A Phased Approach to Resuming Suspended Allergy/Immunology Clinical Services.

In early 2020, the first US and Canadian cases of the novel severe acute respiratory syndrome coronavirus 2 infection were detected. In the ensuing months, there has been rapid spread of the infection. In March 2020, in response to the virus, state/provincial and local governments instituted shelter-in-place orders, and nonessential ambulatory care was significantly curtailed, including allergy/immunology services.

Erratum to: Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement.

[This corrects the article DOI: 10.1186/s40413-016-0122-3.].

Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement.

One of the major concerns in the practice of allergy is related to the safety of procedures for the diagnosis and treatment of allergic disease. Management (diagnosis and treatment) of hypersensitivity disorders involves often intentional exposure to potentially allergenic substances (during skin testing), deliberate induction in the office of allergic symptoms to offending compounds (provocation tests) or intentional application of potentially dangerous substances (allergy vaccine) to sensitized patients. These situations may be associated with a significant risk of unwanted, excessive or even dangerous reactions, which in many instances cannot be completely avoided.

Large local reactions to insect envenomation.

Purpose Of Review: Insect stings often induce large local reactions (LLRs) that result in morbidity. These reactions do have an immunologic basis; however, patients presenting with LLRs should be managed differently than those with systemic allergic reactions, as described in this review.

Recent Findings: Morbidity results from the inflammation itself along with the iatrogenic consequences of treatment.

Anaphylaxis to insect stings.

Anaphylaxis to insect stings has occurred in 3% of adults and can be fatal even on the first reaction. Large local reactions are more frequent but rarely dangerous. The chance of a systemic reaction to a sting is 5% to 10% in large local reactors and in children with mild (cutaneous) systemic reactions, and varies between 30% and 65% in adults with previous systemic reactions, depending on the severity of previous sting reactions.

Large local reactions to insect stings.

Large local reactions (LLRs) are IgE-mediated late-phase inflammatory reactions that can cause great morbidity but are associated with a relatively low risk of future anaphylaxis. Patients with LLR may benefit from consultation with an allergist to help clarify the relative risk, to plan the best treatment for future stings, and to determine whether or not to pursue testing or venom immunotherapy (VIT). The chance of anaphylaxis to future stings is <5%, so VIT is not generally recommended to people who have had LLR.

New directions in diagnostic evaluation of insect allergy.

Purpose Of Review: Diagnosis of insect sting allergy and prediction of risk of sting anaphylaxis are often difficult because tests for venom-specific IgE antibodies have a limited positive predictive value and do not reliably predict the severity of sting reactions.

Recent Findings: Component-resolved diagnosis using recombinant venom allergens has shown promise in improving the specificity of diagnostic testing for insect sting allergy. Basophil activation tests have been explored as more sensitive assays for identification of patients with insect allergy and for prediction of clinical outcomes.

Epidemiology, diagnosis, and treatment of Hymenoptera venom allergy in mastocytosis patients.

Hymenoptera venom allergy is a typical IgE-mediated reaction caused by sensitization to 1 or more allergens of the venom, and accounts for 1.5% to 34% of all cases of anaphylaxis. Patients suffering from mastocytosis are more susceptible to the anaphylactic reactions to an insect sting.

Stinging insect hypersensitivity: a practice parameter update 2011.

These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Stinging insect hypersensitivity: a practice parameter update II." Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters.

The diagnosis and management of anaphylaxis practice parameter: 2010 update.

These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "The Diagnosis and Management of Anaphylaxis Practice Parameter: 2010 Update." This is a complete and comprehensive document at the current time.

Long-term outcome after venom immunotherapy.

Purpose Of Review: There have been a limited number of studies examining the outcome after discontinuing venom immunotherapy (VIT), all of which showed continued protection in the great majority of patients. Several different criteria have been proposed to select patients to stop treatment based on immunologic and clinical factors. Specific high-risk factors have been reported from these published reports.

