Pearls and pitfalls: Adverse cutaneous reactions after COVID-19 vaccination.

Rashes after coronavirus disease of 2019 (COVID-19) mRNA vaccinations occur with typical and atypical presentations. The goal of this article is to increase awareness and review the various diagnosis and management of cutaneous adverse reactions associated with COVID-19 vaccinations for allergy/immunology fellows, residents, general physicians, and general practitioners. Pertinent information was included from the patient's case.

Outcomes of eosinophilic esophagitis in patients managed in a multidisciplinary clinic.

Eosinophilic esophagitis is a complex disease with an increasing prevalence. Multidisciplinary teams are often needed to manage this difficult-to-treat condition. To observe the clinical and histologic outcomes of patients with eosinophilic esophagitis after management in a multidisciplinary clinic.

Combining Discordant Serum IgE and Skin Testing Improves Diagnostic and Therapeutic Accuracy for Hymenoptera Venom Hypersensitivity Immunotherapy.

Background: Diagnosis of patients with hymenoptera venom hypersensitivity consists of elucidating clinical symptoms suggestive of systemic reaction (SR) and then confirmation of sensitization via intradermal skin testing (IDST) first and serum IgE assays such as ImmunoCAP (ICAP) as a complementary modality of diagnosis.

Objective: Determine the concordance between ICAP and IDST in patients with a clinical history suggestive of hymenoptera venom SR. Determine whether venom immunotherapy would change on the basis of IDST versus ICAP results.

Multisystem Inflammatory Syndrome in Children during the COVID-19 Pandemic: A Case Report on Managing the Hyperinflammation.

The novel human coronavirus of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has quickly swept throughout the entire world. As the ongoing pandemic has spread, recent studies have described children presenting with a multisystem inflammatory disorder sharing the features of Kawasaki disease (KD) and toxic shock syndrome, now named Multisystem Inflammatory Syndrome in Children (MIS-C). These cases report a similar phenotype of prolonged fever, multisystem involvement, and biomarkers demonstrating marked hyperinflammation that occurs temporally in association with local community spread of SARS-CoV-2.

Dysfunctional Immune System Reconstitution After Rituximab Exposure In Utero.

Rituximab is an antibody that binds to B-lymphocytes and is increasingly used during pregnancy. As an immunoglobulin G, it will transfer across the placenta. Previous case reports describe a diversity of clinical presentations in neonates born following rituximab exposure in utero.

Birt-Hogg-Dubé Syndrome: Another Battle for a Retired Navy Seal.

Birt-Hogg-Dubé syndrome is an autosomal dominant cancer syndrome characterized by upper torso and facial fibrofolliculomas, acrochordons, pneumothorax, and renal cell carcinoma. Although a rare syndrome, its prevalence is likely underestimated. Additionally, since it presents in patients' 20s or 30s, otherwise healthy members of the military may be affected, as with the index patient discussed in this case report.

Can we find a possible structural explanation for antibody-dependent enhancement of dengue virus infection resulting in hemorrhagic fever?

Dengue virus infection is one of the most prevalent mosquito-borne illnesses worldwide, affecting as many as 400 million persons annually. Most people experience a self-limited viral illness, but some experience life-threatening disease. Subsequent infection with other dengue virus serotypes increases the risk of development of severe dengue disease with plasma leakage with or without hemorrhage and end organ impairment.

Can we use DNA triple helices as treatment for systemic lupus erythematosus?

Systemic lupus erythematosus (SLE) is a chronic disease characterized by a variable clinical course and is associated with the presence of numerous autoantibodies. Autoantibodies against double-stranded DNA are highly specific for SLE and are directly associated with distinct clinical manifestations of the disease, specifically lupus nephritis. Examination of the sequences and the three-dimensional structures of autoantibodies specific for nucleic acids, confirms the presence of positively charged amino acids which could interact with the phosphate groups of self DNA.

Allergen immunotherapy extract treatment set preparation: making a safer and higher quality product for patients.

The best possible allergen immunotherapy clinical outcomes require the provision of high quality and safe allergen immunotherapy extract preparations. Evolving national guidelines and regulatory bodies have devoted special attention to the safe compounding of sterile products, including allergen extracts. It is incumbent upon allergists preparing extract treatment sets for patients to be familiar with and adopt training, procedures and safety measures that lead to standardized high quality products.

