Idiopathic Anaphylaxis Grand Rounds.

Idiopathic anaphylaxis (IA) refers to recurrent, life-threatening hypersensitivity reactions without identifiable triggers, representing a diagnostic and therapeutic challenge. We describe a 17-year-old girl presenting with recurrent episodes of flushing, pruritus, and respiratory symptoms, without consistent allergen exposure or cofactor involvement. Evaluation revealed elevated acute tryptase levels with a normal baseline, negative skin testing, and negative alpha-gal and KIT mutation analysis.

Concomitant Chronic Urticaria in Children: A Distinct Severe Phenotype.

Introduction: Chronic spontaneous urticaria (CSU) presents as repetitive spontaneous hives and/or angioedema lasting for at least six weeks. In contrast, chronic inducible urticaria (CIndU) is triggered by specific stimuli. This study aimed to characterize children who have concurrent CSU and CIndU excluding children with symptomatic dermographism, and to identify factors that distinguish them from children with CSU alone or CIndU alone.

NOURISH-US: a mixed-methods, randomized crossover study of a program designed to reduce the financial burden of food allergy.

Background: Food allergy imposes considerable financial costs on families, but few programs are available in Canada to offset these costs. To fill this gap, we developed, piloted, and evaluated a program designed to address the financial burden of food allergy.

Methods: The current study employed the use of an unblinded, crossover design.

The role of skin testing, drug challenge and IFN-γ ELISpot in delayed hypersensitivity to iodinated contrast media.

Background: The use of in vivo and ex vivo diagnostic tools for delayed hypersensitivity reactions (DHRs) associated with iodinated contrast media (ICM) is currently ill-defined.

Objective: To evaluate the role of in vivo and ex vivo diagnostic tools for DHRs occurring >6 h following intravenous low-osmolality ICM.

Methods: We conducted a prospective, multicenter, international cohort study.

Global Approach for Severe Cutaneous Adverse Reactions (GRASS) Survey.

Background: Consensus guidelines outline the recommended management of delayed drug hypersensitivity reactions (DHR), but clinical practices are largely expert-based and may vary significantly across populations and regions. This study evaluated the approach and management of healthcare specialists globally regarding DHR, including severe cutaneous adverse reactions (SCARs).

Objective: To assess the current practices, knowledge, and availability of allergy testing for DHR, including SCARs, among relevant healthcare professionals globally.

Fear, facts, and the future: An update on coronavirus disease 2019 vaccine-induced anaphylaxis and vaccine hesitancy among those living with allergy.

Background: Despite the low incidence of coronavirus disease 2019 (COVID-19) vaccine-induced allergic reactions reported to date, concerns of such reactions have been reported in the literature among individuals with and without a history of allergic disease.

Objectives: Herein, we provide an update to a previous scoping review published by our group, focusing on COVID-19 vaccine hesitancy in relation to allergy and the incidence of anaphylactic reactions to COVID-19 vaccines.

Methods: The current review follows an protocol drafted in accordance with Arksey and O'Malley's framework for methodological reviews.

A Comparison of Chronic Spontaneous Urticaria Clinical Characteristics and Management between Canadian and Israeli Adults.

Introduction: Chronic spontaneous urticaria (CSU) is increasingly recognized as a significant health issue with significant impacts on quality of life in adult populations. Data are sparse regarding differences in clinical characteristics and management of CU in different countries. We aimed to compare adult CU populations in Canada and Israel to identify demographic, clinical, and management differences.

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.

Assessment of Quality of Life in Children with Chronic Urticaria Using the Children's Dermatology Life Quality Questionnaire Index: A Retrospective Cohort Study.

Introduction: Chronic urticaria (CU) negatively impacts children's quality of life (QoL), yet data on pediatric CU remain limited. This study assessed CU's impact on QoL using the Children's Dermatology Life Quality Index (CDLQI).

Methods: Children (4-16 years) with CU were recruited and completed standardized questionnaires on demographics, CU type, management, and comorbidities.

Rilzabrutinib in Antihistamine-Refractory Chronic Spontaneous Urticaria: The RILECSU Phase 2 Randomized Clinical Trial.

Importance: Chronic spontaneous urticaria (CSU) is a skin disease driven mainly by the activation of cutaneous mast cells through various mechanisms. Bruton tyrosine kinase (BTK), expressed in B cells and mast cells, plays a critical role in multiple immune-mediated disease processes.

