Vaccine hesitancy in patients presenting to a specialized allergy center: clinical relevant sensitizations, impact on mental health and vaccination rates.

Introduction: The COVID vaccination program with new types of vaccinations and early reports of allergic reactions to vaccines led to vaccination hesitancy in patients with allergies. In this study, we aimed to characterize patients who present at an allergy center with specific questions regarding risk assessment to COVID vaccines in comparison to regular allergy center patients. Methods: A total of 50 patient charts of patients with risk assessment for COVID vaccination (COV group) and 50 regular allergy center patients (ALL group) were assessed for documented allergies, comorbidities, total IgE, and tryptase levels and hospital anxiety and depression score (HADS). Skin prick testing (SPT) with additives of COVID vaccines [polyethylene glycol (PEG), polysorbate] were performed if indicated based on medical history. Results: Patients who presented for examination prior to a possible COVID vaccination were mostly female (86%) and had more frequently reported allergic reactions to drugs in the past, but only in a minor group (28%) were the reactions qualified as anaphylaxis. The group COV patients scored significantly higher in the HADS for anxiety and depression than the regular group ALL patients. The same trend was observed when data were corrected for gender. It is worth noting that patients without any prior contact to COVID vaccines scored comparable regarding anxiety to patients with prior reaction to COVID vaccinations, but significantly higher in the depression score. In 19 patients (38%) who met the indications for SPT for the suspicious contents PEG and Polysorbate 80, the tests did not show a positive result. Furthermore, 84% of patients underwent the prick test, but only 15% of patients who received consultation alone agreed to vaccination at our center. No vaccination-related event was documented in these patients. Discussion: In conclusion, vaccination hesitancy was frequently elicited by negative experiences with drugs and putative drug allergies. Female patients predominate in this patient group, and the anxiety and depression scores were significantly elevated. Allergological workup, including SPT, led to a high rate of subsequent vaccinations, whereas a discussion with the patients about risks and individualized advice for vaccination without testing only rarely resulted in documented vaccinations.

English tweets on allergy: Content analysis and association with surveillance data.

BACKGROUND: Analysis of X (formerly Twitter) posts can inform on the interest/perceptions that social media users have on health subjects. In this study, we aimed to analyse tweets on allergic conditions, comparing them with surveillance data. METHODS: We retrieved tweets from England on "allergy," "asthma," and "allergic rhinitis," published between 2016 and 2021. We estimated the correlation between the frequency of tweets on "asthma" and "allergic rhinitis" and English surveillance data on the incidence of asthma and allergic rhinitis medical visits. We performed sentiment analysis, computing a score informing on the emotional tone of assessed tweets. We applied a topic modelling approach to identify topics (clusters of words frequently occurring together) for tweets on each assessed condition. RESULTS: We analysed a total of 13,605 tweets on "allergy," 7767 tweets on "asthma," and 11,974 tweets on "allergic rhinitis." Food-related words were preponderant on tweets on "allergy," while "eyes" was the most frequent meaningful word on "allergy rhinitis" tweets. We observed seasonal patterns for tweets on "allergic rhinitis," both in their frequency and sentiment - the incidence of allergic rhinitis medical visits was moderately to strongly correlated with the frequency (ρ = 0.866) and sentiment (ρ = -0.474) of tweets on "allergic rhinitis." For tweets on "asthma," no such patterns/correlations were observed. The average sentiment score was negative for all assessed conditions, ranging from -0.004 ("asthma") to -0.083 ("allergic rhinitis"). CONCLUSIONS: Tweets on "allergic rhinitis" displayed a seasonal pattern regarding their frequency and sentiment, which correlated with surveillance data. No such patterns were observed for "asthma."

The impact of COVID-19 vaccine reactions on secondary vaccine hesitancy.

