Search

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

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

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

Introduction: India is low‐middle‐income country (LMIC) with a population of 1.3bn, comprising about 20% of the global population. While the high‐income Western countries faced an "allergy epidemic" during the last three decades, there has been a gradual rise in prevalence of allergic diseases in India. Methods: Narrative review. Results and Discussion: Allergic diseases occur as a consequence of a complex interplay between genetic and environmental factors. There are multiple contrasting determinants that are important to consider in India including high levels of air pollution, in particular PM2.5 due to burning of fossil fuels and biomass fuels, diverse aero‐biology, tropical climate, cultural and social diversity, religious beliefs/myths, linguistic diversity, literacy level, breastfeeding and weaning, diet (large proportion vegetarian), and high incidence rates of TB, HIV, malaria, filariasis, parasitic infestations, and others, that not only shape the immune system early in life, but also impact on biomarkers relevant to allergic diseases. India has a relatively weak and heterogeneous healthcare framework, and allergology has not yet been recognized as an independent specialty. There are very few post‐graduate training programs, and allergic diseases are managed by primary care physicians, organ‐based specialists, and general pediatricians. Adrenaline auto‐injectors are not available, there is patient unaffordability for inhalers, nasal sprays, and biologics, and this is compounded by poor compliance leading to 40%‐50% of asthmatic children having uncontrolled disease and high rates of oral corticosteroid use. Standardized allergen extracts are not available for skin tests and desensitization. This article provides a critical analysis of pediatric allergic diseases in India. [ABSTRACT FROM AUTHOR]

The article offers a guide on identifying immunodeficiency. HIV infection is cited as the most common cause of secondary immunodeficiency. The epidemiology of immunodeficiency and the high rate of delay in diagnosis in Great Britain are tackled. Patients suffering from severe, persistent, unusual or recurrent infections are recommended to be considered for immunodeficiency investigation. The common first-line investigation comprises of full blood count, immunoglobulins, serum complement C3/C4, and human immunodeficiency virus (HIV) test (FISH).

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

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

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

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

No abstract available [ABSTRACT FROM AUTHOR]

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

Many patients report allergies to penicillin, although in over 90% of these the label of penicillin allergy is shown to be incorrect following comprehensive testing. Inappropriate and inaccurate penicillin allergy labelling is a barrier to antimicrobial stewardship and can lead to patient harm. This review assesses an emergent evidence base and trend favouring delabelling using direct oral penicillin challenges following a stratified risk assessment of the likelihood and existence of true penicillin allergy, to identify and make recommendations for key components for implementation in standard practice. Research to date has focussed on the feasibility and clinical and financial outcomes of these direct delabelling strategies. There is a paucity of studies exploring the views and engagement of patients and healthcare professionals, and a gap in the evidence for prerequisites to safely deliver, sustain and spread the implementation of such services across health systems. [ABSTRACT FROM AUTHOR]

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

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

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

The article presents a case study of a 43 year old woman who presented with a ten month history of a urticarial rash induced by cold. A discussion of the patient's diagnosis of cold-induced urticaria, which was made with a urticarial weal, and of her subsequent treatment with antihistamines, is presented.

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

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

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

Keywords: asthma; atopic dermatitis; autoimmunity; epidemiology; ethnicity; rheumatoid; rhinitis; SLE; vitiligo EN asthma atopic dermatitis autoimmunity epidemiology ethnicity rheumatoid rhinitis SLE vitiligo 144 147 4 01/05/21 20210101 NES 210101 To the Editor, The burden of allergic diseases (ADs) such as asthma and rhinitis and autoimmune disorders (AIDs) such as rheumatoid arthritis (RA) is relatively low/moderate in low- and low-middle-income countries,1,2 and there is some evidence regarding higher incidence rates of these conditions amongst immigrant population settled in high-income countries.3,4 The burden of ADs is particularly high in high-income countries such as the UK, Republic of Ireland and New Zealand.1 Studies in immigrants have been limited by several factors including relatively small sample size, shorter duration and methodological issues such as selection bias, survey- or questionnaire-based data, focus on a single or limited number of ADs or AIDs, and some not accounting for important disease confounders such as smoking history. Specifically, the risk of AE, ARC, SLE, ATD and vitiligo is uniformly higher amongst British ethnic minority groups in comparison with the White population. Asthma, atopic dermatitis, autoimmunity, epidemiology, ethnicity, rheumatoid, rhinitis, SLE, vitiligo. [Extracted from the article]

Beta-blockers and ACE-inhibitor drugs are prescribed for arterial hypertension that is usually considered a cardiovascular condition, but not all cardiac conditions have arterial hypertension, and therefore each patient will have their own individual risk. Dear Editor, We agree with the commentary by Murat Türk and Insu Yilmaz about the need for head-to-head trials of omalizumab and ligelizumab in chronic spontaneous urticaria (CSU) [[1]], as such trials may provide clinicians with invaluable datasets regarding the possible dose-response relationship. [Extracted from the article]

However, ALK has advised that the Pharmalgen product line will be discontinued, with a plan to substitute with Alutard SQ Bee and Wasp Venom products. In contrast to Pharmalgen which was supplied in a single vial that required manual dilution during updosing, Alutard SQ Bee and Wasp Venoms are supplied in two product kits. There is sufficient existing Pharmalgen product to allow all patients currently being updosed to reach maintenance therapy, but once on maintenance they should all be switched over to Alutard SQ. [Extracted from the article]

Sentinel lymph node biopsy (SLNB) was introduced in the 1990s, as a minimally invasive procedure for staging the axilla with less morbidity to the traditional axillary lymph node dissection and is now standard management of the axilla in the early breast cancer. SLNB using the combined technique of blue dye and radioisotope is currently the recommended method for lymphatic mapping, and studies have shown high identification rates (IR) (>95%) and low false-negative rates (FNR) 5-10%. However, there are several reports raising awareness regarding patent blue V dye-induced peri-operative anaphylaxis. The main aim of this article is to highlight the emergence of patent blue dye as a new allergen and present evidence regarding the utility of alternative safer methods of evaluation of early breast cancer without compromising IR. [ABSTRACT FROM AUTHOR]