Impact of food allergy on health-related quality of life: A case report of 2 patients with adult-onset IgE mediated food allergy.

INTRODUCTION: Food allergy incidence is increasing, and reactions can be life-threatening. Food allergies significantly impact patients' and families' quality of life (QoL). Here, we describe two cases with adult-onset IgEmediated food allergy impacting their physical and psychological health and affecting their quality of life. CASE REPORT: Patient 1: A 29-year-old lady, previously healthy, presented with a history of sneezing, shortness of breath, and eye and lip swelling shortly after drinking cow milk at the age of 28 years. She had multiple episodes of similar symptoms after consumption of dairy products. A positive blood test confirmed Cow's Milk allergy (Table 1). She was very anxious and concerned about accidental exposure and even avoided serving milk to her children. She scored 5.2/7 on the Food Allergy Quality of Life Questionnaire-Adult Form (FAQLQ-AF). The patient currently avoids dairy products and carries Adrenaline autoinjectable (AAI), with no reported anaphylaxis. Patient 2: A 46-year-old man with a history of type 2 DM was evaluated for recurrent urticaria. Further history revealed recurrent episodes of urticaria and angioedema for the past few years one to two hours after wheat intake; the most recent episode was typical for anaphylaxis, and he denied any exercise or presence of other co-factors. Allergy testing confirmed wheat allergy (Table 1). He scored 4.9/7 on FAQLQ-AF. He was concerned about having another anaphylaxis. He was instructed to avoid wheat and to carry AAI, after which no further attacks were reported. INTERVENTION: Identifying the food allergens for both patients alleviates some of their anxiety. Moreover, having an AAI on hand and training on how and when to use it led to increased safety feeling, although initially, they were hesitant to carry AAI. Continuous assessment will be carried out during clinic visits to ensure improved QoL. CONCLUSION: Several factors affect the extent of food allergy's impact on patients' QoL, like age, type, and number of food allergens. Physicians must be aware of the psychological burdens faced by adults with food allergies and implement strategies to address and improve patients' QoL through counseling, proper education, and psychotherapy if needed.

Aeroallergens sensitization pattern in atopic patients in Qatar: A retrospective study.

BACKGROUND: Allergic respiratory diseases (allergic rhinitis and asthma) are major health problems with high prevalence causing significant patient morbidity as well as an economic burden (1). Sensitization to inhaled allergens is a major factor in the pathogenesis of allergic respiratory diseases (2). This study aims to determine the commonest aeroallergen sensitization in patients with allergic symptoms who attended an Adult Allergy Clinic in Qatar. METHODS: This retrospective study reviewed the skin prick test results database of 20 aeroallergens performed between January 1st to December 31st, 2022, at an Adult Allergy clinic in Qatar. Based on skin test results, the most prevalent aeroallergens were determined. RESULTS: A total of 554 patients (43% males, 57% females), aged between 12-87 years, 36±13.8 (mean ± SD), underwent skin prick test, of which 378 patients (68%) had positive results. There were no significant sex differences in the frequency of atopy (males: 60% versus females: 65% p= .076). Of the total 554 patients, 62% were diagnosed with Allergic rhinitis, 19% with non-allergic rhinitis, 32% with asthma, 6.7% with chronic urticaria, and 6.5% with atopic dermatitis. The frequency of sensitivity to aeroallergens was Dermatophagoides pteronyssinus 49.5%, Dermatophagoides farina 38.6%, Cat 37.3%, American Cockroach 25.9%, Russian thistle 24%, German cockroach 20%, Rough pigweed 19%, Bermuda grass 11%, and 8% to seven grass mix. 61 % were sensitized to indoor aeroallergens and 31% to different pollens (outdoor). Of the 378 patients who were sensitized, 145 patients (38%) were monosensitized, and 233 (62%) were polysensitized (≥2 allergens). There were no significant differences in the frequency of polysensitization between males and females (M:F: 1:1, p=0.938). CONCLUSION: Insects (house dust mites and cockroaches) and animal protein (cat hair) were the most prevalent positive aeroallergen by skin tests. However, weed, tree pollens (Russian thistle, Rough pigweed, Mesquite tree), and grass pollens (Bermuda and seven grass mix) were also positive for a minority of patients. 62% of patients were polysensitized to aeroallergens.

Management of Autoimmune urticaria in a patient with Myasthenia Gravis, a challenging case.

