Genetic identification of zoonotic parasite Anisakis pegreffii (Nematoda: Anisakidae) parasitizing the shortfin squid Illex argentinus under commercial exploitation in the Southwestern Atlantic Ocean

Despite the shortfin squid, Illex argentinus, is one of the most important commercial species for the Argentine fisheries, being the third frozen product exported to Europe, the occurrence and distribution of zoonotic anisakid nematodes is scarcely reported. A total of 712 I. argentinus distributed in 17 samples, corresponding to its three main commercial stocks, caught along its distribution range in Argentine waters were examined for anisakid parasites. In total, 360 nematodes were detected in the viscera, however no infestations in the mantle were observed. According to their morphology, all the larvae (L3) were assigned to the genus Anisakis. Genetic identification was performed by sequence analysis of the mitochondrial (mtDNA cox2) gene loci resulting in the record of only Anisakis pegreffii. Distance-based multiple linear regressions (DistLM) evidenced that dorsal mantle length (ML) and date of capture (as surrogate of cohort) were the most important predictors of parasite abundance across infrapopulations in I. argentinus. At component population, DistLM analysis showed that ML and latitude (indirectly representing a gradient in water temperature) were the most important variables determining the prevalence of parasites, however, its mean abundance was only influenced by ML. Parasite burdens were temporally inestable, due to variability in recruitment to host populations, being associated with changing hydrographic conditions and the opportunistic feeding behaviour and annual life cycle of the hosts. The genetic identification of A. pegreffii is relevant for both human health and the fishery industry, given its importance as an etiological agent of human anisakiosis. Due to the restriction of larvae to internal organs, the risk of anisakiosis by the consumption of edible parts of I. argentinus is low.

Investigating health care pathways for anaphylaxis: Seeing the bigger picture through linked data

Background

Anaphylaxis is increasing in Australia involving all levels of the health care system. Although guidelines recommend calling an ambulance and 4-hour observation, knowledge gaps exist regarding where people experiencing anaphylaxis receive care.

Objective

We sought to examine care pathways for anaphylaxis in Western Australia and factors associated with seeking care from ambulance versus the emergency department (ED), and subsequent hospital admission.

Methods

A cross-sectional study was undertaken using linked ambulance, ED, hospital, and mortality data. The proportion of anaphylaxis events following each care pathway from 2010 to 2017 was examined. Multivariable logistic regression was used to determine factors associated with ambulance versus ED as the first point of care, with additional models to determine risk of admission.

Results

Most of the 16,456 anaphylaxis events followed 6 distinct care pathways. ED was first point of care in 9,713 (59.0%) events; ambulance in 5,926 (36.0%); and hospital in 817 (5.0%). Factors associated with ambulance attendance compared with ED were metropolitan region (odds ratio [OR], 3.00; 95% CI, 2.70-3.34), age more than 65 years (OR, 2.98; 95% CI, 2.54-3.50), and anaphylaxis occurring during the day (OR, 1.31; 95% CI, 1.21-1.42). Risk of subsequent hospitalization was associated with food trigger in ED (OR, 1.52; 95% CI, 1.11-2.07), age more than 65 years (OR, 1.48; 95% CI, 1.24-1.77), children younger than 5 years (OR, 1.24; 95% CI, 1.08-1.41), and history of cancer (OR, 1.36; 95% CI, 1.18-1.56).

Conclusions

Most people experiencing anaphylaxis present directly to ED; however, ambulance care is still substantial and around half the events involved observation in the hospital. Discrepancies in recording of anaphylaxis across linked data sets highlight gaps in current burden data, supporting the need for improved reporting.

Effect of comorbid allergic diseases on attention-deficit hyperactivity disorder symptoms and sleep: A cross-sectional study

INTRODUCTION

Recent studies have shown a close relationship between attention-deficit hyperactivity disorder (ADHD) and allergic diseases in children. Regrettably, few studies have investigated the effect of comorbid allergies on ADHD symptoms and sleep, in particular, it is unclear whether comorbid allergic conditions further exacerbate sleep problems in children with ADHD.

OBJECTIVE

To investigate the effect of comorbid allergic on symptoms and sleep in children with ADHD.

