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Rationale: It is unclear how each individual asthma symptom is associated with asthma diagnosis or control. Objectives: To assess the performance of individual asthma symptoms in the identification of patients with asthma and their association with asthma control. Methods: In this cross‐sectional study, we assessed real‐world data using the MASK‐air® app. We compared the frequency of occurrence of five asthma symptoms (dyspnea, wheezing, chest tightness, fatigue and night symptoms, as assessed by the Control of Allergic Rhinitis and Asthma Test [CARAT] questionnaire) in patients with probable, possible or no current asthma. We calculated the sensitivity, specificity and predictive values of each symptom, and assessed the association between each symptom and asthma control (measured using the e‐DASTHMA score). Results were validated in a sample of patients with a physician‐established diagnosis of asthma. Measurement and Main Results: We included 951 patients (2153 CARAT assessments), with 468 having probable asthma, 166 possible asthma and 317 no evidence of asthma. Wheezing displayed the highest specificity (90.5%) and positive predictive value (90.8%). In patients with probable asthma, dyspnea and chest tightness were more strongly associated with asthma control than other symptoms. Dyspnea was the symptom with the highest sensitivity (76.1%) and the one consistently associated with the control of asthma as assessed by e‐DASTHMA. Consistent results were observed when assessing patients with a physician‐made diagnosis of asthma. Conclusions: Wheezing and chest tightness were the asthma symptoms with the highest specificity for asthma diagnosis, while dyspnea displayed the highest sensitivity and strongest association with asthma control. [ABSTRACT FROM AUTHOR]

Background: Asthma presents a significant health challenge, imposing a considerable burden on healthcare services. Discrepancies in asthma‐related hospitalisations may reflect underlying health disparities. We aimed to analyse inequities in asthma hospital admissions in mainland Portugal and Spain, from a regional perspective and considering sex and age. Methods: We conducted a retrospective study using data from the Spanish and Portuguese national hospitalisations databases. We calculated crude national and regional yearly hospitalisation rates according per Nomenclature of Territorial Units for Statistics region. Additionally, we calculated hospitalisation rates adjusted for asthma prevalence and the female‐to‐male ratio in asthma hospital admissions per age group, considering the female‐to‐male ratio in the overall population. Results: Between 2012 and 2016, there were 92,084 asthma hospital admissions in mainland Spain and 7717 in mainland Portugal. There was a trend for a higher‐than‐average rate of asthma‐related hospitalisations in the Northern regions of both countries. Women had a hospitalisation rate that was 3.2 times higher than men. Age was associated with higher risk for asthma hospitalisation, with individuals aged 65 and older displaying a hospitalisation rate 4.5 times higher than those under 65. Additionally, while hospitalisations in women aged <65 years were 2.3 times more likely than in men of the same age, hospitalisations in women aged ≥65 years were 3.5 times higher than in men aged ≥65 years. Conclusion: This study suggests that marked regional inequities in asthma hospital admissions exist in Spain and Portugal. Additionally, women are particularly at risk of hospitalisation due to asthma, and such risk increases with age. [ABSTRACT FROM AUTHOR]

MASK‐air®, a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK‐air® is a Good Practice of DG Santé on digitally‐enabled, patient‐centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co‐operation and Development). MASK‐air® data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK‐air® data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as‐needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combined symptom‐medication score (ARIA‐EAACI‐CSMS) has been validated for clinical practice and trials. The implications of the novel MASK‐air® results should lead to change management in rhinitis and asthma. [ABSTRACT FROM AUTHOR]

Background: Allergic contact dermatitis caused by topical ophthalmic medications (OftACD) is frequently difficult to confirm with patch testing and, therefore, it is considered uncommon. Methods: We collected retrospective data from a cohort of 65 patients with suspected OftACD patch tested in our Dermatology Unit (2005–2021) according to ESCD guidelines, using a series of topical drugs and excipients (Chemotechnique Diagnostics), including betaxolol and timolol 5% pet. kindly supplied by the pharmaceutical industry. Also, frequently used ophthalmic medications as well as patient's own products were also patch tested 'as is' in most patients. Results: Positive patch tests to ophthalmic medications occurred in 44 patients (67.7%) (38F/6M; mean age 63.1 years), with 102 positive reactions. Most positive reactions were associated with active ingredients (n = 56), especially aminoglycoside antibiotics (n = 27), followed by excipients (n = 24) such as sodium metabisulfite (n = 7). There were also positive reactions to topical products tested 'as is' (n = 22), mostly containing beta‐blockers, but only five of these reacted to the active ingredient. Discussion: This study reinforces previous findings in OftACD, such as older age of onset, and the importance of antibiotics, contrasting with the progressively lower prevalence of excipients. In addition, it helps raising awareness for the sensitization to beta‐blockers, which is probably underestimated. Patch test preparations for the diagnosis of OftACD may require protocol optimization. [ABSTRACT FROM AUTHOR]

