Allergy and coronavirus disease (COVID-19) international survey: Real-life data from the allergy community during the pandemic.

BACKGROUND: The COVID-19 outbreak brought an unprecedented challenge to the world. Knowledge in the field has been increasing exponentially and the main allergy societies have produced guidance documents for better management of allergic patients during this period. However, few publications so far have provided real-life data from the allergy community concerning allergy practice during the COVID-19 outbreak. Therefore, we proposed an international survey on the management of allergic patients during the current pandemic. METHODS: We performed an online survey undertaken to reach out the worldwide allergy community by e-mail and social media. The web-based questionnaire contained 24 questions covering demographic data from the participants, clinical practice during this period, and questions related to the new international classification and coding tools addressed for COVID-19. It was circulated for 8 weeks and had anonymous and volunteer context. RESULTS: Data are presented for 635 participants from 78 countries of all continents. Allergists with long-term professional experience were the main audience. As expected, we received many responses as "I have no data" or "I don't know" to the questions of the survey. However, most with more experience on managing allergic patients during the pandemic agreed that patients suffering from allergic or hypersensitivity conditions have no increased risk of contracting COVID-19 or developing SARS CoV-2. Also, participants mentioned that none of the allergy treatments (inhaled corticosteroids, allergen immunotherapy, biological agents) increased the risk of contracting COVID-19 infection including severe presentations. CONCLUSION: The data presented are a starting point in the process of getting feedback on all the recommendations provided by the allergy societies; it could also be the basis of new strategies to support health professionals while new COVID-19 specific treatments and vaccines are being explored. The information here presented intends to be helpful to the community but represents a course of action in a highly specific situation due to the state of emergency, and it should be helpful to health systems.

Clinical features of hereditary angioedema in Chinese patients: new findings and differences from other populations.

BACKGROUND: Hereditary angioedema (HAE), caused by C1 inhibitor deficiency, is characterized by recurrent subcutaneous or submucosal swelling. Because it is rare, data on clinical features, especially in Chinese patients, are not comprehensive. OBJECTIVE: Our aim was to identify the characteristics of HAE in a Chinese population and enhance clinical knowledge of this disease. METHODS: One hundred and fifty-eight symptomatic patients were studied retrospectively. Data were obtained from medical records. Statistical analyses were performed using statistical software package: R version 2.14.0. RESULTS: The majority of patients first experienced attacks during the second (42%) and third (32%) decades: the mean onset of symptoms was at the age of 21.25 years. The percentage of patients having experienced a swelling at least once for the following sites were: extremities (83.54%); pharyngolarynx (58.86%); face (55.06%); gastrointestinal tract (34.17%); trunk (18.35%) and genitalia (15.33%). Rare manifestations included melaena, swollen gastric mucosa inverting into the oesophagus, pleural effusion, dysuria and syncope. For patients who first experienced swelling in pre-adolescence, 41.67% noted intensified attack rates when they entered puberty. In pregnancy, 61.70% did not note a change in HAE attack frequency. CONCLUSION: Compared with previous studies, the mean age of symptom onset is older. The frequencies of abdominal attacks occurring in patients on the Chinese Mainland, as well as in Taiwan and Japan, appears much lower than in western countries. Ethnic or environmental differences may contribute to this finding. Melaena and gastric mucosa inverting into the oesophagus secondary to edema are first reported here.

Comparison and evaluation of several Dermatophagoides pteronyssinus allergen extracts for skin prick test.