INTRODUCTION: The pathophysiology of chronic spontaneous urticaria (CSU) is not yet fully understood; however, increasing evidence supports the association between CSU and autoimmunity. Myasthenia gravis (MG) is an autoimmune neuromuscular disorder. MG management relies on using immunosuppressants and avoiding certain medications that can precipitate an MG crisis. The coexistence of CSU and MG was described in the literature on elderly patients. Herein we present a challenging case regarding the management of CSU in a young female with MG. CASE REPORT: A 22-year-old lady known to have Myasthenia gravis post thymectomy, with a history of multiple MG crises, presented to the Allergy Clinic with recurrent itchy hives typical for urticaria without associated angioedema. Despite being on Azathioprine and low-dose steroids for MG treatment, she had an active CSU disease, UAS7:32, UCT: 5. The neurologist advised against the use of regular oral antihistamines because they might exacerbate MG. Although we do not have serum autologous skin testing, basophil activation test, or IgG autoantibodies for a definitive definition of autoimmune CSU (aiCSU), the patient has some features supporting the diagnosis of aiCSU (see Table 1). In addition, she has a normal total IgE level, normal C3, C4, negative RF, ANA, ANCA, anti-TPO, and anti-thyroglobulin antibodies. After the discussion with the neurologist, we started her on Omalizumab 300 mg every four weeks, which was increased to 450 mg every two weeks with partial control of CSU. She was started on rituximab to treat MG with improvement in CSU. CONCLUSION: To the best of our knowledge, limited data describing the association between MG and CSU in young patients. Moreover, there is insufficient data on the safety of antihistamines in patients with MG, which are the first line of treatment for CSU. There are clinical and laboratory biomarkers that help in identifying CSU endotypes. Recognition of aiCSU endotype is essential as it helps predict disease course and response to treatment. Moreover, careful therapeutic interventions in patients with CSU and coexistent autoimmune diseases are warranted to achieve efficacy and reduce drug interactions and adverse effects.

First allergy conference in Qatar: Let's explore allergy with a new lens.

Allergic diseases are common medical conditions that now show an increasing trend globally and contributes to poor quality of life of the affected individual. Allergies can be fatal in a few instances such as anaphylaxis, severe asthma, and hereditary angioedema if the symptoms are not recognized and treated correctly. (1, 2) The first Allergy Conference in Qatar aimed to highlight the burden of allergic diseases in Qatar and globally with a special focus on educating both the physicians and the community. The preparation for this conference over the past three years threw up a few challenges, mainly owing to the coronavirus disease 2019 (COVID-19) pandemic that affected all forms of face-to-face interactions and social gatherings. Therefore, our conference was held virtually on February 05, 2022, which was more than two years from the first planned date. The conference was sponsored by the Hamad Medical Corporation in partnership with the Qatar Allergy and Immunology Society. In our scientific program, the scientific committees selected topics related to 3 major areas in allergy practice (systemic, respiratory, and skin allergy disorders). Abstract submissions were encouraged in areas related to audits, case reports, service development, and clinical and basic research in the field of allergy. Additional topics were included related to the current COVID-19 pandemic and COVID-19 vaccinations. We received 34 abstracts and accepted 28 for poster abstracts. Among them, 6 received approval for oral presentations; and 6 (21.4%) had the term COVID-19 or SARS-CoV-2 in their title, which supported the burden related to COVID-19 in our community and association between this new pandemic and our allergy practice and disorders.

Hypopigmentation following intradermal allergy skin testing performed as part of mRNA COVID-19 vaccine allergy evaluation.

BACKGROUND: Skin prick test (SPT) and intradermal test (IDT) are standard procedures in the allergy practice that are safe when performed. Individuals with a history of allergic reaction to the COVID-19 vaccine can undergo allergy skin testing for polyethylene glycol and polysorbate 80 to determine their eligibility for the same vaccine or a safe alternative. Hypopigmentation is an infrequent adverse effect of corticosteroids, including triamcinolone acetonide, following local and intralesional treatment. Exposure to high potency corticosteroids for a long duration and the intradermal injection route are risk factors for hypopigmentation. In this case report, we describe the development of hypopigmentation following triamcinolone ID testing. CASE REPORT: A 29-year-old lady with a history of immediate severe allergic reaction following the first dose of mRNA COVID-19 vaccine (Pfizer) underwent SPT and IDT for polysorbate 80 and polyethylene glycol. Triamcinolone acetonide and Prevnar 13 were used as an indicator of polysorbate 80. Following a negative SPT, IDT for triamcinolone acetonide was negative at 1:10 of 40 mg/mL and positive at 1:1 of 40 mg/mL. A few days later, she noticed hypopigmented lesions at the site of the intradermal skin test for both concentrations of triamcinolone. The lesions have increased in size since then (see image). The patient was diagnosed with steroid-induced hypopigmentation secondary to triamcinolone IDT injection. CONCLUSION: Skin hypopigmentation following intraarticular and intralesional triamcinolone injection has been reported previously. However, to the best of our knowledge, this is the first reported case of steroid-induced hypopigmentation following intradermal skin testing. Furthermore, this report highlights that even a low dose of local triamcinolone can cause hypopigmentation. We believe that this case report regarding the rare adverse event will alert clinicians to the potential complication of corticosteroid IDT and help them counsel the patients and provide a thorough explanation before any procedure.

