International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Contact reactions to fragrances

Background: The most common reaction to fragrances is contact dermatitis, a delayed hypersensitivity reaction; however, other reactions include immediate contact reactions (contact urticaria) and photo-allergic reactions. Fragrance mix (FM) and balsam of Peru (BP) are used to screen for fragrance allergy. Objective: To study the different types of allergic skin reactions to fragrance compounds. Methods: Delayed hypersensitivity reactions to FM and BP were studied in 4,975 patients with suspected contact dermatitis by routine patch testing interpreted at 48 and 96 hours. In 664 of the patients, patch tests were read at 30 minutes to evaluate for immediate (wheal-and-flare) contact reactions and again at 48 and 96 hours. Photopatch tests to FM were performed in 111 patients with suspected photo-allergic dermatitis. Results: Delayed contact reactions to FM occurred in 6.6% of females and 5.4% of males and to BP in 3.9% of females and 4.1% of males. Analysis of data over time (12 study years) showed an increased trend for reactions to fragrances, particularly in males. Sensitivity to other contact allergens (polysensitivity) was found in 62% of patients and polysensitivity presented more often with generalized contact dermatitis. The most sensitizing components of the fragrance mix that were tested in 38 patients were cinnamic alcohol, oak moss, and cinnamic aldehyde. There were 112 immediate patch test reactions to FM and 113 to BP in 664 patients. Immediate contact reactions were followed by delayed contact reactions in 13.4% of patients for FM and 8.8% for BP, representing a significant increase in the frequency of delayed contact reactions. Patients with immediate contact reactions to fragrances did not have a higher incidence of atopy (25.9%). No cases of positive photopatch test reactions to FM were seen. Conclusion: Fragrances commonly cause both delayed and immediate patch test reactions and patients with immediate contact reactions have an increase in delayed contact reactions to the same allergen

INFLUENCE OF THE MENSTRUAL-CYCLE ON SKIN-PRICK TEST REACTIONS TO HISTAMINE, MORPHINE AND ALLERGEN

The purpose of this study was to examine the possible influence of the phases of the menstrual cycle on dermal reactivity to skin-prick testing. We studied 15 atopic, menstruating women with seasonal rhinoconjunctivitis and/or asthma, with known sensitivity to olive and parietaria (mean age 25.2 years) and 15 non-atopic, healthy, female controls (mean age 24.7 years). Skin-prick tests with histamine, morphine, and in the atopic group with parietaria/and/or olive, were repeated three times during the same menstrual cycle, corresponding to bleeding (day 1-4), midcycle (day 12-16) and the late progesterone phase (day 24-28). None of the patients had received oral antihistamines or exogenous hormones for at least 1 month prior to testing. Results indicate a significant increase in weal-and-flare size to histamine, morphine, and parietaria on days 12-16 of the cycle, corresponding to ovulation and peak oestrogen levels. This was observed in both atopic and non-atopic women. Differences in skin reactivity to histamine and morphine between the groups were not significant. Therefore, in women, the phase of the menstrual cycle is another factor that may influence skin-test results

Patch tests in children: A review of 13 years of experience in comparison with previous data

The true prevalence of allergic contact dermatitis (ACD) in children remains unknown. Our aim was to compare the results of patch tests in children with suspected ACD between two different periods of time and identify possible changes in emerging allergens. We compared contact allergens, gender, age distribution, and personal history of atopic dermatitis (AD), in correlation with the positivity of patch tests, between two equal periods of time (232 children tested during 1980-1993, period A, and 255 children during 1994-2007, period B) in the same region and in the same institution. Patch test positivity was 47.8% in period A, and 60% in period B (p = 0.083). The most common allergens in period A were: nickel sulfate (16.3%), cobalt chloride (8.6%), fragrance mix (7.3%), potassium dichromate (4.3%), and thimerosal only (1.7%). In period B, the allergen distribution was as follows: nickel sulfate (21.56%), thimerosal (18.03%), cobalt chloride (12.9%), potassium dichromate (9.4%), and fragrance mix (4.7%). Girls were more likely to have a positive patch test compared with boys, with reactions in 53% of girls and 39% of boys in period A (p = 0.003), and 61% of girls and 58% of boys in period B (p = 0.691). Twenty-nine per cent of patients with positive results had a personal history of AD in period A and 44% in period B (p = 0.015). Differences in the positivity of allergens between different time periods reflect changes in habits, of allergens exposure or preventive measures. © 2010 Wiley Periodicals, Inc

