narrative review aims to highlight recent research to have increased our understanding of cMCD and HαT, through recent lessons learned from studying their association with HVA. Additionally, we examined the studies of mast cell‐related disorders in food and drug allergy in an effort to determine whether one should also consider cMCD and/or HαT in cases of severe anaphylaxis triggered by food or drugs. [ABSTRACT FROM AUTHOR]

Epidemiological studies have shown a rise in the prevalence of allergic diseases in India during the last two decades. However, recent evidence from the Global Asthma Network study has observed a decrease in allergic rhinitis, asthma and atopic dermatitis in children. Still, with a population over 1.3 billion, there is a huge burden of allergic rhinitis, asthma and atopic dermatitis, and this is compounded by an unmet demand for trained allergy specialists and poor health service framework. There is wide variation in the prevalence of allergic diseases between different geographical locations in India, and the reasons are unclear at present. This may at least in part be attributable to considerable heterogeneity in aero‐biology, weather, air pollution levels, cultural and religious factors, diet, socioeconomic strata and literacy. At present, factors enhancing risks and those protecting from development of atopy and allergic diseases have not been well delineated, although there is some evidence for the influence of genetic factors alongside cultural and environmental variables such as diet, exposure to tobacco smoke and air pollution and residence in urban areas. This narrative review provides an overview of data from India regarding epidemiology, risk factors and genetics and highlights gaps in evidence as well as areas for future research. [ABSTRACT FROM AUTHOR]

Food allergy affects a small but important number of children and adults. Much of the morbidity associated with food allergy is driven by the fear of a severe reaction and fatalities continue to occur. Foods are the commonest cause of anaphylaxis. One of the aims of the European Union‐funded Integrated Approaches to Food Allergen and Allergy Risk Management (iFAAM) project was to improve the identification and management of children and adults at risk of experiencing a severe reaction. A number of interconnected studies within the project have focused on quantifying the severity of allergic reactions; the impact of food matrix, immunological factors on severity of reactions; the impact of co‐factors such as medications on the severity of reactions; utilizing single‐dose challenges to understand threshold and severity of reactions; and community studies to understand the experience of patients suffering real‐life allergic reactions to food. Associated studies have examined population thresholds and co‐factors such as exercise and stress. This paper summarizes two workshops focused on the severity of allergic reactions to food. It outlines the related studies being undertaken in the project indicating how they are likely to impact on our ability to identify individuals at risk of severe reactions and improve their management. [ABSTRACT FROM AUTHOR]

Innate immune cells experience long lasting metabolic and epigenetic changes after an encounter with specific stimuli. This facilitates enhanced immune responses upon secondary exposition to both the same and unrelated pathogens, a process termed trained immunity. Trained immunity‐based vaccines (TIbV) are vaccines able to induce innate immune memory, thus conferring heterologous protection against a broad range of pathogens. While trained immunity has been well documented in the context of infections and multiple immune‐mediated diseases, the role of innate immune memory and its contribution to the initiation and maintenance of chronic allergic diseases remains poorly understood. Over the last years, different studies attempting to uncover the role of trained immunity in allergy have emerged. Exposition to environmental factors impacting allergy development such as allergens or viruses induces the reprogramming of innate immune cells to acquire a more pro‐inflammatory phenotype in the context of asthma or food allergy. Several studies have convincingly demonstrated that prevention of viral infections using TIbV contributes to reduce wheezing attacks in children, which represent a high‐risk factor for asthma development later in life. Innate immune cells trained with specific stimuli might also acquire anti‐inflammatory features and promote tolerance, which may have important implications for chronic inflammatory diseases such as allergies. Recent findings showed that allergoid‐mannan conjugates, which are next generation vaccines for allergen‐specific immunotherapy (AIT), are able to reprogram monocytes into tolerogenic dendritic cells by mechanisms depending on metabolic and epigenetic rewiring. A better understanding of the underlying mechanisms of trained immunity in allergy will pave the way for the design of novel trained immunity‐based allergen vaccines as potential alternative strategies for the prevention and treatment of allergic diseases. [ABSTRACT FROM AUTHOR]

