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.

Treatment of Drug-Resistant Tuberculosis with Bedaquiline, Pretomanid, Linezolid with or Without Moxifloxacin (BPaL/M): Feasibility and Implementation Challenges in Western Canada.

Background: Rifampin-resistant (RR) and multidrug-resistant (MDR) tuberculosis (TB) previously required treatment with a protracted course of toxic second-line TB drugs with suboptimal efficacy. Novel 6-month regimens of bedaquiline, pretomanid, linezolid with or without moxifloxacin (BPaL/M) are now recommended, but implementation in Canada is not well described.

Methods: We analyzed eight people with MDR or pre-extensively drug-resistant (pre-XDR) TB or rifamycin intolerance treated with BPaL/M in western Canada to inform expanded use.

Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin Treatment for Multi-Drug Resistant Extrapulmonary Tuberculosis in Canada: A Report.

Background: Updated global tuberculosis (TB) guidelines recommend the novel oral 6-month bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) regimen for multidrug-resistant TB (MDR-TB) based on superior efficacy and reduced toxicity demonstrated in clinical trials. These trials were dominated by isolated pulmonary TB; thus, data for BPaLM effectiveness for extrapulmonary tuberculosis (EPTB) remains limited.

Methods: We describe the safe and effective use of BPaLM in a patient for the treatment of MDR-TB involving an extrapulmonary site.

High-Dimensional Disease Risk Score for Dealing With Residual Confounding Bias in Estimating Treatment Effects With a Survival Outcome.

Purpose: Health administrative databases often contain no information on some important confounders, leading to residual confounding in the effect estimate. We aimed to explore the performance of high-dimensional disease risk score (hdDRS) to deal with residual confounding bias for estimating causal effects with survival outcomes.

Methods: We used health administrative data of 49 197 individuals in British Columbia to examine the relationship between tuberculosis infection and time-to-development of cardiovascular disease (CVD).

Preschool Oral Immunotherapy Is Associated With Improved Parental Food Allergy-Specific Anxiety and Quality of Life: A Real-World Observational Study.

Introduction: Preschool oral immunotherapy (OIT) is safe and effective for food allergy, and may improve parental food allergy-specific anxiety (FAA) and food allergy quality of life (FAQL); however, data on these important outcomes are limited, particularly for preschoolers. Herein, we explored the relationship between OIT and parental FAA, including the subdomains: food allergy-related worries, anxiety impact, behavioural avoidance, and coping; and OIT and FAQL in parents of preschool-aged children.

Methods: Parents of preschool-aged children (< 72 months) receiving OIT in Canadian allergy clinics were eligible for this observational study.

A Proposed Framework for an Interdisciplinary Food Allergy Immunotherapy Program for Pediatric Patients Transitioning to Adult Care.

Although established frameworks and guidelines are available to help transition pediatric patients successfully to adult care, patients receiving food allergy immunotherapy have a unique set of needs, and challenges that must be considered. We highlight these considerations for a research-based tertiary care center immunotherapy program. A proposed framework for an interdisciplinary food allergy immunotherapy team that includes not only pediatric allergists and nursing but also adult allergists, dietitians, researchers, and mental health team members working synergistically to address the needs of adolescents and young adults undergoing food allergy immunotherapy as they transition to adult care is presented.

Enhancing risk prediction base on health administrative data using high-dimensional prediction model.

Objectives: Health administrative datasets often do not contain important clinical variables for predicting the risk of medical outcomes. However, they often contain a wide range of health-care variables that can be used to develop a high-dimensional prediction model (hdPM) that compensates for the lack of clinical predictors. We aimed to compare the predictive performance of an hdPM with a conventional model that relies only on investigator-specified clinical predictors.

Evaluation of the post-landing surveillance process for people migrating to British Columbia: A retrospective cohort study.

Objectives: People migrating to Canada are disproportionately impacted by tuberculosis (TB) disease. Prior to arrival, Immigration, Refugees and Citizenship Canada (IRCC) require an immigration medical exam (IME) intended to detect TB disease in all permanent and select temporary residents. People deemed high risk for TB are then referred for post-landing surveillance.

Non-immunoglobulin E-mediated food allergy.

Non-immunoglobulin E (IgE)-mediated food allergies are characterized by delayed gastrointestinal (GI) manifestations that occur after exposure to an inciting food protein; they include food protein-induced allergic proctocolitis (FPIAP), food protein-induced enteropathy (FPE), and food protein-induced enterocolitis syndrome (FPIES). Although the exact mechanisms underlying these disorders are not well understood, non-IgE-mediated food allergies likely represent a spectrum of disease with shared pathophysiological processes. Typically, these non-IgE-mediated food allergies begin in infancy or early childhood, although FPIES can present across the lifespan, with increasing reports in adults in recent years.

