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Background: The usefulness of the mast cell activation test (MAT) in diagnosing patients with uninterpretable basophil activation test (BAT) results caused by nonresponding basophils has not been addressed. Our study evaluated whether the results of the MAT were associated with the severity of the allergic reaction., Methods: We recruited 39 patients with Hymenoptera venom allergy (HVA), 22 nonsensitized controls, and 37 BAT nonresponding HVA patients. Specific IgE levels for honeybee venom (HBV) and yellow jacket venom (YJV) and total IgE were quantified using the IMMULITE® system. We performed a BAT and a MAT, which was based on the response of LAD2 cells to HBV and YJV., Results: We first optimized the susceptibility of LAD2 cells to IgE-mediated degranulation in HVA and showed that prestimulation with IL-33 and IL-6 significantly increased the responsiveness of LAD2 cells to allergen stimulation (P<.01). The LAD2 MAT results correlated with the BAT results, and patients with severe sting reactions (Mueller grades III and IV) had a median 2-fold higher LAD2 MAT score than patients with nonsevere sting reactions (large local reaction or Mueller grades I and II) (P<.05). Furthermore, LAD2 MAT provided conclusive results in 20 of the 37 HVA patients (54.1%) with nonresponding basophils in the BAT., Conclusions: The LAD2 MAT is a new diagnostic tool for HVA patients with nonresponding basophils. LAD2 MAT can identify patients at risk of severe sting reactions and can thus help guide recommendations for venom immunotherapy and improve the management of patients with HVA.

The domestic horse is the third most common source of animal allergens. Currently, five equine allergens have been classified (Equ c 1, 2, 3, 4, 6). Despite the apparently low exposure to allergens, equine allergy is still of great clinical importance. The aim of the study was to analyze equine allergy based on the results of ImmunoCAP ISAC and Allergy Xplorer ALEX tests. The study was retrospective. A total of 1553 patients were analyzed. Immunological tests were performed using the ImmunoCAP ISAC and Allergy Xplorer ALEX systems. From all the results, those with a positive result for at least one horse allergen were selected for further analysis. Horse allergy was found in 9% of subjects by the ImmunoCAP ISAC and in 10% by the Allergy Xplorer ALEX system. In both tests, sIgE for Equ c 1 was most frequently found. Horse allergy was very often accompanied by allergy to other animals. Monosensitization to horse was found only in the ImmunoCAP ISAC tests (0.2% of the population). In the ImmunoCAP ISAC tests, a correlation was found between Equ c 1 and Can f 1, Can f 2, Can f 5, Fel d 1, Fel d 4, Mus m1 and Can f 3; with increasing sIgE concentrations for the allergen Equ c 1, the results for the remaining correlated allergens increased. Horse allergy is a common clinical problem. Equ c 1 is the major horse allergen. Monosensitization to horse is rare. The present study is the first to present analyses of sIgE concentrations for horse allergens.

The skin is a large and sophisticated organ populated by innate and adaptive immune effector cells. These immune cells provide a critical first line of defense against pathogens, but genetic and environmental factors can lead to inappropriate signaling that may manifest as hypersensitivity. The most common cutaneous allergic disorders in children include atopic dermatitis, urticaria/angioedema, and contact dermatitis. In this review, we will briefly review these conditions, with a focus on recent developments in our understanding of the diagnosis and management of these disorders., (© 2025 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

The skin prick test (SPT) is a key tool for identifying sensitized allergens associated with immunoglobulin E-mediated allergic diseases such as asthma, allergic rhinitis, atopic dermatitis, urticaria, angioedema, and anaphylaxis. However, the SPT is labor-intensive and time-consuming due to the necessity of measuring the sizes of the erythema and wheals induced by allergens on the skin. In this study, we used an image preprocessing method and a deep learning model to segment wheals and erythema in SPT images captured by a smartphone camera. Subsequently, we assessed the deep learning model's performance by comparing the results with ground-truth data. Using contrast-limited adaptive histogram equalization (CLAHE), an image preprocessing technique designed to enhance image contrast, we augmented the chromatic contrast in 46 SPT images from 33 participants. We established a deep learning model for wheal and erythema segmentation using 144 and 150 training datasets, respectively. The wheal segmentation model achieved an accuracy of 0.9985, a sensitivity of 0.5621, a specificity of 0.9995, and a Dice similarity coefficient of 0.7079, whereas the erythema segmentation model achieved an accuracy of 0.9660, a sensitivity of 0.5787, a specificity of 0.97977, and a Dice similarity coefficient of 0.6636. The use of image preprocessing and deep learning technology in SPT is expected to have a significant positive impact on medical practice by ensuring the accurate segmentation of wheals and erythema, producing consistent evaluation results, and simplifying diagnostic processes., Competing Interests: Declarations. Ethics Approval: This study was conducted in accordance with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Boards of Gachon University Gil Medical Center (GCIRB2022-264) and Ewha Womans University Medical Center (SEUMC 2022-12-049). Consent to Participate: Informed consent was obtained from all individual participants included in the study. Consent for Publication: Informed consent was obtained from all individual participants included in the study, and it included publication of the image of their skin on the back which did not contain their entire body or face in order not to interrupt their privacy. Competing Interests: The authors declare no competing interests., (© 2024. The Author(s) under exclusive licence to Society for Imaging Informatics in Medicine.)

The major challenge in allergy diagnosis is development of accessible and reliable diagnostics that can predict the clinical outcome following exposure to culprit allergen(s) or cross-reactive molecules and identification of safer alternatives than the current state-of-the-art methods. There is accumulating evidence that flow-based analyses for the quantification of activated basophils and mast cells subsequent to in vitro challenge (the basophil and mast cell activation test [BAT/MAT] or basophil activation test [BAT] and mast cell activation test [MAT]) could meet the diagnostic requirements for IgE-dependent allergies, drug hypersensitivities, and subsets of autoimmune urticaria. Furthermore, the BAT and MAT have found application in research and other nondiagnostic fields. However, appropriate use of the BAT and MAT requires understanding of the diversity of the source materials used and degranulation metrics to ensure correct test performance and interpretation of results. In this review, we provide the main applications and limitations of the BAT and MAT, as performed thus far., Competing Interests: Disclosure statement Supported by funding from the UK Medical Research Council (to R. Bahri), UK Research and Innovation (studentship to C. Tontini), and the Swiss National Science Foundation (grant 219361 [to A. Eggel]). Disclosure of potential conflict of interest: A. Eggel is a cofounder, consultant, and shareholder of ATANIS Biotech AG and Excellergy, Inc, and has received grants from ATANIS Biotech AG unrelated to this work. D. G. Ebo, V. Sabato, and J. Elst are owners of the patent “Methods for Diagnosing Immediate Hypersensitivity Reactions” (WO 2021/191182). V. Sabato is a senior clinical researcher of the Research Foundation Flanders/Fonds Wetenschappelijk Onderzoek (grant 1804518N). D. G Ebo is a senior clinical researcher of the Research Foundation Flanders/Fonds Wetenschappelijk Onderzoek (grant 1800614N). The Antwerp University Hospital and AZ Jan Palfijn Hospital Ghent are excellence centers of the World Allergy Organization. The rest of the authors declare that they have no relevant conflicts of interest., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Introduction: Numerous studies have characterised trajectories of asthma and allergy in children using machine learning, but with different techniques and mixed findings. The present work aimed to summarise the evidence and critically appraise the methodology., Methods: 10 databases were searched. Screening, data extraction and quality assessment were performed in pairs. Trajectory characteristics were tabulated and visualised. Associated risk factor and outcome estimates were pooled using a random-effects meta-analysis., Results: 89 studies were included. Early-onset (infancy) persistent, mid-onset (∼2-5 years) persistent, early-onset early-resolving (within ∼2 years) and early-onset mid-resolving (by ∼3-6 years) wheezing and eczema, respectively, were the most commonly identified disease trajectories. Intermediate/transient trajectories were rare. Male sex was associated with a higher risk of most wheezing trajectories and possibly with early-resolving eczema, while being slightly protective against mid-onset persistent eczema. Parental disease/genetic markers were associated with persistent trajectories of wheezing and eczema, respectively. Prenatal (and less so postnatal) tobacco smoke exposure was associated with most wheezing trajectories, as were lower respiratory tract infections in infancy (particularly with the early-onset resolving patterns). Most studies (69%) were of low methodological quality (particularly in modelling approaches and reporting). Few studies investigated allergic multimorbidity, allergic rhinitis and food allergy., Conclusions: Childhood asthma/wheezing and eczema can be characterised by a few relatively consistent trajectories, with some actionable risk factors such as pre-/postnatal smoke exposure. Improved computational methodology is warranted to better assess generalisability and elucidate the validity of intermediate/transient trajectories. Likewise, allergic multimorbidity and trajectories of allergic rhinitis and food allergy need to be further elucidated., Competing Interests: Conflict of interest: H. Kankaanranta reports personal fees for lectures and consulting from AstraZeneca, Boehringer-Ingelheim, Chiesi Pharma, GSK, MSD, Novartis, Orion Pharma, and Sanofi Genzyme outside the current work. The remaining authors report that they have no conflict of interest., (Copyright ©The authors 2025.)

