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This article explores the challenges of managing asthma in India, specifically in rural areas, where there are deficiencies in self-management and training for primary care physicians. The study aims to understand the perspectives of patients and primary care physicians on asthma and the barriers to treatment and engagement with health services. Interviews were conducted with patients and physicians in rural, semi-urban, and urban areas. The findings emphasize the need for interventions that are culturally appropriate for patients and training that is clinically focused for primary care physicians in order to improve asthma management in India. The study focuses on the understanding and management of asthma among adult patients in the Vellore district of India. It reveals that many patients have limited knowledge about asthma and its treatment, resulting in poor adherence to prescribed care. Financial constraints and limited access to mainstream health services are identified as additional obstacles to asthma management. Social stigma and a preference for alternative treatments also influence patient behavior. The study recommends interventions that are tailored to the cultural context, improved training for primary care physicians, and affordable treatment options for economically disadvantaged patients. However, it is important to note that the findings may not be applicable to other regions of India, and further research is necessary. [Extracted from the article]

Background: Food hypersensitivity (FHS) management requires daily risk assessments of all food and drinks consumed to prevent unpleasant and potentially fatal adverse reactions. Most research has focussed on food allergy in children and families. Little is known about the impact on adults or those with other FHS, such as food intolerance or coeliac disease. This study assessed differences in practices and risk assessment behaviours when eating out for adults with FHS. Methods: Adult UK residents (N = 930; 820 females, 90 males; 95% White; mean age 50 years [±16.6SD]), with food allergy (18%), food intolerance (23%) coeliac disease (44%) or multiple FHS (15%) completed an online survey. Results: Adults checked information to identify foods causing a reaction always or most of the time when eating out. However, adults with food intolerance reported checking significantly less often than adults with other FHS (all ps < 0.001). Adults reporting more severe FHS, medical rather than self‐diagnosis of FHS, previous anaphylaxis, had called an ambulance or been in hospital due to a reaction checked information significantly more often (all ps < 0.001), but were also less confident in the information provided (all ps < 0.05). Adults with allergy, coeliac disease or multiple FHS were also less confident in written and verbal information provided than those with food intolerance (p < 0.01). The type of FHS, greater perceived severity of FHS and having a medical diagnosis consistently predicted risk assessment behaviours when eating out (all ps < 0.001). Conclusion: Clinicians, patients and the food industry should be aware that the type of FHS, patient‐perceived severity and past experience of reactions affect risk assessment behaviours when eating out. This should be considered when providing clinical advice and emergency plans. [ABSTRACT FROM AUTHOR]

A qualitative study conducted in Egypt, Sri Lanka, Barbados, and Trinidad and Tobago found that these countries lack equitable drug allergy management pathways. The study suggests that computerized decision support systems, along with basic training and education, could improve accurate labeling and de-labeling of drug allergies. The participants expressed concerns about the lack of standardized policies and guidelines for managing drug allergies, as well as a lack of clarity among healthcare professionals regarding the distinction between drug allergies and other adverse drug reactions. The study also highlights the need for more allergy specialists and resources in these countries. [Extracted from the article]