Background: Comprehensive national assessments of paediatric allergy services are rarely undertaken, and have never been undertaken in the United Kingdom. A 2006 survey estimated national capacity at 30,000 adult or paediatric new allergy appointments per year and identified 58 hospital clinics offering a paediatric allergy service. Objective: The UK Paediatric Allergy Services Survey was the first comprehensive assessment of UK paediatric allergy service provision. Methods: All 450 UK hospitals responded to a survey. Paediatric allergy services are provided in 154 lead hospitals with 75 further linked hospitals. All 154 lead paediatric allergy services completed a detailed questionnaire between February 2019 and May 2020. Results: The 154 paediatric allergy services self‐define as secondary (126/154, 82%) or tertiary (28/154, 18%) level services. The annual capacity is 85,600 new and 111,400 follow‐up appointments. Fifty‐eight percent (85/146) of services offer ≤10 new appointments per week (no data provided from 8 services—2 no response, 6 unknown) and 50% (70/139) of the services undertaking challenges undertake ≤2 food or drug challenges per week (no data from 3 challenge services). Intramuscular adrenaline is rarely used during challenges—median annual frequency 0 in secondary services and 2 in tertiary services. Allergen‐specific immunotherapy is offered in 39% (60/154) of services, with 71% (41/58) of these centres treating ≤10 patients per annum (no data from 2 immunotherapy services). The 12 largest services see 31% of all new paediatric allergy appointments, undertake 51% of new immunotherapy patient provision and 33% of food or drug challenges. Seventy percent (97/126) of secondary and all tertiary services are part of a regional paediatric allergy network. Only nine services offer immunotherapy for any food (3 for peanut), 10 drug desensitization and 18 insect venom immunotherapy. Conclusions: There has been a fourfold increase in paediatric allergy clinics and an approximately sevenfold increase in new patient appointment numbers in the United Kingdom over the past 15 years. Most services are small, with significant regional variation in availability of specific services such as allergen immunotherapy. Our findings emphasize the need for national standards, local networks and simulation training to ensure consistent and safe service provision. [ABSTRACT FROM AUTHOR]

The Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and a committee of experts and key stakeholders have developed this guideline for the evaluation and testing of patients with an unsubstantiated label of penicillin allergy. The guideline is intended for UK clinicians who are not trained in allergy or immunology, but who wish to develop a penicillin allergy de‐labelling service for their patients. It is intended to supplement the BSACI 2015 guideline "Management of allergy to penicillin and other beta‐lactams" and therefore does not detail the epidemiology or aetiology of penicillin allergy, as this is covered extensively in the 2015 guideline (1). The guideline is intended for use only in patients with a label of penicillin allergy and does not apply to other beta‐lactam allergies. The recommendations include a checklist to identify patients at low risk of allergy and a framework for the conduct of drug provocation testing by non‐allergists. There are separate sections for adults and paediatrics within the guideline, in recognition of the common differences in reported allergy history and likelihood of true allergy. [ABSTRACT FROM AUTHOR]

Food allergy is a major public health concern with avoidance of the trigger food(s) being central to management by the patient. Food information legislation mandates the declaration of allergenic ingredients; however, the labelling of the unintentional presence of allergens is less defined. Precautionary allergen labelling (PAL) was introduced by the food industry to help manage and communicate the risk of reaction from the unintended presence of allergens in foods. In its current form, PAL is counterproductive for consumers with food allergies as there is no standardized approach to applying PAL. Foods with a PAL often do not contain the identified food allergen while some products without a PAL contain quantities of common food allergens that are capable of inducing an allergic reaction. Integrated Approaches to Food Allergen and Allergy Risk Management (iFAAM) was an EU‐funded project that aimed to improve the management of food allergens by the food industry for the benefit of people with food allergies. Within iFAAM, a clinically validated tiered risk assessment approach for food allergens was developed. Two cross‐stakeholder iFAAM workshops were held on 13‐14 December 2016 and 19‐20 April 2018. One of the objectives of these workshops was to develop a proposal to make PAL effective for consumers. This paper describes the outcomes from these workshops. This provides the basis for the development of more informative and transparent labelling that will ultimately improve management and well‐being in consumers with food allergy. [ABSTRACT FROM AUTHOR]

Cites a study on the role of mite and pet allergens in the prevalence of allergic diseases in Great Britain. Identification of allergic diseases caused by airborne allergens that are found in British homes; Efforts of the researchers to define the threshold amounts of mite allergens and mites that will produce sensitization; Assessment on the efficacy and safety of methods of allergen eradication and avoidance; Recommendations about the use of anti-allergen products and their regulation.

Background: An increasing interest in the field of molecular diagnosis of allergy has been developed in recent years and it goes to be as the routine in vitro protocol in allergy diagnosis. friendly allergen nano-bead array (FABER) is a new multiplex assay for the evaluation of specific IgE against 244 allergens including whole extracts and allergenic molecules. The research intended to assess the pattern of IgE sensitization to allergenic components of allergens in allergic adults using FABER 244. Methods: Sixty patients with allergic diseases entered this cross-sectional study. Specific IgE to 122 whole allergens extracts and 122 allergenic components were assessed using an allergen nano-bead array (FABER) for all patients. This test includes inhalant and food allergens. Results: Thirty-seven patients were male (61.7%). The mean (SD) age of patients was 30.73(±6.87) years. As the allergen nano-bead array results showed, Lolium perenne (63.3%), Phleum pratense (60%) and Platanus acerifolia (51.7%) were considered as the most common IgE sensitizations to the aeroallergen extracts. Moreover, Lol p 1, Phl p 1.0102 and Cup a 1 were found as the most frequent allergenic components in our allergic patients. Among protein families, CCD-bearing proteins, expansin, cysteine protease and profilin families illustrated the highest allergic sensitization. Conclusions: The results of the present study demonstrated that despite the higher prevalence of sensitization to Salsola kali (47.2%) using extract-based assays in the previous phase of this research, allergenic components of grasses (Lol p 1, Phl p 1.0102), Cup a 1 as well as Sal k1 as the major components of Cupressuss arizonica and Salsola kali showed the higher sensitization, respectively, in adults' allergic patients using FABER test. [ABSTRACT FROM AUTHOR]

