The role of mobile health technologies in allergy care: An EAACI position paper.

Mobile health (mHealth) uses mobile communication devices such as smartphones and tablet computers to support and improve health-related services, data and information flow, patient self-management, surveillance, and disease management from the moment of first diagnosis to an optimized treatment. The European Academy of Allergy and Clinical Immunology created a task force to assess the state of the art and future potential of mHealth in allergology. The task force endorsed the "Be He@lthy, Be Mobile" WHO initiative and debated the quality, usability, efficiency, advantages, limitations, and risks of mobile solutions for allergic diseases. The results are summarized in this position paper, analyzing also the regulatory background with regard to the "General Data Protection Regulation" and Medical Directives of the European Community. The task force assessed the design, user engagement, content, potential of inducing behavioral change, credibility/accountability, and privacy policies of mHealth products. The perspectives of healthcare professionals and allergic patients are discussed, underlining the need of thorough investigation for an effective design of mHealth technologies as auxiliary tools to improve quality of care. Within the context of precision medicine, these could facilitate the change in perspective from clinician- to patient-centered care. The current and future potential of mHealth is then examined for specific areas of allergology, including allergic rhinitis, aerobiology, allergen immunotherapy, asthma, dermatological diseases, food allergies, anaphylaxis, insect venom, and drug allergy. The impact of mobile technologies and associated big data sets are outlined. Facts and recommendations for future mHealth initiatives within EAACI are listed.

Comparative performance of four penicillin allergy prediction strategies in a large cohort.

BACKGROUND: A safe and pragmatic guide for labeling and delabeling patients with suspected penicillin allergy is mandatory. OBJECTIVE: To compare the performance of four penicillin allergy prediction strategies in a large independent cohort. METHODS: We conducted a retrospective study for subjects presenting between 01/2014 and 12/2021 at the University Hospital of Montpellier, with a history of hypersensitivity to penicillins. The outcome targeted by the study was a positive penicillin allergy test. RESULTS: Of the 1884 participants included, 382 (20.3%) had positive penicillin allergy tests. The ENDA (European Network on Drug Allergy) and Blumenthal strategies yielded relatively high sensitivities and low specificities, and, by design, did not misclassify any positive subjects with severe index reactions. The PEN-FAST<3 score had a negative predictive value of 90% (95%CI, 88%-91%), with a sensitivity of 66% (95%CI, 62%-71%) and a specificity of 73% (95%CI, 71%-75%), and incorrectly delabeled 18 subjects with anaphylaxis and 15 with other severe non-immediate reactions. For the adapted Chiriac-score, the specificity corresponding to 66% sensitivity was 73% (95%CI, 70%-75%). Conversely, at a 73% specificity threshold, the sensitivity was 65% (95%CI, 61%-70%). Attempts to improve these prediction algorithms did not substantially enhance performance. CONCLUSION: The ENDA and Blumenthal strategies are safe for high-risk subjects, but their delabeling effectiveness is limited, leading to unnecessary avoidance. Conversely, the PEN-FAST and Chiriac scores are performant in delabeling, but more frequently misclassify high-risk subjects with positive penicillin allergy tests. Selection of the most appropriate tool requires careful consideration of the target population and the desired goal.

Skin Test Reactivity Patterns in Patients Allergic to Iodinated Contrast Media: A Refined View.

BACKGROUND: Two-dimensional (2D) classifications of iodinated contrast media (ICM) are insufficient to explain the observed skin test (ST) reactivity patterns in patients with drug hypersensitivity reactions (DHRs) to ICM. OBJECTIVE: To refine the current view on allergic DHRs to ICM by analyzing ST reactivity patterns in patients with previous reactions to ICM. METHODS: Patients with a history of DHR to ICM and positive STs, who presented at the University Hospital of Montpellier between 2004 and 2022, were included in the study. The relative difference between every two ICM products was measured by Manhattan distance and odds ratios were computed for all pairs of products in the immediate reaction (IR) and non-immediate reaction (NIR) ST groups. RESULTS: A total of 181 patients were included in the study. Odds ratio analysis identified significant associations between classical cross-reactive ICM, such as iohexol-ioversol, iohexol-iomeprol, iomeprol-ioversol, and iohexol-iodixanol in the IR ST group and iohexol-ioversol, iopromide-iohexol, and iomeprol-ioversol in the NIR ST group. We also identified uncommon associations, such as ioxitalamate-amidotrizoate in the IR ST group and amidotrizoate-iopamidol and amidotrizoate-ioxitalamate in the NIR ST group. The results were reflected by the Manhattan distance, which suggested the existence of clusters containing the same classically associated ICM as well as uncommon associations, which we hypothesize to be related to similarities in the 3D structure of the respective ICM. CONCLUSIONS: Current chemical (2D) classifications cannot explain all observed ST reactivity patterns. Whether the 3D structure can be integrated into the current classifications to interpret the observed ST reactivity patterns and predict tolerance to alternative ICM requires further research.

A Practical Risk Score for Prediction of Early Readmission after a First Episode of Acute Heart Failure with Preserved Ejection Fraction.

