Comparative efficacy and safety of biologics and systemic immunomodulatory treatments for chronic urticaria: Systematic review and network meta-analysis.

Background: Chronic urticaria is a common skin condition characterized by itchy wheals (hives), angioedema, or both, lasting for 6 weeks or more. Beyond antihistamines, multiple systemic treatments are available, but there is uncertainty regarding their comparative effects on chronic urticaria outcomes.

Objective: We systematically synthesized the comparative benefits and harms of systemic treatments for chronic urticaria.

Differential Diagnosis of Chronic Spontaneous Urticaria.

Patients with chronic recurrent wheals most commonly receive the diagnosis of chronic spontaneous urticaria, although a number of autoimmune, autoinflammatory, and malignant diseases can be suspected based on certain red flags. These warning signs are a wheal duration of more than 24 hours, post-inflammatory hyperpigmentation, and systemic symptoms such as arthralgia and fever and/or elevated inflammatory markers. Here, we detail the case of an adult patient who initially received the diagnosis of chronic spontaneous urticaria, discussing possible differential diagnoses and outlining options for treating the patient once a diagnosis has been established.

Direct Amoxicillin Challenges for Penicillin Allergy Through Pediatric Primary Care Group Visits: A Pilot Study.

Novel strategies are needed to expand equitable access to penicillin allergy testing. We performed a pilot study of penicillin allergy testing through direct challenges performed at pediatric primary care group office visits. Ninety-five percent of subjects were delabeled with no severe reactions noted, providing conceptual basis for further implementation studies.

The Association of Social Determinants of Health and Penicillin Allergy Labels: a case-control study.

Background: Penicillin allergy labels (PAL) are associated with numerous adverse outcomes including poor infectious outcomes and antimicrobial resistance. Studies assessing the association of social vulnerability (SV) characterized by social determinants of health factors (SDoH) and PAL epidemiology are lacking.

Methods: This retrospective case-control study included patients encountering a US academic medical center between 2014-2023.

The drug allergy history tool (DAHT): Validation of a patient-reported survey instrument.

Background: While the reaction history is critical for drug allergy evaluations and is typically self-reported, there is no validated survey instrument to collect drug allergy history from patients.

Objective: We validated a survey instrument that collects patient-reported drug allergy history.

Methods: The drug allergy history tool (DAHT) was revised after 3 rounds of cognitive testing, assessed for reliability through test-retest comparisons, and assessed for quality and validity through a concordance analysis against electronic health record allergist documentation.

Engineering nanoallergens to investigate origins of immunogenicity and cross-reactivity in cephalosporin allergy.

Background: A major obstacle to the effective diagnosis of cephalosporin allergies is that the haptens, or segments of their molecular structures, which are responsible for the initiation of an immunogenic response, are unknown.

Objective: This study aimed to identify immunogenic moieties of cefazolin to accurately predict IgE-mediated allergy and cross-reactivity with other cephalosporin antibiotics.

Methods: Hapten immunogenicity analysis is performed using liposomal nanoallergens integrated in a cellular degranulation assay to quantify secreted allergic mediators.

A Guide to Pediatric Antibiotic Allergy Testing: A Report From the US Drug Allergy Registry.

Pediatric antibiotic labels are common, and unnecessary antibiotic avoidance is associated with negative personal and public health outcomes; as a result, there is an increasing emphasis on the importance of pediatric antibiotic allergy evaluations. Different testing strategies have been advised, including skin testing and challenge testing with varied doses and duration. Established consensus testing protocols are lacking.

The relationship between asthma and suggested alcohol dependence and heavy alcohol use in the Cooper Center Longitudinal Study: The role of depressive symptom severity.

Background: Asthma appears to be associated with a variety of psychiatric illnesses including depression and alcohol use disorder. The current study examined the relationship between asthma, heavy alcohol intake and suggested alcohol dependence controlling for depressive symptom severity.

Methods: Data from 37,625 adult patients at the Cooper Clinic who enrolled in the Cooper Center Longitudinal Study, completed a medical history questionnaire including information on asthma, depressive symptoms and alcohol use were used.