Summary: Background: Prenatal maternal stress may influence offspring's atopic risk through sustained cortisol secretion resulting from activation of the hypothalamic‐pituitary axis (HPA), leading to Th2‐biased cell differentiation in the foetus. We undertook a systematic review and meta‐analysis investigating the relationship between prenatal maternal psychosocial stress and risk of asthma and allergy in the offspring. Methods: We searched 11 electronic databases from 1960 to 2016, searched the grey literature and contacted experts in the field. Type of stress indicator included mood disorders, anxiety, exposure to violence, bereavement and socio‐economic problems occurring during pregnancy, both objectively and subjectively measured. We included all possible asthma and IgE‐mediated allergy outcomes. We conducted random‐effects meta‐analyses to synthesize the data. Results: We identified 9779 papers of which 30 studies (enrolling >6 million participants) satisfied inclusion criteria. The quality of 25 studies was moderate, 4 were strong, and one was weak. Maternal exposure to any type of stressors was associated with an increased risk of offspring atopic eczema/dermatitis (OR 1.34, 95% CI 1.22‐1.47), allergic rhinitis (OR 1.30, 95% CI 1.04‐1.62), wheeze (OR 1.34, 95% CI 1.16‐1.54) and asthma (OR 1.15, 95% CI 1.04‐1.27). Exposure to anxiety and depression had strongest effect compared to other stressors. Exposure during the third trimester had the greatest impact compared to first and second trimesters. The increased risk was stronger for early‐onset and persistent than for late‐onset wheeze. Bereavement of a child (HR 1.28, 95% CI 1.10‐1.48) or a spouse (HR 1.40, 95% CI 1.03‐1.90) increased the risk of offspring asthma. Conclusions: Exposure to prenatal maternal psychosocial stress was associated with increased risk, albeit modestly, of asthma and allergy in the offspring. The pronounced risk during the third trimester may represent cumulative stress exposure throughout pregnancy rather than trimester‐specific effect. Our findings may represent a causal effect or a result of inherent biases in studies, particularly residual confounding. [ABSTRACT FROM AUTHOR]

The article provides information on the changes in the journal "Clinical and Experimental Allergy." The vision for the journal is based on three principles which is to serve the allergy community to the best of their ability, to publish the best papers and to lead allergy opinion. The author said that they will maintain the tradition of giving equal weight to all disciplines within the field of asthma and allergic disease.

The COVID‐19 pandemic raised acute awareness regarding inequities and inequalities and poor clinical outcomes amongst ethnic minority groups. Studies carried out in North America, the UK and Australia have shown a relatively high burden of asthma and allergies amongst ethnic minority groups. The precise reasons underpinning the high disease burden are not well understood, but it is likely that this involves complex gene–environment interaction, behavioural and cultural elements. Poor clinical outcomes have been related to multiple factors including access to health care, engagement with healthcare professionals and concordance with advice which are affected by deprivation, literacy, cultural norms and health beliefs. It is unclear at present if allergic conditions are intrinsically more severe amongst patients from ethnic minority groups. Most evidence shaping our understanding of disease pathogenesis and clinical management is biased towards data generated from white population resident in high‐income countries. In conjunction with standards of care, it is prudent that a multi‐pronged approach towards provision of composite, culturally tailored, supportive interventions targeting demographic variables at the individual level is needed, but this requires further research and validation. In this narrative review, we provide an overview of epidemiology, sensitization patterns, poor clinical outcomes and possible factors underpinning these observations and highlight priority areas for research. [ABSTRACT FROM AUTHOR]

In children with mild reactions, a simplified algorithm avoiding skin and serum testing is efficacious to manage penicillin allergy and is gaining support from the academic field. Ruling out drug allergy is always advisable as these mild clinical presentations have proven to be poor predictors of true allergy.2 Although these conditions are among the most frequent causes of allergy referral, their management is still controversial. While penicillin allergy-labels are usually acquired in childhood and up to 20% of the general population self-denominate as penicillin-allergic, only less than 6% of these are confirmed after proper work up. Allergic reactions to beta-lactam antibiotics, specifically aminopenicillin, are the most common cause of adverse drug reactions reported in children and adults.1 A substantial number of children treated with beta-lactams (BLs) develop delayed maculopapular exanthema or urticaria, and the most frequent aetiology for these symptoms is either infectious or unknown. [Extracted from the article]