Background: Venom-allergic patients are frequently double-sensitized to honeybee venom (BV) and Vespula venom (VV). Genuine double allergy is uncommon., Objectives: To assess whether a quantitative comparison of BV- and VV-specific IgE levels permits an identification of the culprit venom in double-sensitized patients, and to evaluate whether independent sensitization to BV- and VV-specific components corresponds to an indication for double immunotherapy., Methods: This single-center observational study evaluated 1,069 consecutive patients; 490 nonallergic controls were available for statistical comparison. The diagnosis (BV allergy, VV allergy, or double allergy) was based on a comprehensive allergological workup including patient history, IgE serology, intradermal skin test, and, when required, basophil activation testing. Quantitative allergen-specific IgE to BV, VV, rApi m 1, and rVes v 5 was retrospectively compared with the final diagnosis. The ratio of BV/VV-specific IgE levels was considered in double-sensitized venom-allergic patients., Results: Sensitization to whole-venom preparations and components was frequent in patients and asymptomatic controls, with higher specific IgE levels in the patient group. At least 5:1 dominance of the specific IgE to either BV or VV was documented in 239 of 459 double-sensitized venom-allergic patients (52.1%). Of these patients 232 (97.1%) received a diagnosis of monoallergy to only the venom to which they were dominantly sensitized., Conclusions: Dominant specific IgE at a ratio of 5:1 indicates the culprit venom in double-sensitized allergic patients. Additional component-resolved diagnostic testing can be restricted to cases with double sensitization to whole venom at a ratio of less than 5:1. Double sensitization to rApi m 1 and rVes v 5 per se does not justify double venom immunotherapy., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Summary: Background. Patients with severe allergic conditions often request support from the prehospital emergency services given the rapid, unexpected and po-tentially life-threatening nature of the reactions, such as anaphylaxis. Studies regarding prehospital incidents for allergic conditions are scarce. This study aimed to characterize prehospital medical requesting assistance due to suspected hypersensitivity reactions (HSR). Methods. Retrospective study of allergic-re-lated requesting assistances between 2017 and 2022 of a Portuguese emergency dispatch center ‒ Emergency and Resuscitation Medical Vehicle (VMER) ‒ in Coimbra University Hospital. Demographic and clinical variables were analyzed, including clinical manifestations, anaphylaxis severity grading, therapeutic interventions, and post-incident allergic work-up. Regarding anaphylactic events, three diagnosis timings were compared: on-site, hospital emergency department and investigator-diagnosis based on data reviewed. Results. Out of 12,689 VMER requesting assistances, 210 (1.7%) were classified as suspected HSR reactions. After on-site medical evaluation, 127 (60.5%) cases maintained the HSR classification (median age 53 years; 56% males) and the main diag-noses included HSR to Hymenoptera venom (29.9%), food allergy (29.1%), and pharmaceutical drugs (25.5%). Anaphylaxis was assumed on-site in 44 (34.7%) cases, in the hospital emergency department in 53 cases (41.7%) and by investigators in 76 (59.8%) cases. Regarding management, epinephrine was administered on-site in 50 cases (39.4%). Conclusions. The main reason for prehospital requesting assistance was HSR to Hymenoptera venom. A high proportion of incidents met the criteria for anaphylaxis and despite the inher-ent difficulties of the prehospital setting, many of the on-site diagnoses agreed with the criteria. Regarding management, epinephrine was underused in this setting. After pre-hospital events, a proper referral to a specialized consultation is crucial for a full diagnostic work-up and disease management.

Background: Cutaneous mastocytosis (CM) is the most common type of mastocytosis in children. The atopy frequency in these patients is typically similar to that in the general population, but a higher incidence of anaphylaxis is reported. Objective: This study aimed to evaluate the presence of allergic diseases in children diagnosed with CM and its impact on clinical manifestations. Methods: Children diagnosed with CM at Ankara Bilkent City Hospital Pediatric Allergy and Immunology Clinic between September 2019 and September 2023 were included in the study. Data, including demographic information, clinical details, and laboratory results, were gathered from medical records, encompassing personal and family allergy history. Results: The study included 58 patients (median [interquartile range{IQR}] age, 64 months [29-100.5 months]; 69% boys) with skin lesions as the primary concern. The median (IQR) age at which the lesions appeared was 9 months (3-39.25 months), and the median (IQR) age at hospital admission was 12 months (5- 50 months). The median (IQR) age at CM diagnosis was 13 months (6-53.5 months). The median (IQR) baseline tryptase value was 5.45 μg/L (3.93-9.00 μg/L), and 16 had an elevated tryptase value (>8 μg/L). Allergic diseases were present in 39.65% of the patients, with atopic dermatitis (18.9%) being the most common, followed by asthma (10.3%), allergic rhinitis (5.2%), food allergy (1.7%), and drug and bee venom allergies (1.7%). One patient had a history of anaphylaxis, diagnosed 4 months after consuming yogurt. A total of 18 patients, including this patient, were prescribed an adrenaline autoinjector. Conclusion: Various allergic diseases occurred in ∼40% of patients with CM and most commonly manifest as atopic dermatitis; 31% patients with risk factors for anaphylaxis were prescribed an adrenaline autoinjector.

Hymenoptera venom allergy (HVA) is a potentially life-threatening condition, making accurate diagnosis crucial for identifying significant IgE sensitizations and enabling effective venom immunotherapy. In this review, we provide a detailed overview of biomarkers for the molecular diagnosis of IgE-mediated hypersensitivity to Hymenoptera insect venoms in clinical practice, and we present, in a structured manner, their importance in differentiating genuine sensitizations versus cross-sensitizations using different diagnostic procedures. Updated algorithms are provided, along with the advantages and limitations of molecular diagnosis approaches. Geographical variations and rare species may pose further challenges in diagnosing and treating HVA, adding complexity to HVA management. This review informs readers about performing tailored diagnostics based on molecular allergen biomarkers and subsequent treatment strategies.