METHODS

This was a cross-sectional study, 222 ADHD children (aged 6-14 years) were enrolled in, of whom 93 had allergic diseases and 129 without allergic diseases. Collected all ADHD symptom severity and functional impairment scales, including: Swanson, Nolan and Pelham (SNAP) scale, Integrated Visual and Auditory Continuous Performance Test (IVA-CPT), Conners Parents Symptom questionnaire (PSQ) and Weiss Functional Impairment Rating Scale-Parent Form (WFIRS-P). Every guardian of children diagnosed with ADHD is required to complete the Children's Sleep Habits Questionnaire (CSHQ).

RESULTS

Compared to ADHD children without allergic diseases, we observed significantly higher hyperactivity and impulsivity scores on the SNAP-IV, higher hyperactivity index and impulsivity index on the PSQ, and higher risky activities on the WFIRS-P in ADHD children with comorbid allergic diseases (all p < 0.05). CSHQ total score and sleep disordered breathing were particularly prominent in ADHD children with comorbid allergic diseases (all p < 0.05), and changes in CSHQ correlate with ADHD symptoms and functional impairment. Further analyses revealed that ADHD symptoms and sleep did not worsen with increasing number of comorbid allergic diseases (all p > 0.05). The primary influence on ADHD symptoms and sleep was the type of allergic diseases, where food allergies predominantly influence ADHD symptoms, including attention deficit disorder and hyperactivity disorder (all p < 0.05); allergic rhinitis notably impacts parasomnias, sleep disordered breathing (all p < 0.05); and allergic asthma significantly affects sleep anxiety, daytime sleepiness, and sleep disordered breathing in children with ADHD (all p < 0.05).

CONCLUSION

The presence of comorbid allergic diseases affects both the hyperactivity and impulsivity symptoms of ADHD and sleep disordered breathing, predominantly influenced by the type of the allergic diseases.

ADP101 multifood oral immunotherapy for food-allergic patients: Harmony phase 1/2 randomized clinical trial

Background

Oral immunotherapy is an established approach to desensitize the immune system in the context of allergic disease; however, the only currently approved product is for peanut allergy. ADP101 is a novel, pharmaceutical-grade, multifood oral immunotherapy in development to simultaneously treat single or multiple food allergies, containing allergenic proteins from 15 foods in equal parts by protein weight.

Objective

The phase 1/2 Harmony trial (NCT04856865) evaluated efficacy and safety of ADP101 in participants with qualifying allergy to 1 to 5 foods in ADP101, defined as dose-limiting symptoms with a ≤100 mg challenge dose during double-blind, placebo-controlled food challenge (DBPCFC).

Methods

Participants were randomized to low-dose (1500 mg/d; 100 mg protein per food) or high-dose (4500 mg/d; 300 mg protein per food) ADP101, or matched placebo, with dose escalation followed by daily maintenance dosing over 40 weeks. The primary endpoint was the proportion of participants tolerating a ≥600 mg challenge dose of a single qualifying food without dose-limiting symptoms at the Week 40 Exit DBPCFC (ie, responders).

Results

In the primary analysis population (61 pediatric participants aged 4-17 years), a greater response rate was observed in both the high-dose ADP101 (55.0%) and low-dose ADP101 (38.1%) groups compared with pooled placebo (20.0%) (nominal P = .048, P = .306, respectively; adjusted for multiple comparisons, P = .097, P = .306, respectively). Desensitization to ≥2 foods was observed in individuals with multiple food allergies, as was desensitization at levels over 600 mg. ADP101-treated participants showed an overall reduction in skin-prick test reactivity, with an increase in maximum tolerated dose across the majority of foods tested. Adverse events were mostly mild or moderate, with no life-threatening events or deaths.

Conclusions

The study did not meet its primary endpoint, but ADP101 demonstrated a favorable safety profile and increased the reactive threshold in DBPCFC in pediatric participants with single or multiple food allergies across multiple endpoints, warranting further clinical investigation.