The yellow‐legged or Asian wasp (Vespa velutina nigrithorax) has spread rapidly across Europe since its first introduction in France, in 2004. Originally from South‐East Asia, it is considered an invasive species outside its native region. Apart from the ecological and economic implications of its presence, it may cause health problems to humans due to the toxic and allergenic components of its venom. Vespa velutina nigrithorax has become the most prevalent cause of anaphylaxis due to Hymenoptera venom in some regions of Spain. Although sIgE against both antigen 5 (Vesp v 5) and A1‐phospholipase (Vesp v 1) has been detected in these patients, only Vesp v 5 may be considered a dominant allergen. Interestingly, Vesp v 1 appears to be a glycosylated allergen different from A1‐phospholipases from other species. Inhibition studies suggest that Vespula spp venom could behave as primary sensitizer. Besides, changes in sIgE and sIgG4 during Vespula venom immunotherapy in patients with anaphylaxis due to V. velutina support the use of Vespula venom extracts to treat these patients. The purpose of this review is to explore the biological behaviour of V. velutina and to summarize the current knowledge of the allergic reactions provoked by this wasp. [ABSTRACT FROM AUTHOR]

In the first of two papers we described the development in the field of allergy mechanisms as described by Clinical and Experimental Allergy in 2015. Experimental models of allergic disease, basic mechanisms, clinical mechanisms and allergens are all covered. A second paper will cover clinical aspects. [ABSTRACT FROM AUTHOR]

Sensitization to lipid transfer protein (LTP), the most frequent cause of food allergy in southern Europe, still shows several controversial, but also intriguing, aspects. Some of these include the degree of cross‐reactivity between LTPs from botanically distant sources, the definition of risk factors, the role of some cofactors, clinical outcomes, geographical differences and the identification of the primary sensitizer in different areas. This review article tries to analyse and comment on these aspects point by point suggesting some explanatory hypotheses with the final scope to stimulate critical thoughts and elicit the scientific discussion about this issue in the readership. [ABSTRACT FROM AUTHOR]

Background: Serum total tryptase has been shown to increase during acute allergic reactions (acute tryptase, TA); however, few studies have investigated the values of TA or a combination of TA and baseline tryptase (TB) to discriminate positive from negative testing in perioperative hypersensitivity reaction (POH) allergy work‐up. The aim of this study was to determine the diagnostic performance of TA in order to differentiate positive from negative allergy testing suspected POH and analyse the diagnostic performance of serial tryptase levels using several formulas. Methods: All patients from the University hospital of Montpellier and Strasbourg, France, who presented with suspected POH and underwent complete drug allergy work‐up between March 2011 and December 2019 with available TA and TB were included. Four formulas, including a change in TA > 11 (F1), or >2 + 1.2 × TB (F2), or >3 + TB (F3), or >120%TB (F4), were applied. Results: One hundred and sixty‐two patients were included, and 131 of them (80.8%) had Grade III or IV reactions. Ninety patients had positive allergy testing. The optimal cut‐off value of TA to distinguish positive from negative allergy testing patients was 9.8 μg/L with an AUC of 0.817 (95% CI: 0.752–0.882, p <.001). The 93% PPV threshold for TA was 33 μg/L (95.8% specificity). Paired tryptase levels according to formulas F2 and F3 yielded the highest Youden index (0.54 and 0.53, respectively). Conclusion: The optimal cut‐off point for TA for distinguishing positive from negative allergy testing suspected POH was 9.8 μg/L. TA value of 33 μg/L was required to achieve >90% PPV. [ABSTRACT FROM AUTHOR]

Background: Deaths attributed to Coronavirus Disease 2019 (COVID‐19) are mainly due to severe hypoxemic respiratory failure. Although the inflammatory storm has been considered the main pathogenesis of severe COVID‐19, hypersensitivity may be another important mechanism involved in severe cases, which have a perfect response to corticosteroids (CS). Method: We detected the serum level of anti‐SARS‐CoV‐2–spike S1 protein‐specific IgE (SP‐IgE) and anti‐SARS‐CoV‐2 nucleocapsid protein‐specific IgE (NP‐IgE) in COVID‐19. Correlation of levels of specific IgE and clinical severity were analysed. Pulmonary function test and bronchial provocation test were conducted in early convalescence of COVID‐19. We also obtained histological samples via endoscopy to detect the evidence of mast cell activation. Result: The levels of serum SP‐IgE and NP‐IgE were significantly higher in severe cases, and were correlated with the total lung severity scores (TLSS) and the PaO2/FiO2 ratio. Nucleocapsid protein could be detected in both airway and intestinal tissues, which was stained positive together with activated mast cells, binded with IgE. Airway hyperresponsiveness (AHR) exists in the early convalescence of COVID‐19. After the application of CS in severe COVID‐19, SP‐IgE and NP‐IgE decreased, but maintained at a high level. Conclusion: Hypersensitivity may be involved in severe COVID‐19. [ABSTRACT FROM AUTHOR]

To the Editor, Although relatively rare, immediate perioperative hypersensitivity reactions (POH) are important complications of drug administration prior to, during and after surgical and other interventional procedures. Keywords: anaphylaxis; drug allergy; drug hypersensitivity reaction; general anaesthesia; perioperative EN anaphylaxis drug allergy drug hypersensitivity reaction general anaesthesia perioperative 192 196 5 01/05/22 20220101 NES 220101 Key messages In 39.4% of patients with a perioperative hypersensitivity reaction the culprit could be identified Reactions were most frequently caused by antibiotics particularly cefazoline Other culprits include NMBA, patent blue dye and chlorhexidine, comparable to current literature. Anaphylaxis, drug allergy, drug hypersensitivity reaction, general anaesthesia, perioperative The proportion of sensitization was comparable to other studies for chlorhexidine (9.8%)3,5 and NRL (4.9%).8 In 39% and 21% of the referred patients, a drug hypersensitivity was definite or probable. [Extracted from the article]

