The usability of testing skin reaction applying skin prick tests with Comirnaty (Pfizer, USA) vaccine in detecting the risk of developing post-vaccination immediate hypersensitivity response (anaphylaxis) after administration of this vaccine.

Introduction: COVID-19 vaccines became a relevant element of prevention during COVID-19 pandemic. It is worth highlighting the importance of severe allergic post-vaccination reactions. Aim: To evaluate the usability of skin reaction tests using skin prick tests with Comirnaty (Pfizer, USA) vaccine in risk detection of the post-vaccine immediate hypersensitivity reaction (anaphylaxis) after administration of this vaccine [PvIHR(A)]. Material and methods: The analysis embraces 102 people, 85 women and 17 men with a history of immediate hypersensitivity (anaphylaxis) [IHR(A)]. Detailed medical history was collected and skin prick tests were made among participants. The positive and negative test results were illustrated in Figure 1. Results: As it stands in Table 1, considering all participants of the study, a positive result of the skin prick tests was obtained only in 2 cases, a negative result in 99 and 1 result was questionable. The two positive results were found in participants from a group with a previous PvIHR(A) in their past medical history and they decided not to get vaccinated. The one questionable result was of a person that had PvIHR(A) after administration of the first dose of Comirnaty vaccine (Pfizer, USA). This person decided to get vaccinated again and there was no PvIHR(A) observed. Conclusions: COVID-19 vaccination involves a low risk of anaphylaxis. Purposefulness of providing the skin prick tests using the mRNA vaccine is questionable, due to their low sensitivity and low specificity.

Assessment of selected parameters of the circulatory system in patients undergoing oral aspirin challenge.

INTRODUCTION: It is known that the administration of the drug during the oral aspirin challenge (OAC) can cause hypersensitivity symptoms not only from the respiratory system or skin, but also from the cardiovascular system. AIM: To assess the occurrence and nature of cardiovascular adverse events during the OAC in patients suspected of hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs). MATERIAL AND METHODS: The study included 52 patients with symptoms of hypersensitivity to aspirin (ASA) or other NSAIDs in the form of skin reactions or respiratory response in anamnesis. Patients were treated with OAC and simultaneously were subject to monitoring of clinical manifestations of hypersensitivity to ASA/NSAIDs, ventilation disorders and cardiovascular functions. RESULTS: The most common reaction of the cardiovascular system during OAC was tachycardia or supraventricular and ventricular extrasystoles, regardless of the day of the study and the result of OAC. Supraventricular and ventricular tachycardia was recorded incidentally. Atrial or ventricular fibrillation or flutter was not observed. There was no evidence of any ischemic heart disease. In 2 patients, hypotension was registered, but only 1 of them required typical treatment of anaphylaxis. CONCLUSIONS: No clinically significant cardiac arrhythmias were recorded during OAC. The changes observed in the records of blood pressure and ECG monitoring show that OAC performed in accordance with the current guidelines does not pose a high risk to the patient's health and life as a result of cardiovascular reactions.

Analysis of Hymenoptera venom allergy in own material. Clinical evaluation of reactions following stings, in patients qualified for venom immunotherapy.

INTRODUCTION: Hymenoptera venom allergy (HVA) in some patients occurs with general symptoms involving respiratory and cardiovascular system with anaphylactic shock with constitutes a significant threat to life. AIM: Assessment of the prevalence of HVA in our own material. MATERIAL AND METHODS: There were 498 patients after a general reaction to wasp and/or bee venom. The survey included questions: the type of stinging insect, body parts stung by insects, profession, frequency of stings by wasps and bees depending on professional activity, places of stings, clinical symptoms using the scale according to Muller, and the treatment following the sting. Among 498 patients, there were 281 women and 217 men. RESULTS: Wasp stings were more frequent and affected 382 (77%) persons, while bee stings affected 116 (23%) persons. Limbs constituted the most common area of the body stung by both wasps and bees. The sting was more frequent in rural areas and during summer rest. A severe systemic reaction (class III and IV according to Muller) occurred more often in people stung by bees. The most common medications included intravenous glucocorticosteroids, calcium preparations and antihistamines. Intramuscular Adrenaline injection was used in 48% of patients, while only 15% received its prescription as an emergency medication. Bee stings were the most common cause of severe systemic symptoms. CONCLUSIONS: The treatment after the sting in a significant percentage of episodes still deviates from the recommendations of the guidelines, especially in the field of adrenaline recommendations for patients in case of a resting by an insect.