OBJECTIVE: To evaluate the significance of several Dermatophagoides pteronyssinus allergen extracts for skin prick test (SPT) in patients allergic to Dermatophagoides pteronyssinus. METHODS: Two hundred and nineteen patients enrolled in Peking Union Medical College Hospital underwent SPT and serum specific IgE assay to detect the Dermatophagoides pteronyssinus allergen. Three kinds of house dust mite allergen extracts were used for SPT, including the Dermatophagoides pteronyssinus extract prepared by our laboratory (group A), standardized Dermatophagoides pteronyssinus extract (group B), and mixed extracts of Dermatophagoides pteronyssinus and Dermatophagoides farinae (group C). Human serum specific IgE result was regarded as the reference standard for diagnosis of Dermatophagoides pteronyssinus allergy. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of SPT with the extracts of three groups. RESULTS: SPT results showed that the median wheal diameter of group A, group B, and group C was 0.43, 0.35, and 0.28 cm, respectively, with significant difference among three groups (P<0.05). The difference was significant between group A and B (P<0.01) as well as group A and C (P<0.01), but not between group B and C (P>0.05). There was no local urticaria or systemic allergic reactions following the procedure of SPT. Local reaction was observed in 5 patients and delayed reaction was in 2 patients of group A. As for group B and C, local reaction occurred in 3 cases and delayed reaction in 2 cases in each group. The area under ROC curve of SPT with extract in group A, group B, and group C was 0.765, 0.801, and 0.782, respectively. Based on the detection results of serum specific IgE, the sensitivity of SPT in diagnosis of Dermatophagoides pteronyssinus allergy with extract of group A, group B, and group C was 92.4%, 87.0%, and 81.5%, and the specificity was 60.6%, 73.2%, and 74.8%, respectively. CONCLUSION: The Dermatophagoides pteronyssinus extract for SPT prepared by our laboratory offers good sensitivity and specificity comparable to commercially available allergen extracts, and it may be an appropriate candidate for clinical screening and diagnosis of Dermatophagoides pteronyssinus allergy.

[Value of intradermal skin test and serum sIgE detection in diagnosing artemisia pollinosis].

OBJECTIVE: To evaluate the value of intradermal skin test (IDT) and serum sIgE detection in diagnosing Artemisia sensitivity in Chinese patients with autumnal hay fever. METHODS: 1150 patients with autumnal rhinitis or asthma, 504 males and 646 females, aged 5 approximately 77, were evaluated by experienced physicians, then underwent IDT by using 20 kinds of aeroallergen extracts. The concentrations of Artemisia and Ragweed extracts employed in skin test were 1:1000 (W/V) and the concentrations of other aeroallergens were all 1:100 (W/V). Then all patients underwent detection of Artemisia sIgE. Diagnostic standards were established based on the results of IDT and sIgE results respectively. A reference standard was established according to the typical history, symptoms, and an wheal with a diameter >or= 5mm and a sIgE level >or= 0.35 kU(A)/L, an wheal with the diameter >or= 10 mm alone; or a sIgE level >or= 0.70 kUa/L alone. RESULTS: When using the reference standard as criteria, using IDT had better sensitivity (96.2%), specificity (74.2%), positive predictive value (+PV, 93.5%), negative predictive value (-PV, 85.7%), and efficiency (91.6%) than using sIgE >or= 0.35 kUa/L alone as the criteria of IDT; sIgE detection had better sensitivity (97.6%), specificity (94.9%), +PV (98.7%), -PV (91.1%), and efficiency (97.0%) than using wheal diameter >or= 5 mm alone as the criteria of sIgE detection. The false positive rate of IDT and sIgE detection decreased from 35% and 22.7% to 25.6% and 5.1% respectively when using the wheal diameter >or= 10 mm or sIgE >or= 0.70 kUa/L as a positive criteria. CONCLUSION: IDT and sIgE detection are correlated with each other well in diagnosing Artemisia pollinosis, both of them have the possibility of being false positive, but IDT has higher false positive rate than sIgE detection. The false positive rates of IDT and sIgE detection can be decreased by increasing the positive criteria to higher grading reaction.

[Values of intradermal skin test and serum sIgE detection in diagnosing Humulus scandens pollinosis].