In this study, we focused on the relationship between severity and IgE reactivity against fish collagen, and our results suggest that it may be possible to detect patients with severe fish allergy by measuring collagen-specific IgE. Recently, the clinical relevance of fish collagen was investigated in a large patient population ( I n i = 101).9 The inclusion of relevant collagen allergens in routine diagnosis has shown to improve the ability to accurately diagnose fish allergy. Keywords: allergen component; anaphylaxis; component-resolved diagnostics; ELISA; fish collagen EN allergen component anaphylaxis component-resolved diagnostics ELISA fish collagen 183 187 5 01/05/22 20220101 NES 220101 Key Message We investigated the relationship between symptom severity and IgE reactivity to specific allergens in fish. Sensitivity to fish collagen is under-reported because of solubility problems and false-negative SPT results.10 SPT, using heated fish extract, is very useful for diagnosing fish collagen-induced allergy. [Extracted from the article]

While 2020 will be remembered for the global coronavirus pandemic, there were also important advances in the field of allergy. In this review article, we summarize key findings reported in Clinical and Experimental Allergy during 2020. We hope this provides readers with an accessible snapshot of the work published in our journal during this time. [ABSTRACT FROM AUTHOR]

Integration of the Toolkit into the allergy AHPs annual appraisal would ensure maintenance of anaphylaxis competency and potentially positively impact patient care, improving patient outcomes. Allergy testing in children with low-risk penicillin allergy symptoms. B Conclusions: b Using a simple algorithm at vaccination hubs with easy access to virtual allergy clinics allowed more individuals to receive COVID-19 vaccines safely despite their previous allergies, and provided more confidence to vaccinators at various vaccination hubs within NCA. O01 Trends in Allergic Rhinitis prevalence amongst UK adults between 2010-2019 Anuraadha Subramanian SP 1 sp , Krishnarajah Nirantharakumar SP 1 sp , Sumithra Subramaniam SP 2 sp , Divya Shah SP 2 sp , Lavanya Diwakar SP 1,3 sp I SP 1 sp University of Birmingham, Birmingham, United Kingdom; SP 2 sp Wellcome Trust, London, United Kingdom; SP 3 sp University Hospital of North Midlands, Stoke-on-Trent, United Kingdom i B Objectives: b To assess the trends in annual lifetime point prevalence estimates of General practitioner (GP) diagnosed ARC between 2010 and 2019 amongst UK adults (aged 18 years or over) To assess odds of ARC prevalence based on age, gender and ethnicity as independent variables B Method: b We obtained a longitudinal cohort of all patients included in The Health Improvement Network (THIN) database between 1st January 2010 and 1st January 2019. [Extracted from the article]

In 2012, we received 683 submissions and published 20 editorials, 38 reviews, 11 letters and 128 original articles. This represents an acceptance rate for original papers in the range of 20%. About 30% of original papers were triaged not to go out to review, either because the editors did not feel they had sufficient priority for publication or because the topic did not feel right for the readers of the journal. We place great emphasis on obtaining sufficient high-quality reviews to make our decisions on publication fair and consistent. Inevitably, however, there is a degree of luck about what gets published and which papers miss out, and we are always happy to receive an appeal on our decisions either at the triage stage or after review. This gives us the opportunity to revisit the decision and revise it or explain in more detail to the authors the basis for the decision. Once again in 2012, we were delighted by the quality of the papers submitted and the breadth and depth of research into allergic disease that it revealed. The pattern of papers submitted was similar in previous years with considerable emphasis on all aspects of asthma and rhinitis. We were particularly pleased with our special issue on severe asthma. Elucidating mechanisms using either animal models or patients has always been a major theme of the journal, and the excellent work in these areas has been summarized by Harissios Vliagoftis with a particularly interesting section on early-life events guiding the development of allergic disease, which understandably continue to be a major theme of research. Magnus Wickman summarized the papers looking at the epidemiology of allergic disease including work from birth cohorts, which are an increasingly rich source of data on risk factors for allergic disease, and two papers on the epidemiology of anaphylaxis. Giovanni Passalacqua discussed the papers in the clinical allergy section of the journal, and Adriano Mari who runs the excellent Allergome website discussed the papers looking at allergens including characterization and the relative usefulness of allergen arrays versus single extracts in diagnosis and management. [ABSTRACT FROM AUTHOR]