Classic Kaposi's sarcoma in two young heterosexual men

Classic Kaposi's sarcoma is primarily a skin disease of the lower extremities affecting predominantly elderly men of Mediterranean origin. We report classic Kaposi's sarcoma first presenting in the third decade in two heterosexual, HIV-negative, males of Greek origin from Albania. Ten years after onset, the disease became aggressive with unusual clinical features that included exophytic tumors, extensive lesions on the hands as well as the legs, and prominent leg edema. One of the patients also presented lesions on the face, trunk and palate, and bubonic lymphadenopathy. In both cases, CD4 counts were normal and HLA-DR5 was positive. Treatment included radiation therapy, subcutaneous interferon (alpha -2b) and combined chemotherapy (ABV). At follow up 1 and 2 years later, both patients remain in partial remission with significant improvement in clinical disease, on maintenance interferon

Frequency of immediate reactions to the European standard series

Immediate contact reactions (contact urticaria) can occur after skin contact with a wide range of substances. We studied the incidence of immediate contact reactions (wheal and flare) to the European standard series allergens in 664 patients. Patch tests were first examined at 30 min for immediate patch test (IPT) reactions, and again at D2 and D4 for delayed patch test (DPT) reactions. Almost all the allergens of the European standard series caused IPT reactions. IPT reactions were most commonly seen with Myroxylon Pereirae (balsam of Peru) (113 reactions), fragrance mix (112 reactions), paraben mix (30 reactions) and clioquinol (13 reactions); these reactions were followed by DPT reactions to the same substance in 13.4%, 8.8%, 10% and 7.7%, respectively. For certain substances, patients with (+) IPT reactions had a significantly higher incidence of DPT reactions to the same allergen, as compared to patients with (-) IPT reactions (fragrance compounds p<0.001, formaldehyde p<0.005, thiuram mix p<0.01, paraben mix p<0.05). Thus, perhaps the mechanisms involved in IPT reactions are not the same for all substances. At least for certain substances, an IPT reaction may be related to the development of a DPT reaction

Anaphylaxis induced by lentils

Background: The legume food family is large and includes peanut and soybean, two of the most frequent causes of food allergy. Literature on type I hypersensitivity to lentils, also a legume, is scarce. Objective: To describe a child with repeated anaphylactic reactions related to lentils. Methods: Skin prick tests with both commercial and cooked extracts and serum- specific IgE measured by CAP-RIA were used to identify specific IgE antibodies to various legumes. Results: An 8-year-old girl suffered four episodes of anaphylaxis related to lentils from ages 3 to 7 years. The first three involved ingestion of cooked lentils and each time smaller amounts induced symptoms. The fourth episode occurred with inhalation exposure to cooking lentil soup. Subsequently, she presented with contact urticaria from raw chickpeas and an anaphylactic reaction after ingestion of cooked chickpeas. Prick tests showed strongly positive reactions to lentil and chickpea and weaker positive reactions to peanut, pea, soybean, and white bean. CAP-RIA was class 6 to lentil; class 5 to peanut, pea, and soybean: class 4 to white bean, and class 0 to green bean. Conclusion: Severe type I hypersensitivity to lentils occurred in this patient and was associated with clinically relevant hypersensitivity to chickpeas. Prick tests and CAP-RIA demonstrated multiple positive reactions to other legumes

Effect of an antioxidant (quercetin) on sodium-lauryl-sulfate-induced skin irritation

Quercetin is a bioflavonoid with antioxidant and anti-inflammatory activity. The purpose of this study was to examine the effect of quercetin on acute skin irritation, with special interest in the skin barrier function recovery. Acute irritant contact dermatitis was induced in 15 patients by 24h occlusion of 2% sodium lauryl sulfate (SLS) (day (D) 1). The influence of application on SLS-irritated skin of topical quercetin for 5 consecutive Ds, compared to vehicle and controls, was studied. Parameters measured were transepidermal water loss (TEWL) and erythema index. Final measurements were taken on D 7 after a 1-D rest period. TEWL and the erythema index continued to rise 2 D after application of SLS and 1 D after treatment with quercetin, vehicle or controls. Both TEWL and erythema values at D 7 did not return to values before the SLS barrier disruption at all the test sites. Therefore, quercetin topically applied after induction of irritant contact dermatitis does not appear to increase the recovery of barrier function and erythema caused by SLS