Atopic dermatitis, food allergy, allergic rhinitis, and asthma are among the most common diseases in childhood. They are heterogeneous diseases, can co-exist in their development, and manifest complex associations with other disorders and environmental and hereditary factors. Elucidating these intricacies by identifying clinically distinguishable groups and actionable risk factors will allow for better understanding of the diseases, which will enhance clinical management and benefit society and affected individuals and families. Artificial intelligence (AI) is a promising tool in this context, enabling discovery of meaningful patterns in complex data. Numerous studies within pediatric allergy have and continue to use AI, primarily to characterize disease endotypes/phenotypes and to develop models to predict future disease outcomes. However, most implementations have used relatively simplistic data from one source, such as questionnaires. In addition, methodological approaches and reporting are lacking. This review provides a practical hands-on guide for conducting AI-based studies in pediatric allergy, including (1) an introduction to essential AI concepts and techniques, (2) a blueprint for structuring analysis pipelines (from selection of variables to interpretation of results), and (3) an overview of common pitfalls and remedies. Furthermore, the state-of-the art in the implementation of AI in pediatric allergy research, as well as implications and future perspectives are discussed., Conclusion: AI-based solutions will undoubtedly transform pediatric allergy research, as showcased by promising findings and innovative technical solutions, but to fully harness the potential, methodologically robust implementation of more advanced techniques on richer data will be needed., What Is Known: • Pediatric allergies are heterogeneous and common, inflicting substantial morbidity and societal costs. • The field of artificial intelligence is undergoing rapid development, with increasing implementation in various fields of medicine and research., What Is New: • Promising applications of AI in pediatric allergy have been reported, but implementation largely lags behind other fields, particularly in regard to use of advanced algorithms and non-tabular data. Furthermore, lacking reporting on computational approaches hampers evidence synthesis and critical appraisal. • Multi-center collaborations with multi-omics and rich unstructured data as well as utilization of deep learning algorithms are lacking and will likely provide the most impactful discoveries., Competing Interests: Declarations. Ethics approval: This is a review work; therefore, ethical approval is not warranted. Consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

We have read with great interest the recent review published by Dr. Ebo and collaborators on cannabis allergy. It highlights the difficulties in getting a valid diagnosis because some patients do not admit its consumption, which may not be legalized, there are no commercial extracts and there are problems in cutaneous tests interpretation due to cross-reactivity with other related allergens. In addition to this, bronchial challenge is considered the confirmatory diagnosis, but it is complex to perform. This also occurs in diagnosis of occupational asthma, such as in baker's asthma, in which we have investigated a reliable marker to avoid the bronchial challenge. However, we think it is necessary to do this test to ensure a correct etiological diagnosis of cannabis asthma, and we have carried out bronchial challenge with cannabis on more than 600 patients since 2009, all them active consumers. In our country cannabis consumption has not been legalized, but to do this challenges we asked the National Court for permission, which we obtained easily. Although molecular diagnosis has helped in revealing the problems caused by cross-reactivity, the gold standard continues to be the provocation. In our articles we detail how to do it safely, and we encourage our colleagues to reach a definitive diagnosis that cannabis is the cause of their bronchial symptoms., Competing Interests: Declarations. Ethical approval: This letter does not contain any studies with human or animal subjects performed by any of the authors. Competing Interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

From a taxonomic point of view, Hymenoptera are subclassified into families: Apidae, including honeybees (Apis mellifera) and bumblebees (Bombus), and Vespidae, which, in turn, are divided into the subfamilies of Vespinae (wasps, including hornets, vespules, dolichovespules) and Polistinae (paper wasp). Hypersensitivity to Hymenoptera venom can be linked to immunological (IgE-mediated or non-IgE-mediated) and non-immunological mechanisms. Reactions are classified into local reactions, large local reactions, systemic reactions, toxic reactions, and unusual reactions. In general, children sensitize less frequently and have less severe reactions than adults, probably due to less exposure to repeated stings and fewer comorbidities. There are risk factors for systemic reactions that should be discussed with patients and their parents as appropriate. A correct diagnosis of Hymenoptera venom allergy relies on a careful clinical history and the appropriate use of skin and in vitro tests. The in vitro tests include serum specific IgE toward venom extracts and toward allergenic molecules. In complex diagnoses, CAP-inhibition and the Basophil Activation Test can also be used. In the presence of a systemic reaction, the basal serum tryptase measurement should be performed to rule out mastocytosis. In case of allergic reactions to Hymenoptera stings, in the acute phase, according to the current guidelines, the treatment of signs and symptoms mainly includes the use of adrenaline as first-line treatment in case of anaphylaxis and antihistamines and corticosteroids as subsequent lines of treatment. Given the impossibility of avoiding a new sting with certainty, the treatment of choice in subjects with hypersensitivity to Hymenoptera venom who have experienced systemic reactions is based on venom immunotherapy (VIT), with the venom of the responsible stinging insect identified after an adequate allergological work-up. VIT is performed in a suitable environment and has proved to be safe and effective with various administration protocols, both accelerated and conventional. The prevention of Hymenoptera venom anaphylaxis in patients who have already developed a previous episode is crucial and must be supported by environmental protection interventions and early therapy. Places where one is more likely to encounter insects and risky behaviors should be avoided., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

Introduction: Chronic urticaria (CU) is not traditionally classified as an allergic disease, but emerging evidence suggests a link to atopy. The quintessential marker of atopy is IgE sensitization, there is scarce information on the IgE sensitization characteristics of CU., Methods: To investigate IgE sensitization characteristics in CU, and compare them with classic allergic diseases. We retrospectively analyzed the results of specific IgE (sIgE) and total IgE (tIgE) in CU patients, explored the distribution patterns of these atopic markers in CU, and compared these data with those of atopic dermatitis (AD), allergic rhinitis (AR), asthma (AS), and healthy controls (HC)., Results: 1149 patients (396 CU, 411 AD, 101 AR, 139 AS and 102 HC) were included in the study. 33.1% of CU patients showed positive sIgE and 49.0 % had elevated tIgE levels, significantly higher than those in HC. Comparative analysis with classic allergic diseases showed CU patients had a lower sIgE positivity rate but no significant difference in tIgE levels. Gender and age influenced sensitization profiles, with male CU patients showing a higher sIgE positivity rate. The distribution of sIgE levels, allergen categories, and tIgE elevated levels range in CU differed from classic allergic disease. The concordance rate between sIgE and tIgE results in CU was lower than in classic allergic disease., Conclusion: Our study reveals that a significant proportion of CU patients display IgE sensitization, suggesting a clear atopic background compared to the general population. However, the IgE sensitization profile in CU differs from that of classical allergic diseases such as AD, AR, and AS, characterized by relatively lower intensity of IgE sensitization. The underlying reasons for this phenomenon and its clinical implications in CU warrant further research., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Yang, Li, Chen, Wang, Deng, Ni, Song and Chen.)