OBJECTIVE: To evaluate the values of intradermal skin test (IDT) and serum specific IgE detection in diagnosing Humulus scandens sensitivity in Chinese patients with autumnal hay fever. METHODS: 1150 patients, 504 males and 646 females, aged 5 approximately 75, were evaluated as with autumnal rhinitis and asthma by experienced physicians. Then the patients underwent IDT by using 20 kinds of aeroallergen extracts, at the concentration of 1:1000 (w/v) for Artemisia spp. and ragweed or at the concentration of 1:100 (w/v) for Humulus scandens and others. The Humulus sIgE level was performed in all patients. A diagnosing criteria was established according to typical history, symptoms, and any one of the following findings: (1) wheal > or = 5 mm in diameter by IDT and sIgE to Humulus of the concentration > or = 0.35 kUa/L at same time; (2) wheal > or = 10 mm in diameter by IDT alone; and (3) sIgE to Humulus of the concentration > or = 0.70 kUa/L alone. RESULTS: When using the above diagnosing criteria as the reference standard, IDT had better sensitivity (97.2%), positive predictive value (PV+) (77.9%), negative predictive value (PV-) (90.6%) and efficiency (80.4% than using sIgE > or = 0.35 kUa/L alone as the reference criteria of IDT, however, had a lower specificity (49.8%); and sIgE detection had better sensitivity (89.0%), specificity (97.5%), PV+ (98.8%), PV- (88.0%) and efficiency (92.0%) than using wheal > or = 5 mm in diameter alone as the reference criteria of sIgE detection. The false positive rate of IDT decreased from 59.9% to 17.4% when using wheal diameter > or = 10 mm as the positive criteria. In the 288 patients with a negative sIgE result and a positive IDT result 84 cases had stronger positive IDT result (with the wheal diameter > or = 10 mm). CONCLUSION: IDT is correlated well with sIgE detection in diagnosing Humulus scandens pollinosis, but the false positive rate of IDT is higher than that of sIgE test. The false positive rate of IDT can be decreased by increasing the positive criteria to higher grading reaction. The immunotherapy according to the lower grading positive result of IDT alone or sIgE alone should be avoided.

[Natural course from rhinitis to asthma in the patients with autumnal pollinosis: a clinical study of 1096 patients].

OBJECTIVE: To investigate the natural course from rhinitis to asthma in the patients with autumnal pollinosis. METHODS: 1096 patients with autumnal pollinosis, 488 males and 632 females, aged 38 +/- 14 (5 - 77), 511 with pure allergic rhinitis and 585 with allergic rhinitis complicated with asthma, underwent skin test of inhalant allergens, serum IgE specific to autumnal pollens, and questionnaire survey. RESULTS: The age range of rhinitis induced by autumnal pollens was 2 - 75. The peak onset age of rhinitis was 15 - 44, and the peak onset age of asthma was 25 - 54. 33% of the rhinitis patients complicated with asthma (194/585) had their first attack of rhinitis and the first attack of asthma in the same year, 66% of them (386/585) had the first attack of asthma later than the first attack of rhinitis, and only 0.8% of them (5/585) had their first attack of asthma earlier than that of rhinitis. 37% of the patients with autumnal pollen allergic rhinitis (410/1096) developed asthma within 5 years, 47% (511/1096), within 9 years, 5% (58/1096) within 10 approximately 19 years, and 1.5% (16/1096) within 20 - 40 years. CONCLUSION: Almost half of the patients with autumnal pollen allergic rhinitis develop to seasonal allergic asthma within 9 years.

[The clinical study of the relationship between allergic rhinitis and allergic asthma in the patients with autumnal pollinosis].

OBJECTIVE: To investigate the relationship between allergic rhinitis and allergic asthma in the patients with autumnal pollinosis. METHODS: 1120 patients with autumnal pollinosis, aged 5 - 75, excluding those with typical symptoms of seasonal rhinitis or asthma but with positive skin test and serum IgE specific to dustmite and fungi, underwent standardized clinical questionnaire survey, including the onset age, onset time, and symptoms as well as the severity of asthma, skin tests, and examination of serum IgE specific to autumnal pollens. RESULTS: The average onset age of the allergic rhinitis patients induced by autumnal pollens was 27.9 years, significantly younger than that of the allergic asthma patients (32.6 years, P < 0.001). Out of the 1120 patients 1096 (97.9%) had allergic rhinitis, 602 (53.8%) had asthma, 507 (45.3%) had allergic rhinitis only, and 10 (0.9%) had allergic asthma only. Among the 1096 patients with allergic rhinitis 585 (53.4%) suffered from seasonal asthma. Among the 602 patients with asthma 585 (97.2%) suffered from seasonal rhinitis, and 183 of the 602 patients (30.8%) needed emergency treatment. CONCLUSION: Autumnal pollens are very important causes which induce asthma during autumnal season in northern China.