Severity and outcome of COVID-19 disease in patients with allergic rhinitis during the pandemic in Qatar - A preliminary report.

BACKGROUND: Allergic rhinitis and asthma exacerbation are strongly linked to respiratory viral and bacterial infections. COVID-19 pandemic has raised concerns about the risk of infection and the severity of COVID-19 infection in patients with asthma and allergic rhinitis. However, increasing evidence suggests that atopic disease protects against severe COVID-19 illness owing to the underlying type 2 inflammatory process. Many studies have reported the impact of asthma on COVID-19 disease; however, data on allergic rhinitis are scarce. In this study, we aimed to investigate the severity and outcome of COVID-19 disease in adult patients with allergic rhinitis in Qatar during the first pandemic wave. METHODS: We conducted a retrospective chart review of adult patients with a confirmed diagnosis of asthma and/or allergic rhinitis who had a positive COVID-19 RT-PCR between February 01, 2020, and December 01, 2020. Parameters evaluated included the WHO classification of COVID-19 disease severity as mild, moderate, severe, and critical; COVID-19 disease outcome; and mortality. Patients with allergic rhinitis were defined as those with typical allergic rhinitis symptoms and positive skin prick test or specific IgE to perennial or seasonal inhaled allergens. Only data about patients with allergic rhinitis has been presented in this report. RESULTS: We screened 97 EMR Cerner records of patients who had the diagnosis code for allergic rhinitis. Nine patients met the inclusion criteria of allergic rhinitis diagnosis; the remaining either had no allergy testing or had negative allergy tests. Seven (77.7%) patients had mild COVID-19, whereas only one (11.1%) patient each had moderate and severe disease. The length of hospital stays for 6 patients ranged from 5-13 days, and the remaining 3 patients were quarantined at home. No reports of critical cases or death were identified. All the patients recovered from COVID-19 with a favorable outcome. CONCLUSION: This preliminary data showed that most patients with allergic rhinitis had mild COVID-19 disease. Furthermore, all of them recovered well, similar to the available data from previous studies. A limitation of this study is the small population size.

Asthma knowledge, care, and outcome during pregnancy: The QAKCOP study.

Asthma is the most common chronic medical condition affecting pregnancy. Optimizing asthma management in pregnancy is paramount for the well-being of both the mother and the baby. The primary objectives of this study were to assess patient's knowledge about asthma, the level of asthma care, and fetal and maternal outcomes among pregnant asthmatic women in this wealthy country with tremendous improvement in maternal and fetal health care. The secondary objective was to identify barriers to asthma control. This was a cross-sectional, face-to-face, prospective study of 80 pregnant women with physician-diagnosed asthma. About 56% of patients reported worsening of their asthma control during pregnancy, of which 52.3% felt this worsening in the third trimester. About 65% of patients had uncontrolled asthma during their pregnancy, and inhaler technique was incorrect in 64.4%. Only 38% of patients knew the difference between controller and reliever asthma medications, 12.7% of patients had received written asthma action plan, 17% had a spirometry done in the previous 5 years, and 3.8% had peak expiratory flow meter at home. The main reasons for uncontrolled asthma were lack of knowledge about right asthma medications in 30% and fear of side effects of inhaled corticosteroids in 19% of patients. No financial reason was reported. Significant associations between total number of pregnancies, poor perception of asthma medications, asthma exacerbation during delivery and poor asthma control were observed. Preeclampsia and congenital anomalies occurred at higher rates than previously reported among general population in this country. The tremendous improvements in maternal health care and socioeconomic status do not seem to be a barrier to the globally recognized poor asthma care in pregnancy. Important strategies are much needed.