How fast does wasp venom immunotherapy affect a regulatory T cell subpopulation (CD4+ CD25+ Foxp3+) and the synthesis of interleukins 10, 21 and transforming growth factor ß1?

INTRODUCTION: The literature describes the influence of venom immunotherapy (VIT) on the subpopulation of T regulatory cells (CD4+ CD25+ Foxp3+) and the synthesis of IL-10, TGF-ß1 as well as many other cytokines at various times after immunotherapy. AIM: To assess changes in the percentage of cells of CD4+ and CD25+ in peripheral blood and serum concentrations of IL-10, IL-21 and TGF-ß1 in the early stages of VIT. MATERIAL AND METHODS: The study included 18 patients who were allergic to wasp venom and who in the past underwent systemic anaphylactic reaction after stinging, meeting the criteria to qualify for VIT. The immunoenzymatic method (ELISA) was used to assess concentrations of cytokines IL-10, IL-21 and TGF-ß1 and the surface antigens CD4 and CD25 on the cells. The concentrations were determined by flow cytometry method at baseline (before VIT) and after 2.5 and 24 h from the VIT starting point. RESULTS: The mean values of the activity of T lymphocytes CD4+ CD25+ FoxP3+ and concentrations of the cytokines IL-10, IL-21 and TGF-ß1 are shown in table. CONCLUSIONS: A 24-hour activation assessment of serum concentrations of cytokines IL-10, IL-21 and TGF-ß1 during the first day of the Hymenoptera venom immunotherapy by ultra-rush protocol does not show the significant dynamics of change of the examined parameters.

Evaluation of the placebo effect in the trials of allergen immunotherapy effectiveness: meta-analysis of randomized and placebo-controlled trials.

INTRODUCTION: The total effect of the method of treatment is composed of its specific activity depending on its impact on the disease mechanism and the non-specific activity, i.e. the placebo effect. Many methods of treatment make use of such an inflammatory action. AIM: To assess the placebo effect in the overall result of the specific immunotherapy and the analysis of its dependence on the type of specific immunotherapy, the disease, the age of a patient, the type of allergy, indicators used (objective and subjective), in patients with allergic diseases - asthma, allergic rhinitis and/or allergic conjunctivitis. MATERIAL AND METHODS: A systematic review of Medline database was conducted using the EntrezPubmed search engine to find randomized placebo-controlled trials evaluating the effectiveness of specific immunotherapy in the treatment of asthma, allergic rhinitis and/or allergic conjunctivitis. After determining the contribution of the placebo effect for each of the test subjects, the calculation involved the average share of the placebo effect depending on the type of specific immunotherapy used, the type of disease, the age of the test subject, the type of allergy and the used measures of their effectiveness. RESULTS: The share of the placebo effect in the overall specific immunotherapy effect amounted to 39% and was comparable in the analyzed disease entities. A significantly higher share (p < 0.01) of 68% of the placebo effect in adult patients treated with sublingual immunotherapy vs. 29% in adult patients treated with subcutaneous immunotherapy.

Occurrence of sleep-related breathing disorders in patients with chronic urticaria at its asymptomatic or oligosymptomatic stages.