BACKGROUND: Primary and booster vaccinations are critical for mitigating COVID-19 transmission, morbidity, and mortality. Future booster vaccine campaigns rely on an increased understanding of vaccine hesitancy. OBJECTIVE: To evaluate self-reported allergic and skin vaccine reactions as factors potentially associated with vaccine hesitancy in a nationwide vaccine allergy registry. METHODS: Responses to survey questions concerning COVID-19 vaccine perceptions, coded from free text by 2 independent reviewers. Multivariable logistic regression models were used to determine the association between changed negative perception and respondent demographics, vaccination history, and reaction characteristics. RESULTS: A total of 993 individuals (median of 46 years [IQR, 36-59], 88% female, 82% White) self-reported reactions to COVID-19 vaccination. Reactions included the following: delayed large local skin reaction (40%), hives/urticaria (32%), immediate large local skin reaction (3%), swelling (3%), anaphylaxis (2%), and other or unspecified (20%). Most respondents were initially unconcerned about the safety of COVID-19 vaccines (56%). After reactions, 401 of 993 (40%) report negative change in perception of vaccination, with more than half of these respondents (n = 211, 53%) citing their reasoning as a negative experience with adverse effects. Of 102 individuals asked about future vaccination, 79 (77%) indicated that they were unlikely or very unlikely to receive future COVID-19 vaccinations. Increased negative perception after reaction was associated with younger age, later COVID-19 vaccination dose number, and reaction type. CONCLUSION: Our findings reveal that an individual's experience with allergic or cutaneous adverse effects after COVID-19 vaccination affects attitudes and decision-making regarding future vaccination, even in initially non-hesitant individuals. Further investigation of secondary vaccine hesitancy is necessary for adapting public health messaging to this important population.

The relationship between allergic diseases and internalising and externalising behaviours in Spanish children: A cross-sectional study.

INTRODUCTION AND OBJECTIVES: The relationship between allergic diseases and behavioural disorders is still unclear. The objective of this study was to describe and compare children's behaviour (internalising and externalising) across a sample of children aged 6-11 years with and without allergic diseases. MATERIALS AND METHODS: This was a cross-sectional observational case-control study. A survey to 366 families (194 allergic cases and 172 controls), including a child behaviour checklist (CBCL) and a socio-demographic questionnaire with questions related to family, school education, health conditions and allergy symptoms, was administered. RESULTS: Children with a diagnosis of allergy showed higher scores in the overall CBCL score (standardised mean differences [SMD] = 0.47; confidence intervals [CI]: 0.26-0.68) and in the internalising and externalising factors (SMD = 0.52 and SMD = 0.36, respectively) than non-allergic children. Odds ratio (OR) analyses showed a higher risk (OR = 2.76; 95% CI [1.61 to 4.72]) of developing a behavioural difficulty in children diagnosed with allergies. Age and level of asthma appear as modulatory variables. CONCLUSIONS: Children aged 6-11 years diagnosed with allergies showed larger behavioural problems than non-allergic children, especially in the case of internalising behaviours. These findings suggest the importance of attending to them and treating them in the early stages of diagnosis to avoid future psychological disorders.

Prevalence and Risk Factors of COVID-19 Symptoms among U.S. Adults with Allergies.

BACKGROUND: This study sought to evaluate COVID-19 associated physical and mental health symptoms among adults with allergies compared to the general U.S. adult population. METHODS: Data for these analyses were obtained from the publicly available COVID-19 Household Impact Survey, which provides national and regional statistics about physical health, mental health, economic security, and social dynamics among U.S. adults (ages 18 and older). Data from 20-26 April 2020; 4-10 May 2020; and 30 May-8 June 2020 were included. Our primary outcomes for this analysis were physical and mental health symptoms experienced in the last seven days. The primary predictor was participants' self-report of a physician diagnosis of an allergy. RESULTS/DISCUSSION: This study included 10,760 participants, of whom 44% self-reported having allergies. Adults with allergies were more likely to report physical symptoms compared to adults without allergies including fever (aOR 1.7, 95% CI 1.44-1.99), cough (aOR 1.9, 95% CI 1.60-2.26), shortness of breath (aOR 2.04, 95% CI 1.71-2.43), and loss of taste or sense of smell (aOR 1.9, 95% CI 1.58-2.28). Adults with allergies were more likely to report feeling nervous (cOR 1.34, 95% CI 1.13, 1.60), depressed (cOR 1.32, 95% CI 1.11-1.57), lonely (cOR 1.23, 95% CI 1.04-1.47), hopeless (cOR 1.44, 95% CI 1.21-1.72), or having physical reactions when thinking about COVID-19 pandemic (cOR 2.01, 95% CI 1.44-2.82), compared to those without allergies. During the COVID-19 pandemic, adults with allergies are more likely to report physical and mental health symptoms compared to individuals without allergies. These findings have important implications for diagnostic and treatment challenges for allergy physicians.

Multimorbidity in asthma, association with allergy, inflammatory markers and symptom burden, results from the Swedish GA2 LEN study.