Patient-Reported Outcome Measures in Atopic Dermatitis and Chronic Urticaria Are Underused in Clinical Practice.

BACKGROUND: Patient-reported outcome measures (PROMs) are validated and standardized tools that complement physician evaluations and guide treatment decisions. They are crucial for monitoring atopic dermatitis (AD) and chronic urticaria (CU) in clinical practice, but there are unmet needs and knowledge gaps regarding their use in clinical practice. OBJECCTIVE: We investigated the global real-world use of AD and CU PROMs in allergology and dermatology clinics as well as their associated local and regional networks. METHODS: Across 72 specialized allergy and dermatology centers and their local and regional networks, 2,534 physicians in 73 countries completed a 53-item questionnaire on the use of PROMs for AD and CU. RESULTS: Of 2,534 physicians, 1,308 were aware of PROMs. Of these, 14% and 15% used PROMs for AD and CU, respectively. Half of physicians who use PROMs do so only rarely or sometimes. Use of AD and CU PROM is associated with being female, younger, and a dermatologist. The Patient-Oriented Scoring Atopic Dermatitis Index and Urticaria Activity Score were the most common PROMs for AD and CU, respectively. Monitoring disease control and activity are the main drivers of the use of PROMs. Time constraints were the primary obstacle to using PROMs, followed by the impression that patients dislike PROMs. Users of AD and CU PROM would like training in selecting the proper PROM. CONCLUSIONS: Although PROMs offer several benefits, their use in routine practice is suboptimal, and physicians perceive barriers to their use. It is essential to attain higher levels of PROM implementation in accordance with national and international standards.

Impact of COVID-19 on Antenatal Care Utilization Among Pregnant Women in Qassim, Saudi Arabia.

Background and objectives Coronavirus disease 2019 (COVID-19) pandemic has affected routine service delivery which might affect antenatal care (ANC) utilization among pregnant women. This study aimed to assess the proportion of missed appointments among pregnant women in the Qassim region of Saudi Arabia during the COVID-19 pandemic. Methods A facility-based cross-sectional survey was conducted among pregnant women admitted for delivery in Maternity and Children Hospital (MCH), Buraidah. Data were collected on socio-demographics, obstetric history, missed appointments and reasons for missing the appointment. Analysis was carried out in Statistical Package for the Social Sciences (SPSS), version 21.0 (IBM Corp., Armonk, NY). Medians with interquartile range (IQR) were presented for continuous variables and frequency and proportions for categorical variables. Logistic regression was used to assess the factors associated with the missed appointment. Results A total of 400 women were included in the study. About one-third (30%) of the women had missed at least one ANC appointment in their current pregnancy. The most common reasons for missing the appointments in primary care and hospitals, respectively, were: fear of infection 52% and 47%, facility not working usual 25% and 7.5%, fear of infection to child 19% and 17%. Family size and gravidity were the significant factors associated with missed appointments in our study. Conclusions Nearly one-third of women missed their ANC appointments during the COVID-19 pandemic. Major reasons were related to COVID-19 fear and its effect on services. This calls for proper health communication in the general population and delivering routine care with evidence-based guidelines to maintain continuity of care.

In vitro Interleukin-7 treatment partially rescues MAIT cell dysfunction caused by SARS-CoV-2 infection.

MAIT cells have been shown to be activated upon several viral infections in a TCR-independent manner by responding to inflammatory cytokines secreted by antigen-presenting cells. Recently, a few studies have shown a similar activation of MAIT cells in response to severe acute respiratory coronavirus 2 (SARS-CoV-2) infection. In this study, we investigate the effect of SARS-CoV-2 infection on the frequency and phenotype of MAIT cells by flow cytometry, and we test in vitro stimulation conditions on the capacity to enhance or rescue the antiviral function of MAIT cells from patients with coronavirus disease 2019 (COVID-19). Our study, in agreement with recently published studies, confirmed the decline in MAIT cell frequency of hospitalized donors in comparison to healthy donors. MAIT cells of COVID-19 patients also had lower expression levels of TNF-alpha, perforin and granzyme B upon stimulation with IL-12 + IL-18. 24 h' incubation with IL-7 successfully restored perforin expression levels in COVID-19 patients. Combined, our findings support the growing evidence that SARS-CoV-2 is dysregulating MAIT cells and that IL-7 treatment might improve their function, rendering them more effective in protecting the body against the virus.