Venom immunotherapy reduces large local reactions to insect stings.

Background: Large local reactions to insect stings cause significant morbidity and impair quality of life. Venom immunotherapy is not recommended because of a low risk for future systemic reaction and unproven efficacy in preventing large local reactions.

Objective: To determine the feasibility of performing a controlled trial to examine the efficacy of venom immunotherapy in reducing the size and duration of large local reactions.

Dialyzed venom skin tests for identifying yellow jacket-allergic patients not detected using standard venom.

Background: The chance of a nonspecific intradermal skin test response at venom concentrations greater than 1.0 microg/mL limits the diagnostic range and can interfere with the diagnosis of some affected patients.

Objective: To compare the diagnostic ranges and clinical detection rates of skin tests using dialyzed yellow jacket venom (DYJV) and undialyzed YJV (UYJV), particularly in patients who have had negative venom skin test results.

Risk assessment in anaphylaxis: current and future approaches.

Risk assessment of individuals with anaphylaxis is currently hampered by lack of (1) an optimal and readily available laboratory test to confirm the clinical diagnosis of an anaphylaxis episode and (2) an optimal method of distinguishing allergen-sensitized individuals who are clinically tolerant from those at risk for anaphylaxis episodes after exposure to the relevant allergen. Our objectives were to review the effector mechanisms involved in the pathophysiology of anaphylaxis; to explore the possibility of developing an optimal laboratory test to confirm the diagnosis of an anaphylaxis episode, and the possibility of improving methods to distinguish allergen sensitization from clinical reactivity; and to develop a research agenda for risk assessment in anaphylaxis. Researchers from the American Academy of Allergy, Asthma & Immunology and the European Academy of Allergology and Clinical Immunology held a PRACTALL (Practical Allergy) meeting to discuss these objectives.

What is anaphylaxis?

Purpose Of Review: In the century since the discovery of anaphylaxis, research has yet to identify the mechanisms that cause a localized allergic response to become rapidly generalized, and particularly why only some sensitized individuals develop the clinical reaction on exposure. The possible components and steps in the process (proven and hypothetical) are reviewed with respect to their variation and regulation and their potential for therapeutic intervention.

Recent Findings: Studies of insect sting allergy have revealed some of the gaps in our understanding, the relatively poor predictive value of our diagnostic tests, and more recently the early evidence for 'priming' of basophils and mast cells as a precursor or predictor of clinical reactivity.

Insect sting anaphylaxis.

Anaphylaxis to insect stings has occurred in 3% of adults and can be fatal even on the first reaction. Large local reactions are more frequent but rarely dangerous. The chance of a systemic reaction to a sting is low (5% to 10%) in large local reactors and in children with mild (cutaneous) systemic reactions, and varies between 25% and 70% in adults depending on the severity of previous sting reactions.

Expression of activation markers on basophils in a controlled model of anaphylaxis.

Background: Anaphylaxis has variable clinical presentations and lacks reliable biomarkers. Expression of activation markers on basophils has been useful in assessing sensitization in IgE-mediated diseases but has not been examined in vivo in anaphylaxis.

Objective: The study's goals were to assess the baseline expression of activation markers on basophils in individuals with a sting reaction history, the degree of change in expression of these markers after intentional sting challenge, and the relationship between in vitro and in vivo activation marker expression.

Insect allergy in children.

Purpose Of Review: Some aspects of insect sting allergy are unique in children. This review will identify and update the published data that exist pertaining specifically to insect allergy in children.

Recent Findings: Children have a different pattern of insect sting allergy than adults.

Clinical and entomological factors influence the outcome of sting challenge studies.

Background: The reported frequency of systemic reactions to challenge sting varies greatly.

Objective: To evaluate the interaction of clinical and entomological factors that determine the outcome of a challenge sting.

Methods: Patients allergic to yellow jacket were stung and monitored for systemic reaction.