Objective: To determine the efficacy and risk profile of rilzabrutinib (SAR444671), an oral, reversible, covalent, next-generation BTK inhibitor, in treating patients with CSU.

Diagnostic Utility of Biomarkers in Anaphylaxis: A Systematic Review and Meta-Analysis.

Background: Anaphylaxis is a life-threatening allergic reaction commonly triggered by food, venom, or drugs. Clinical criteria are central to diagnosing anaphylaxis. However, laboratory biomarkers could provide valuable confirmation when clinical diagnosis is challenging.

Health-Related Quality of Life in Chronic Urticaria: A Systematic Review and Meta-Analysis.

Background: Chronic urticaria (CU), including chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU), significantly affect patients' health-related quality of life (HRQOL). To date, no systematic reviews or meta-analyses have summarized the HRQOL tools used in CU and the magnitude of HRQOL impact in CU.

Objective: To determine the HRQOL tools used in CU, the burden of CU regarding HRQOL in adults and children, and whether CU subtypes differentially affect HRQOL.

Predicting Cow's Milk Challenge Outcomes in Children: Multivariate Analysis of Clinical Predictors.

Introduction: Oral food challenges are the gold standard for diagnosis and reactivity thresholds but are resource intensive and high risk for reactions. Limited data on factors associated with increased risk of positive oral food challenges exist. We aimed to assess factors associated with positive oral food challenges and create a model to predict cow milk oral food challenge outcomes.

Serum Sickness-Like Reactions Clinical Characteristics and Management: A Systematic Review.

Background: Serum sickness-like reaction (SSLR) is an adverse reaction mainly to drugs, infectious agents, or vaccines, characterized by the presence of rash, arthralgia, or arthritis and occasionally fever.

Objective: This systematic review aimed to analyze the clinical characteristics, implicated agents, symptomatology, and management of SSLR.

Methods: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Serum Sickness-Like Reactions in Children-Is Lifelong Avoidance Indicated?

Serum sickness-like reactions (SSLRs) consist of urticaria or urticarial-like rashes with joint pain and variable features of fever, angioedema, and gastrointestinal distress. Allergists typically evaluate patients in the clinic for an implicated medication, such as an antibiotic or vaccine. Although SSLR may be mistaken for classical serum sickness or anaphylaxis owing to overlapping clinical features, there is minimal evidence for type I or type III hypersensitivity reactions.

Updates in Food Anaphylaxis Management.

The management of food allergy has evolved over the past several years with regulatory approval of food allergy therapeutics as well as the common practice of oral immunotherapy. Whether a patient or family chooses one of these therapies or avoidance, they are still considered at risk of reaction, and thus clinicians still need to stay up to date with the latest advancements in the management of anaphylaxis in patients with food allergy. This review will highlight some of these updates, starting with the definition, diagnosis, and classifications of anaphylaxis.

Drug allergy.

Drug allergy encompasses a spectrum of immunologically-mediated hypersensitivity reactions (HSRs) with varying mechanisms and clinical presentations. This type of adverse drug reaction (ADR) not only affects patient quality of life, but may also lead to delayed treatment, unnecessary investigations, and increased morbidity and mortality. Given the spectrum of symptoms associated with the condition, diagnosis can be challenging.

Cost-effectiveness of watchful waiting versus immediate emergency department transfer after epinephrine autoinjector use in Canada.

Background: Until recently, immediate emergency department (ED) transfer after food-related anaphylactic reactions was recommended regardless of symptom resolution following use of an epinephrine autoinjector (EAI). We evaluated the cost-effectiveness of delayed ED transfer after EAI use in non-medical settings (watchful waiting) compared to immediate ED transfer among pediatric patients with food allergies in Canada.

Methods: We developed a probabilistic Markov model of individuals starting at age of one year who are at risk of severe food-related allergic reactions requiring epinephrine.

Chronic urticaria treatment challenges in children.

Objective: This paper aims to review the efficacy and safety of current chronic urticaria (CU) treatment in children and the existing patient-reported outcome measures (PROMs) used in this age group.

Data Source: Since there are few studies of CU in children, the authors performed a non-systematic review of published articles in English, Spanish, and Portuguese in the PubMed database in the last decade. Keywords used were (antihistamines OR omalizumab OR cyclosporine OR treatment) AND (chronic urticaria) AND (children OR adolescents).