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In rare cases, AGEP has been attributed to infections (e.g. parvovirus B19).[1] Moreover, drug-related cases of AGEP have been reported in COVID-19 patients and following COVID-19 vaccination.[[4], [6]] In those cases, it remains unclear whether AGEP was related to COVID-19 infection or to its treatment. Bacterial and fungal infections were ruled out by negative hemocultures and bacterial/fungal cultures from pustules, however fever could be explained by COVID-19 infection. However, on only one occasion the culprit drug was confirmed by patch tests.[8] Our patient had no skin reaction following her COVID-19 vaccines, nor during a previous COVID-19 infection. [Extracted from the article]

GA is an idiopathic non-infectious granulomatous skin disease with an annual incidence of 0.04% in the United States.[2] Skin lesions are mostly localized and self-resolving but disseminated GA (>=10 lesions) is present in 15% of those affected.[[1]] In contrast to localized GA, disseminated GA is often refractory to conventional treatments.[1] Finding an effective treatment remains difficult because the GA pathogenesis has not yet been fully elucidated. The efficacy of other JAK inhibitors, such as tofacitinib and upadacitinib, in the treatment of GA lesions has also been described (Table 1).[[3], [5], [7], [9]] This case underlines the favourable therapeutic potential of pathway-specific treatment of rare inflammatory diseases. In this table, we summarize prior case reports of GA treatment with JAK inhibitors and their outcome. [Extracted from the article]

This article discusses the use of pulsed dye laser (PDL) treatment for facial erythema in Netherton syndrome (NS), a rare genetic disorder characterized by atopic diathesis, ichthyosis linearis circumflexa (ILC), and hair shaft abnormalities. The patient in this case study, a 34-year-old male with NS, experienced persistent facial erythema that significantly impacted his emotional well-being. Previous treatments had been ineffective, so the patient consented to PDL treatment, which resulted in significant improvement after the first session. PDL proved to be a safe and effective treatment option for reducing facial erythema in NS, improving the patient's quality of life. [Extracted from the article]

Seventy per cent of EGR cases is associated with an underlying malignancy and treatment is directed at the cancer. In idiopathic cases of EGR, therapy with topical steroids seems more efficient.4 Treatment of pruritus with antihistamines is generally insufficient. As EGR usually antedates malignancy1 and in view of the personal and family history, immunosuppressive treatments like methotrexate were not started. [Extracted from the article]

Background: Chronic spontaneous urticaria (CSU) is characterized by the repeated occurrence of persistent hives and/or angioedema for ≥6 weeks, without specific external stimuli. H1‐antihistamines have long been the standard of care of CSU, but many patients remain uncontrolled even at 4× the approved dose. Add‐on therapy with omalizumab has proven effective in clinical trials, but little is known about omalizumab treatment in Belgium. Objective: To collect real‐world clinical data on omalizumab treatment in adults with CSU in Belgium. Methods: This was an observational, retrospective chart review of adults with CSU, who initiated omalizumab treatment between August 2014 and December 2016 (maximum 28 months follow‐up). Results: In total, 235 patients were included (median time from symptom onset to diagnosis, 5.4 months; median time from diagnosis to commencing omalizumab, 6.7 months). Treatments used before/after commencing omalizumab did not always adhere to guidelines; many patients (26.4%/11.1%) received first‐generation H1‐antihistamines, while 20.4% used omalizumab monotherapy after initiating treatment. The mean interval between omalizumab administrations was 4.8 (SD 1.7) weeks; 67.8% of patients had ≥1 interval prolongation and/or shortening. Mean baseline 7‐day Urticaria Activity Score (UAS7) was 32.0 (SD 6.05); this improved to 12.6 (SD 11.2) after 1 month of omalizumab. About 67.2% of patients reached UAS7 ≤ 6 (well controlled) during the study. A total of 87 patients stopped omalizumab and never restarted before the end of the observation period; the most prevalent reason was remission of symptoms (49.4% of patients), followed by lack of effect (12.6%), lost to follow‐up (6.9%) and adverse events (3.4%). Headache was the most common adverse event (n = 8/82). No anaphylaxis was reported. Conclusions: This study revealed that patients initiated on omalizumab in Belgium had severe CSU at baseline, and showed substantial improvements after 1 month of treatment. Greater adherence to the prescription of guideline‐recommended medications is needed for the treatment of CSU. [ABSTRACT FROM AUTHOR]