Background: Observational studies have reported an association between allergic disease and mental health, but a causal relationship has not been established. Here, we use Mendelian randomization (MR) to investigate a possible causal relationship between atopic disease and mental health phenotypes. Methods: The observational relationship between allergic disease and mental health was investigated in UK Biobank. The direction of causality was investigated with bidirectional two‐sample MR using summary‐level data from published genome‐wide association studies. A genetic instrument was derived from associated variants for a broad allergic disease phenotype to test for causal relationships with various mental health outcomes. We also investigated whether these relationships were specific to atopic dermatitis (AD), asthma or hayfever. Given the multiple testing burden, we applied a Bonferroni correction to use an individual test p‐value threshold of.0016 (32 tests). Results: We found strong evidence of an observational association between the broad allergic disease phenotype and depression (ORself‐report=1.45, 95% CI: 1.41–1.50, p = 3.6 × 10−130), anxiety (OR=1.25, 95% CI: 1.18–1.33, p = 6.5 × 10−13), bipolar disorder (ORself‐report=1.29, 95% CI: 1.12–1.47, p = 2.8 × 10−4) and neuroticism (β = 0.38, 95% CI: 0.36–0.41, p = 6.8 × 10−166). Similar associations were found between asthma, AD, hayfever individually with the mental health phenotypes, although the associations between AD and hayfever with bipolar disorder were weaker. There was little evidence of causality in either direction (all p‐values>.02). Conclusion: Using MR, we were unable to replicate most of the phenotypic associations between allergic disease and mental health. Any causal effects we detected were considerably attenuated compared with the phenotypic association. This suggests that most comorbidity observed clinically is unlikely to be causal. [ABSTRACT FROM AUTHOR]

Looks at the trends and opportunities in allergy research in Europe. Discussion of the main themes and strong points of allergy research; Global impact and evolution of European allergy research; Analysis of the current state of support of European allergy research by state or private institutions.

The inadequate description of the clinics, together with the absence of a drug challenge, hinder to ascertain that the patients had experienced from a basophil-mediated hypersensitivity to a FQ. We have read with interest the paper by Loli-Ausejo and colleagues about the basophil activation test (BAT) in the diagnosis of hypersensitivity to fluoroquinolones (FQs).1 The authors report on a heterogeneous group of 19 patients who experienced a hypersensitivity reaction reported as immediate, accelerated/non-immediate or as unknown time of onset. Hypersensitivity to fluoroquinolones: the expression of basophil activation markers depends on the clinical entity and the culprit fluoroquinolone. [Extracted from the article]

Background: Food allergy continues to pose problems due to its increased frequency and its increasingly high severity. In this context, alongside the traditional avoidance strategies of allergenic foods and desensitization through the cautious progression of exposure to foods in the context of oral immunotherapy (OIT), alternative strategies have made their way in the last decades. We review the possibilities of intervention in food allergy with the use of biological drugs capable of interfering with the synthesis of IgE, with their mechanisms of action, or with complex biological mechanisms that lead to the establishment of a food allergy. Methods: Repeated Entrez PubMed searches using the template algorithm "Food allergy" and "biologics" or "Omalizumab" or "Dupilumab" or "milk desensitization" or "oral tolerance induction" or "oral immunotherapy" or "Etokimab" or "Tezepelumab" or "Quilizumab" or "Ligelizumab" or "Tralokinumab" or "Nemolizumab" or "Mepolizumab" or "Reslizumab" or "Benralizumab". The authors' clinical experience in paediatric allergy units of University hospitals was also drawn upon. Results: The landscape in this context has changed dramatically over the past 10 years. We have acquired knowledge mainly on the effect of different types of anti‐IgE treatments in poliallergic patients with food allergy, and in patients treated with OIT. However, other mediators are being targeted by specific biologic treatments. Among them, the alarmins Il‐33 and TSLP, IL‐4 and IL‐13, eosinophil‐related molecules as IL‐6, IL‐8, IL‐10, IL‐12, and mostly IL‐5, and integrins involved in the pathogenesis of eosinophilic gastrointestinal diseases (EGIDs), as SIGLEC‐8. Conclusions: The ever‐better knowledge of the mechanisms of food allergy allowing these developments will improve not only the perspective of patients with the most serious immediate food allergies such as anaphylaxis, but also those of patients with related diseases such as atopic dermatitis, eosinophilic esophagitis, and EGIDs. Biologics are also intended to complement OIT strategies that have developed over the years. [ABSTRACT FROM AUTHOR]

In the second of two papers, we describe developments in the field of clinical allergy as documented by Clinical and Experimental Allergy in 2015. Epidemiology, clinical allergy, asthma and rhinitis are all covered. [ABSTRACT FROM AUTHOR]

