The role of skin tests with polyethylene glycol and polysorbate 80 in the vaccination campaign for COVID-19: results from an Italian multicenter survey

Summary

Background. International guidelines suggested skin tests with Polyethylene-glycol (PEG) and polysorbate 80 (PS-80), to investigate a possible hypersensitivity to these excipients either to identify subjects at risk of developing allergic reactions to Covid-19 vaccines, or in patients with suspected IgE mediated hypersensitivity reactions (HR) to the Covid-19 vaccine. The main purpose of this study was to investigate the prevalence of PEG and PS sensitization in patients with a clinical history of HR to drugs containing PEG/PS and in patients with a suspected Covid-19 vaccine immediate HR. Methods. This was a multicenter retrospective study conducted by allergists belonging to 20 Italian medical centers. Skin testing was performed in 531 patients with either a clinical history of suspected hypersensitivity reaction (HR) to drugs containing PEG and/or PS-80 (group 1:362 patient) or a suspected HR to Covid-19 vaccines (group 2: 169 patient), as suggested by the AAIITO/SIAAIC guidelines for the "management of patients at risk of allergic reactions to Covid-19 vaccines" [1]. Results. 10/362 (0.02%) had positive skin test to one or both excipients in group 1, 12/169 (7.1%) in group 2 (p less than 0.01). In group 2 HRs to Covid-19 vaccines were immediate in 10/12 of cases and anaphylaxis occurred in 4/12 of patients. Conclusions. The positivity of skin test with PEG and or PS before vaccination is extremely rare and mostly replaceable by an accurate clinical history. Sensitization to PEG and PS has to be investigated in patients with a previous immediate HR to a Covid-19 vaccine, in particular in patients with anaphylaxis.

Kounis syndrome: an underestimated emergency

Summary

Background. Kounis syndrome (KS) is defined as a rare cause of an acute coronary syndrome associated with systemic allergic reactions. To establish the prevalence of KS among the patients with diagnosis of anaphylaxis, we described clinical features, cardiological and allergological outcomes of patients evaluated in our allergy outpatient clinic. Methods. A retrospective study was carried out in the Allergy Unit of Novara hospital, from January 2008 to March 2020. Skin tests and in vitro tests were performed with suspected etiological agents. Results. We found 9 adults with KS (2%) out of 444 subjects who had experienced anaphylactic reactions (4/9 to Hymenoptera stings, 5/9 to drugs). Conclusions. The present study highlights the importance of suspicion of KS that appears not so uncommon in patients with anaphylaxis. KS seems to be a rare disease because unrecognized in diagnosis of anaphylaxis.

A case of acute generalized exanthematous pustulosis due to amoxicillin-clavulanate with multiple positivity to beta-lactam patch testing

We present a case of acute generalized exanthematous pustolosis (AGEP) induced by amoxicillin-clavulanate. Clinical diagnosis was confirmed by symptoms presentation and  histological features (Euroscar score point compatible with definite diagnosis). Patch testing performer six months later confirmed sensitization to the culprit drug and showed positivity also to other beta-lactam antibiotics (penicillin G and cephalexin). We believe that a T cell delayed response to betalactams common ring could be involved.

A case of protracted hypotension as unique symptom of a biphasic anaphylaxis to amoxicillin

We are reporting a case of one patient who have experienced itching of palms and soles, thorax erythema, conjunctive injection immediately after oral administration of amoxicillin, and hypotension after 3 hours. In E.D. hypotension was monitored because he was a cardiopatic but it wasn't treated even if it was protracted. A positive result of immediate-reading intradermal test with amoxicillin at 2 mg/ml concentration was found confirming the diagnosis of allergic biphasic anaphylaxis to amoxicillin.

Maize food allergy: a double-blind placebo-controlled study

BACKGROUND

Maize allergy is not very common especially in Europe. The number of studies that address IgE mediated maize allergy is all too few.

OBJECTIVE

Evaluate subjects with a history of maize allergy by double-blind, placebo-controlled food challenge; identify the spectrum of symptoms manifested during challenge; determine the lowest provocation dose (PD) during challenge; determine the performance characteristics of maize skin prick test and specific IgE.

METHODS

Twenty-seven patients with a history of maize allergy were enrolled to be evaluated by skin test, specific IgE and double-blind placebo-controlled maize challenge.

RESULTS

Forty-eight percent of the patients were challenge positive. PD range was 0.1-25 g. Fifty-four percent of the maize allergic subjects had a PD that was < or = 2.5 g; two subjects reacted to 100 mg of maize. Comparison of maize specific IgE levels and skin test results to the challenge results revealed the following (specific IgE level/skin testing): sensitivity 1.00/0.846, specificity 0.077/0.384, positive predictive value 0.520/0.579, and negative predictive value 1.00/0.714.

CONCLUSION

Maize is a cause of IgE-mediated allergic reactions to foods in adults and children. Nearly half of the subjects recruited were confirmed by challenge to be allergic to maize. Twenty-three percent of the positive challenge patients manifested symptoms that involved two organ systems, thus fulfilling the criteria for maize induced anaphylaxis. Maize is allergenic and can pose a risk for symptomatic food allergy at a dose of 100 mg.

[Anxiety and ++phobia in dental patients. Recent findings regarding the "fear of the dentist"]

The authors review the most recent literature on "dental phobia" which is responsible for discomfort and delays in prevention and treatment of odontoiatric disorders. Special attention is devoted to the multifactorial etiology and to diagnostic classification of these difficulties, as well as to the therapeutic possibilities available today.

[Objectives and results of therapy in a psychiatric day hospital. Follow-up of 70 patients]

Ten years after the institution of a Day Hospital in Rome, the authors make an assessment of treatment results achieved for 70 patients admitted for the first time in 1986 and assessed after five years. Literary studies emphasizing Day Hospital effectiveness are reviewed; then the authors describe the setting in which this research was carried out. The primary aim was: to evaluate the efficacy of this unit to satisfy its users' needs, to permit their reentry into the community and to prevent their relapses and rehospitalizations.