BACKGROUND: Asthma is common worldwide and a large part of subjects with asthma have concomitant allergic multimorbidity in the form of rhinitis and/or eczema. OBJECTIVE: The aim of this study is to investigate whether the presence of allergic multimorbidity in asthma relates to allergic sensitization, allergic and respiratory symptoms, quality of life, inflammatory markers, lung function, use of medication and background factors. METHODS: A total of 437 asthmatics from the (GA2 LEN) cross-sectional survey in Sweden were grouped depending on the presence of rhinitis and/or eczema. The impact of allergic multimorbidity was assessed in terms of allergic sensitization, allergic and respiratory symptoms, quality of life, type-2 inflammatory markers (exhaled nitric oxide, eosinophil activation markers, periostin), lung function, use of medication and background factors. RESULTS: Subjects with asthma, rhinitis and eczema were more likely to be sensitized to seasonal allergens (67% vs 32%, P < .001), food allergens (54% vs 18%, P < .001) and to have a higher degree of sensitization than subjects with only asthma (23% vs 10%, P < .001). Subjects with allergic multimorbidity more often had allergic reactions to food (28% vs 10%, P = .002), more respiratory symptoms and anxiety/depression (40% vs, 14%, P < .001) than subjects with only asthma, despite having similar levels of type 2 inflammatory markers. Individuals with allergic multimorbidity were more likely to be diagnosed with asthma before the age of 12 (48% vs 27%, P = .016) and to have maternal heredity for allergy (53% vs 33%, P = .011) than subjects with only asthma. CONCLUSION AND CLINICAL RELEVANCE: Asthmatics with allergic multimorbidity are more likely to be sensitized to seasonal aeroallergens, food allergens and they have a higher degree of sensitization compared with those with only asthma. Allergic multimorbidity is associated with respiratory and allergy symptoms, anxiety and/or depression.

Allergic diseases do not impair the cognitive development of children but do damage the mental health of their caregivers.

This study aimed to investigate whether children with atopic diseases exhibited different neurodevelopment function from healthy controls and whether their caregivers had differential parental stress. In total, we recruited 109 patients with atopic diseases (mean age 6.8 years, 54.1% male) and 82 healthy children (mean age 6.3 years, 54.9% male). Based on the children's age, they underwent developmental, cognitive evaluations and attention deficit/hyperactivity disorder (ADHD) symptoms. The parenting stress of children's caregivers was evaluated using the Chinese Health Questionnaire (CHQ-12) and Family APGAR. Of the children with atopic diseases, 87.2%, 74.3%, 29.4%, and 8.3% of them had allergic rhinitis, asthma, atopic dermatitis, and urticaria, respectively. None of these conditions were associated with children's cognitive profiles or ADHD symptoms. However, the caregivers of patients who had asthma suffered from higher CHQ-12 scores than those of patients without asthma. Furthermore, the number of atopic diseases had a dose-response effect on caregivers' CHQ-12 scores. In conclusion, allergic diseases did not impair the cognitive development of children. However, caregivers of patients with asthma or multiple atopic diseases may suffer a greater mental health burden with regard to caring for their children. Such caregivers may require support to effectively fulfill their parenting roles.

The impact of psychological stress on mast cells.

OBJECTIVE: Atopic diseases worsen with psychological stress, but how stress contributes to their pathogenesis is still not clear. We review the evidence supporting the premise that stress contributes to allergic and inflammatory processes through stimulation of mast cells (MCs) by neuroimmune stimuli. DATA SOURCES: PubMed was searched between 1950 and 2019 using the following terms: allergies, atopic diseases, corticotropin-releasing hormone, inflammation, hypothalamic-pituitary-adrenal axis, mast cells, mastocytosis, neuropeptides, psychological stress, neurotensin, and substance P. STUDY SELECTIONS: Only articles published in English were selected based on their relevance to stress and MCs, especially those that discussed potential mechanisms of action. RESULTS: Psychological stress worsens many diseases, especially asthma, atopic dermatitis, and mastocytosis. This effect is mediated through MCs stimulated by neuropeptides, especially corticotropin-releasing hormone, neurotensin, and substance P, a process augmented by interleukin-33. CONCLUSION: Understanding how stress stimulates MCs to release proinflammatory mediators is important in advancing treatments for diseases that worsen with stress.

Impact of nickel oral hyposensitization on quality of life in systemic nickel allergy syndrome.