Background: House dust mite (HDM) is the most common sensitising allergen in asthma. Ethnic minority groups (EMGs) in the UK are more likely to live in deprived conditionings with a greater exposure to HDM and other aero‐allergens. Aim: To compare the ethnicity‐based patterns of sensitisation to aero‐allergens and the impact of ethnicity on clinical outcomes in patients with difficult‐to‐treat asthma (DTA). Methods: Data of patients with DTA were extracted from the registry of the Birmingham Regional Severe Asthma Service (BRSAS), which have a catchment population of 7.3million from Central England. Patients from White and EMG backgrounds were compared in terms of the prevalence of atopy, total serum immunoglobulin E (IgE), specific serum IgE (ssIgE) and asthma related clinical outcomes. Logistic regression analysis was conducted to explore ethnicity‐based risk factors for HDM sensitisation. Results: A total of 1272 patients [White 1016 (79.9%), EMG 256 (20.1%) EMG] with a median age of 51 years (range 16–97) were included in the analysis. Patients from EMG were more likely (64%) to reside in the worst scale of index of multiple deprivation (IMD) than the White patients (25.5%), p < 0.0001. Positive HDM sensitisation was more prevalent in the EMG than in the White group [142/216 (66%) versus 375/842 (45%), p < 0.0001]. The median HDM ssIgE level was higher in the EMG than in the White group [3.0 KUA/L (IQR 0.06, 11.5) versus 0.1 (0.01, 3.0), p < 0.000001]. The odds ratio for positive sensitisation to HDM conveyed by the EMG status was 2.61 (95%CI, 1.8–3.8), p < 0.0001. Compared to the White group, the EMG had higher median total serum IgE [326 KU/L (115, 971) versus 114 (29.8, 434.8), p < 0.000001], higher blood eosinophil count (0.36 × 109(0.18, 0.62) versus 0.23 (0.1,0.47), p < 0.000001), were marginally more atopic (79.2% vs. 75.6%, p = 0.098) and were less likely to being on maintenance oral corticosteroids (22% vs. 39.7%, p < 0.0001). Conclusion: In this DTA cohort, positive HDM sensitisation was greater amongst the EMG than the White patients. The EMG status was a significant risk factor for HDM sensitisation. [ABSTRACT FROM AUTHOR]

Keywords: anaphylaxis; angioedema; clinical immunology; drug allergy; IgE EN anaphylaxis angioedema clinical immunology drug allergy IgE 781 784 4 07/05/23 20230701 NES 230701 Key messages The prevalence of unverified drug allergy labels (DALs) was 5.6%. In all, seven (6.37%) patients reported an allergy but could not recall the names of the drugs and five patients reported an allergy to anti-TB drugs and could not recall the name of the implicated drug. The most common drug classes implicated were antibiotics - 59 (53.15%), followed by nonsteroidal anti-inflammatory drugs (NSAIDs) - 20 (18.01%), radio-contrast medium - 12 (10.8%) and antihistamines - 6 (5.40%). [Extracted from the article]

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]

A wide range of topics have been covered by leading experts from India including indoor and outdoor allergens, allergic airways disease, allergic bronchopulmonary aspergillosis (ABPA) and food allergy. India has recently overtaken China as the most populous country in the globe with an estimated total population of ~1.43 billion people, comprising approximately 20% of the globe. REFERENCES 1 Laha A, Moitra S, Podder S. A review on aero-allergen induced allergy in India. [Extracted from the article]

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]

Pollen food syndrome (PFS) is a highly prevalent food allergy affecting pollen‐sensitized children and adults. Sufferers experience allergic symptoms when consuming raw plant foods, due to the homology between the pollen allergens and unstable proteins in these foods. The triggers involved can vary depending on the pollen sensitization, which in turn is affected by geographical location. The British Society of Allergy and Clinical Immunology (BSACI) Standards of Care Committee (SOCC) identified a need to develop a guideline for the diagnosis and management of PFS in the United Kingdom (UK). Guidelines produced by the BSACI use either the GRADE or SIGN methodology; due to a lack of high‐quality evidence these recommendations were formulated using the SIGN guidelines, which is acknowledged to be less robust than the GRADE approach. The correct diagnosis of PFS ensures the avoidance of a misdiagnosis of a primary peanut or tree nut allergy or confusion with another plant food allergy to non‐specific lipid transfer proteins. The characteristic foods involved, and rapid‐onset oropharyngeal symptoms, mean PFS can often be diagnosed from the clinical history alone. However, reactions involving tree nuts, peanuts and soya milk or severe/atypical reactions to fruits and vegetables may require additional diagnostic tests. Management is through the exclusion of known trigger foods, which may appear to be simple, but is highly problematic if coupled with a pre‐existing food allergy or for individuals following a vegetarian/vegan diet. Immunotherapy to pollens is not an effective treatment for PFS, and although oral or sublingual immunotherapy to foods seems more promising, large, controlled studies are needed. The typically mild symptoms of PFS can lead to an erroneous perception that this condition is always easily managed, but severe reactions can occur, and anxiety about the onset of symptoms to new foods can have a profound effect on quality of life. [ABSTRACT FROM AUTHOR]