The term "allergy" is inaccurate for the vast majority of the contents in the current allergy fields of electronic health records (EHRs). While EHRs have transformed access to health information and streamlined the delivery of care, their ability to reliably indicate medications, vaccines, or foods that mandate avoidance versus preferences or mild intolerances, is suboptimal. The current systems are reactive instead of being proactive and frequently fail to communicate the appropriate course of action. This Position Statement of the American Academy of Allergy, Asthma and Immunology (AAAAI) advocates for a change in terminology. The section of the EHR currently labeled "allergies" should be renamed "alerts." The term "alert" accurately captures the purpose of this section without incorrectly assigning an allergic mechanism, and prioritizes easily understood and actionable labels. This change has the potential to simultaneously improve patient safety and care. This shift will be the first step in the transformation of the alerts section of the EHR. This document provides a framework for categorizing what should be included in this section. Enacting these changes will require EHR and clinical decision support vendors, healthcare and data standard regulators, allergists, and the larger health care community to work together to bring about these important advances., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Allergen-based diagnostics are essential in the management algorithm of allergic diseases. Unlike systemic allergy, where the indications and interpretation of these diagnostic modalities are well established, their utility in ocular allergy is not well-defined. With the rising prevalence of ocular allergies and the need for personalized treatment strategies, there is a growing demand for precision allergen diagnostics. This review describes the commonly used tests with their indications, procedures, and limitations. A review of the literature was carried out on articles on allergen diagnostics in ocular allergy, and after excluding articles that were not relevant, 82 papers were included in the current review. IgE-mediated pathways contribute significantly to seasonal and perennial ocular allergy and partly to vernal keratoconjunctivitis. Most diagnostic techniques aim to detect IgE sensitization. In vivo tests include skin prick (SPT), intradermal, and patch tests. SPT is considered the gold standard and directly evaluates the presence of allergen-specific IgE in the skin. In vitro tests measure total and specific IgE from either tears or sera. Tear IgE measurement is relatively specific for allergic conjunctivitis and can provide insight into the potential allergens responsible for local sensitization. The conjunctival provocation test can help establish true allergy, especially in patients with polysensitization. This review also provides an overview of evidence in literature segregated based on the test employed. This includes 17 studies on only SPT; 42 studies on IgE measured in serum, tears, or both; and 20 studies which have evaluated both SPT and IgE. The pattern of allergen sensitization can guide recommendations for avoidance measures and immunotherapy. Thus, this could create a corticosteroid-sparing therapy avenue in these patients, reducing disease severity and resulting visual morbidity., Competing Interests: Declarations. Competing Interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: The anti-COVID vaccination campaign has led to a significant increase in the demand for allergology consultations in patients considered at risk of reaction to anti-COVID-19 vaccines. This study aims to describe the experience of the vaccination campaign held in Piedmont (Italy) which developed a new service of Allergy Call Center (ACC) thus providing for the screening and management of allergy high-risk patients during pandemic., Study Design: A retrospective analysis was performed on all patients considered at high risk for the development of allergic reactions who were referred by the Immunology and Allergy Unit of Azienda Ospedaliera Ordine Mauriziano in Turin, Italy, between December 2020 and December 2022 and also on ACC consultations., Methods: During the COVID-19 pandemic, Piedmont Region instituted the ACC, active from May 10th, 2021 to December 31st 2022, to allow vaccinating doctors to require a telephonic consultation for patients who were considered at high risk for the development of allergic reactions. If further diagnostic evaluations were required, the ACC scheduled a visit with a Consultant of the Unit to better assess the clinical situation of the patient. Furthermore, patients referred by General Practitioners, Occupational Doctors and other consultants were also evaluated by the Unit when required., Results: During the operational period the ACC received a total of 15,865 calls and referred only 336 patients to the unit (27.4% of the total referrals), while General Practitioners referred 499 patients (40.8%), Occupational Doctors referred 61 patients (4.9%), and other consultants referred 326 patients (26.6%)., Conclusions: Evaluation and management of a large volume of requests seemed to be facilitated by a proactive framework for screening patients at high risk for allergic reactions as the ones referred by our ACC. This approach led to a prominent decrease in allergological visits to our tertiary care Centre, reducing the waiting times and providing additional support for both patients and healthcare providers, thus allowing the vaccinations to be more easily handled., Competing Interests: Declarations. Conflict of interest: The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royal-ties. Ethics Approval and Consent to Participate: The local Ethics Committee (Comitato Etico Territoriale interaziendale AOU Città della Salute e della Scienza di Torino) accepted the study, which was carried out in accordance with the Declaration of Helsinki’s principles., (© 2024. The Author(s).)

Objective: This study aims to gain a deeper understanding of the patterns of allergen detection positivity rates among different age and gender groups, and to explore cross-reactivity patterns among allergens., Methods: We conducted a retrospective analysis of patients who underwent allergen testing at our hospital. The sample for this study included all patients who underwent allergen testing. We utilized immune blotting to detect specific IgE antibodies to 20 allergens in patient sera., Results: The study results showed a higher proportion of female samples (72.35%) compared to male samples (27.65%). Among all participants, the age distribution was primarily concentrated in the 25-35 age group, accounting for 37.43% of the total sample, followed by the 45 years and older age group, accounting for 27.00%. This indicates that allergic symptoms may occur not only in children and adolescents but also at any time after adulthood. We further observed significant influences of factors such as gender and age on individual sensitivity to specific allergens. For example, compared to males, females were found to be more sensitive to certain allergens such as cat hair, dust mites, and dog epithelium. Similarly, we also found variations in sensitivity to specific allergens among different age groups., Conclusion: Close monitoring of allergen distribution in populations facilitates active engagement of allergic individuals in self-management, while gender and age may be important factors influencing individual sensitivity to specific allergens. These findings provide valuable insights for understanding the pathogenesis of allergic diseases and designing more effective prevention and treatment strategies., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethics approval and consent to participate The current study was conducted in accordance with the Helsinki Declaration of the World Medical Association and approved by the Ethics Committee of Beijing Chao-yang Hospital, Capital Medical University. Informed consent was obtained from all the study subjects before enrollment., (© 2024. The Author(s).)

Anaphylactic reactions are rare but potentially life-threatening events that may occur during medical procedures. This present case highlights a distinct occurrence of an anaphylactic reaction in a patient undergoing hemodialysis, specifically induced by the utilization of a fistula needle along with a review of the literature., Competing Interests: The authors declare no competing interests., (Copyright: Meriam Khadhar et al.)

Background: Various formulations of dog allergen extracts, including conventional dog (also known as dog epithelium) and acetone precipitated (AP) dog, have been used for skin-prick testing (SPT), with AP dog showing improved antigen content but experiencing stability issues due to precipitant formation. Ultrafiltered (UF) dog extract has been developed to address these concerns by offering comparable allergen content to AP dog. This study retrospectively compared UF dog with conventional dog and AP dog in SPT. Objective: To compare the efficacy of UF dog extract with conventional dog and AP dog extracts in detecting dog sensitization through SPT. Methods: Retrospective analysis of SPT results from a single U.S. allergy clinic was conducted. Tests performed between October 2022 and March 2024 were included. Primary and secondary outcomes were analyzed by using descriptive statistics and statistical tests. Results: UF dog, AP dog, and conventional dog showed positivity rates of 24.2%, 23.5%, and 16.3%, respectively. UF dog demonstrated significantly higher average wheal and erythema sizes compared with conventional dog and AP dog, but UF dog was not statistically different from AP dog in terms of test positivity. Conclusion: UF dog extract showed comparable number of positive tests to AP dog and a greater number of positive tests to conventional dog. Results of the study suggest UF dog as a viable alternative to AP dog, which offered improved stability and similar test responses. Further research with larger sample sizes is recommended to confirm these findings.