Can we explain the allergenicity of peanuts on the basis of the three-dimensional structure of its allergens and use the information to devise means of eliminating peanut allergy?

Helical bundles are found in all the known structures of peanut allergens. The peptide fragments, which survive gastrointestinal digestion of the allergens and are absorbed intact, are hypothesized to reassociate and form stable helical bundles in the circulation, which could elicit a specific IgE response resulting in peanut allergy. The hypothesis is supported by the finding of a diminished allergenicity of an isoform of the peanut allergen, Ara h 3, which has a major deletion.

Solar urticaria.

A case of solar urticaria is presented, followed by a discussion of the clinical characteristics, pathophysiology, diagnosis, and management of this disease. Special emphasis is given to clinical pearls and pitfalls for the practicing allergist. Solar urticaria is a physical urticaria that can be difficult to diagnose and distinguish from other photodermatoses.

Risk of angioedema with angiotensin receptor blockers in patients with prior angioedema associated with angiotensin-converting enzyme inhibitors: a meta-analysis.

Background: Patients who have angioedema after taking angiotensin-converting enzyme inhibitors (ACE-Is) have been reported to develop angioedema when taking an angiotensin receptor blocker (ARB), but few studies quantify the risk.

Objective: To perform a systematic review of the literature.

Methods: A literature search was performed in MEDLINE, EMBASE, BIOSIS, and Current Contents, with no limitations from January 1990 to May 2007.

Common variable immune deficiency (CVID) presenting as an autoimmune disease: role of memory B cells.

Common variable immunodeficiency (CVID) is a clinically heterogeneous disorder. Most often patients present with recurrent sinopulmonary infections, although it may present with autoimmune manifestations. Immune cytopenias, particularly thrombocytopenia and hemolytic anemia, are the most commonly observed.

Why is there a greater incidence of allergy to the tropomyosin of certain animals than to that of others?

Tropomyosin is a major allergen in various foods, implicated in a spectrum of mild to life threatening systemic reactions. The incidence of allergy to tropomyosin varies greatly by species, with sensitivity to crab, shrimp, cockroach, and dust mite tropomyosins, among others, being the highest, while tropomyosins in vertebrate species are considered non-allergenic. We have analyzed the possible fragments which may result from Pepsin A digestion of tropomyosins from various species and find that larger fragments of the tropomyosins from crab, shrimp, cockroach, and especially, dust mites will probably survive gastric digestion, compared to those from, for example, chicken, cattle, rabbit, or fish.

Vocal cord dysfunction.

A case of vocal cord dysfunction (VCD) is presented, followed by a discussion of the clinical characteristics, pathogenesis, diagnosis, and management of this disorder. Special emphasis is given to clinical pearls and pitfalls for the practicing allergist. VCD is a common condition that mimics asthma.

Allergic bronchopulmonary aspergillosis.

A case of allergic bronchopulmonary aspergillosis (ABPA) is presented, followed by a discussion of the clinical characteristics, pathogenesis, diagnosis, and management of this disease. Special emphasis is given to clinical pearls and pitfalls for the practicing allergist. ABPA is a hypersensitivity response to Aspergillus antigens in the lung and is distinct from other forms of Aspergillus pulmonary disease.

Nosocomial transmission of methicillin-resistant Staphylococcus aureus: a blinded study to establish baseline acquisition rates.

Objective: To define the extent of nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to a tertiary-care hospital.

Design: A blinded, prospective surveillance culture study of patients admitted to the hospital to determine the transmission (acquisition) rate of MRSA. Risk factors associated with the likelihood of MRSA colonization on admission were investigated.

Sedation for pediatric diagnostic imaging: use of pediatric and nursing resources as an alternative to a radiology department sedation team.

Objective: To develop a pathway to provide safe, effective, and efficient sedation for pediatric diagnostic imaging studies using non-radiology personnel.

Materials And Methods: A multidisciplinary team considered manpower and training requirements and national sedation standards before designing a sedation pathway, which included scheduling, pre-sedation history and physical, medication protocols, and monitoring. Oral and IV medication protocols were developed based on patient age and weight.