Several studies have proposed that the neutrophil–lymphocyte ratio (NLR) is one of the various biomarkers that can be useful in assessing COVID-19 disease-related outcomes. Our systematic review analyzes the relationship between on-admission NLR values and COVID-19 severity and mortality. Six different severity criteria were used. A search of the literature in various databases was conducted from 1 January 2020 to 1 May 2021. We calculated the pooled standardized mean difference (SMD) for the collected NLR values. A meta-regression analysis was performed, looking at the length of hospitalization and other probable confounders, such as age, gender, and comorbidities. A total of sixty-four studies were considered, which included a total of 15,683 patients. The meta-analysis showed an SMD of 3.12 (95% CI: 2.64–3.59) in NLR values between severe and non-severe patients. A difference of 3.93 (95% CI: 2.35–5.50) was found between survivors and non-survivors of the disease. Upon summary receiver operating characteristics analysis, NLR showed 80.2% (95% CI: 74.0–85.2%) sensitivity and 75.8% (95% CI: 71.3–79.9%) specificity for the prediction of severity and 78.8% (95% CI: 73.5–83.2%) sensitivity and 73.0% (95% CI: 68.4–77.1%) specificity for mortality, and was not influenced by age, gender, or co-morbid conditions. Conclusion: On admission, NLR predicts both severity and mortality in COVID-19 patients, and an NLR > 6.5 is associated with significantly greater the odds of mortality. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is the commonest cause of death by a single infectious agent globally and ranks amongst the top ten causes of global mortality. The incidence of TB is highest in Low‐Middle Income countries (LMICs). Prompt institution of, and compliance with, therapy are cornerstones for a favourable outcome in TB and to mitigate the risk of multiple drug resistant (MDR)‐TB, which is challenging to treat. There is some evidence that adverse drug reactions (ADRs) and hypersensitivity reactions (HSRs) to anti‐TB drugs occur in over 60% and 3%–4% of patients respectively. Both ADRs and HSRs represent significant barriers to treatment adherence and are recognised risk factors for MDR‐TB. HSRs to anti‐TB drugs are usually cutaneous and benign, occur within few weeks after commencement of therapy and are likely to be T‐cell mediated. Severe and systemic T‐cell mediated HSRs and IgE mediated anaphylaxis to anti‐TB drugs are relatively rare, but important to recognise and treat promptly. T‐cell‐mediated HSRs are more frequent amongst patients with co‐existing HIV infection. Some patients develop multiple sensitisation to anti‐TB drugs. Whilst skin tests, patch tests and in vitro diagnostics have been used in the investigation of HSRs to anti‐TB drugs, their predictive value is not established, they are onerous, require specialist input of an allergist and are resource‐dependent. This is compounded by the global, unmet demand for allergy specialists, particularly in low‐income countries (LICs)/LMICs and now the challenging circumstances of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic. This narrative review provides a critical analysis of the limited published evidence on this topic and proposes a cautious and pragmatic approach to optimise and standardise the management of HSRs to anti‐TB drugs. This includes clinical risk stratification and a dual strategy involving sequential re‐challenge and rapid drug desensitisation. Furthermore, a concerted international effort is needed to generate real‐time data on ADRs, HSRs, safety and clinical outcomes of these interventions. [ABSTRACT FROM AUTHOR]

AFS in our study was characterized by earlier age of onset, higher IgE levels and lower FEV1 We suggest AFS is worth considering in uncontrolled asthma and those with moderate-severe asthma There is a need to assess anti-fungal drugs as an adjunct to standard therapy in AFS To the editor, The biological role of fungi in the pathophysiology of asthma has attracted renewed attention during the last decade. Assessment of sensitization to aero-allergens including fungal allergens was performed by the skin prick tests using allergen kits by Hollister Stier Allergy (Jubilant Pharma LLC, USA). Patients with multiple fungal sensitizations had poorer ACT scores in comparison to those with sensitization to a single fungal allergen ( I p i < 0.001), that is the median ACT scores in subjects with no fungal allergen was 23.0 (22.0-24.0); with sensitization to one fungal allergen was 21.0 (19.0-22.0) and with sensitization to >=2 fungal allergens was 18.0 (18.0-20.0) (Figure 1C). (C) Box plot illustrating the relationship between ACT scores and sensitization to none, 1 or >=2 fungal allergens: The plot illustrates that sensitization to >=2 fungal allergens was associated with poorer asthma control. [Extracted from the article]

