Anaphylaxis to vaccinations: A review of the literature and evaluation of the COVID-19 mRNA vaccinations.

Recent reports of allergic reactions to the Pfizer-BioNTech and the Moderna COVID-19 vaccines have resulted in questions about how and to whom they can be safely administered. Although anaphylaxis was not observed in clinical trials for either vaccine, there have been 21 reported possible cases of anaphylaxis associated with the Pfizer vaccine (11.1 cases per million doses administered) and 10 possible cases associated with the Moderna vaccine (2.5 anaphylaxis cases per million doses administered). The etiology of anaphylaxis in these cases is not fully understood and is an area of active research. The overall incidence of anaphylaxis to COVID-19 mRNA vaccines is very low. By following recommendations from the US Centers for Disease Control and Prevention, an overwhelming majority of the US population can be safely immunized.

Cysteinyl leukotriene receptor 1 expression identifies a subset of neutrophils during the antiviral response that contributes to postviral atopic airway disease.

BACKGROUND: Viral respiratory tract infections increase the risk of development and exacerbation of atopic disease. Previously, we demonstrated the requirement for a neutrophil (PMN) subset expressing CD49d to drive development of postviral atopic airway disease in mice. OBJECTIVE: We sought to determine whether human CD49d+ PMNs are present in the nasal mucosa during acute viral respiratory tract infections and further characterize this PMN subset in human subjects and mice. METHODS: Sixty subjects (5-50 years old) were enrolled within 4 days of acute onset of upper respiratory symptoms. Nasal lavage for flow cytometry and nasal swabs for viral PCR were performed at enrollment and during convalescence. The Sendai virus mouse model was used to investigate the phenotype and functional relevance of CD49d+ PMNs. RESULTS: CD49d+ PMN frequency was significantly higher in nasal lavage fluid during acute respiratory symptoms in all subjects (2.9% vs 1.0%, n = 42, P < .001). In mice CD49d+ PMNs represented a "proatopic" neutrophil subset that expressed cysteinyl leukotriene receptor 1 (CysLTR1) and produced TNF, CCL2, and CCL5. Inhibition of CysLTR1 signaling in the first days of a viral respiratory tract infection was sufficient to reduce accumulation of CD49d+ PMNs in the lungs and development of postviral atopic airway disease. Similar to the mouse, human CD49d+ PMNs isolated from nasal lavage fluid during a viral respiratory tract infection expressed CysLTR1. CONCLUSION: CD49d and CysLTR1-coexpressing PMNs are present during symptoms of an acute viral respiratory tract infection in human subjects. Further study is needed to examine selective targeting of proatopic neutrophils as a potential therapeutic strategy to prevent development of postviral atopic airway disease.

Dermatology elective curriculum: Birdwatching list and travel guide.

Primary care physicians often see patients with dermatologic complaints, but do not perform as well as dermatologists in the diagnoses of common dermatologic conditions. This article describes a dermatology curriculum that aims to close the clinical practice gap by providing an efficient and effective way to teach dermatology to medical students and non-dermatology residents in the setting of a busy, outpatient dermatology practice.

Neuropsychiatric symptoms in dementia patients with and without a history of traumatic brain injury.

The authors aim to determine if a history of traumatic brain injury (TBI) assessed before dementia onset is associated with a higher risk of neuropsychiatric symptoms after dementia onset. A population-based incident series of people with dementia were assessed for TBI prior to onset of dementia and for neuropsychiatric symptoms after the onset, using the Neuropsychiatric Inventory. Participants with predementia TBI were more likely to exhibit disinhibition (12.7% versus 5.4%, OR=2.8, p=0.02), but not other neuropsychiatric symptoms. Traumatic brain injury may increase the risk of disinhibition in patients with dementia.