Cephalosporin Allergy: Updates on Diagnostic Testing.

Purpose Of Review: Cephalosporins are one of the most prescribed antibiotics worldwide and are implicated in a wide range of hypersensitivity reactions (HSR). This review summarizes recent updates in cephalosporin hypersensitivity with a focus on diagnostic testing.

Recent Findings: Reported testing strategies to evaluate different immediate and delayed cephalosporin HSR have included skin testing, in vitro testing, and diagnostic drug challenges.

Topical corticosteroids for hives and itch (urticaria): Systematic review and Bayesian meta-analysis of randomized trials.

Background: Topical corticosteroids are widely used as a treatment for itch and wheals (urticaria), but their benefits and harms are unclear.

Objective: To systematically synthesize the benefits and harms of topical corticosteroids for the treatment of urticaria.

Methods: We searched MEDLINE, EMBASE, and CENTRAL from database inception to March 23, 2024, for randomized trials comparing topical corticosteroids with placebo for patients with urticaria (either chronic spontaneous or inducible urticaria or acute urticaria elicited from skin/intradermal allergy testing).

Leukotriene receptor antagonists as add-on therapy to antihistamines for urticaria: Systematic review and meta-analysis of randomized clinical trials.

Background: The benefits and harms of adding antileukotrienes to H antihistamines (AHs) for the management of urticaria (hives, itch, and/or angioedema) remain unclear.

Objective: We sought to systematically synthesize the treatment outcomes of antileukotrienes in combination with AHs versus AHs alone for acute and chronic urticaria.

Methods: As part of updating American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters urticaria guidelines, we searched Medline, Embase, Central, LILACS, WPRIM, IBECS, ICTRP, CBM, CNKI, VIP, Wanfang, US Food and Drug Administration, and European Medicines Agency databases from inception to December 18, 2023, for randomized controlled trials (RCTs) evaluating antileukotrienes and AHs versus AHs alone in patients with urticaria.

The Impact of Prior Authorization on Clinical Practice and Patient Care Outcomes: A Work Group Report of the AAAAI Prior Authorization Task Force.

The Prior Authorization Task Force of the American Academy of Allergy, Asthma & Immunology (AAAAI), a presidential initiative of David Khan, MD, FAAAI, was established to develop an AAAAI position statement outlining ways to improve health care for our patients, to support legislation that advocates for prior authorization (PA) reform and identify the impact PA has on its membership using a questionnaire survey. This article describes the results of this survey. An electronic anonymous survey questionnaire was developed to assess the impact and burden of PA on AAAAI members and their staff and patients.

Patient-Reported Outcome Measures in Food and Drug Allergy.

A patient-reported outcome is directly reported by the patient without interpretation of the patient's response by anyone else. It refers to the patient's health (symptoms and feelings), quality of life, or functional status associated with health care or treatment. Patient-reported outcome measures (PROMs) are defined as the tools or instruments that are used to measure patient-reported outcomes.

Drug Allergy Mimics.

When approaching a case of apparent drug allergy, the consulting clinician should consider a broad differential diagnosis. This article presents a series of cases that could be commonly referred to an allergist for assessment as "drug allergy," however, a real diagnosis exists that mandates a different diagnostic and treatment strategy, including a case of inducible laryngeal obstruction, multiple drug intolerance syndrome, viral rash, seizure due to metastatic malignancy, and hemophagocytic lymphohistiocytosis initially diagnosed as drug reaction and eosinophilia with systemic symptoms. The initial misdiagnoses of these patients delayed or interfered with their medical care, emphasizing the importance of accurate diagnoses for the benefit of our patients.

Severe Multiple Drug Intolerance Syndrome in Fibromyalgia and Irritable Bowel Syndrome.

Background: Multiple drug intolerance syndrome (MDIS) describes patients with multiple nonimmunologically mediated adverse reactions to medications. Patients with more than 10 medication intolerance labels are considered to have severe MDIS. There is overlap in the characteristics of patients with MDIS and fibromyalgia and irritable bowel syndrome (IBS).