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Background Anosmia and ageusia are symptoms commonly associated with COVID-19, but the relationship with disease severity, onset and recovery are unclear. Objective To examine factors associated with anosmia and ageusia and the recovery from these symptoms in an ethnically diverse cohort. Methods Individuals tested for SARS-CoV-2 between March and April 2020 were eligible for the study. Randomly selected participants answered a telephone questionnaire on COVID-19 symptoms with a focus on anosmia and ageusia. Additionally, relevant past medical history and data on the COVID-19 clinical course were obtained from electronic medical records. 486 patients were in the COVID-19 group and 103 were COVID-19-negative. Results Patients who were younger were more likely to report anosmia and/or ageusia (odds ratio (OR) for anosmia per 1-year increase in age: 0·98, 95%CI:0–97-0·99, p = 0·003; for ageusia: 0·98, 95%CI:0·97-0·99, p = 0·005) as were patients with lower eosinophil counts (OR for anosmia per 0.1-K/μL increase in eosinophils: 0·02, 95%CI:0·001-0·46, p = 0·01, for ageusia 0·10, 95%CI:0·01-0·97, p = 0·047). Male gender was independently associated with a lower probability of ageusia (OR:0·56, 95%CI:0·38-0·82, p = 0·003) and earlier sense of taste recovery (HR:1·44, 95%CI:1·05-1·98, p = 0·02). Latinos showed earlier sense of taste recovery than white patients (HR:1·82, 95%CI:1·05-3·18, p = 0·03). Conclusion Anosmia and ageusia were more common among younger patients and those with lower blood eosinophil counts. Ageusia was less commonly reported among men, and time to taste recovery was earlier among both men and Latinos.

Objective Patients with coronavirus disease 2019 (COVID-19) can progress to a state of unregulated inflammation called cytokine storm syndrome (CSS). We describe formation and operation of a COVID-19 multidisciplinary consultation service that was allowed to individualize treatment for critically ill patients with COVID-19 during the pandemic. Methods Institutional experts from different subspecialties formed a COVID-19 CSS task force at Montefiore Medical Center, Bronx, NY. They agreed on a set of four clinical and six laboratory parameters that can help early identify COVID-19 CSS. We describe the formation and implementation of the COVID-19 task force. The case series description of the COVID-19 CSS consultation cohort highlights consultation volume, baseline characteristics, clinical and laboratory parameters, and how biologic treatments were allocated to these patients. Results Between April 4,2020, and May 7,2020, the COVID-19 CSS task force was formed, consisting of adult and pediatric rheumatologists and allergy and immunology physicians. The task force evaluated a total of 288 patients, of whom 197 (68%) were male, the median (interquartile range [IQR]) age was 62 (51-70) years, 122 (42%) were Hispanic, and 88 (31%) were Black or African American. The common presenting symptoms in all referred patients were dyspnea (85%) and diarrhea (80%). Thirty-one patients who received biologic therapy were younger, with a median (IQR) age of 53 (32-63) years, as opposed to 62.5 (52-70) years in the nonbiologic group (P = 0.008). A higher proportion receiving biologics was in the critical care setting (26 [84%] vs 151 [59%]; P = 0.006). Conclusion To the best of our knowledge, this is the first multidisciplinary collaborative effort to provide individualized patient recommendations for evaluation and treatment of patients with COVID-19 who may have CSS. This working model helped to devise an approach that may have identified patients who were most likely to benefit from biologic therapy in the absence of evidence-based guidelines.

Background There is a paucity of information on coronavirus disease 2019 (COVID-19) outcomes in asthmatics. Objective To identify risk factors associated with admission and subsequent mortality among COVID-19–infected asthmatics. Methods Adults at our institution with a positive polymerase chain reaction for COVID-19 between March 14 and April 27, 2020, were retrospectively identified. Comorbidities, laboratory results, and mortality rates during hospitalization were recorded. Results In total, 737 of 951 (77.5%) asthma patients with COVID-19 were seen in the emergency department (ED), and 78.8% of these ED patients (581 of 737) were admitted. Individuals with previously measured mean absolute eosinophil counts (AEC) ≥150 cells/μL were less likely to be admitted (odds ratio [OR] = 0.46, 95% confidence interval [CI]: 0.21-0.98, P = .04), whereas concomitant heart failure (CHF), chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD) were risk factors for admission. Hospitalized patients with asthma with peak hospital-measured AEC ≥150 cells/μL (n = 104) were less likely to die compared with those whose AEC remained