Moving beyond biology: the critical role of social and structural determinants in atopic dermatitis

Atopic dermatitis (AD) is a prevalent chronic inflammatory skin disease with a substantial global burden and negative impact on quality of life. While genetics and pathophysiology are key to understanding AD, emerging evidence indicates that social and structural determinants of health (SDOH and StDOH) strongly influence the condition's onset, severity, and outcomes. SDOH, such as economic stability, education quality and access, healthcare quality and access, neighborhood environment, and social/community context, shape individual risk and disease experience. StDOH, including government processes, economic policies, social/public policies, and cultural/societal values, further act as upstream forces that directly and indirectly influence AD outcomes. In this review, we synthesize current knowledge on the impacts of SDOH and StDOH on AD incidence, severity, and disparities. Embracing a biopsychosocial model is crucial to elucidate the etiology, epidemiology, and optimal management of AD. Future research should adopt a holistic approach, moving beyond a purely biological perspective to consider the intricate interplay of social and structural determinants in understanding and managing AD.

Cystic fibrosis patients' preferences for electronic devices that monitor their inhalation - A qualitative study

BACKGROUND

Patients with cystic fibrosis (CF) use inhaled medicines daily due to respiratory manifestations. However, only 31 % of users is inhaling correctly. Digital solutions targeting inhalation could help CF patients improve their technique and thus health outcomes. However, the use of electronic monitoring devices shows a decrease over time. Therefore, the aim of study was to investigate CF patients' preferences for the use of electronic devices on their inhalation technique on a regular basis and reasons behind these preferences.

METHODS

Semistructured interviews were conducted with 11 CF patients from four European countries to understand their disease history and experiences, daily use of inhaler medication, experiences with digital devices to achieve disease control, and expectations of new devices for monitoring inhalation. A conventional content analysis was applied.

RESULTS

CF patients knew their body well due to their lifelong experiences. However, some patients still experienced periods with more symptoms and need for support. Non-app support was preferred. CF patients reported that digital systems should provide high benefits for regular use. Patients differed in their interest in digital systems for inhalation. Such systems were mostly relevant to CF patients starting a new inhaled treatment/inhaler device or during periods in which the disease was out of control.

CONCLUSIONS

CF patients perceived limited value of digital systems to monitor their inhalation and mostly considered them necessary for specific periods. Extensive experience in using inhalers and existing daily routines to manage a high treatment burden appear involved in limited need of such systems.

Impact of underlying diseases and complications on COVID-19 mortality in South Korea: analysis of national health insurance service data

BACKGROUND

Comorbidities or complications significantly influence coronavirus disease-2019 (COVID-19) severity and mortality risk. Therefore, this study aimed to compare treatment outcomes of COVID-19 inpatients by underlying diseases or complications.

METHOD

Data on COVID-19 patients from the National Health Insurance Service customized research database were analyzed while focusing on eight underlying diseases and complications: diabetes, hypertension, heart disease, kidney disease, liver disease, dementia, depression, and respiratory disease.

RESULTS

Of the 377,812 COVID-19 patients in 2021, 51.47% were male and 48.53% were female, and post-diagnosis mortality was 2.04%; 68.7% (n = 259,560) of patients had at least one underlying condition, with the following frequency: respiratory disease (78.88%), heart disease (33.84%), hypertension (30.29%), liver disease (21.38%), depression (9.32%), kidney disease (4.89%), and dementia (3.87%). Among patients without any underlying diseases, 19.8% (n = 74,925) were treated for post-diagnosis complications, with the following frequency: respiratory disease (89.21%), liver disease (19.12%), heart disease (14.90%), diabetes (10.37%), hypertension (8.22%), depression (3.86%), kidney disease (2.04%), and dementia (0.64%). Except for liver disease, all underlying diseases were associated with mortality. COVID-19 patients with diabetes exhibited a 1.42-fold higher mortality risk (95% confidence interval [CI ]1.35-1.50). All complications were associated with death, with kidney-related complications conferring a 4.84-fold higher mortality risk (95% CI 3.62-6.48).

CONCLUSION

Underlying diseases and complications in COVID-19 patients were associated with death. Even with the same disease, the timing of onset, before or after COVID-19 diagnosis, induced a difference in the mortality risk. Both underlying diseases and complications should be considered for more proactive medical interventions.

The role of neutrophils in allergic disease

Neutrophils are short-lived cells of the innate immune system and represent 50-70% of the circulating leucocytes. Their primary role is antimicrobial defence which they accomplish through rapid migration to sites of inflammation followed by phagocytosis, degranulation, and the release of neutrophil extracellular traps (NETosis). While previously considered terminally differentiated cells, they have been shown to have great adaptability and to play a role in conditions ranging from cancer to autoimmunity. This review focuses on their role in allergic disease. In particular: their role as potential amplifiers of type 1 hypersensitivity reactions leading to anaphylaxis; their involvement in alternative pathways of food and drug allergy; their role in allergic rhinitis and asthma and neutrophil dysfunction in atopic dermatitis. The use of potential biomarkers and therapeutic targets is also discussed with a view to guiding future research.