As the international refugee crisis has reached new proportions (BMJ, 355, 2016 and i5412), survivors of torture increasingly present in treating physicians with an array of acute or chronic skin lesions. Physicians should be aware of common presentations and likely differential diagnoses in order to avoid mislabelling or under‐recognizing torture. Survivors of torture also frequently suffer from psychological sequelae, such as post‐traumatic stress disorder, and appropriate referrals are essential in order to improve recovery trajectory. Skin sequelae are the most common physical findings of torture. Not all skin lesions seen in tortured survivors are due to perpetrator inflicted injuries, and many dermatological conditions can mimic lesions typical of torture, as can scars as a result of folk remedies or cultural practices specific to geographical regions. Medical documentation of torture includes injury and lesion description. While forensic dermatology and other forensic specialties use an injury description taxonomy, and the standard dermatologic taxonomy uses an anatomic description, they are complementary sciences for lesions inflicted by torture. This results in an opportunity for learning across disciplines in order to improve evidence documentation for survivors of torture. This article describes features of common skin lesions consistent with torture, including their clinical appearances, differential diagnoses, patterns of injury and appropriate clinical descriptions. Linked article: A. Morrone. J Eur Acad Dermatol Venereol 2019; 33: 1199–1200. https://doi.org/10.1111/jdv.15724 [ABSTRACT FROM AUTHOR]

In our patient skin patch testing with mesalazine was negative, but the complete resolution without subsequent flares strongly point towards a mesalazine-induced glossitis in our patient. One year after stopping mesalazine the patient had no recurrence of UC, eosinophilia or tongue swelling. A 74-year-old male, with a four-year history of ulcerative colitis (UC) treated with mesalazine, presented with episodic cheek and progressive tongue swelling respectively since 27 months. [Extracted from the article]

Relapsing symmetric livedo reticularis in a patient with COVID-19 infection During the Coronavirus 2019 (COVID-19) pandemic, several associated skin conditions were reported in infected patients, including, urticaria,1 exanthema,1 erythema multiforme,2 chickenpox-like vesicles,1 pityriasis rosea,3 erythema nodosum like Sweet's syndrome,4 symmetrical drug-related intertriginous and flexural exanthema,5 petechial rash,6 vasculitic purpura,7 acro-ischaemia/necrosis,6 Kawasaki disease2 and chilblain lesions.6 We present a 57-year-old man with cough, dyspnoea, headache, myalgia arthralgia, fever up to 38.7 °C and abdominal pain worsening over 8 days. Livedo was not blanching on pressure and typical clinical signs of vasculitis, like purpura, (asymmetric) LRC or skin necrosis were absent. [Extracted from the article]

Background Anaphylaxis is a life-threatening emergency of which reliable epidemiological data are lacking. This study aimed to analyze how quickly patients presenting with anaphylaxis were treated in emergency and whether treatment followed the European Academy of Allergy and Clinical Immunology ( EAACI) guidelines. Methods Patient data were collected between April 2009 and April 2013. Emergency doctors completed a questionnaire for adult patients presenting at the emergency department ( ED) of the St. Pierre hospital in Brussels with anaphylaxis. Inclusion criteria were based on the Sampson criteria of anaphylaxis. Data were analyzed using a Microsoft Excel database. Results About 0.04% (100/230878) of all emergency visits in adults presented with anaphylaxis. 64% of patients received their first medical help later than 30 min after symptom onset. 67% of patients received adrenaline, 85% oral antihistamines, and 89% received IV glucocorticosteroids. 46/100 patients were discharged directly from the ED, of which 87% received further medical prescriptions for self-administration: 67% corticosteroids, 83% antihistamines, and 9% intramuscular adrenaline. 74% were instructed to consult an allergologist for adequate diagnosis. 54/100 patients were hospitalized. Conclusion The majority of patients were treated according to the EAACI guidelines for management of anaphylaxis, but only a minority received the recommended adrenaline auto-injector for self-administration at discharge. Because the majority of patients received medical help later than 30 min after symptom onset, adrenaline auto-injector prescription is a necessity. The low rate of doctors prescribing adrenaline auto-injectors in the ED setting underlines the need to train doctors of various backgrounds in prevention and treatment of anaphylaxis and the close collaboration with allergologists. [ABSTRACT FROM AUTHOR]

Lightening skin tone is an ancient and well-documented practice, and remains common practice among many cultures. Whitening agents such as corticosteroids, tretinoin and hydroquinone are medically applied to effectively lighten the skin tone of hyperpigmented lesions. However, when these agents are used cosmetically, they are associated with a variety of side-effect. Alternative agents, such as arbutin and its derivatives kojic acid and nicotinamide have been subsequently developed for cosmetic purposes. Unfortunately, some cosmetics contain whitening agents that are banned for use in cosmetic products. This article provides an overview of the mode of action and potential side-effects of cosmetic legal and illegal whitening agents, and the pattern of use of these types of products. Finally, an EU analysis of the health problems due to the presence of illegal products on the market is summarized. [ABSTRACT FROM AUTHOR]