Background: Allergic reactions to food allergens usually occur after ingestion. However, fear of reactions to airborne peanut is a common concern for people with peanut allergy. There are no scientific reports on severe reactions with airborne peanut allergen. Objective: To investigate the occurrence of allergic reactions in peanut‐allergic children undergoing airborne peanut challenge and to determine levels of airborne peanut protein in a separate experimental evaluation. Methods: Eighty‐four children with peanut allergy underwent an airborne peanut challenge, 0.5 m from a bowl of peanuts for 30 min under controlled conditions. In a separate experiment, airborne peanut proteins from roasted and dry‐roasted peanuts were collected at varying distances and at varying times with an electret SensAbues filter connected to an air pump. Collected airborne peanut proteins were extracted, dissolved and detected by ELISA. Basophil activation test was used to confirm biological activity. Results: No moderate/severe allergic reactions to airborne peanut allergens were observed. Two children (2%) had mild rhino‐conjunctivitis which required no treatment. The IgE‐antibodies to peanut or Ara h 2 did not predict a reaction. In the experimental set‐up, biological active peanut proteins were detected, in a very low amount, in median 166 ng/ml for dry‐roasted and 33 ng/ml for roasted peanuts and decreased dramatically when the collection occurred at a greater distance (0.5–2 m) from the peanut source. Increased exposure time did affect the amount of collected peanut protein at 0 m, and the highest median was obtained after 60 min (p =.012); for time trend p =.0006. Conclusions and Clinical Relevance: Allergic reactions to airborne peanut proteins are rare and cannot be predicted by high levels of IgE‐antibodies to peanut or Ara h 2. Only small amounts of biologically active peanut proteins were detected in the air and seem unlikely to trigger moderate/severe allergic reactions. [ABSTRACT FROM AUTHOR]

To the Editor, Quinolones are a family of antibiotics containing a bicyclic core structure related to the compound 4-quinolone and have presented an increased use because of their high potency, broad spectrum of activity, convenient formulations, as well as a comparatively low incidence of side effects.1-3 However, quinolones are the second most common antibiotic class associated with drug hypersensitivity reactions (DHR),3 being the fourth cause of consultations due to suspected drug allergy in Spain, and showing an increased incidence in the last years (4.3% of consultations in 2015 vs 1% in 1992).4 Allergic reactions to quinolones can be classified as IgE-mediated immediate reactions (IR) if they appear within 1 hour after drug intake, and T-cell-mediated nonimmediate reactions (NIR) if they appear more than 1 hour after drug intake.5,6 Current European guidelines5 for in vitro tests in the diagnosis of DHR indicate that the basophil activation test (BAT) can be recommended for diagnosing IgE-mediated allergy to fluoroquinolones although different studies have shown discordant results.6 A high rate of cross-reactivity among different quinolones has been described.6,7 We conducted a retrospective review of patient's clinical histories in a real-life setting, in whom BAT to quinolones was performed, from April 2015 to October 2018 at a tertiary hospital (La Paz University Hospital, Madrid, Spain). From the 10 patients with mild reactions (grade 1), three had presented a positive BAT result and one patient chose to not be studied with DPT. The allergy workup included compatible clinical history, skin testing (prick, intradermal, and/or epicutaneous tests), BAT, and, for some mild cases, drug provocation tests (DPT). [Extracted from the article]

Background: The prevalence of allergy‐related diseases (ARDs), including rhinitis, allergic conjunctivitis and eczema, is on the increase globally. The causes of this increase are not well established. Objectives: To investigate the risk factors associated with ARDs among schoolchildren in Uganda. Methods: We conducted a secondary data analysis of a large asthma case–control study involving 1700 schoolchildren, 5–17 years, in urban Uganda. ARDs were defined according to the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Skin prick testing (SPT) was conducted using standard procedures and allergen‐specific IgE (asIgE) using ImmunoCAP®. We employed inverse probability weighted analysis to generate estimated prevalence data and weighted odds ratios. Results: The lifetime estimated weighted prevalence of reported rhinitis, allergic conjunctivitis and eczema was 43.3%, 39.5% and 13.5%; weighted prevalence in 12 months was 10.1%, 9.1% and 2.3%, respectively. There was overlap of ARDs, with 66.3% of 1193 schoolchildren who reported having ever an ARDs (including asthma) reporting two or more. Risk factors associated with reported rhinitis in the last 12 months were city residence at birth [adjusted odds ratio (95% confidence interval) 2.66 (1.42–4.99) compared to rural]; father's [2.62 (1.79–3.83)] and mother's history of allergic disease [2.12 (1.48–3.02)]; frequent de‐worming in the last 12 months [2.01 (1.30–3.11), ≥2 versus none]; current high frequency of 'trucks passing on the street near home' [2.59 (1.48–4.52), 'almost all the time' versus rarely] and positive SPT [1.54 (1.09–2.18)] but not asIgE [1.38 (0.60–3.15)]. The same pattern of risk factors was observed for allergic conjunctivitis and eczema. Conclusion: We found extensive multi‐morbidity of, and overlap in the risk factors for, rhinitis, conjunctivitis and eczema—similar to asthma risk factors—among schoolchildren in urban Uganda. This suggests a similar underlying cause for all ARDs, associated with exposure to urban lifestyles and environment in Uganda. [ABSTRACT FROM AUTHOR]