Targeting cow's milk allergy using hypoallergenic protein-polyphenol formulas: A proof of concept

Cow's milk allergy caused by a hypersensitivity to milk proteins has increased over the last years. Hypoallergenic responses can be induced by altering the structure of such proteins with chemical modifiers; this paper is about the creation of edible matrices based on polyphenols from orange peel. Some compounds were able to significantly lower the IgE binding from β-lactoglobulin allergic serum in sensitized patients. Such effects could also be observed for casein allergic serum in patients sensitized to both proteins. A certain inter-individual variability is observed, although polyphenols do actually induce salient structural changes. This indicates that molecular modifications aimed at oral treatments against food allergy may or may not correlate with reduced allergenicity, and hence the necessity for serum monitoring through immunological assays. Overall, the results are promising enough to validate the polyphenol-fortified approach. In addition, this study highlights the upgrading of vegetable waste, consistent with a circular economy in food chemistry.

Sustainable leather alternatives: High-performance and dyeable bio-based materials from fungal chitin and tannic acid

Leather alternatives (LAs) offer a promising solution to address the environmental and ethical concerns associated with traditional leather production relying animal hides and chemical tanning agents. However, synthetic polymer-based LAs, such as polyurethane and polyvinyl chloride, have limited broader applications due to their complex manufacture process, high emission of volatile organic compounds, and poor biodegradability. Herein, we present the development of biomass-based LAs fabricated by combining two low-cost natural components - fungal chitin and plant polyphenols (i.e., tannic acid, TA), through non-covalent interactions. Specifically, chitin was extracted from common mushrooms (e.g., Pleurotus ostreatus and Agaricus bisporus) through alkali treatment, and the biodegradable LAs were subsequently prepared by filtration, TA crosslinking, hot pressing, and dyeing. The incorporation of TA significantly enhanced the mechanical and antibacterial properties of LAs, achieving a tensile strength of 156 MPa. Additionally, the chitin-based LAs exhibited good water vapor permeability and were dyed in various colors with excellent levelness and fastness. Importantly, this synthetic strategy avoided the use of organic solvents and hazardous chemicals, showing potential for large-scale production. This work provides a simple and effective strategy to prepare biodegradable LAs from low-cost non-animal resources, aligning with social ethical standards and environmental requirements for sustainable development.

Drug challenge testing: a critical step in the investigation of neuromuscular blocking agent hypersensitivity

Neuromuscular blocking agents are a common cause of perioperative hypersensitivity. The sensitivity and specificity of skin tests and in vitro tests in this context have not been determined conclusively, which poses a barrier to accurate diagnosis. Use of challenge testing represents a promising development in this field and a key tool in confirming tolerance to an alternate neuromuscular blocking agent for use in future anaesthesia. However, its use is currently limited to specialised centres, and a standardised approach to testing has not yet been established. This article summarises the role of challenge testing to neuromuscular blocking agents and highlights the advantages and disadvantages of the different approaches.

Confronting allergies: strategies for combating pollution and safeguarding our health

Increasing evidence demonstrates a robust link between environmental pollutants and allergic reactions, with air and indoor pollution exacerbating respiratory allergies and climate change intensifying seasonal allergies. Comprehensive action, including government regulations, public awareness, and individual efforts, is essential to mitigate pollution's impact on allergies and safeguard public health and ecological balance. Recent findings indicate a strong correlation between environmental pollutants and allergic reactions, with air pollution from vehicular emissions and industrial activities exacerbating respiratory allergies like asthma and allergic rhinitis. Additionally, indoor pollutants such as mold and volatile organic compounds are significant triggers of allergic responses, especially among vulnerable populations. Furthermore, climate change, driven by pollution, is intensifying seasonal allergies due to altered weather patterns and increased pollen production. This review emphasizes the critical importance of addressing pollution and allergies, highlighting the growing concerns in contemporary society. This review highlights the urgent need to address pollution and allergies, emphasizing their increasing significance in modern society and outlining effective allergy management strategies.