Nickel (Ni) oral hyposensitization treatment (NiOHT) is an effective management approach for Ni allergy. No health-related quality of life (HRQoL) data exist for the pre- and post-treatment with NiOHT in systemic nickel allergy syndrome (SNAS). The aims of this study were (a) to explore HRQoL in SNAS patients, (b) to assess changes of HRQoL after 1 year of NiOHT; (c) to evaluate psychological status of patients. SNAS patients completed the Short-Form 36-Item Health Survey and Psychological General Well-Being Index before and 1 week after the end of NiOHT. Moreover, psychological state was assessed with the Minnesota Multiphasic Personality Inventory (MMPI-2). A total of 52 patients self-reported pre- and post-treatment questionnaires. HRQoL was poor at baseline. After 1 year of NiOHT, all outcome measure scores improved by about 20% with respect to baseline data (P < 0.01 for all indices, except depressed mood). Finally, 33 patients performed the MMPI-2. High rates for hypochondriasis and depression were noted. Furthermore, most of the patients had high scores for anxiety, depression, and health concerns. This is the first study showing that NiOHT improves HRQoL of SNAS patients, which can be considered a "personalized medicine" approach.

Sex Differences in Adults with Insect Venom Allergy regarding Psychological Distress, Attitudes toward the Emergency Medication, and Factual Knowledge about the Disease.

BACKGROUND: Hymenoptera venom allergy (HVA) has a prevalence of 3% in adults. Although patients have no ongoing symptoms, they often suffer from an impairment of their psychological well-being and quality of life. OBJECTIVE: The aim of this study was to analyze sex-specific differences regarding the psychological burden caused by this allergy and handling of the emergency medication. METHOD: Study participants filled out a questionnaire including sociodemographic and disease-specific characteristics, the Hospital Anxiety and Depression Score (HADS), and theoretical knowledge about the emergency medication set (EMS). Additionally, an objective structured clinical examination was used to assess practical knowledge and handling of the EMS. RESULTS: Fifty-six patients were included (55.4% females). Female patients showed higher subjective anxiety levels due to HVA compared to men (mean 7.2 vs. 4.6, p = 0.0003). Furthermore, the HADS revealed that women had a significant higher anxiety level, especially after Mueller grade I-II anaphylactic reactions (mean 6.3 vs. 2.8, p = 0.0134). This was associated with a higher theoretical but not practical knowledge about their disease. On the other hand, males were less inclined to carry the emergency medication "always" or "almost always" (56 vs. 87.1%, p = 0.0015) but showed higher self-assurance in using it (mean 7.3 vs. 6.1, p = 0.0446). CONCLUSIONS: This clinical study provides evidence for sex differences in coping with HVA. The results suggest that females should be monitored more closely for allergy-associated anxiety symptoms, while men need more encouragement to carry the emergency medication.

QUALITY OF LIFE EVALUATION AND ASSOCIATED FACTORSIN ASTHMATIC CHILDREN AND ADOLESCENTS ATTENDED IN A SPECIALIZED OUTPATIENT CLINIC.

OBJECTIVE: To evaluate the quality of life and its association with disease control, severity, allergic comorbidities and adherence to treatment in children and adolescents with asthma. METHODS: A cross-sectional study that included children and adolescents aged seven to 17. The Paediatric Asthma Quality of Life Questionnaire (PAQLQ) was used to assess their quality of life. Sociodemographic and clinical data were obtained from the chart and from a questionnaire. Descriptive statistics were performed and chi-square or Fisher's exact tests were used to verify the existence of associations between quality of life and disease control, severity, comorbidities and adherence to treatment. The level of statistical significance was set at p<0.05. RESULTS: 101 children/adolescents were evaluated (62.4% boys), with a mean age of 10.1 years. On average, the PAQLQ score was ≤5.9 points, indicating moderate / severe quality of life impairment. Higher levels of control, as well as higher disease severity, were associated with higher quality of life impairment, both in total PAQLQ score and domains (p<0.05). The presence of comorbidities was also associated with higher quality of life impairment (p=0.01), except in the emotional function domain. Adherence to treatment showed no association with quality of life. CONCLUSIONS: Children and adolescents with asthma present impairment in their quality of life, and this is related to poorer control and severity of the disease, as well as to the presence of allergic comorbidities.

Illness perception of adolescents with allergic conditions under specialist care.