The registry is governed by a steering committee consisting of BSACI members alongside IQAS and two patient organizations (Allergy UK and Anaphylaxis Campaign). Immunomodulatory therapies alter the natural course of allergic and autoimmune disease and have cemented their place in clinical management. Allergy UK receives grants and sponsorship from a range of companies which support the patient organization projects and activities. GLO:ETE/01aug21:cea13887-fig-0001.jpg PHOTO (COLOR): 1 The BRIT Registry Logic Model shows the potential of a professional and patient interface to address gaps in safety and effectiveness of immunotherapy in allergies and urticaria. [Extracted from the article]

Briefly, the questionnaire had 21 items, including core questions to assess the prevalence of rhinitis, asthma and eczema. Asthma insights and management in India: lessons learnt from the Asia pacific-asthma insights and management (AP-AIM) Study. In conclusion, the prevalence of asthma and rhinitis in this Bengaluru cohort is higher than the previously reported overall prevalence in India. [Extracted from the article]

Nearly 60%-70% of patients have co-existing allergic rhinitis and asthma, and it remains unclear at present how well the allergic rhinitis is controlled amongst asthmatics. This editorial focusses on gaps in evidence and highlights "high-priority" areas and strategies for research in asthma and allergy in India. [Extracted from the article]

Competing Interests: MTK has the following declarations: Co-author of BSACI guidelines for penicillin allergy; Research grant from the University of Birmingham for Antibiotic Allergy Research (PALAR study) in Low-Middle Income Countries; Research in the UK funded by NIHR for penicillin allergy de-labelling in secondary care (SPACE study)—not directly related to this manuscript. Other co-authors have none to declare.

Background: Multiple drug allergy and multiple drug intolerance syndrome (MDAS/MDIS) labels are an impediment to clinical care and knowledge regarding these conditions is limited. This systematic review investigated the characterization, epidemiology, risk factors, clinical impact and pharmaco-economics of MDAS and MDIS., Methods: Systematic literature search across 11 databases (01 January 2000-06 November 2020) for MDIS, MDAS and related terminology. Studies were reviewed for quality of evidence and risk of bias by employing Critical Appraisal Skills Programme cohort study checklist. A narrative synthesis approach facilitated by systematic textual descriptions, tabulation and thematic analysis was adopted., Results: There was heterogeneity in terminology and methodology. Few studies applied standard drug allergy diagnostic methods. There is some evidence to suggest that multiple drug hypersensitivity syndrome (MDHS; i.e., confirmed allergies in MDAS) is a distinct clinical entity. Prevalence of MDIS and MDAS labels in unselected & selected populations varied between 2.1%-6.4% & 4.9%-90% and 1.2% & 0%-36% respectively. Reported risk factors included female gender, increasing age, body mass index, anxiety, depression, co-morbidities, concurrent allergies and increased healthcare utilization. Drugs commonly implicated were antibiotics and non-steroidal anti-inflammatory drugs. No studies relating to clinical impact and pharmaco-economics were found., Conclusion: There is considerable burden of MDAS and MDIS labels. Data needs cautious interpretation as majority of studies described involved unverified labels. Despite this limitation and heterogeneity of studies, there is some evidence to suggest that MDHS is a distinct clinical entity. Well-designed multi-centre studies applying standardized terminology and diagnostic methodology are needed to gain further insight into these conditions., Competing Interests: Mamidipudi Thirumala Krishna's department received educational grants from ALK Abello, Allergy Therapeutics, MEDA and other pharmaceutical companies for annual PracticAllergy course. Mamidipudi Thirumala Krishna has received grants from NIHR, MRC CiC, GCRF and FSA outside of the work presented in this manuscript. Other authors have none to declare., (© 2022 The Authors. Clinical and Translational Allergy published by John Wiley and Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.)