Background: Allergen component resolved diagnosis (CRD) is a method for identifying specific protein molecules that cause hypersensitivity. Unlike traditional methods that use crude allergen extracts containing multiple component species, CRD focuses on individual allergen protein molecules for more precise diagnosis. The World Allergy Organization (WAO) recommends CRD as a supplement to clinical history and allergen extract testing, and in some cases, it can replace crude extract tests., Methods: CRD involves the use of natural or recombinant proteins to detect specific IgE antibodies directed at individual allergenic components. This method allows for a more detailed analysis of a patient's allergic response compared to the use of whole allergen extracts. The Allergy Prevention and Control Specialty Committee of the Chinese Preventive Medicine Association, in collaboration with multidisciplinary experts, developed an expert consensus that incorporates the consensus of the European Academy of Allergy and Clinical Immunology (EAACI), WAO, and important domestic literature on CRD in recent years., Results: The consensus aims to standardize the algorithm of allergen diagnosis and provides a reference for clinical practice. It also offers guidance for clinicians on the common protein families identified by CRD, the scenarios where CRD is applicable, and the significance of detecting common allergen components., Conclusions: Despite its potential, CRD is not widely used in clinical practice in China due to the lack of allergen component reagents and a general unawareness among clinicians about CRD's application and interpretation of test results. The expert consensus developed by the Chinese Preventive Medicine Association aims to address this gap and enhance the clinical application of CRD in China., (© 2024 The Author(s). Pediatric Allergy and Immunology published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Knowledge of the military regulations is key to guiding medical evaluations for applicants and service members. Military and civilian allergy consultants are often called on for their expertise to provide guidance with regard to the allergic conditions that may be potentially disqualifying from service per the published regulations for accession and retention. This review focuses on the role of the allergy consultant in military accession, retention, and deployments. To better understand and attempt to define the role of the allergy consultant in the process of medical evaluation for military applicants and for active duty service members, in the context of the ongoing national recruitment and force sustainment crisis, it is imperative to comprehend the intricacies of military accession and retention guidelines. Military medical standards guidelines are easy to access and should be used when evaluating applicants or active duty service members with allergic conditions. Medical documentation that aligns with military guidelines can help our patients streamline accession, retention, and waiver requests. The objective of this review is to provide a framework for how to address allergic concerns in the context of military service and apply accession and retention standards as indicated for patients who present with common allergic diagnoses.

Summary: Background. Little is known about the relationship between allergic diseases and seizure disorders including epilepsy. It is hypothesized that inflammation from allergic diseases may predispose children to seizures. The aim of this study is to investigate the frequency of seizure disorder in children with asthma and allergy. Methods. This is a cross-sectional survey study of parents of 1,300 children and adolescents under 20 years of age referred to the Allergy and Asthma Clinic of Imam Ali Hospital (Karaj) who were asked to complete a screening questionnaire for seizures in their children. Parents who reported any history of seizures in their children were contacted to answer a second in-depth questionnaire to determine more detail of type, triggers, and treatment of seizures. Results. A total of 705 males (62%) and 433 females (38%) participated in this study, with a mean and standard age of 6.62 ± 4.57 years. Among them, 70.6% had asthma, 15.2% had allergic rhinitis, 5.6% had atopic dermatitis, 3.5% had urticaria, 2.7% had food allergies, 1% had drug allergies, and 1.4% had other allergic diseases. Additionally, 88 patients (7.7%) had a history of doctor-diagnosed seizures, 57 patients (5%) had febrile convulsions, and 15 patients (1.31%) had idiopathic epilepsy. There was no significant relationship found between febrile convulsions, seizures, and epilepsy with the type of allergic diseases. However, a significant association was observed between the number of comorbid allergic diseases in patients with febrile convulsions (OR 1.4, 95%CI 1.07-1.83, p = 0.013). There was also an association between the epilepsy and comorbid allergic diseases number with an odds ratio OR 1.84, 95%CI 0.28-12, however the risk of epilepsy was increased by 0.84% but this increase was not significant. Regarding the relation between the number of allergic diseases in parents and idiopathic epilepsy in their children, a significant association was found only for mothers (OR 1.28, 95%CI 1.04-2.23, p = 0.024), but not for fathers (p > 0.05). Conclusions. Febrile convulsion is associated with the number of comorbid allergic diseases in children and the mother's number of allergic diseases is more related to idiopathic epilepsy in children than the father's.

Introduction: Clinical recognition of potential immune-mediated allergic responses to implanted metal devices is increasing. For orthopaedic implants, while 'pure' compounds are used in specific circumstances, the majority of components are alloys - a combination of two or more distinct metals. Titanium is found commonly in many orthopaedic devices and is often championed as a 'hypoallergenic' option or inclusion. In the absence of a relevant previously published summary on the topic, this paper explores the current state-of-understanding of titanium allergy and proposes a patient management algorithm whereby such immune reactions are clinically-suggested., Methods: A structured, systematic literature review was performed following PRISMA search principles to provide a contemporary summary-of-understanding in this area and to highlight clinical and knowledge deficiencies., Results: Thirty-five topic-related articles were identified, the majority reflecting small case series' or proof-of-concept studies. The general standard of scientific evidence available was poor. Justification for arthroplasty utilization of titanium as a 'hypoallergenic' option is largely extrapolated from non-orthopaedic domains., Conclusions: Both ionic and conjugated titanium particles released from implant surfaces have the potential to trigger innate immune responses and true allergy. There exists no simple, high-sensitivity, screening test for titanium allergy. Conventional skin-patch testing is unreliable due to poor dermal penetration. Given established lymphocyte and macrophage activation pathways for allergy responses, in vitro methods using both cell-types show diagnostic promise. Surgical biopsy analysis from host-implant interfaces remains the contemporary 'gold-standard', however this represents an invasive, costly and highly-specialized approach not readily available in most settings. Further research to establish reliable/accessible diagnostic methods are indicated., (© 2024 The Author(s). ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.)

Background: Half of U.S. households own a dog despite 10% of individuals being sensitized to dog. Assessment and treatment options for dog allergy include the use of commercial dog extracts which have inconsistent performance, making diagnosing and managing dog allergy challenging. Contamination of dog extracts with other allergens has previously been reported. Objective: We sought to determine whether commercial dog extracts contain other aeroallergens. Methods: An extract purity and quantification study on acetone precipitated dog hair and dander extract (AP dog) was performed, 6 aeroallergens; Alternaria (Alt a 1), Ragweed (Amb a 1), German Cockroach (Bla g 2), Dust Mite (Der p t), Cat (Fel d 1), and Rye Grass (Lol p 1). Following, conventional dog hair and dander extract (CV dog) and the new ultrafiltered dog hair and dander extract (UF dog) were also assessed based on the initial results of AP dog. SDS-PAGE was performed on all three dog extracts to compare allergen content. Lastly, serology results and aeroallergen immunotherapy prescriptions were compared. Results: The ELISA trays with Alt a 1, Amb a 1, Bla g 2, Der p 1, and Lol p 1 antibodies did not capture AP dog, while the ELISA tray with Fel d 1 antibody captured AP dog, CV dog, and UF dog. SDS-PAGE results of the 3 dog extracts did not reveal a band at the molecular weight for Fel d 1. Conculsion: Contamination of commercial dog extracts was not found. However, our findings are supportive of commercial dog extracts containing a Fel d 1-like dog allergen that is cross-reactive to Fel d 1. Cross-reactivity between commercial dog extracts and Fel d 1 could be responsible for double positivity to cat and dog in serology. Additional studies are needed to better illustrate this Fel d 1-like dog allergen.