BACKGROUND: Our understanding of how adolescents perceive and cope with their allergic condition/s is limited. This study used the Brief Illness Perception Questionnaire (BIPQ) in a group of adolescents with allergies and correlates the findings with demographic and clinical conditions. METHODS: In this retrospective questionnaire-based study, we analysed 100 valid questionnaires from adolescents (11-18 years) attending our service after receiving management and treatment for their allergic condition/s. RESULTS: The overall BIPQ score was 4.8 (IQR 3.6-5.6). The highest item-related scores were for "timeline" (illness duration) followed by "concern." The lowest scores were found for "coherence/understanding," demonstrating that adolescents do not perceive that they have a sound understanding of their condition/s. We found a significant difference in the overall BIPQ scores between the genders and in the emotional representation score, with females showing a highest score. Older adolescents reported a more chronic perception of the allergic disease/s. CONCLUSION: Our results suggest that a better understanding and support of the allergic condition/s in adolescents, particularly in females, are likely an important target for intervention intended to improve their quality of life. BIPQ can be used as adjunct to routine allergy clinic appointments for further exploration of the wider impact of allergies on adolescents' lives.

Anxiety is the cause of the worse outcomes of allergic patients after total knee arthroplasty.

PURPOSE: The presence of allergies has been proposed as a risk factor for worse outcomes in total knee arthroplasty surgery. The aim of this study is to evaluate if the presence of some psychiatric disorders is more frequent in patients who report allergies and if they could be the main cause for the worse outcomes. METHODS: A prospective study, including patients undergoing a primary total knee arthroplasty, was designed. In the preoperative visit, all the patients completed a questionnaire about the presence of allergies and also psychiatric tests for anxiety (State-Trait Anxiety Inventory-STAI-), depression (Remission from Depression Questionnaire-RDQ-), somatization disorder (Patient Health Questionnaire-15-PHQ-15-), pain catastrophizing syndrome (Pain Catastrophizing Scale-PCS), and personality disorder (Reduced NEO-Inventory of Five Factors-NEO-FFI-). In the preoperative and at 6 months of follow up, the functional results of the surgery were assessed by the WOMAC, the SF-12, and the KSS scores. RESULTS: A total of 209 patients was included: 136 (65%) did not have reported allergies and 73 (35%) did report some allergies. The psychiatric questionnaires showed that the presence of anxiety was more prevalent in the group of patients with reported allergies (STAI-T: no allergies 24.08 points vs. allergies 19.18 points, p = 0.039). When comparing the functional outcomes at 6 months of follow up, most of the analyzed scores improved less in the group of patients with reported allergies than in the no allergy-referred group: WOMAC-total score (34.37 vs. 40.10 points, p = 0.023), WOMAC-pain score (6.03 vs. 7.50 points, p = 0.018), WOMAC-function score (22.97 vs. 27.24 points, p = 0.023), KSS-knee score (25.37 vs. 33.79 points, p = 0.002), and SF-12 physical score (7.89 vs. 11.15 points, p = 0.046). The significance of the difference in the outcomes scores in this group was lost after adjusting for anxiety (p > 0.05). CONCLUSION: Allergies reported by patients are confirmed as a risk factor for worse results after TKA surgery. The relationship with anxiety disorder seems to explain the association between self-reported allergies and sub-optimal outcomes. LEVEL OF EVIDENCE: II.

[Identifying Trajectories of Behavioral Problems in Children with Allergic Diseases: Secondary Data Analysis of the 5th to 7th Panel Study of Korean Children].

PURPOSE: This study aimed to identify latent classes of behavioral problem trajectories in children with allergic diseases and investigate their predictors. METHODS: This study used data from the 5th to 7th Panel Study of Korean Children. The participants included 840 children aged 4~6 years with allergic diseases. Statistical analyses were conducted using latent class growth analysis and multinomial logistic regression. RESULTS: The trajectories of both internalizing and externalizing behavioral problems in children with allergic diseases were classified into five groups, that is deteriorative, recovering, changing 1 (decreasing-increasing), changing 2 (increasing-decreasing), and low state persistent group. For the internalizing behavioral problems, predictors were temperament, father's education, family interaction, and disconnection in peer interaction. For the externalizing behavioral problems, predictors child's gender, temperament, marital conflict, parenting stress, family interaction, and parenting environment. CONCLUSION: Deteriorative group has high-risk behavioral problems in children with allergic diseases. We suggest to provide interventions considering latent problem trajectories based on ecological environments for allergic children.