Keywords: bladder cancer; case report; intravesical chemotherapy; mitomycin C; systemic allergic contact dermatitis EN bladder cancer case report intravesical chemotherapy mitomycin C systemic allergic contact dermatitis 207 209 3 07/19/22 20220801 NES 220801 Mitomycin C (MMC) is frequently used as an adjuvant intravesical chemotherapy after transurethral resection of urothelial bladder carcinoma.1,2 Most common adverse effects are cystitis and cutaneous reactions, which are estimated to occur in up to 9% of the patients.3-5 Dermatitis usually involves the genital area, but often also the hands, feet, and can be widespread, due to systemic allergic contact dermatitis after MMC absorption through the vesical mucosa.3 CASE REPORT A 48-year-old woman with high-grade non-invasive papillary bladder tumour (TaN0M0) was treated with MMC intravesical instillation (40 mg MMC in 40 mL of saline solution of NaCl 0.9%). M, mitomycin C; V, petrolatum gl MMC treatment was suspended with no further recurrence of skin lesions, and control cytology excluded tumor recurrence for 12 months, even though treatment was not completed. Systemic allergic contact dermatitis from intravesical instillation of the antitumor antibiotic mitomycin C. Contact Dermatitis. [Extracted from the article]

Patient-reported outcome measures (PROMs) using the MASK-air® app in severe asthma VAS asthma appears to be an interesting PROM in severe asthma. VAS asthma was more strongly correlated with other PROMs related to lower airways or to functional domains (e.g. VAS work) than with PROMs related to rhinitis. [Extracted from the article]

Drug hypersensitivity is one of the most frequent causes of anaphylaxis, particularly in adults and in hospitalized patients. Drug-induced anaphylaxis (DIA) is also associated with more severe outcomes than other anaphylaxis triggers, and drugs are responsible for the majority of deaths due to anaphylaxis. We here review the current knowledge on the incidence, prevalence, drugs involved, mortality, and mortality risk factors for DIA. The incidence of both anaphylaxis and DIA seems to be increasing worldwide. Antibiotics and analgesics are the most frequently reported triggers of DIA. However, the importance of other drug groups should be taken into account, especially in particular settings (e.g., peri-operative and oncology). The identification of risk factors, geographical variables, and drugs associated with higher risk for DIA may improve the outcomes of this entity. [ABSTRACT FROM AUTHOR]

Having a penicillin allergy label associates with worse healthcare outcomes and increased treatment costs.[[1], [3]] However, whether penicillin allergy testing is cost-saving remains unclear, particularly as there is heterogeneity in the practice of such testing.[4] In the public sector, our cost assessment identified skin tests costs per patient of €95.0 (€73.5 for material costs + €21.5 for personnel costs) and DPT costs of €77.0 (€11.0 for material costs + €66.0 for personnel costs). The estimates reported in this study provide unique contextual information on the need for context-based cost assessments and on when penicillin allergy testing might be cost-saving. [Extracted from the article]

We here report the use of benralizumab in a patient with severe PDGFRA-negative idiopathic HES involving three organs and refractory to glucocorticoid and other immunosuppressor therapies. Introduction Hypereosinophilic syndrome (HES) is a rare, heterogeneous group of disorders characterized by persistent, marked blood eosinophilia associated with eosinophil-induced tissue/organ damage, causing a wide range of clinical manifestations [[1]]. In a phase 2 trial with twenty PDGFRA-negative HES patients, benralizumab reduced blood, bone marrow, and tissue eosinophilia, and allowed tapering of immunosuppressive therapies [[2]]. [Extracted from the article]