Objective: Conduct a systematic review and meta‐analysis examining the association between hypertensive disorders of pregnancy (HDP) and risk of asthma, eczema, food allergies and allergic rhinitis in the offspring. Design: A systematic review and random‐effects meta‐analyses were used to synthesize the published literature. PRISMA guidelines were followed throughout. Two independent reviewers carried out data extraction and quality assessment of included studies. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess certainty of findings. Data Sources: A systematic search of PubMed, Embase, Web of Science and CINAHL was performed from inception of databases‐21 April 2020, supplemented by hand‐searching reference lists of included articles. Eligibility Criteria: Two reviewers independently reviewed titles, abstracts and full‐text articles. English language, cohort, case‐control and cross‐sectional published studies examining the association between HDP (primary exposure: pre‐eclampsia; secondary exposures: all other HDP) and asthma, eczema, food allergies and allergic rhinitis were included. Results: Of the 2833 studies retrieved, 14 studies met inclusion criteria. Of these, 11 studies reported evidence of association between HDP and atopic disorders. Thirteen studies reported estimates for asthma. Seven of these included adjusted estimates (including 3 645 773 participants) for a pre‐eclampsia‐asthma relationship resulting in a pooled odds ratio (OR) of 1.14 (95% CI: 1.04, 1.26) (I2 = 62%). However, this OR was reduced to 1.08 (95% CI: (0.78, 1.48) when the large registry‐based cohort studies were excluded, and only studies using parent‐reported measures to determine a diagnosis of asthma were included. Four studies included adjusted estimates (including 254 998 participants) for other HDP and asthma (pooled OR: 1.02, 95% CI: 0.96, 1.09) (I2 = 0%). Two studies provided adjusted estimates (including 1 699 663 participants) for a pre‐eclampsia‐eczema relationship (pooled OR: 1.06, 95% CI: 0.98, 1.14) (I2 = 0%). One study including pre‐eclampsia‐food allergies was identified (OR: 1.28, 95% CI: 1.11, 1.46). Three studies examined a HDP (including pre‐eclampsia) and allergic rhinitis relationship, with effect estimates ranging from 1.14 to 2.10. Studies were classified as low or low‐moderate risk of bias, while GRADE certainty of findings were low to very low. Conclusions: While pre‐eclampsia was associated with a possible increased risk of asthma in offspring, there was no evidence for a relationship between other HDP and asthma. There is a lack of published literature examining the association between HDP and eczema, food allergy and allergic rhinitis. Further primary research is warranted to gain a better understanding of the association between HDP and the risk of childhood atopic disease. Systematic review registration: Review protocol in appendix. [ABSTRACT FROM AUTHOR]

In the second of two linked articles, we describe the development in clinical as described by Clinical & Experimental Allergy and other journals in 2019. Epidemiology, clinical allergy, asthma and rhinitis are all covered. In this article, we described the development in the field of allergy as described by Clinical and Experimental Allergy in 2019. Epidemiology, clinical allergy, asthma and rhinitis are all covered. [ABSTRACT FROM AUTHOR]

In the first of two linked articles, we describe the development in the mechanisms underlying allergy as described by Clinical & Experimental Allergy and other journals in 2019. Experimental models of allergic disease, basic mechanisms, clinical mechanisms and allergens are all covered. [ABSTRACT FROM AUTHOR]

Keywords: drug allergy; IgE; immunological tests anaphylaxis; tryptase EN drug allergy IgE immunological tests anaphylaxis tryptase 977 980 4 08/01/20 20200801 NES 200801 To the Editor, Allergic reactions are a rare complication of anaesthesia and anaphylaxis is estimated to affect 1 in every 10 000 anaesthetics in the UK. Results of skin testing, drug provocation tests and IgE tests were also recorded along with advice given to patients and details of any subsequent reaction. We identified an allergy to chlorhexidine but unfortunately, when the patient was readmitted for a second attempt, he had another episode of anaphylaxis following insertion of a urinary catheter that was not recognized as being impregnated with chlorhexidine. Drug allergy, IgE, immunological tests anaphylaxis, tryptase. [Extracted from the article]

Allergy to insects of the family Tabanidae (order Diptera), commonly called horseflies or deerflies, is anecdotally common, although the published literature is limited to case reports and small case series. This review summarizes the available literature, in which there is enormous variability in clinical detail, identification of species or even genus, and means and thoroughness of assessment of sensitization. The clinical utility of in vivo and in vitro assays remains unclear. Investigation and management of patients reporting anaphylaxis to suspected bites must therefore be pragmatic, by considering other insects (eg Hymenoptera), provision of a written action plan and self‐injectable adrenaline if appropriate, and advice on avoidance. [ABSTRACT FROM AUTHOR]

To the Editor, The selection of an antibiotic for treatment of bacterial infection should ideally be based on clinical findings, guideline recommendations and microbiological test results. If antibiotic therapy was necessary, the medication of first choice was administered even if an allergy to this antibiotic or corresponding class of antibiotics was reported - provided that allergy was considered unlikely according to our algorithm (Figure). All 124 patients who received the suspected antibiotic again tolerated the re-administration: 82 were treated with the antibiotic as indicated (mostly because of soft tissue infection), and 42 received the antibiotic in a controlled provocation following negative skin testing (Figure). [Extracted from the article]