Allergic diseases are becoming increasingly common, and they are a threat to people's health. Exploring the distribution characteristics of allergen-specific immunoglobulin E (sIgE) in people from Sichuan province, southwest China, can provide clinical epidemiological data. This study enrolled 12,204 consecutive patients with suspected allergies from May 2018 to May 2021. Among the patients, 4206 were diagnosed with allergic rhinitis or asthma. The Rayto Lumiray 1600 detection system and sIgE and total IgE (tIgE) detection kits were used to measure the levels of nine common sIgE and tIgE. sIgE ≥ 0.35 IU/mL was considered positive. The sensitization rate of D1 ( Dermatophagoides pteronyssinus ) is the highest (22.97%), followed by D2 ( Dermatophagoides farinae ) (23.33%); M3 ( Aspergillus fumigatus ) has the lowest positive rate (1.5%). E5 ( Canis familiaris ) and I6 ( Blatella germanica ) exhibited relatively high sensitization rates (8.64% and 12.35%, respectively). Allergen sensitization was significantly higher in men than in women. Moreover, 90.3% of sensitization samples from D1 were combined with at least one of the other eight allergens. Similarly, a positive correlation was demonstrated between D1, D2, and E1 ( Felis domesticus ). In addition, patients with allergic rhinitis (91.88% and 91.54%, respectively), allergic asthma (72.44% and 74.01%, respectively), and allergic rhinitis with asthma (92.12% and 93.22%, respectively) were mainly sensitized to D1 and D2. D1, D2, I6, and E5 are the main allergens. Moreover, D1 and D2 are the main allergens in patients with respiratory allergic diseases. Research focusing on the distribution of allergens and the characteristics of hypersensitivity in different people helps prevent, diagnose, and treat allergic diseases., Competing Interests: Sources of funding: This work was partially supported by the Sichuan Provincial Science and Technology Department Application Foundation Project, No. 2021YJ0198; Scientific Research Project of Sichuan Provincial Health Commission, No. 20PJ196; and the Technical Innovation Research and Development Project of Chengdu Science and Technology Bureau, No. 2019-YF05-01161-SN

Purpose of Review: Ocular surface disorders (OSDs) are a prevalent and often debilitating condition encountered in clinical practice, particularly by allergists and clinical immunologists., Recent Findings: A comprehensive guide to office procedures for evaluating and managing OSDs, with a specific focus on ocular allergies, would assist in the evaluation process that begins with an initial patient assessment utilizing standardized forms to systematically gather detailed medical history, symptomatology, and environmental exposure data. This structured approach ensures a thorough understanding of the patient's condition and facilitates targeted interventions. In addition to allergy testing, the assessment of the tear film is essential for a comprehensive evaluation of OSDs. The Schirmer test is employed to quantify tear production, providing objective data on tear film adequacy and guiding interventions for tear film deficiencies., Summary: This multifaceted diagnostic approach ensures that all contributing factors to OSDs are identified and appropriately managed. By integrating these office procedures, allergists and clinical immunologists can enhance their diagnostic accuracy and therapeutic efficacy, ultimately improving patient outcomes. This manuscript provides a practical resource, outlining some of the methodologies and clinical applications of each procedure, and highlighting their role in the holistic management of OSDs in allergic patients., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Evidence on the early life risk factors of adult CRS, and the history of asthma and allergies across the life course, is limited., Aim: To investigate relationships between respiratory infective/allergic conditions in childhood, and asthma and allergies across the life course and CRS in middle age., Methods: Data were from the population-based Tasmanian Longitudinal Health Study (TAHS) cohort, first studied in 1968 when aged 6-7 years (n = 8583) and serially followed into middle age (n = 3609). Using a well-accepted epidemiological definition, participants were assigned a CRS-severity subtype at age 53: no sinusitis/CRS (reference); past doctor diagnosis only; current symptoms without doctor diagnosis; and doctor-diagnosed CRS with current symptoms. Relationships with infective/allergic respiratory illnesses at age 7, and previously published asthma-allergy trajectories from 7 to 53 years, were examined using multinominal regression., Results: In middle age, 5.8% reported current CRS symptoms with 2.5% doctor-diagnosed. Childhood conditions associated with symptomatic doctor-diagnosed CRS included frequent head colds (multinomial odds ratio [mOR] = 2.04 (95% confidence interval [95% CI]: 1.24, 3.37)), frequent tonsillitis (mOR = 1.61 [95% CI: 1.00, 2.59]) and current childhood asthma (mOR = 2.23 [95% CI: 1.25, 3.98]). Life course trajectories that featured late-onset or persistent asthma and allergies were associated with all CRS subtypes in middle age; early-onset persistent asthma and allergies (mOR = 6.74, 95% CI: 2.76, 16.4); late-onset asthma allergies (mOR = 15.9, 95% CI: 8.06, 31.4), and late-onset hayfever (mOR = 3.02, 95% CI: 1.51, 6.06) were associated with symptomatic doctor-diagnosed CRS., Conclusion: Current asthma, frequent head colds and tonsillitis at age 7 could signal a susceptible child who is at higher risk for CRS in mid-adult life and who might benefit from closer monitoring and/or proactive management. Concurrent asthma and allergies were strongly associated and are potential treatable traits of adult CRS., (© 2024 The Author(s). Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Purpose of Review: This review will identify and summarize the published existing data pertaining specifically to Hymenoptera venom allergy in children and adolescents, highlighting the major studies currently available on venom immunotherapy (VIT) and its prognosis in children., Recent Findings: The current review covers the incidence and prevalence of Hymenoptera venom allergy (HVA) in children, factors influencing occurrence and severity of reactions (age, sex, comorbidities, etc.), indications to perform diagnostic tests and start VIT in children, different existing VIT protocols and their safety and efficacy., Summary: Hymenoptera venom allergy is the second most common cause of anaphylaxis in children and it considerably affects quality of life. Cutaneous reactions are the most prevalent clinical presentation in children who usually have a more favourable prognosis than adult patients. However, studies on HVA in children and adolescents are still limited. Currently VIT is the only treatment able to modify the natural history of HVA in adults as well as in children, and to protect patients from systemic reactions after subsequent stings., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Objectives : Allergy to dust mites (HDMs) plays an important role in atopic dermatitis (AD). However, the role of this allergy in other dermatoses is little known. The aim of this study was to assess hypersensitivity to HDMs in patients with AD or hand disease using the basophil activation test. Material and Methods : A total of 52 patients with AD, 57 with hand eczema disease, and 68 healthy volunteers qualified for this study. Diagnosis was based on the Hanifin and Rajka criteria, dermatological assessment, and exclusion of other dermatoses. The participants underwent skin prick tests (SPTs), a basophil activation test (BAT) with D. pteronyssinus allergen extract, and the concentration of specific IgE (sIgE) for the same allergen in blood serum was determined. Results : Positive results in all tests (SPT, sIgE, and BAT) were obtained (24 (46.2%) patients with AD, 9 (15.8%) with hand disease, and none in the control group for p < 0.05). The results of the SPT, sIgE, and BAT correlated with each other in the AD and hand eczema groups (Spearmen correlation test, r = 0.72 or 0.85, p < 0.05). However, the BAT was positive more often than the SPT and sIgE for D. pteronyssinus. Conclusions : House dust mite hypersensitivity is common in patients with AD and eczema. The BAT may be more sensitive for assessing sensitization to house dust mites, especially in patients with hand eczema.