Keywords: allergic contact dermatitis; case report; contact urticaria; occupational; patch test; rubber chemicals EN allergic contact dermatitis case report contact urticaria occupational patch test rubber chemicals 471 472 2 09/21/21 20211001 NES 211001 Aquagenic urticaria (AU) is a chronic, rare type of physical urticaria that is elicited by skin contact with water, including sweat and tears.1 Due to its rarity and the existence of other skin diseases caused by water exposure, exclusion of differential diagnoses is essential.2 We, here, describe a patient with concomitant AU and allergic contact dermatitis (ACD) that impaired her work ability during the coronavirus disease 2019 (COVID-19) pandemic. Concomitant allergic contact dermatitis and aquagenic urticaria caused by personal protective equipment in a healthcare worker during the COVID-19 pandemic To exclude other chronic urticarias, we tested for cold urticaria, performed a methacholine skin challenge (intradermal, at concentrations of 0.001 mg/mL, 0.01 mg/mL, and 0.1 mg/mL) and an autologous serum test, all of which were negative. [Extracted from the article]

Regulatory T ( Treg) cells are critically important for the maintenance of immunological tolerance. Both centrally arising natural n Treg cells and those emerging in the periphery in response to TGF-β, i Treg cells, play a role in the control of unwanted immune responses. Treg cells adopt multiple mechanisms to inhibit effector T cells, yet it is unclear whether these mechanisms are shared by n Treg cells and i Treg cells alike. Here, we show that i Treg cells, like n Treg cells, are able to out-compete naïve T cells in clustering around dendritic cells (DCs). However, using both a tamoxifen-responsive inducible Foxp3 retroviral construct and TGF-β-induced i Treg cells from h CD2- Foxp3 knock in reporter mice, we show that it is prior antigen-induced activation rather than Foxp3 expression per se that determines the ability of i Treg cells to competitively cluster around DCs. We found no difference in the capacity of i Treg cells to displace naïve T cells around DCs to that of Tr1, Th1, Th2, or Th9 cells. An important difference was, however, that clustering of i Treg cells around DCs, just as for naïve T cells, did not effectively activate DCs. [ABSTRACT FROM AUTHOR]

Levels of anti-inflammatory extracellular adenosine are controlled by the sequential action of the ectonucleotidases CD39 and CD73, whose expression in CD4+ T cells has been associated with natural regulatory T cells (nTregs). We here show that CD73 expression on activated murine CD4+ T cells is induced by TGF-β independently of Foxp3 expression, operates at the transcriptional level and translates into gain of functional capacity to generate adenosine. In the presence of AMP, CD73 induced by TGF-β generates adenosine able to suppress proliferation of activated CD4+ T cells in vitro. These effects are contextual and opposed by proinflammatory cytokines. CD73 is also upregulated by TGF-β in CD8+ T cells, DCs and macrophages, so providing an amplification mechanism for adenosine generation in tissue microenvironments. Together, these findings expose a novel anti-inflammatory role for TGF-β. [ABSTRACT FROM AUTHOR]

A variety of different molecular mechanisms have been proposed to explain the suppressive action of regulatory T cells, including the production of anti-inflammatory cytokines, negative costimulatory ligands, indoleamine 2,3-dioxygenase-mediated tryptophan catabolism, CD73-mediated adenosine generation, and downregulation of antigen-presenting cells. Until now it has been unclear how important each of these different mechanisms might be and how they are coordinated. In this review, we examine the hypothesis that it is the interaction between regulatory T cells and dendritic cells that creates a local microenvironment depleted of essential amino acids and rich in adenosine that leads to the amplification of a range of different tolerogenic signals. These signals are all eventually integrated by mammalian target of rapamycin inhibition, which enables the induction of new forkhead box protein 3-expressing Tregs. If correct, this provides a molecular explanation for the in vivo phenomena of linked suppression and infectious tolerance. [ABSTRACT FROM AUTHOR]

Keywords: allergic contact dermatitis, case report, metals, occupational, patch test EN allergic contact dermatitis, case report, metals, occupational, patch test 523 524 2 11/26/20 20201201 NES 201201 Due to long hours of practice, professional musicians often develop occupational skin diseases.1 String players have the highest risk of contact dermatitis, often suffering from "fiddler's neck",2 most frequently due to irritant contact dermatitis (ICD) while allergic contact dermatitis (ACD) is rarely reported.1 Nickel sulfate and colophonium are the most commonly reported sensitizers. Fiddler's neck: Chin rest-associated irritant contact dermatitis and allergic contact dermatitis in a violin player. [Extracted from the article]

The article presents a case study of a 79-year-old male with a past history of tophaceous gout, hypertension and heart failure developed generalized pruritic exanthema10 days after he started taking amlodipine and allopurinol. Topics include spironolactone is an aldosterone antagonist used as a diuretic and antihypertensive drugtients.