INTRODUCTION: Chronic urticaria (CU), in view of its manifestations (pruritus, wheals), chronic and recurrent nature is very bothersome for patients and significantly influences their quality of life. AIM: To assess the importance of sleep problems and sleep-related breathing disorders (SRBDs) declared by CU patients, for their quality of life. MATERIAL AND METHODS: Twenty-eight patients with CU at an asymptomatic stage or with minimal symptoms and signs were qualified for the study. In these patients, assessment of urticaria severity, QoL and SRBDs incidence was carried out. RESULTS: In a questionnaire study (CU-Q2oL), about 54% of the patients with CU complained of sleeping problems, about 80% reported significant fatigue and lack of concentration in the daytime. Respiratory polygraphy, an objective measure of sleep-related breathing disorders (SRBDs) demonstrated their higher incidence in patients with CU than in the general population, but these disorders were mild and had no influence on the reduced quality of life of the study patients, compared with a group of patients without SRBDs. CONCLUSIONS: The occurrence of SRBDs was found in 25% of patients with CU at asymptomatic or oligosymptomatic stages. The SRBDs in those patients were mild, required no treatment and their occurrence did not cause any significant reduction in their quality of life.

Atopic dermatitis: current treatment guidelines. Statement of the experts of the Dermatological Section, Polish Society of Allergology, and the Allergology Section, Polish Society of Dermatology.

Atopic dermatitis (AD) is a condition frequently encountered in medical practices across the country. More than 60% of children with AD are at risk to develop allergic rhinitis or asthma (the atopic march). Patients with AD have a unique predisposition to colonization or infection by Staphylococcus aureus. Treatments for AD need to rapidly control symptoms of the disease, improve quality of life and prevent exacerbations. Given the chronic and relapsing nature of the disease, therapies need to encourage good compliance and be well tolerated.

Venom Immunotherapy Does Not Affect Survival of Patients with Malignant Tumor in Poland.

Background: Allergen immunotherapy (AIT) is a well-established and efficient method of causative treatment for allergic rhinitis, asthma and insect venom allergy. Traditionally, a recent history of malignant neoplasm is regarded as a contraindication to AIT due to concerns that AIT might stimulate tumor growth. However, there are no data confirming that the silencing of the Th2 response affects prognosis in cancer. Objectives: The aim of this study was to investigate frequency of malignant tumors in patients undergoing AIT and the association between AIT and cancer-related mortality. Patients and Methods: A group of 2577 patients with insect venom allergy undergoing AIT in 10 Polish allergology centers was screened in the Polish National Cancer Registry. Data on cancer type, diagnosis time and patients' survival were collected and compared with the general population. Results: In the study group, 86 cases of malignancies were found in 85 patients (3.3% of the group). The most common were breast (19 cases), lung (9 cases), skin (8 cases), colon and prostate cancers (5 cases each). There were 21 cases diagnosed before AIT, 38 during and 27 after completing AIT. Laplace's crude incidence rate was 159.5/100,000/year (general population rate: 260/100,000/year). During follow-up, 13 deaths related to cancer were revealed (15% of patients with cancer). Laplace's cancer mortality rate was 37.3/100,000/year (general population rate: 136.8/100,000/year). Conclusions: Malignancy was found in patients undergoing immunotherapy less often than in the general population. Patients with cancer diagnosed during or after AIT did not show a lower survival rate, which suggests that AIT does not affect the prognosis.

Angioneurotic edema: a rare case of hypersensitivity to metoclopramide.

The case of a 30-year-old woman who had already experienced two incidents of angioneurotic edema and urticaria caused by drugs during the acute gastroenteritis. The allergological workup revealed hypersensitivity to metoclopramide. This case documents that metoclopramide, a drug commonly used to inhibit the vomiting, may cause not only bronchospastic reaction in an asthmatic patient but also angioneurotic edema of the tongue and larynx as well as urticaria. No similar cases in the literature were found.

[Assessment of the size of the placebo effect in treating asthma based on meta-analysis of efficacy trials of selected antiasthmatic drugs]. / Ocena wielkosci efektu placebo w leczeniu astmy na podstawie metaanalizy badan skutecznosci wybranych leków przeciwastmatycznych.