Factors Associated with Weaning in Infants with Cow's Milk Allergy: A Cohort Study

Objective: To analyze the factors associated with weaning in infants with cow's milk allergy (CMA) treated at a food allergy reference center in a state in the northeast of Brazil. Method: A prospective cohort study, with a case group (children with CMA) and two control groups (symptomatic nonallergic children [SC] and asymptomatic [AC]). At the beginning of the study, 30 children comprised the CMA group, 84 the SC group, and 52 the AC group. Survival analysis was performed to compare breastfeeding time between the three groups and an adjusted linear regression model to verify the factors associated with breastfeeding time. Results: At the beginning of the study, 33.3% of children in the CMA group, 17.1% in the SC group, and 69.6% in the AC group were exclusively breastfeeding (p = 0.005). The most common factors for weaning in children with CMA were the cow's milk elimination diet (30%), allergic symptoms in the child (20%), and breast engorgement (20%). Children who used a cup as a means of offering infant formula spent 281 more days breastfeeding compared with those who used a baby bottle (Bstd = 1.39; p = 0.031). Conclusion: Children with CMA and nonallergic gastrointestinal complaints weaned earlier compared with asymptomatic children. The main causes of weaning in CMA children were maternal difficulty adhering to the elimination diet, breast engorgement, and allergic symptoms in the child. Using a cup was the main factor associated with longer breastfeeding duration, regardless of gastrointestinal symptoms and socioeconomic factors.

Stinging Ant Anaphylaxis: Advances in Diagnosis and Treatment

Stinging ants represent a wide range of over 200 different species across the world, of which Solenopsis, Myrmecia, Pogonomyrmex, and Brachyponera genera account for a substantial economic and healthcare burden. S. invicta (red imported fire ant [IFA]) and M. pilosula (jack jumper ant [JJA]) are 2 species of high clinical importance, known to cause anaphylaxis in humans, with numerous reported fatalities. Diagnostic testing should be performed in patients with a history of a systemic reaction with skin testing and/or in vitro specific immunoglobulin E (IgE) testing. In vitro testing is commercially available for IFA through whole-body extract specific IgE and JJA venom-specific IgE, but not widely available for other stinging ant species. Commercial venom component testing for IFA and JJA is currently not available. Patients with a clinical history and positive specific IgE testing should undergo treatment with specific immunotherapy, which is currently available for IFA and JJA. Buildup may be performed using conventional, semi-rush, rush, or ultra-rush schedules with similar risk profiles for IFA. Optimal duration for whole=body extract immunotherapy for IFA and specific JJA venom immunotherapy is not well studied, but generally recommended for at least 3 to 5 years. Sting challenges are used in research settings, primarily to assess treatment efficacy of immunotherapy.

V Brazilian Consensus on Rhinitis - 2024

Since we published the "IV Brazilian Consensus on Rhinitis", in2017, several advances have been achieved and have enabled a further understanding of the different aspects of "Rhinitis". This new guideline, developed jointly by ASBAI, SBP and SBORL, represents a relevant milestone in the updated and integrated management of the different forms of the disease, and it aims to unify evidence-based approaches to improve the diagnosis and treatment of this common and often underestimated condition. The document covers a wide range of topics, including clear definitions of the different phenotypes and endotypes of rhinitis, risk factors, updated diagnostic criteria, and recommended methods for clinical and laboratory investigation. We stress the importance of detailed clinical history and objective assessment, as well as tools for control and assessing severity tools an accurate diagnostic approach to the disease. Regarding treatment, it emphasizes the treatment customization, considering the severity of symptoms, the presence of comorbidities and the impact on the patient's quality of life. We discuss different drug treatment, in addition to non-pharmacological measures, such as environmental control and specific immunotherapy; and the possible role of immunobiological agents. Furthermore, the consensus addresses issues related to patient education, prevention and management of special situations, such as rhinitis in children, in pregnant women and in the elderly. In short, the "V Brazilian Consensus on Rhinitis" represents a comprehensive and updated guide for healthcare professionals involved in the diagnosis and management of rhinitis, aiming to improve patients' quality of life through an integrated and evidence-based approach.