Objective: To establish a next-generation reference interval (RI) for total IgE (tIgE) and evaluate its usefulness., Methods: A new allergen-specific IgE (sIgE)-based tIgE RI, including a continuous RI in children, was established using the NHANES 2005-2006 project. The usefulness of the RI was evaluated by sensitivity (Sen), specificity (Spec), positive predictive value (PPV), negative predictive value (NPV), κ coefficient and consistency., Results: The new tIgE RI showed better performance in identifying allergic sensitization (Sen 0.53, Spec 0.90, PPV 0.83, NPV 0.68, κ 0.44, consistency 0.72) than allergic diseases (Sen 0.37, Spec 0.75, PPV 0.55, NPV 0.60, κ 0.13, consistency 0.59). The 2014 U.S. tIgE RI was more effective in identifying allergic diseases (consistency 0.63 vs. 0.54, P<0.001) but less accurate in identifying allergic sensitization (consistency 0.59 vs. 0.67, P<0.001) in children than in adults. The new RI improved the accuracy of identifying allergic sensitization in children to a level similar to that in adults (consistency 0.72 vs 0.73, P=0.37) and maintained its advantage in identifying allergic diseases in children (consistency 0.64 vs 0.55, P<0.001)., Conclusions: The established next-generation tIgE RI is useful for identifying allergic sensitization, especially in children., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: Hypersensitivity reactions (HR) are common in mastocytosis. However, little is known about triggers and risk factors. The registry of the European Competence Network on Mastocytosis (ECNM) enables reliable studies in a larger cohort of mastocytosis patients. We assessed prevalence, triggers and risk factors of HR in adults with mastocytosis in the ECNM registry., Methods: Data were collected in 27 ECNM centers. We analyzed potential triggers (Hymenoptera venoms, food, drug, inhalant and others) and risk factors at diagnosis and during follow-up. The study group consisted of 2485 adults with mastocytosis, 1379 women (55.5%) and 1106 men (44.5%). Median age was 48.2 years (range 18-91 years)., Results: Nine hundred and forty eight patients (38.1%) reported one or more HR`. Most common triggers were Hymenoptera venoms in cutaneous mastocytosis (CM) and indolent systemic mastocytosis (ISM), whereas in advanced SM (advSM), most common elicitors were drugs, including nonsteroidal anti-inflammatory agents and penicillin. In multivariate analyses, tryptase level < 90 ng/mL, <15% infiltration by mast cells in bone marrow biopsy-sections, and diagnosis of ISM were identified as independent risk factors for HR. For drug-induced HR, prominent risk factors were advSM and high tryptase levels. New reactions were observed in 4.8% of all patients during 4 years follow-up., Conclusions: HR are mainly triggered by Hymenoptera venoms in patients with CM and ISM and by drugs in patients with advSM. Tryptase levels <90 ng/mL, mast cell bone marrow infiltration <15%, and WHO category ISM are predictors of HR. New HR occur in 4.8% of all patients within 4 years., (© 2024 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

House dust mite (HDM) is the most significant indoor allergen, responsible for not only many cases of rhinoconjunctivitis but also for many cases of bronchial asthma, rendering it of considerable socioeconomic relevance. Besides symptomatic treatment and avoidance measures, allergen immunotherapy (AIT) is crucial, as the only causal, disease-modifying therapeutic approach. However, high diagnostic certainty is essential for initiating AIT. The challenge in making a correct diagnosis lies in interpreting the demonstrated HDM sensitization regarding its clinical relevance (clinically silent sensitization vs. allergy). While the risk of allergy increases with the level of IgE titers against HDM extract, Der p 1, or Der p 2, as well as with the breadth of the molecular sensitization profile against HDM components (Der p 1, Der p 2, Der p 23), no threshold can be defined for the presence of allergy, nor can sensitization to a specific component be confidently considered allergy inducing. It should be noted that at least in Southern Bavaria, the prevalence of Der p 23 sensitization is too low to be considered a major allergen, and Der p 23 is not able to molecularly differentiate all HDM sensitizations when added to the two major allergens Der p 1 and Der p 2. Evidently, HDM possesses a diverse profile of allergens, with some relevant ones possibly yet to be described. Unfortunately, patient history does not provide a sufficient assessment of the clinical relevance of a demonstrated HDM sensitization, necessitating allergen provocation testing before initiating AIT with HDM, despite the relatively large effort involved., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Purpose of Review: Allergy diagnostics and immunotherapeutics in Asia heavily rely on imported products from Western countries, raising concerns about the accuracy and efficacy of these products for the management of Asian allergy patients., Recent Findings: Recent advancements in allergen research have led to the identification and characterization of novel allergens from indigenous Korean species. While some allergens share homology with well-known allergens, others lack counterparts in imported allergen extracts. Classifying regional allergens in Asia into three categories based on their cross-reactivity with imported allergens offers valuable insights. Highly cross-reactive allergens, such as oak allergens Que m 1 from Quercus mongolica and Que ac 1 from Q. acutissima, can be effectively substituted with the imported allergens. Allergens with partial cross-reactivity, like the Asian needle ant allergen Pac c 3 (Antigen 5), permit limited diagnostic value by the currently available products. Unique allergens, including the Japanese hop allergen Hum j 6 (pectin methylesterase inhibitor) and the silkworm pupa allergen Bomb m 4 (30 kDa hemolymph lipoprotein) lack alternatives in the available product list. Greater attention is needed, particularly for species listed as ecologically invasive in Western regions. Additionally, allergens from domestic fruits and vegetables causing pollen food allergy syndrome require characterization for the development of improved diagnostics., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: In patients who require venom immunotherapy (VIT), there is a need to identify underlying mast cell (MC) disorders since these may affect the risk and severity of future sting reactions and the long-term effectiveness of VIT., Methods: 1319 individuals with Hymenoptera venom allergy (HVA) who needed VIT from referral centers in Slovenia, Austria, Croatia, and Poland underwent examination for KIT p.D816V in peripheral blood leukocytes (PBL) using a highly sensitive PCR test and tryptase genotyping by digital droplet PCR. We also included 183 control individuals with large local reactions (LLRs) to Hymenoptera stings and with asymptomatic sensitization to Hymenoptera venoms., Results: 285 of 1319 individuals recommended for VIT (21.6%) were positive for KIT p.D816V in PBL, preferably those who present with severe reaction (33.9% [n = 207 of 610] with Ring-Messmer grade 3-4 vs. 11% [n = 78 of 709] with Grade 1-2; p < .0001), whereas only 1.3% (n = 2 of 152) of controls with LLR and none with asymptomatic sensitization (n = 31) had KIT p.D816V. KIT p.D816V allelic burden was higher in those with severe reaction (median 0.018% [n = 207] in Grade 3-4 vs. 0.001% [n = 78] in Grade 1-2; p < .0001), and the majority had normal baseline serum tryptase levels (69% [n = 196 of 285]). All KIT p.D816V-positive individuals (n = 41) who underwent bone marrow (BM) biopsy were found to have underlying clonal diseases, principally BM mastocytosis. HαT was also associated with severe HVA and symptoms (p < .01), and remarkably, 31.0% (n = 31 of 100) were found to have concomitant KIT p.D816V. Concomitant HαT and KIT p.D816V showed an additive effect, and having both was associated with the highest risk for severe HVA, even higher than having either HαT or KIT p.D816V alone (OR = 3.8; p < .01)., Conclusions: By employing prospective universal tryptase genotyping and examination for KIT p.D816V in PBL in large HVA populations, we have demonstrated a high burden of clonal MC disorders and HαT in patients who require VIT., (© 2024 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Neuropsychiatric symptoms have long been acknowledged as a common comorbidity for individuals with allergic diseases. The proposed mechanisms for this relationship vary by disease and patient population and may include neuroinflammation and/or the consequent social implications of disease symptoms and management. We review connections between mental health and allergic rhinitis, atopic dermatitis, asthma, vocal cord dysfunction, urticaria, and food allergy. Many uncertainties remain and warrant further research, particularly with regard to how medications interact with pathophysiologic mechanisms of allergic disease in the neuroimmune axis. Proactive screening for mental health challenges, using tools such as the Patient Health Questionnaire and Generalized Anxiety Disorder screening instruments among others, can aid clinicians in identifying patients who may need further psychiatric evaluation and support. Although convenient, symptom screening tools are limited by variable sensitivity and specificity and therefore require healthcare professionals to remain vigilant for other mental health "red flags." Ultimately, understanding the connection between allergic disease and mental health empowers clinicians to both anticipate and serve the diverse physical and mental health needs of their patient populations., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Skin prick tests (SPTs), or intraepidermal tests, are often the first diagnostic approach for people with a suspected allergy. Together with the clinical history, SPTs allow doctors to draw conclusions on allergies based on the sensitization pattern. The purpose of this study is to investigate the potential cost consequences that would accrue to a Swiss University hospital after the adoption of computer vision-based SPTs., Methods: We conducted a cost-consequence analysis from a hospital's perspective to evaluate the potential cost consequences of using a computer vision-based system to read SPT results. The patient population consisted of individuals who were referred to the allergology department of one of the five university hospitals in Switzerland, Inselspital, whose allergology department averages 100 SPTs a week. We developed an early cost-consequence model comparing two SPT techniques; computer vision-based SPTs conducted with the aid of Nexkin DSPT and standard fully manual SPTs. Probabilistic sensitivity analysis and additional univariate sensitivity analyses were used to account for uncertainty., Results: The difference in average cost between the two alternatives from a hospital's perspective was estimated to be CHF 7 per SPT, in favour of the computer vison-based SPTs. Monte Carlo probabilistic simulation also indicated that SPTs conducted using the computer vision-based system were cost saving compared to standard fully manual SPTs. Sensitivity analyses additionally demonstrated the robustness of the base case result subject to plausible changes in all the input parameters, with parameters representing the costs associated with both SPT techniques having the largest influence on the incremental cost. However, higher sensitization prevalence rates seemed to favour the more accurate standard fully manual SPTs., Conclusion: Against the backdrop of rising healthcare costs especially in Switzerland, using computer-aided or (semi) automated diagnostic systems could play an important role in healthcare cost containment efforts. However, results should be taken with caution because of the uncertainty associated with the early nature of our analysis and the specific Swiss context adopted in this study., (© 2024. The Author(s).)