INTRODUCTION: Many different methods of treatment use at least partially not only their obvious influence on a disease mechanism but also their non-specific effects on the patients. It can be measured using different types of indicators using both self-assessment of a patient and different types of measuring devices. The aim of this study was to assess the size of the placebo effect in asthma treatment based on analysis of previously published high-quality research of the efficacy of inhaled antiasthmatic drugs and and to investigate its dependence on the type of measurement used. MATERIAL AND METHODS: A systematic review of the Medline database (using the Entrez PubMed browser) was done by typing international drug name in English and words: inhaled, randomised and placebo-controlled and meta-analysis of publications of the results of randomized placebo-controlled efficacy trials of the inhaled drugs used to treat asthma (454 publications - ultimately enrolled 41). For comparison, a similar method was used for hypertension treated with captopril (232 tests - ultimately enrolled 10). RESULTS: During the investigation of its dependence on the type of indicators used it has been demonstrated that placebo effect in treatments of asthma was significantly higher (reaching even 29%) than in treatments of hypertension with captopril (17%). The share of the placebo effect was also significantly higher in the studies in which clinical (subjective) indicators were used compared with the studies using objective (based on measuring devices) indicators of drug efficacy. CONCLUSIONS: The share of a placebo effect in treatments of asthma is higher than in treatments of hypertension and depends on the drugs efficacy indicators used (it is higher when clinical indicators are being used). This allows to draw conclusions as to the discrepancy between treatment goals of patient and physician and shows the need to take more account of such important issues as the patient's commitment to manage a disease in order to achieve his greater satisfaction.

[Small airways in obstructive lung diseases]. / Drobne drogi oddechowe w chorobach obturacyjnych pluc.

The term small airways (SA) applies to the bronchi below 7th generation with diameter smaller than 2 mm. This paper presents data showing that this part of the respiratory system is distinct in terms of its architecture, physiology and pathophysiology. The most important role SA play in obstructive airway diseases. In healthy subjects SA resistance accounts for 10% of the total airway resistance while in patients with obstructive disease, due to the constriction of the airways together with airway inflammation, SA are responsible even for 60% of the total resistance. Changes in SA in asthma and COPD are responsible for air trapping especially prominent in the latter disease. There are no precise tools to diagnose SA. Depending availability and experience HRCT, body pletysmography (RV/TLS plus other parameters) are frequently used. Some hope for the future is placed in combined use of oscilometry, multiple (or single) breath nitrogen wash-out and eNO concentration measurement. Due to our increasing knowledge on the role of SA in airway obstruction ultra-fine particle aerosols have been developed that penetrate to this compartment of the respiratory system (deposition confirmed in cascade impactors as well as by ozone scans after aerosol inhalation). Authors present selected publications investigating whereas deep drug penetration influences its clinical efficacy. For LABAs deposition in SA doesn't seem to increase their bronchodilating effect. Using ultrafine CS aerosol allows to maintain clinical effects even with half the dose of the active steroid, however. In summary, SA seem to be crucial in obstructive diseases of the airways and therefore constitute an important target for therapy.

Protocol of safe vaccination against COVID-19 in patients with high risk of allergic reactions.

Background: Sars-CoV-2 infections are hazardous, especially to the elderly and patients with comorbidities. With no efficient treatment available, newly developed vaccines are the only way to change the course of the pandemic. However, reports of allergic reactions resulted in some patients and practicing physicians being concerned about the safety of vaccine administration, particularly in people with severe anaphylactic reactions to multiple or unknown factors in their medical history.This study aimed to develop an allergic work-up protocol based on skin prick tests (SPT), intradermal testing (IDT) and intramuscular provocations, and desensitisation which may contribute to diagnosis and management of anti-COVID-19 vaccine allergy. Methods: Two hundred and eighty-five patients were enrolled. Two hundred and five of them entered the study based on severe anaphylactic reaction to unknown or multiple factors in their medical history which disqualified them for standard treatment. Another 80 patients were enrolled after developing an allergic reaction to the first dose of one such vaccine. In all subjects, SPT and IDT were performed. Serum tryptase was assessed in 79 patients randomly chosen from the study group. Results: Two hundred and seventy-seven patients with negative tests were given a vaccine without complications. Seven patients had positive skin tests. In two cases, tests confirmed Comirnaty allergy, while the other five confirmed solely skin sensitisation with no exposure prior to the study. Six patients with positive tests received titrated challenge using desensitisation protocol with a reasonable tolerance. One patient did not consent to desensitisation and one patient resigned despite negative tests. Overall, 283 (99%) patients were vaccinated using this newly developed protocol. Patients with adverse reactions to the first dose of the vaccine before the study had a significantly lower basal serum tryptase concentration (p = 0.001). Conclusion: Skin tests with anti-COVID-19 vaccines are a useful tool in the vaccination protocol. This protocol enables safe immunisation of high-allergy-risk patients even in cases of positive skin tests.