Supplemental material, sj-pdf-1-ajr-10.1177_19458924211004800 for COVID-19-Induced Anosmia and Ageusia Are Associated With Younger Age and Lower Blood Eosinophil Counts by Esha Sehanobish, Mali Barbi, Valerie Fong, Meryl Kravitz, Denise Sanchez Tejera, Mohammad Asad, Cynthia Matsumura, Denisa Ferastraoaru, Meaghan O’Neill, Merhunisa Karagic, Nadeem Akbar, Danielle M. Bottalico, Viraj Patel, Alexandre Peshansky, Mahendra Rangareddy, Golda Hudes, Mimi Kim, Ruth Eisenberg, Avindra Nath, Bryan R. Smith, Thomas J. Ow and Elina Jerschow in American Journal of Rhinology & Allergy

As populations age, the prevalence of reported drug "allergy" increases, often leading to suboptimal care and increased morbidity because of unnecessary avoidance of safe and effective medications. Evaluation by a drug allergy specialist is often warranted when a patient has more than 2 unrelated drug "allergies" listed in the medical record. In this commentary, we clarify and propose standard terminology to use when evaluating patients with multiple drug allergy labels including and more specifically when diagnosing multiple drug intolerance syndrome and the much rarer multiple drug hypersensitivity syndrome. We review epidemiology and key features of multiple drug intolerance syndrome and multiple drug hypersensitivity syndrome. We summarize the methodologic and practical diagnostic workup and management of individuals with MDIS to assist with the accurate delabeling of drug "allergies" in the electronic health record.

Background: Research subjects may receive payment for their participation. Multiple models for payment have been proposed, however, the most ethical model is not completely clear. Objective: The purpose of the present study is to evaluate and quantify the public’s perception and to identify demographic determinants influencing said perceptions. Methods: Patients from a New York City medical clinic were queried using an adapted survey on medical research compensation consisting of 6 opinion-style questions pertaining to the payment of subjects enrolling in clinical trials and 9 demographic questions. Pearson’s chi-squared tests of independence with two-tailed alpha of 0.05 and correction for multiple testing were performed to determine statistical significance. Results: 440 respondents were recruited for participation, with broad distribution across age, race, and socioeconomic levels. For research payment, surveyed respondents preferred the market model (n = 265, 62%) compared to the reimbursement model (n = 72, 16.8%) or wage payment model (n = 64, 15%) and no payment (n = 27, 6.3%). Patients under the age of 60 were more likely to choose the market model ( p = .01) compared to those over 60 selecting the reimbursement model ( p = .001). 88.7% (n = 377) of respondents indicated they did not perceive clinical trial payment to be a bribe, with non-white patients being more likely to identify payment as a bribe ( p = .025). 73.2% of respondents (n = 344) believed that poorer individuals were more likely to enroll. Patients without high school education and patients 60 years of age or older were more likely to believe that payment ( p = .006 and p < .001, respectively) would have no influence on enrollment than those with high school education. Conclusions: Differences in mind-set towards clinical trials demonstrate older patients and individuals without a high school education may have differing opinions with regards to financial incentives in clinical trials. Sensitivity towards these attitudes may require alternative models of payment for future clinical trials.

Allergen immunotherapy is a rapidly evolving field. Although subcutaneous immunotherapy has been practiced for over a hundred years, improved understanding of the underlying immunological mechanisms has led to the development of new, efficacious and better tolerated allergen-derivatives, adjuvants and encapsulated allergens. Diverse routes of allergen immunotherapy - oral, sublingual, epicutanoeus and intralymphatic - are enabling immunotherapy for anaphylactic food allergies and pollen-food allergy syndrome, while improving the tolerability and effectiveness of aeroallergen immunotherapy. The addition of Anti-IgE therapy decreases adverse effects of subcutaneous and oral immunotherapy.

