Endotyping of IgE-Mediated Polyethylene Glycol and/or Polysorbate 80 Allergy.

BACKGROUND: Polyethylene glycol (PEG) and polysorbate 80 (PS80) allergy preclude from SARS-CoV-2 vaccination. The mechanism(s) governing cross-reactivity and PEG molecular weight dependence remain unclear. OBJECTIVES: To evaluate PEGylated lipid nanoparticle (LNP) vaccine (BNT162b2) tolerance and explore the mechanism of reactivity in PEG and/or PS80 allergic patients. METHODS: PEG/PS80 dual- (n = 3), PEG mono- (n = 7), and PS80 mono-allergic patients (n = 2) were included. Tolerability of graded vaccine challenges was assessed. Basophil activation testing on whole blood (wb-BAT) or passively sensitized donor basophils (allo-BAT) was performed using PEG, PS80, BNT162b2, and PEGylated lipids (ALC-0159). Serum PEG-specific IgE was measured in patients (n = 10) and controls (n = 15). RESULTS: Graded BNT162b2 challenge in dual- and PEG mono-allergic patients (n = 3/group) was well tolerated and induced anti-spike IgG seroconversion. PS80 mono-allergic patients (n = 2/2) tolerated single-dose BNT162b2 vaccination. Wb-BAT reactivity to PEG-containing antigens was observed in dual- (n = 3/3) and PEG mono- (n = 2/3), but absent in PS80 mono-allergic patients (n = 0/2). BNT162b2 elicited the highest in vitro reactivity. BNT162b2 reactivity was IgE mediated, complement independent, and inhibited in allo-BAT by preincubation with short PEG motifs, or detergent-induced LNP degradation. PEG-specific IgE was only detectable in dual-allergic (n = 3/3) and PEG mono-allergic (n = 1/6) serum. CONCLUSION: PEG and PS80 cross-reactivity is determined by IgE recognizing short PEG motifs, whereas PS80 mono-allergy is PEG-independent. PS80 skin test positivity in PEG allergics was associated with a severe and persistent phenotype, higher serum PEG-specific IgE levels, and enhanced BAT reactivity. Spherical PEG exposure via LNP enhances BAT sensitivity through increased avidity. All PEG and/or PS80 excipient allergic patients can safely receive SARS-CoV-2 vaccines.

A late diagnosis of myasthenia gravis at the respiratory practice: back to basics.

Myasthenia gravis may affect respiratory muscles. To differentiate between other neuromuscular diseases, evaluation for muscle fatigability can be demonstrated by cardiopulmonary exercise testing and the maximal voluntary ventilation test. https://bit.ly/3qMeWFd.

Laparoscopic treatment of a Brunner's gland hamartoma: a case report.

Background Brunner's gland hyperplasia is a rare benign tumour and occurs most frequently in the upper part of the duodenum, mostly in the fifth or the sixth decade. Pathogenesis is still unknown. Symptoms are mostly absent, but larger lesions can cause gastric outlet obstruction or bleeding. Biopsies are necessary for differential diagnosis and to rule out cancerous changes. Mostly a resection is required. Methods A case report of a symptomatic Brunneroma is described with a review of the literature. Results: A 72-year-old female presented with melena due to a post-pyloric Brunneroma. After medical work-up a full laparoscopic resection was performed, with an uneventful recovery. Conclusion Brunner's gland hyperplasia is a benign lesion, although malignant transformation has been described. Small pedunculated Brunneromas can be resected endoscopically, but larger lesions need surgical treatment. A full laparoscopic treatment is possible and safe.