COVID-19 Vaccination Is Safe among Mast Cell Disorder Patients, under Adequate Premedication.

Reported cases of anaphylaxis following COVID-19 vaccination raised concerns about the safety of these vaccines, namely in patients suffering from clonal mast cell (MC) disorders-a heterogenous group of disorders in which patients may be prone to anaphylaxis caused by vaccination. This study aimed to assess the safety of COVID-19 vaccines in patients with clonal MC disorders. We performed an ambidirectional cohort study with 30 clonal MC disorder patients (n = 26 in the prospective arm and n = 4 in the retrospective arm), that were submitted to COVID-19 vaccination. Among these, 11 (37%) were males, and median age at vaccination date was 41 years (range: 5y to 76y). One patient had prior history of anaphylaxis following vaccination. Those in the prospective arm received a premedication protocol including H1- and H2-antihistamines and montelukast, while those in the retrospective arm did not premedicate. Overall, patients received a total of 81 doses, 73 under premedication and 8 without premedication. No MC activation symptoms were reported. COVID-19 vaccination seems to be safe in patients with clonal mast cell disorders, including those with prior anaphylaxis following vaccination. Robust premedication protocols may allow for vaccination in ambulatory settings.

Case Report: Mastocytosis: The Long Road to Diagnosis.

Mastocytosis is a heterogeneous group of disorders characterized by expansion and accumulation of clonal mast cells. Patients mainly present with either cutaneous lesions, anaphylaxis, or both. Its low prevalence and unusual features often hinder its diagnosis for several years. We report the case of an 18-year-old male who was referred to our department with a long-standing history of atypical skin lesions, allergic rhinitis, exercise-induced bronchoconstriction and what was believed to be food-related flushing and anaphylaxis, that was later diagnosed with mastocytosis. This case illustrates the need to consider investigating for mastocytosis when recurrent anaphylaxis is present, especially in the presence of atypical skin lesions, even if normal serum basal tryptase levels and allergic sensitization are present.

Timothy grass pollen therapeutic vaccine: optimal dose for subcutaneous immunotherapy.

AIMS: To establish the optimal dose of Phleum pratense subcutaneous immunotherapy (SCIT) in patients with allergic rhinoconjunctivitis with/without asthma. MATERIALS & METHODS: One hundred and fifty-one patients were randomized to receive SCIT 0.25, 0.5, 1.0, 2.0 or 4.0 skin-prick test units (SPT) or placebo. The primary end point was the variation in the concentration of Phleum pratense extract needed to produce a positive nasal provocation test from baseline (V0) to final visit (FV). RESULTS: After 17 weeks, a dose-dependent trend was apparent in the concentration of P. pratense extract needed to produce a positive nasal provocation response. Systemic adverse reactions occurred with 3.2% of administered doses. Grade III (n = 2) and IV (n = 2) events were observed only at the two highest doses. CONCLUSION: P. pratense depot SCIT showed signs of clinical and immunological efficacy by dose-dependently decreasing the allergen sensitization rate. Risk-benefit favored doses below 1.0 SPT units for confirmatory trials.

Melkersson-Rosenthal syndrome - delay in the diagnosis of an early-onset oligosymptomatic variant.

Melkersson-Rosenthal syndrome is a rare neuro-mucocutaneous disease with a chronic intermittent course, characterized by a classic triad of orofacial swelling, fissured tongue (lingua plicata) and facial paralysis. The authors describe the case of an oligosymptomatic variant (lip and tongue involvement) with childhood onset, whose diagnosis was only established at the age of 19 years. The syndrome's pathophysiology is unclear and the treatment is challenging; corticosteroid therapy is the mainstay of treatment and is associated with clinical and histological improvement.

Tuberculosis - Risk of continued transmission in healthcare workers.

INTRODUCTION: Control of tuberculosis (TB) in healthcare workers requires an early recognition of contacts, the adoption of efficient protective measures and screening for cases of latent tuberculosis (TL) and recent TL. AIMS: Systematic screening for TB and TL in healthcare workers with contact with patients or other workers with TB and risk of contagion. MATERIAL AND METHODS: In a hospital with approximately 5400 workers 13 screenings were performed September 2007- December 2008 due to risk of continued TB. These consisted of clinical observation, tuberculin skin test (PT), Quantiferon(R)-TB Gold (QTF) test if PT > or =10mm and <15 mm and chest X-ray. The diagnoses were performed according to the recommendations of the Portuguese Pulmonolgy Society (SPP). RESULTS: 792 workers (563 men; 229 women) were included in the 13 screenings. Of these, 75 presented symptoms and 31 had radiology abnormalities. PT was performed in 490 workers, with results <10 mm in 250, > or =10 and <15 mm in 175 (QTF positive in 36) and > or =15 mm in 65. Of the screened workers, 280 had a previous PT > or =15 mm, and therefore it was not repeated. 1 case of active TB was diagnosed in a worker, as well as 408 cases of TL (51.5%) and 42 cases of recent TL (5.3%). CONCLUSIONS: TB is considered an occupational disease in healthcare workers. The screening of contacts and TL cases is an important tool for an early diagnosis of active disease and for identifying the cases with higher risk of future disease.