Allergen immunotherapy in Italy: How, when, and why-A real-world study conducted through a patient association

Background

Allergen immunotherapy (AIT) is the only treatment that modifies the natural course of allergies. However, AIT is only used in some eligible patients, is frequently underused, and only a few studies investigated this aspects. Understanding AIT utilization patterns might disclose information about why it is underused, thus providing valuable insights on how to broaden the positive impact it can have on the population.

Methods

A questionnaire aiming to assess the trends of the use of AIT in Italy, patient health literacy on AIT, and the impact of respiratory allergies and AIT on patients' lives was submitted to patients affiliated with Respiriamo Insieme APS patient's association during the period between May and October 2023.

Results

Nine hundred forty-four patients completed the questionnaire. Most patients reported to be affected by allergic rhinitis (81.1%), allergic asthma (45.4%), and/or allergic conjunctivitis (41.2%), and many of them presenting a combination of these diseases. Only 53.8% knew about AIT's existence, and AIT was proposed to only 33.1% of the 858 patients affected by allergic rhinitis and/or allergic asthma, of which 29.2% decided not to initiate the therapy. Common reasons for AIT refusal were related to indecisiveness (26.5%), costs (22.9%), and skepticism (19.3%). Among the remaining 70.8% who accepted to start AIT, 21.4% discontinued the treatment beforehand, on average 18.26 months from initiation. There was a high heterogeneity in the suggested duration of AIT, with 20.4% of patients receiving indications to continue AIT for less than 3 years. AIT positively impacted patients' lives as most patients who completed AIT found it effective and safe, and experienced a significant reduction in the workdays/schooldays lost due to disease exacerbations.

Conclusions

The outcomes of this research pointed out a lot of misinformation surrounding AIT, calling for improvements in awareness and information on its efficacy and safety. Also, we noted a significant reduction in work/school days lost in patients who completed AIT and a good patient-reported safety and efficacy profile. We advocate for better economic accessibility through national-level standardization in treatment refundability. Notably, the collaboration with the patient association was crucial, and it would have been challenging to conduct this research otherwise.

Contact Dermatitis in the United States: A Population-Based Study on Patient Visit Characteristics and Treatment Prescription Patterns

Background: Contact dermatitis (CD) affects ∼15% of the general population over a lifetime. However, there is a lack of epidemiological studies on treatment patterns for CD. Objective: We aim to analyze the patient characteristics and prescribing patterns among dermatologists and general practitioners (GPs) (internal medicine [IM] and family medicine [FM]) for CD in the United States. Methods: We conducted a population-based study using the National Ambulatory Medical Care Survey. Results: We identified 178,017,680 weighted patient visits for CD from 2001 to 2016. Dermatologists saw more white and non-Hispanic patients than GPs. GPs were less likely to prescribe ultrahigh potency topical corticosteroids (FM OR 0.27; P < 0.001, IM OR 0.41; P < 0.001) and more likely to prescribe oral antihistamines (FM OR 3.71; P < 0.001, IM OR 3.56; P < 0.001), oral corticosteroids (FM OR 5.35; P < 0.001, IM OR 6.87; P < 0.001), and injectable corticosteroids (FM OR 3.42; P = 0.006, IM OR 5.68; P < 0.001) than dermatologists. Conclusions: Across CD visits, GPs were less likely than dermatologists to prescribe ultrahigh potency topical corticosteroids and more likely than dermatologists to prescribe oral antihistamines and systemic corticosteroid therapy.

Malignant and Benign Head and Neck Tumors of the Pediatric Age: A Narrative Review

Malignant tumors of the head and neck are rare in children, but it is important to know these lesions and identify them early in order to have a good outcome for these patients. Benign lesions of the head and neck are much more frequent and have an excellent prognosis. For this reason, it is necessary to recognize the warning signs and symptoms and understand when to refer the patient to a reference center for the treatment of these pathologies. The clinical presentation of both benign and malignant lesions in children may be similar as usually, both categories have compressive effects. This confirms the fact that the clinical diagnosis is not sufficient and always requires instrumental investigations and biopsies. In this narrative review, we analyzed both malignant lesions such as lymphoma, rhabdomyosarcoma, thyroid tumors, salivary gland tumors, neuroblastoma, and nasopharyngeal carcinoma, and benign ones such as cystic dermoid teratoma, hemangioma, juvenile angiofibroma and fibrosis dysplasia. Indeed, we set out to discuss the most common lesions of this site