Background: Studying the sensitisation profiles of patients with allergies allows for a deeper understanding of the disease which may facilitate the selection of the best-personalised allergen immunotherapy. This observational, cross-sectional, multicentre study aimed to demonstrate the heterogeneity of the German population with allergies by analysing specific immunoglobulin E (sIgE) patterns towards aeroallergens and exploring the relationship between sensitisation and clinical symptoms., Methods: In total, 500 patients with allergies from different regions of Germany were recruited based on their case histories, clinical allergic symptoms and skin prick test data for aeroallergens. Serum samples were analysed using ImmunoCAP assays to determine sIgE levels for 33 allergenic sources and 43 molecular allergens., Results: Most patients (81%) were polysensitised. Betula verrucosa pollen was the most common cause of sensitisation (59%), followed by Phleum pratense (58%) and Dermatophagoides pteronyssinus (44%). The highest prevalence rates of molecular allergens were observed for Bet v 1 (84%) from birch pollen, Phl p 1 from grass pollen (82%), Der p 2 (69%) from mites and Fel d 1 (69%) from cat. Polysensitisation was significantly associated with the presence of asthma and the severity of rhinitis symptoms., Conclusions: Our findings show a high rate of polysensitisation and emphasise the importance of molecular diagnosis for more precise and comprehensive insights into sensitisation patterns and their association with clinical symptoms. These data may help improve personalised diagnosis and immunotherapy adapted to the needs of individual patients in the region., (© 2024 John Wiley & Sons Ltd.)

Purpose of the Review: With increased access and decriminalization of cannabis use, cases of IgE-dependent cannabis allergy (CA) and cross-reactivity syndromes have been increasingly reported. However, the exact prevalence of cannabis allergy and associated cross-reactive food syndromes (CAFS) remains unknown and is likely to be underestimated due to a lack of awareness and insufficient knowledge of the subject among health care professionals. Therefore, this practical roadmap aims to familiarize the reader with the early recognition and correct management of IgE-dependent cannabis-related allergies. In order to understand the mechanisms underlying these cross-reactivity syndromes and to enable personalized diagnosis and management, special attention is given to the molecular diagnosis of cannabis-related allergies., Recent Findings: The predominant signs and symptoms of CA are rhinoconjunctivitis and contact urticaria/angioedema. However, CA can also present as a life-threatening condition. In addition, many patients with CA also have distinct cross-reactivity syndromes, mainly involving fruits, vegetables, nuts and cereals. At present, five allergenic components of Cannabis sativa (Can s); Can s 2 (profilin), Can s 3 (a non-specific lipid protein), Can s 4 (oxygen-evolving enhancer protein 2 oxygen), Can s 5 (the Bet v 1 homologue) and Can s 7 (thaumatin-like protein) have been characterized and indexed in the WHO International Union of Immunological Sciences (IUIS) allergen database. However, neither of them is currently readily available for diagnosis, which generally starts by testing crude extracts of native allergens. The road to a clear understanding of CA and the associated cross-reactive food syndromes (CAFS) is still long and winding, but well worth further exploration., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Allergy to insects is the most common skin allergy in horses. Pruritus in affected patients can be extreme. Face, ears, mane, and tail area are commonly affected areas. Diagnosis of insect bite hypersensitivity (IBH) is clinical and is based on history, clinical signs, and response to repellents. Allergy tests are not to be used for diagnostic purposes. Currently, there is no specific treatment for IBH other than insect avoidance, treatment of secondary infections, and symptomatic relief of pruritus. Many allergic horses become also sensitized to pollens. For these patients, allergen specific immunotherapy is beneficial., Competing Interests: Disclosure The author has no conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Allergic diseases affect nearly 30% of people worldwide. There is a wide range of allergen sources, such as animal dander, food, venom, dust mites, and pollen. The skin prick test is the predominant technique used to identify allergenic sensitivity in vivo; the main problem is that it can be imprecise as many of the allergen extracts are made of mixtures of allergic and nonallergic components, making it difficult to identify the disease-eliciting allergen. An alternative to solve this problem is employing cellular models in vitro that may allow allergen identification, allergy diagnosis, and testing of novel potential compounds that can be used in immunotherapeutics. For example, rat basophilic leukemia (RBL) cells are a well-suited model for studying allergies. Unfortunately, cells generated from RBL cells are not commercially available. Therefore, we developed an RBL model with a degranulation gene reporter capable of recognizing human IgE involved in allergenic sensitivity using commercial plasmids. Employing this model, we successfully evaluated the capacity of union between IgE from allergic patients to allergenic proteins from Oleaceae tree pollen. This RBL cell model can be used as a diagnostic method for sensitivity to any allergens from different sources in vitro., (© 2024. The Author(s).)

Purpose of Review: Perioperative hypersensitivity reactions are rare but potentially catastrophic events. This review acts to summarize recent recommendations for both immediate and poststabilization management of suspected reactions, alongside practical advice for anaesthetists who may be faced with these events., Recent Findings: Prompt treatment is essential but may be hampered by delay in recognition. This can occur because there are multiple differential diagnoses for the observed clinical signs as well as variations in clinical presentation. Resuscitation is dependent on the use of adrenaline and fluids. Adrenaline should be administered in small, titrated intravenous boluses. Low-dose infusions should be commenced early if the response to boluses is poor. Large volume fluid resuscitation may be required to maintain adequate circulating volume. Chest compressions are recommended when there is evidence of inadequate perfusion, rather than waiting until cardiac arrest is confirmed. Antihistamines and corticosteroids are no longer recommended in the immediate management phase. Once the patient has been stabilized, it is important to obtain serial tryptase concentrations to aid the subsequent clinic investigation. The decision to proceed or abandon surgery will be based on an individual risk-benefit analysis. All cases of suspected perioperative hypersensitivity, including fatal cases, must be referred for formal investigation., Summary: There have been recent updates to management guidelines in perioperative hypersensitivity. Treatment algorithms, treatment packs and referral packs can all help the anaesthetist manage these complex cases, aid the subsequent investigation and ensure patient safety in the future., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)