Introduction DRESS Syndrome can vary in presentation from mild to life threatening. We report a case of suspected DRESS myocarditis presenting with cardiogenic shock. Case Description A 38-year-old man presented to the ED with fever, dizziness, skin rash and facial swelling. Four weeks prior he was treated with amoxicillin/clavulanate for presumed sinusitis which was changed to sulfamethoxazole/trimethoprim and prednisone 30 mg daily 3 weeks later due to lack of improvement. Three days later he developed presenting symptoms. On ED admission, he was febrile (T =102.5F), tachycardic (HR 150 bpm) and hypotensive (BP 80/50 mmHg) with generalized erythematous macular skin rash and submandibular lymphadenopathy. Laboratory investigation revealed mildly elevated liver enzymes and creatinine, metabolic acidosis, hyponatremia and hypocalcemia, thrombocytopenia (125/nL) and absolute eosinophils of 0.30/nL. Chest x-ray was clear. He was hemodynamically stabilized with intramuscular followed by intravenous epinephrine and 6 liters intravenous fluids. Echocardiogram revealed severely reduced ejection fraction of 35% with diffuse hypokinesis. DRESS syndrome with hypersensitivity myocarditis was suspected. Treatment with prednisolone 80mg was initiated and laboratory abnormalities resolved within 5-10 days. A repeat echocardiogram 3 months later showed near normalization of EF (50-55%). Discussion Cardiac involvement in DRESS syndrome has been reported in 4 to 21 %. DRESS was suspected in this patient given regiSCAR and J-SCAR score of 5 in absence of peripheral eosinophilia (likely suppressed due to prior prednisone treatment). Clinicians should have a high suspicion for cardiac involvement in a patient presenting with suspected DRESS syndrome and hemodynamic compromise. Prompt diagnosis is crucial for successful treatment outcome.

Background: Increasing prevalence of allergic disorders has been observed over the last fifty years. The disparate rates of allergic disorders have been well-characterized in several minority groups. However, few studies have reported the distribution of atopic disorders among Asian Americans. Objective: To gain a greater understanding of the prevalence of atopic disorders in Asian Americans presenting to an Allergy Clinic. Methods: A retrospective chart review was performed on 471 Asian American patients receiving treatment in an inner city allergy clinic located in New York. Family history and past medical history of asthma, allergic rhinitis, atopic dermatitis, food allergy, and drug allergy were recorded. The patients were primarily of Chinese, Japanese or Korean origin; 34% male (n=158), 66% female (n=313), with a mean age of 32 ± 12.9 years. Results: Allergic rhinitis (62%) and atopic dermatitis (50%) were more prevalent (P

Background: Patients with sinus pain and discomfort often seek additional adjunct therapies. Objective: To determine the efficacy of osteopathic manipulation techniques (OMT) to relieve sinus pain in our outpatient allergy clinic setting. Methods: Sixteen patients who presented to our clinic in pain and requesting alternative therapies for relief of their chronic sinus pain were offered to receive OMT treatment as an adjunct to their office visit. One patient declined participation after receiving printed information about the OMT techniques. The remaining fifteen patients were given a symptom score card to assess the severity of their sinus pain before offering OMT. The OMT offered consisted of four different direct pressures and "milking" techniques combined with one sinus drainage technique. These five techniques were selected to relieve sinus pain, pressure, and congestion by unblocking nasal passages and improving lymphatic flow. Each technique was given for 3 minutes and the entire process took approximately 18 minutes to complete. Results: Each patient was given a symptom score card to rate their symptoms before and after manipulation. Data was plotted and statistical analysis computed with GraphPad Software using paired t-test. OMT was not associated with any adverse effects or complaints. Nine of the 15 patients reported symptom relief immediately following OMT. The average reported sinus pain/congestion before OMT was 3.07 (Moderate.) Following OMT, sinus pain/congestion decreased to 2.33 (Minimal.) Average decrease in symptom score after OMT was 0.74 with a p-value of 0.0012 via paired t-test. Subjective data reported by the patients showed symptom improvement immediately following each OMT session. Four of the fifteen patients reported minimal pain during the procedure. No other adverse effects were reported. Conclusion: This study demonstrated that after OMT, utilizing direct pressure and sinus drainage technique, the overall sinus pain/congestion for all patients improved (p=0.0012). All fifteen patients reported feeling more relaxed after OMT.