Background Structured educational programmes for patients at risk for anaphylaxis have not yet been established. Patients and caregivers often lack adequate skills in managing the disease. Methods To investigate effects of structured patient education intervention on knowledge, emergency management skills and psychological parameters in patients with previous episodes of anaphylaxis and caregivers of affected children 95 caregivers (11 male, 84 female, mean age 37 years) of affected children and 98 patients (32 male, 66 female, mean age 47.5 years) were randomly assigned to an intervention ( IG) or control group ( CG) in a multicentre randomized controlled trial. The IG received two 3-h schooling modules of group education; the CG received standard auto-injector training only. Knowledge of anaphylaxis and emergency management competence in a validated training anaphylaxis situation as main outcome measures as well as secondary psychological parameters were assessed at baseline and 3 months after intervention. Results In comparison with controls, the intervention led to significant improvement of knowledge from baseline to 3-month follow-up (caregivers: IG 3.2/13.2 improvement/baseline vs CG 0.7/12.6; P < 0.001; patients: IG 3.9/10.8 vs 1.3/12.6; P < 0.001). Moreover, emergency management competence was increased after intervention as compared to controls (caregivers: IG 8.6/11.2 vs CG 1.2/10.8; P < 0.001; patients: 7.1/11.0 vs 1.1/11.1; P < 0.001). Intervention showed significant reduction of caregiver anxiety (−1.9/8.4 vs −0.7/7.5; P < 0.05). There were no significant changes in the depression scores. Conclusion Structured patient education programmes may be beneficial in the management of anaphylaxis by increasing patients' empowerment to prevent and treat the disease. [ABSTRACT FROM AUTHOR]

Minimizing tuberculosis risk in patients receiving anti-TNF therapy. Annual screening for patients at risk for exposure to tuberculosis (e.g. patients travelling to endemic areas) has previously been suggested.3-5 This case shows that it is important to always include tuberculosis in the differential diagnosis of ulcerated or indurated oral lesions in patients treated with TNF- blockers. Patients treated with TNF- blockers have an increased risk of reactivating latent tuberculosis (TB). [Extracted from the article]

Skin tests are of paramount importance for the evaluation of drug hypersensitivity reactions. Drug skin tests are often not carried out because of lack of concise information on specific test concentrations. The diagnosis of drug allergy is often based on history alone, which is an unreliable indicator of true hypersensitivity.To promote and standardize reproducible skin testing with safe and nonirritant drug concentrations in the clinical practice, the European Network and European Academy of Allergy and Clinical Immunology ( EAACI) Interest Group on Drug Allergy has performed a literature search on skin test drug concentration in MEDLINE and EMBASE, reviewed and evaluated the literature in five languages using the GRADE system for quality of evidence and strength of recommendation. Where the literature is poor, we have taken into consideration the collective experience of the group.We recommend drug concentration for skin testing aiming to achieve a specificity of at least 95%. It has been possible to recommend specific drug concentration for betalactam antibiotics, perioperative drugs, heparins, platinum salts and radiocontrast media. For many other drugs, there is insufficient evidence to recommend appropriate drug concentration. There is urgent need for multicentre studies designed to establish and validate drug skin test concentration using standard protocols. For most drugs, sensitivity of skin testing is higher in immediate hypersensitivity compared to nonimmediate hypersensitivity. [ABSTRACT FROM AUTHOR]

Background The BRAF-inhibitor vemurafenib, used in patients with metastatic melanoma, induces multiple cutaneous side-effects. Objective The aim of this work was to evaluate the development of palmoplantar fibromatosis in a population of patients treated with the BRAF inhibitor vemurafenib. Methods Between April 2011 and February 2013, we initiated a treatment with vemurafenib in 53 patients with an unresectable stage IIIC or stage IV melanoma. The patients were followed-up on a regular base to monitor possible side-effects. Results A plantar or palmar fibromatosis was observed in five of 53 patients treated with vemurafenib. In four of these patients other risk factors for the development of palmoplantar fibromatosis were absent. Conclusion The BRAF-inhibitor vemurafenib might induce palmoplantar fibromatosis. [ABSTRACT FROM AUTHOR]

Positive patch testing with omeprazole in Stevens-Johnson syndrome: a case report Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening cutaneous reactions, caused by a delayed-type hypersensitivity reaction to medication.1 Proton pump inhibitors (PPIs) are among the most commonly prescribed medications worldwide with a large proportion of non-evidence-based applications.2 A 69-year-old man, known with arterial hypertension and gout, was started on 64 mg methylprednisolone for a chronic inflammatory demyelinating polyneuropathy. For SJS/TEN caused by PPIs, a positive patch test result was observed in 40% of patients.7 To our knowledge, this is the first case of SJS caused by omeprazole, confirmed by patch testing. [Extracted from the article]

The article presents a case study of a 63-year-old male patient who was suffering from malaise, asthenia and hyponatremia and was diagnosed with the paraneoplastic systemic lupus erythematosus disorder which was associated with an oat cell tumour in his lungs. Details regarding his therapeutic proceedings are presented, which comprised of carboplatin and etoposide drug chemotherapy.