Clinical significance of plasma PAF acetylhydrolase activity measurements as a biomarker of anaphylaxis: Cross-sectional study.

INTRODUCTION: Platelet-activating factor (PAF) has a direct role as a mediator in the pathogenesis of various disorders with an inflammatory component, including those with allergic aetiology. The peripheral blood concentration of PAF is dynamically regulated by plasma PAF acetylhydrolase (PAF-AH). Previous research suggest that low activity of plasma PAF-AH could be a predictive marker for increased severity of some types of allergic hypersensitivity reactions-especially anaphylaxis. The purpose of the study was to evaluate the association between plasma PAF-AH activity and severity in patients with anaphylactic reactions following a wasp or bee sting. MATERIALS AND METHODS: The study group of 89 patients was divided into two subgroups depending on the increasing severity of the most severe anaphylactic reaction in the past, which was assessed according to the Müller's scale. The first subgroup included participants with a history of hypersensitivity reactions up to grade II. The second subgroup consisted of patients who have experienced at least one grade III or IV reactions in the past. A control group of 20 people was established. Plasma PAF-AH activity was measured using a colorimetric method. RESULTS: It has been observed that plasma activity of platelet-activating factor acetylhydrolase was significantly lower in patients with anaphylaxis history compared to the control group with negative atopic history (on average 21.38 nmol/min/ml for the control group, 9.47 nmol/min/ml for the first subgroup and 10.16 nmol/min/ml for the second subgroup, in both cases p < 0.0001). CONCLUSION: The plasma activity of PAF-AH is a promising parameter that can help to distinguish a group of patients not threatened with development of anaphylaxis and not requiring laborious or expensive prophylactic procedures.

[Antihistamines in the treatment of allergic rhinitis--update 2008/2009]. / Leki przeciwhistaminowe w leczeniu alergicznego niezytu nosa--uaktualnienie 2008/2009.

The following paper reviews the latest news on antihistamines used in the treatment of allergic rhinitis. It describes the new results of investigations on clinical application of H3 and H4 receptors in therapy of allergic diseases as well as the effect of emedastine on histamine-induced tissue remodeling. Contemporary clinical research of these drugs fulfills the requirements of placebo-controlled trials, including the comparison with a reference drug, usually cetirizine. The paper discusses efficacy and safety of a new drug--bilastine, and the possibility to improve clinical outcome by combining antihistamine drugs with inhaled glucocorticosteroids and antileukotrienes. It also presents the studies on high efficacy of nasal antihistamines, which most probably results from their high concentration in inflamed tissue, as well as describes the latest news on safe use of antihistamines, including studies of fexofenadine enantiomers in drug interactions with P-glycoprotein, safety of a new antihistamine medication--rupatadine, and psychostimulating effect of some other antihistamines. The review shows that antihistamines, the most frequently used class of anti-allergy medications, have been constantly improved, which is of significant importance for progress of allergic diseases treatment.

Increased sensitization prevalence to common inhalant and food allergens in young adult Polish males.