BACKGROUND: The first admission for acute heart failure with preserved ejection fraction (HFpEF) drastically influences the short-term prognosis. Baseline characteristics may predict repeat hospitalization or death in these patients. METHODS: A 103 patient-cohort, admitted for the first acute HFpEF episode, was monitored for six months. Baseline characteristics were recorded and their relation to the primary outcome of heart failure readmission (HFR) and secondary outcome of all-cause mortality was assessed. RESULTS: We identified six independent determinants for HFR: estimated glomerular filtration rate (eGFR) (p = 0.07), hemoglobin (p = 0.04), left ventricle end-diastolic diameter (LVEDD) (p = 0.07), E/e' ratio (p = 0.004), left ventricle outflow tract velocity-time integral (LVOT VTI) (p = 0.045), and diabetes mellitus (p = 0.06). Three of the variables were used to generate a risk score for HFR: LVEDD, E/e', LVOT VTI -DEI Score = - 28.763 + 4.558 × log (LVEDD (mm)) + 1.961 × log (E/e' ratio) + 1.759 × log (LVOT VTI (cm)). Our model predicts a relative amount of 20.50% of HFR during the first 6 months after the first acute hospitalization within the general population with HFpEF with a DEI Score over -0.747. CONCLUSIONS: We have identified three echocardiographic parameters (LVEDD, E/e', and LVOT VTI) that predict HFR following an initial acute HFpEF hospitalization. The prognostic DEI score demonstrated good accuracy.

TGF-ß1 Drives Inflammatory Th Cell But Not Treg Cell Compartment Upon Allergen Exposure.

TGF-ß1 is known to have a pro-inflammatory impact by inducing Th9 and Th17 cells, while it also induces anti-inflammatory Treg cells (Tregs). In the context of allergic airway inflammation (AAI) its dual role can be of critical importance in influencing the outcome of the disease. Here we demonstrate that TGF-ß is a major player in AAI by driving effector T cells, while Tregs differentiate independently. Induction of experimental AAI and airway hyperreactivity in a mouse model with inducible genetic ablation of the gene encoding for TGFß-receptor 2 (Tgfbr2) on CD4+T cells significantly reduced the disease phenotype. Further, it blocked the induction of pro-inflammatory T cell frequencies (Th2, Th9, Th17), but increased Treg cells. To translate these findings into a human clinically relevant context, Th2, Th9 and Treg cells were quantified both locally in induced sputum and systemically in blood of allergic rhinitis and asthma patients with or without allergen-specific immunotherapy (AIT). Natural allergen exposure induced local and systemic Th2, Th9, and reduced Tregs cells, while therapeutic allergen exposure by AIT suppressed Th2 and Th9 cell frequencies along with TGF-ß and IL-9 secretion. Altogether, these findings support that neutralization of TGF-ß represents a viable therapeutic option in allergy and asthma, not posing the risk of immune dysregulation by impacting Tregs cells.

Type I Kounis Syndrome after Protracted Anaphylaxis and Myocardial Bridge-Brief Literature Review and Case Report.

The term allergic angina, introduced for the first time by Nicholas Kounis in 1991, initially referred to the coexistence of acute coronary syndromes with allergy or hypersensitivity. At present, it is believed that Kounis syndrome is a particular case of systemic disease, with multiorgan arterial involvement generated during immediate hypersensitivity reactions. Myocardial bridging (MB), a condition that can induce coronary artery spasm, has long been regarded as a benign condition. Since both pathologies are associated with arterial spasm, Kounis syndrome and MB are considered to be confounding pathologies for acute coronary syndromes, and their association is quite a rare finding. To date, there are no precise data on the epidemiology, and the population affected by Kounis syndrome seems to be highly heterogeneous. Since this is a rare disease, even less is known about possible different phenotypes, including MB overlap. We report a case of type I variant Kounis syndrome associated with MB with no evidence of coronary artery disease, occurring as late presentation, following a severe systemic reaction (anaphylaxis) induced by a Hymenoptera sting. At present, only two other cases of type I and one case of type II Kounis syndrome occurring in patients with myocardial bridging have been described.

[The role of allergological tests in allergic bronchopulmonary aspergillosis (ABPA)]. / Rolul investigatiilor alergologice în diagnosticul aspergilozei bronho-pulmonare alergice (ABPA).

Allergic Bronchopulmonary Aspergillosis (ABPA) is an uncommon respiratory condition in which Asp. spp spores and mycelia inhalation trigger an immuno allergic inflammatory response in the bronchial airways. ABPA mostly develops in asthmatic and cystic fibrosis patients. The true prevalence of ABPA in not known. It is important to exclude ABPA in all asthmatics with positive skin reactivity to Aspergillus. Currently, a number of allergens from A. fumigatus have been cloned and the mRNA was purified - these are the recombinant antigens which can be used to distinguish between ABPA and fungal sensitization. IgE specific for Asp f 4 and Asp f 6 are restricted to ABPA patients and have a sensitivity and specificity of 90% and 100%, respectively. Aspergillus hipersensitivity can be demonstrated using in vivo (skin prick test) and in vitro methods (specific IgE and IgG, serum precipitins). In ABPA skin prick test is almost always positive. Normal levels of total IgE exclude ABPA. Serum total and specific IgE vary according to disease activity and are usefull for monitoring the treatment.