Three cases of anaphylaxis following injection of a depot corticosteroid with evidence of IgE sensitization to macrogols rather than the active steroid

We present three cases with anaphylaxis after injection of a depot corticosteroid. First, the steroid was suspected as the elicitor, but after evaluation the excipient macrogol was found to be the elicitor. One of the patients had reactions to several unrelated drugs. Increased awareness of anaphylaxis to excipients such as macrogols is needed, especially when allergy tests for the active drug is negative and in patients with a history of repeated anaphylaxis to seemingly unrelated drugs. To establish the correct diagnosis it is important to test with the exact formulation of the culprit drug, as well as all the ingredients including excipients

In vitro Release of Eosinophil Proteins in Allergic and Atopic Dermatitis Patients

To investigate whether eosinophils are stimulated in vivo or have acquired an increased susceptibility to stimuli from the coagulation cascade, the release of eosinophil proteins was compared for three groups of donors with different levels of serum IgE. (1) with atopic dermatitis (s-IgE > 5000 IU/ml, n = 11); (2) with inhalant allergy (200 < s-IgE < 2 000 IU/ml, n = 10); and (3) non-allergic (s- IgE < 100 IU/ml, n = 10). The levels of eosinophil cationic protein and eosinophil protein X (ECP, EPX) were determined in serum (clotting time = 2.0 h) and plasma. Serum and plasma ECP in normal donors demonstrated large intra-personal variations (C.V. 50–80%), but serum-ECP (mean 8.1 ng/ml) was clearly distinguishable from plasma ECP (mean 1.0 ng/ml) by a factor of 8 (range: 5.6–11.6). The ECP released during clotting was markedly increased in the atopic dermatitis group (serum:plasma ratio 13.5, p < 0.003) compared with the other groups (6.7 and 5.6). EPX, having a higher plasma level, demonstrated a less pronounced release (serum: plasma ratios 2.0, 1.7 and 1.4), with no statistical difference between donor groups. Considering all donors together the levels of ECP and EPX in plasma and in serum were correlated to the number of eosinophils (coefficients of correlation 0.54-0.58, p < 0.002)

Quality of life in childhood, adolescence and adult food allergy: patient and parent perspectives

Background: Studies of children with food allergy typically only include the mother and have not investigated the relationship between the amount of allergen needed to elicit a clinical reaction (threshold) and health-related quality of life (HRQL). Our aims were (i) to compare self-reported and parent-reported HRQL in different age groups, (ii) to evaluate the impact of severity of allergic reaction and threshold on HRQL, and (iii) to investigate factors associated with patient-reported and parent-reported HRQL. Methods: Age-appropriate Food Allergy Quality of Life Questionnaires (FAQLQ) were completed by 73 children, 49 adolescents and 29 adults with peanut, hazelnut or egg allergy. Parents (197 mothers, 120 fathers) assessed their child's HRQL using the FAQLQ-Parent form. Clinical data and threshold values were obtained from a hospital database. Significant factors for HRQL were investigated using univariate and multivariate regression. Results: Female patients reported greater impact of food allergy on HRQL than males did. Egg and hazelnut thresholds did not affect HRQL, but lower peanut threshold was associated with worse HRQL. Both parents scored their child's HRQL better than the child's own assessment, but whereas mother-reported HRQL was significantly affected by limitations in the child's social life, father-reported HRQL was affected by limitations in the family's social life. Severity of allergic reaction did not contribute significantly to HRQL. Conclusion: The risk of accidental allergen ingestion and limitations in social life are associated with worse HRQL. Fathers provide a unique perspective and should have a greater opportunity to contribute to food allergy research

Green, Yellow, and Red risk perception in everyday life - a communication tool

Background: Adolescents have the highest risk for food allergy-related fatalities. Our main aim was to investigate the level of risk in everyday social situations as perceived by adolescents/young adults with peanut allergy, their families, and their friends. Methods: The web-based ‘Colours Of Risks’ (COR) questionnaire was completed by 70 patients (aged 12–23 years), 103 mothers and fathers, 31 siblings (aged 12–26 years), and 42 friends (aged 12–24 years). COR deals with six main contexts (home, school/university, work, visiting/social activities, special occasions/parties, and vacations), each with 1-12 items. Response categories are green (I feel safe), yellow (I feel uncertain), or red (I feel everything is risky). Results: There was a high level of agreement between participants in defining situations as safe, uncertain, or risky, but female patients and mothers rated fewer situations as safe compared to male patients and fathers. Being with close friends and family, and attending planned parties without alcohol were perceived as situations of low risk. While 94% of patients took an epinephrine auto-injector (EAI) into risky situations, only 65% took it into safe situations. In contrast to the close family, 31% of the friends did not know the patient had an EAI, and fewer knew how to administer the EAI. Conclusion: Young adults with peanut allergy face challenges when moving from the safe home with ready assistance if needed, to independence with unpredictable surroundings and less certain help. Perceived ‘safe’ situations may in fact be the riskiest, as patients often do not take the EAI with them

Should lip dosing be reconsidered when performing open food challenges?

To the Editor, A lip dose or labial food challenge (LFC) is a simple, easy to perform method of diagnosis that could potentially be a convenient alternative to conducting an oral food challenge in children (1). Rance and Dutau (1) published a paper on LFC in 1997 demonstrating their clinical utility, according to the technique described by Moneret-Vautrin et al. (2). This involved a drop of the allergen being placed on the lower lip and left for 10 seconds to two minutes, with the mouth slightly opened. However, in the study by Rance et al. (1), children with positive LFC did not continue to have an oral food challenge (OFC). A subsequent study by Cantani et al.(3) concluded that the LFC should not replace the OFC, but be used at the first step in a food challenge, particularly where there is a risk of anaphylaxis (4). LFCs are not currently included in international food challenge guidelines (5) (7). Here we present data from lip dose reactions in the Food Allergy and Intolerance (FAIR) study from the Isle of Wight in the United Kingdom (UK), with the aim of demonstrating the predictive value of LFCs for diagnosis of food allergy, compared to OFC