Predicting Risk of Tuberculosis (TB) Disease in People Who Migrate to a Low-TB Incidence Country: Development and Validation of a Multivariable, Dynamic Risk-Prediction Model Using Health Administrative Data.

Background: Tuberculosis (TB) incidence remains disproportionately high in people who migrate to Canada and other countries with low TB incidence, but systematic TB screening and prevention in migrants are often cost-prohibitive for TB programs. We aimed to develop and validate a TB risk-prediction model to inform TB screening decisions in foreign-born permanent residents of Canada.

Methods: We developed and validated a proportional baselines landmark supermodel for TB risk prediction using health administrative data from British Columbia and Ontario, 2 distinct provincial healthcare systems in Canada.

Real-world experience: a retrospective pediatric chart review to determine why patients and caregivers discontinue oral immunotherapy.

Background: Oral immunotherapy (OIT) is an increasingly utilized management strategy for IgE-mediated food allergy. Despite promising efficacy and effectiveness, there is still a lack of data surrounding the reasons for discontinuation of OIT. The primary reason stated in the literature for discontinuation is adverse gastrointestinal effects.

Focused allergic rhinitis practice parameter for Canada.

Allergic rhinitis (AR) is a prevalent disease in Canada that affects both children and adults. Several guidelines for the management of AR have been published by professional allergy societies worldwide. However, there are regional differences in the clinical management of AR, and regulatory approval of some AR pharmacotherapies varies among countries.

A practical focus on oral immunotherapy to tree nuts.

Tree nut (TN) allergy is common, with a global prevalence of up to 4.9%. TN allergy is persistent in most patients, and accidental reactions are common.

Revaccination outcomes among adolescents and adults with suspected hypersensitivity reactions following COVID-19 vaccination: A Canadian immunization research network study.

Background: COVID-19 vaccination has been associated with anaphylaxis and hypersensitivity reactions. Infectious disease physicians and allergists in the Canadian Special Immunization Clinic (SIC) Network developed guidance for evaluating patients with adverse events following immunization (AEFI) including suspected hypersensitivity. This study evaluated management and adverse event recurrence following subsequent COVID-19 vaccinations.

Sustainability and impact of an intervention to improve initiation of tuberculosis preventive treatment: results from a follow-up study of the ACT4 randomized trial.

Background: In a cluster randomized trial (clinicaltrials.gov: NCT02810678) a flexible but comprehensive health system intervention significantly increased the number of household contacts (HHC) identified and started on tuberculosis preventive treatment (TPT). A follow-up study was conducted one year later to test the hypotheses that these effects were sustained, and were reproducible with a simplified intervention.

High-dose, short-duration versus standard rifampicin for tuberculosis preventive treatment: a partially blinded, three-arm, non-inferiority, randomised, controlled trial.

Background: Tuberculosis preventive treatment (TPT) is a key component of tuberculosis elimination. To improve completion and reduce the burden for people and health systems, short, safe, and effective TPT regimens are needed. We aimed to compare safety and treatment completion of various doses and durations of rifampicin in people who were recommended to receive TPT.

Age-Related Food Aversion and Anxiety Represent Primary Patient Barriers to Food Oral Immunotherapy.

Background: Although oral immunotherapy (OIT) for food allergy is a reasonable treatment option, barriers to this procedure's implementation have not been extensively evaluated from a patient perspective.

Objective: We evaluated the barriers patients face during OIT administration, including anxiety and taste aversion, and the role of health care professionals, especially dietitians.

Methods: A survey in Canada and the United States involved families currently enrolled in food OIT programs.

Human resource implications of expanding latent tuberculosis patient care activities.

Introduction: The World Health Organization (WHO) declared increasing services for latent tuberculosis infection (LTBI) a priority to eliminate tuberculosis (TB) by 2035. Yet, there is little information about thehuman resource needs required to implement LTBI treatment scale-up. Our study aimed to estimate the change in healthcare workers (HCW) time spent on different patient care activities, following an intervention to strengthen LTBI services.

Using the canadian egg ladder in children with food protein-induced enterocolitis syndrome: a case series.

Background: Current management of food protein-induced enterocolitis syndrome (FPIES) involves strict avoidance of the offending food for 12-18 months, followed by oral food challenge (OFC) under physician supervision. OFCs are resource-intensive and there is a lack of a universal standardized protocol for FPIES. Prolonged avoidance may increase the risk of IgE-mediated allergy, particularly in atopic patients.

Distinct healthcare utilization profiles of high healthcare use tuberculosis survivors: A latent class analysis.

Background: Recent data have demonstrated that healthcare use after treatment for respiratory tuberculosis (TB) remains elevated in the years following treatment completion. However, it remains unclear which TB survivors are high healthcare users and whether any variation exists within this population. Thus, the primary objective of this study was to identify distinct profiles of high healthcare-use TB survivors to help inform post-treatment support and care.