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.

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 (AU)

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.

Escuchando al placebo, o cómo averiguar por qué funcionan los tratamientos / Listening to the placebo, or how to find out why treatments work

El efecto placebo es poderoso y ha demostrado su eficacia en múltiples estudios, compitiendo incluso con tratamientos bien establecidos. Esto pone de manifiesto un efecto en absoluto inerte o inespecífico. Tiene una naturaleza ubicua y da razón de todo tipo de tratamientos, si bien es la psicología el ámbito que le hace comprensible. Desgranar y conocer qué le hace tan eficaz es una tarea útil e ilustrativa de cómo operan los tratamientos al uso. En este sentido hay que destacar que para que opere debe ser construido en términos contextuales, no requiere de engaños y sí de una persona con problemas, en desequilibrio homeostático. El estudio de las condiciones en que el efecto placebo ocurre ha sido útil para delinear qué aspectos son importantes en los tratamientos, a saber: la facilitación de información y el sentido de ésta, las experiencias previas y las creencias del paciente, la aplicación del tratamiento en condiciones favorables y el uso de tratamientos bien reconocidos y aceptados en sus fundamentos y procedimiento

The placebo effect is powerful and has been proved effective in multiple studies, competing even with well-established treatments. It is not an unspecific or inert effect. It has a ubiquitous nature and accounts for all types of treatments, although psychology is the area that makes it comprehensible. Discussing and discovering what makes it so effective is a useful and illustrative task regarding how treatments work. In this sense, it must be emphasized that in order for the placebo effect to operate, it must be considered from contextual view, it does not require deception, and it does require a person with problems, in homeostatic imbalance. The study of the conditions in which the placebo effect occurs has been useful in delineating which aspects are important in treatments. These are as follows: the provision of information and its meaning, the patient's previous experiences and beliefs, the application of the treatment under favorable conditions, and the use of well-recognized and accepted treatments in their foundations and procedure

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.

[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.

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.

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.

Quality of life evaluation and associated factorsin asthmatic children and adolescents attended in a specialized outpatient clinic / Avaliação da qualidade de vida e fatores associados em crianças e adolescentes asmáticos atendidos em ambulatório especializado

ABSTRACT 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.

RESUMO Objetivo: Avaliar a qualidade de vida e sua associação com controle da doença, gravidade, comorbidades alérgicas e adesão ao tratamento em crianças e adolescentes com asma. Métodos: Estudo transversal que incluiu crianças e adolescentes com idade entre sete e 17 anos. O Paediatric Asthma Quality of Life Questionary (PAQLQ) foi utilizado para avaliar a qualidade de vida. Dados sociodemográficos e clínicos foram obtidos a partir do prontuário e de um questionário. Foi realizada estatística descritiva e o teste do qui-quadrado ou o teste exato de Fisher foi utilizado para verificar existência de associações entre qualidade de vida e controle da doença, gravidade, comorbidades e adesão ao tratamento. O nível de significância estatística adotado foi de p<0,05. Resultados: 101 adolescentes/crianças foram avaliados (62,4% meninos), com média de idade de 10,1 anos. Em média, a pontuação do PAQLQ foi ≤5,9 pontos, indicando comprometimento moderado/grave da qualidade de vida. Piores níveis de controle e a maior gravidade da doença estiveram associados ao maior comprometimento da qualidade de vida, tanto no escore total do PAQLQ quanto por domínios (p<0,05). A presença de comorbidades também esteve associada ao maior comprometimento da qualidade de vida (p=0,01), exceto no domínio função emocional. A adesão ao tratamento não demonstrou associação com a qualidade de vida. Conclusões: Crianças e adolescentes com asma apresentam prejuízo na qualidade de vida, e este está relacionado com pior controle e maior gravidade da doença, assim como com a presença de comorbidades alérgicas.