The psychological impact of food allergy and undergoing a food challenge test in adult age.

SUMMARY: Introduction. Despite an increasing number of adults being affected by food allergy, there is currently limited research regarding the psychological impact of living with this condition in this age group and the effect of undergoing food challenge testing - the gold standard for diagnosis - on health-related quality of life (HRQoL). Objective. To assess whether ruling out a food allergy using an open food challenge could improve HRQoL and emotional well-being. To evaluate whether HRQoL gains are higher among people testing negative for food allergy and whether people higher on health anxiety would be less reassured by a negative food challenge. Methods. A cross-sectional study (n = 276) and a prospective study (n = 53) were performed. Adults with a positive (n = 34), or negative food challenge (n = 34), or with an allergy confirmed via other means (No challenge, n = 208), completed the Food Allergy Quality of Life Questionnaire-Adult Form, General Health Questionnaire-12, State-Trait Anxiety Inventory short form, Positive and Negative Affect Schedule, shortened version of the Health Anxiety Questionnaire in addition to clinical and demographic variables. A prospective study examined these measures before and three months after a food challenge (negative, n = 45; positive, n = 8). Results. Adults with a negative food challenge outcome had better HRQoL than those with a food allergy confirmed via other means (No challenge), with no differences between the two allergy positive groups (food challenge vs no challenge). No group differences in emotional distress, health anxiety or mood were found. The prospective study showed HRQoL significantly improved following a food challenge (F(1,39) = 16.868; p minor 0.001; Intention-to-treat F(1,52) = 15.346; p minor 0.001). High health anxiety was not associated with lower reassurance following a negative test. Conclusions. People who have a food allergy excluded following a food challenge have better HRQoL. There was a significant improvement in HRQoL following an open food challenge which supports the need to increase provision of food challenge testing in this age group.

Dropouts in sublingual allergen immunotherapy trials - a systematic review.

Participant dropouts can reduce the power of allergen immunotherapy clinical trials. Evaluation of the dropout rate and reasons for dropout are important not only in the planning of clinical studies but are also relevant for adherence to immunotherapy in daily clinical practice. A systematic review was carried out in order to establish the overall dropout rate among published double-blind, placebo-controlled randomized clinical trials of sublingual immunotherapy for respiratory allergic diseases. Dropouts were analysed in regards to allergen, formulation, treatment schedule, participant age, study size, number of centres and type of allergic disease. Relative dropout rates in placebo and active groups as well as reasons for dropout were also assessed. A total of 81 studies, comprising 9998 patients, were included. Dropout rates in sublingual immunotherapy controlled studies do not appear to be a major problem with a composite dropout percentage of 14% (95% CI:11.9-16). Furthermore, they are not different for active compared to placebo-treated participants. This lends support to the positive clinical outcomes seen in meta-analyses of these trials.

Penile granulomatosis presenting as pseudoangioedema.

Many conditions may present as angioedema. We report a case of a 46 year-old man presenting with intermittent episodes of penile swelling. Following a series of investigations, he was diagnosed with genital granulomatosis. Ano-genital granulomatosis is a rare chronic inflammatory condition and that can present as diffuse penile, scrotal, vulvar or ano-perineal swelling with non-caseating non-necrotising granulomas on histology.

Subcutaneous allergen specific immunotherapy: best clinical practice as cornerstone for future development.

Allergen subcutaneous immunotherapy is a long lasting treatment which can modify the natural history of allergic respiratory diseases. Recommended administration is required for a minimum of three years. During this long term therapy the daily management is based on two crucial points, discussed in this review, such as the prevention and the treatment of side effects and the improvement and follow-up of patient adherence. This review specifically focuses on subcutaneous immunotherapy.

Safety of ultrashort-term sit with pollen allergoids adjuvanted by monophosphoryl lipid A: a prospective Italian survey.

A 3-year prospective post marketing survey on the safety of the recently developed ultrashort pre-seasonal subcutaneous immunotherapy (uSCIT-MPL4) with pollen allergoids adjuvanted with monophosphoryl lipid A was performed. A total of 510 patients received uSCIT-MPL4, 61% for grass, 35.7% for birch, 13.2% for parietaria and 3% for other pollens (ragweed, mugwort, and olive). A total of 3308 injections were given and the mean duration of uSCIT-MPL-4 was 2.3 years. Overall, only 7 slight systemic reactions (SR) were observed in 510 patients (1.37%) and 2.11/1000 injections suggesting that this treatment is even safer than traditional depot injection SIT.

Hypogammaglobulinaemia after rituximab treatment-incidence and outcomes.

BACKGROUND: Rituximab, a chimeric monoclonal antibody against CD20, is increasingly used in the treatment of B-cell lymphomas and autoimmune conditions. Transient peripheral B-cell depletion is expected following rituximab therapy. Although initial clinical trials did not show significant hypogammaglobulinaemia, reports of this are now appearing in the literature. METHODS: We performed a retrospective review of patients previously treated with rituximab that were referred to Clinical Immunology with symptomatic or severe hypogammaglobulinaemia. Patient clinical histories, immunological markers, length of rituximab treatment and need for intravenous immunoglobulin replacement therapy (IVIG) were evaluated. An audit of patients receiving rituximab for any condition in a 12-month period and frequency of hypogammaglobulinaemia was also carried out. RESULTS: We identified 19 post-rituximab patients with persistent, symptomatic panhypogammaglobulinaemia. Mean IgG level was 3.42 ± 0.4 g/l (normal range 5.8-16.3 g/l). All patients had reduced or absent B-cells. Haemophilus Influenzae B, tetanus and Pneumococcal serotype-specific antibody levels were all reduced and patients failed to mount an immune response post-vaccination. Nearly all of them ultimately required IVIG. The mean interval from the last rituximab dose and need for IVIG was 36 months (range 7 months-7 years). Of note, 23.7% of 114 patients included in the audit had hypogammaglobulinaemia. CONCLUSION: With the increasing use of rituximab, it is important for clinicians treating these patients to be aware of hypogammaglobulinaemia and serious infections occurring even years after completion of treatment and should be actively looked for during follow-up. Referral to clinical immunology services and, if indicated, initiation of IVIG should be considered.