A letter to the editor is presented in response to the article "Is isotretinoin treatment safe in patients with known peanut allergy?," in the previous issue.

The article presents several case studies related to association of hyperprolactinaemia with diffuse hair loss. Topics discussed include disclosure if high serum level of prolactin in a 24 year old women during her endocrinological work-up, risperidon treatment to tackle psychological problems due to lysergic acid diethylamide and ecstasy drug abuse in a 21 year old male patient who complaints acute hair fall and hair loss in a 26 year old women who has a history of haloperidol treatment.

There are only a few clinical trials which address the treatment of acute urticaria (AU). Especially, the added value of systemic corticosteroids to antihistamines is unclear in treatment of severe AU. To review the existing evidence-based approaches for AU treatment. A systematic electronic search was done in PubMed and Web of Science to retrieve all studies on the treatment of patients with AU. A descriptive synthesis was conducted based on the PRISMA statement. Quality assessment was independently performed by both reviewers ('Cochrane risk-of-bias tool' for RCTs). Ten randomized controlled trials (RCTs) (n = 857 participants) were included. Four studies assessed corticosteroid effectiveness added to antihistamines and six studies compared the efficacy of H 1 and/ or H 2 -antihistamines. The addition of corticosteroid (prednisone) to an antihistamine (levo)cetirizine did not improve symptoms of AU compared to antihistamine alone in two out of three RCTs. The combination of diphenhydramine (50 mg, IV) and ranitidine (50 mg, IV) or cimetidine (300 mg, IV) was most efficient for relief of urticaria in two out of five studies. Most frequent adverse effects were sedation and drowsiness. Recent guidelines on urticaria treatment mainly focus on chronic urticaria rather than on AU. Moreover, only few, small RCTs provide evidence for the management of AU. Thus, the state-of-the-art management of this frequent condition remains unclear. The addition of corticosteroids to an antihistamine as treatment for AU needs to be further investigated. Well-designed, high-quality interventional trials are needed to establish evidence-based treatment guidelines for AU., (© 2024 European Academy of Dermatology and Venereology.)

Background: Anaphylaxis, which is rare, has been reported after COVID-19 vaccination, but its management is not standardized., Method: Members of the European Network for Drug Allergy and the European Academy of Allergy and Clinical Immunology interested in drug allergy participated in an online questionnaire on pre-vaccination screening and management of allergic reactions to COVID-19 vaccines, and literature was analysed., Results: No death due to anaphylaxis to COVID-19 vaccines has been confirmed in scientific literature. Potential allergens, polyethylene glycol (PEG), polysorbate and tromethamine are excipients. The authors propose allergy evaluation of persons with the following histories: 1-anaphylaxis to injectable drug or vaccine containing PEG or derivatives; 2-anaphylaxis to oral/topical PEG containing products; 3-recurrent anaphylaxis of unknown cause; 4-suspected or confirmed allergy to any mRNA vaccine; and 5-confirmed allergy to PEG or derivatives. We recommend a prick-to-prick skin test with the left-over solution in the suspected vaccine vial to avoid waste. Prick test panel should include PEG 4000 or 3500, PEG 2000 and polysorbate 80. The value of in vitro test is arguable., Conclusions: These recommendations will lead to a better knowledge of the management and mechanisms involved in anaphylaxis to COVID-19 vaccines and enable more people with history of allergy to be vaccinated., (© 2022 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)

This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria., (© 2021 GA²LEN. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

The strongest and best-documented risk factor for drug hypersensitivity (DH) is the history of a previous reaction. Accidental exposures to drugs may lead to severe or even fatal reactions in sensitized patients. Preventable prescription errors are common. They are often due to inadequate medical history or poor risk assessment of recurrence of drug reaction. Proper documentation is essential information for the doctor to make sound therapeutic decision. The European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology have formed a task force and developed a drug allergy passport as well as general guidelines of drug allergy documentation. A drug allergy passport, a drug allergy alert card, a certificate, and a discharge letter after medical evaluation are adequate means to document DH in a patient. They are to be handed to the patient who is advised to carry the documentation at all times especially when away from home. A drug allergy passport should at least contain information on the culprit drug(s) including international nonproprietary name, clinical manifestations including severity, diagnostic measures, potential cross-reactivity, alternative drugs to prescribe, and where more detailed information can be obtained from the issuer. It should be given to patients only after full allergy workup. In the future, electronic prescription systems with alert functions will become more common and should include the same information as in paper-based documentation., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)