Numerous epidemiological studies concluded recently have suggested that the prevalence of allergic diseases has increased, which mainly results from an increase in the prevalence of atopic diseases. The problem is even more difficult because the number of people sensitized, who are prone to fall ill, exceeds the number of people presently ill. The prevalence of sensitization to atopic allergens and its time dynamic is still unknown. The aim of the study was to determine the prevalence of atopic sensitization in the population of young Polish males and to compare these findings with those obtained 16 years before. The present study was performed on a group of 156 randomized healthy men, voluntary blood donors, aged 18-27 years. Having filled out a questionnaire, they underwent skin prick tests (SPTs) to common inhalant allergens. They also had a blood sample taken to have serum total IgE concentration and allergen-specific IgE (asIgE) determined to inhalant and food allergens. Positive SPT findings to at least one allergen were found in 50 (32%) subjects, and in equivocal 12 (8%). In 54 (35%) subjects asIgE to inhalant allergens was found, including 11 (7%) who had been tested for food allergens. The most common sensitizing allergen was house dust mite (20%), followed by grass/rye pollen (17%), while mould spore was the least common (4%). In town dwellers, positive SPTs were found in 41%, and were positive in 19% of people living in rural areas. While comparing the present findings with those of a similar study carried out in 1986, we found that in the last 16 years there had been a 52% increase in the prevalence of asIgE to atopic allergens. This means that the percentage of sensitized people can be estimated to have increased at a rate of approximately 3.25%/year.

[Antihistamines in allergic rhinitis]. / Leki przeciwhistaminowe w alergicznych niezytach nosa.

Antihistamines are the first line of pharmacotherapy in allergic diseases, especially in allergic rhinitis. The article also presents the interesting 2005-2007 publications on the use of antihistamine in practical point of view, especially the newly introduced ones (desloratadine, fexofenadine, levocetirizine) and those which are to be introduced soon (rupatadine). The efficacy in skin histamine provocation model and various clinical model were discussed.

[Does new antihistamines characterize tachyphylaxis phenomenon?]. / Czy nowe leki przeciwhistaminowe cechuje zjawisko tachyfilaksji?

THE AIM OF THE STUDY: was to estimate the skin microcirculation reactivity after histamine administration in patients treated with 10 mg daily dose of cetirizine for 180 days. MATERIAL AND METHODS: Thirty seven young men age 27+12 year, patients suffering from persistent rhinitis were randomized into three groups which received 10 mg/day of cetirizine, 5 mg/day of levocetirizine or placebo respectively. Twenty eight completed the study. The skin microcirculation reaction after 10 mg/ml histamine administration was estimated visually on the forearm (diameter of wheal and flare) and by laser Doppler flowmetry before and after study drug or placebo administration 24 hours and every 30 days during the time of the study. The blood flow was measured by Periflux PF3, using a skin probe 5 mm away from the histamine-induced point. RESULTS: Statistically significant inhibition of skin reaction (over 92%) and blood flow (over 85%) in relation to the start values in cetirizine group as well as between the groups which received cetirizine or placebo (p<0.001), remained at the same level all the time during the examination. CONCLUSION: Tachyphylaxis phenomenon for antihistamine effect of 10 mg/day cetirizine and 5 mg/day levocetirizine was not observed during the whole 180-days treatment.

[On the 100th anniversary of Clemens von Pirquet "Allergie", Muenchener medizinische Wochenschrift; 53, 1457-1458]. / W stulecie publikacji Clemensa von Pirqueta: "Allergie" Muenchener medizinische Wochenschrift; 53, 1457-1458.

One hundred years ago Clemens von Pirquet's paper Allergie was published in Muencher medizinische Wochenschrift (vol. 53, 1457-1458). It was the first attempt ever made to define the term "allergy", currently considered a mile-stone in the development of contemporary allergology. The following paper presents the historical background of the event, including earlier descriptions of the diseases that later became considered allergic, as well as not-always-successful, sometimes naive, attempts to explain their causes. It also shows von Pirquet's profile, his scientific and medical achievements, especially the results of the research on reactions to second injections of antiserums and vaccines, which became the base for the presented conception of allergy, understood as body's changed reactivity. The paper describes the further evolution of this concept as well as the arisen controversy, which led to the contemporary way of understanding of this term.