mRNA COVID-19 vaccine is well tolerated in patients with cutaneous and systemic mastocytosis with mast cell activation symptoms and anaphylaxis

Mastocytosis encompasses a heterogeneous group of diseases characterized by the presence of clonal mast cells (MCs) in tissues and symptoms of MC activation, including anaphylaxis.1 Vaccination has been shown to cause exacerbation of MC mediator-related symptoms.2 Vaccines against coronavirus disease 2019 (COVID-19) are the solution to the current pandemic, but reports of anaphylaxis following vaccination with the BNT162b2 Pfizer-BioNTech mRNA vaccine have emerged.3 As such, it is important to provide evidence of the safety of mRNA vaccines in populations at risk for anaphylaxis, including patients with mastocytosis and MC activation symptoms

Real-world evidence on the risk of cancer with anti-IL-5 and anti-IL-4Ra biologicals

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Hypersensitivity to the Moderna COVID-19 vaccine caused by tromethamine: PEG is not always the culprit excipient

Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are considered the cornerstone of the solution to the current global pandemic. The first vaccines to receive authorization for emergency use in humans were the BNT162b2 Pfizer-BioNTech and the mRNA-1273 Moderna vaccines. Both contain synthetic mRNA that codes for the SARS-CoV-2 spike (S) protein, which is encased in a lipid nanoparticle envelope. Anaphylaxis and immediate hypersensitivity reactions were noted in only 1 case during phase III trials for BNT162b2, while no immediate hypersensitivity reactions were noted for the mRNA-1273 vaccine. However, a history of hypersensitivity to any component of the vaccines was an exclusion criterion. Nonetheless, cases of anaphylaxis were reported shortly after initiation of the vaccination campaign

An Algorithm for the Continuous Morlet Wavelet Transform

This article consists of a brief discussion of the energy density over time or frequency that is obtained with the wavelet transform. Also an efficient algorithm is suggested to calculate the continuous transform with the Morlet wavelet. The energy values of the Wavelet transform are compared with the power spectrum of the Fourier transform. Useful definitions for power spectra are given. The focus of the work is on simple measures to evaluate the transform with the Morlet wavelet in an efficient way. The use of the transform and the defined values is shown in some examples.Comment: 15 pages, 4 figures, revised for MSS

COVID-19 Vaccination Is Safe among Mast Cell Disorder Patients, under Adequate Premedication

Reported cases of anaphylaxis following COVID-19 vaccination raised concerns about the safety of these vaccines, namely in patients suffering from clonal mast cell (MC) disorders—a het-erogenous group of disorders in which patients may be prone to anaphylaxis caused by vaccination. This study aimed to assess the safety of COVID-19 vaccines in patients with clonal MC disorders. We performed an ambidirectional cohort study with 30 clonal MC disorder patients (n = 26 in the prospective arm and n = 4 in the retrospective arm), that were submitted to COVID-19 vaccination. Among these, 11 (37%) were males, and median age at vaccination date was 41 years (range: 5 y to 76 y). One patient had prior history of anaphylaxis following vaccination. Those in the prospective arm received a premedication protocol including H1-and H2-antihistamines and montelukast, while those in the retrospective arm did not premedicate. Overall, patients received a total of 81 doses, 73 under premedication and 8 without premedication. No MC activation symptoms were reported. COVID-19 vaccination seems to be safe in patients with clonal mast cell disorders, including those with prior anaphylaxis following vaccination. Robust premedication protocols may allow for vaccination in ambulatory settings. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.This research received no external funding. Article processing charges were paid by the IAPorto Research Center

Mastocytosis presenting with mast cell-mediator release-associated symptoms elicited by cyclo oxygenase inhibitors: prevalence, clinical, and laboratory features

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently avoided in mastocytosis, because of a potential increased risk for drug hypersensitivity reactions (DHRs) due to inhibition of cyclo-oxygenase (COX), subsequent depletion of prostaglandin E2 and release of leukotrienes. Objectives: Here, we aimed at determining the prevalence of mast cell (MC) mediator release symptoms triggered by NSAIDs in mastocytosis patients and the associated clinical and laboratory features of the disease. Methods: Medical records from 418 adults to 223 pediatric mastocytosis patients were retrospectively reviewed. Patients were classified according to tolerance patterns to NSAIDs and other COX inhibitors (COXi) and compared for epidemiological, clinical and laboratory findings. Results: Overall, 87% of adults and 91% of pediatric patients tolerated NSAIDs and other COXi. Among adult and pediatric patients presenting DHRs, 5% and 0% reacted to multiple NSAIDs, 4% and 0.7% were single reactors, and 3% and 8% were single reactors with known tolerance to paracetamol but unknown tolerance to other COXi, respectively. Among adults, hypersensitivity to ≥2 drugs was more frequent among females (p = 0.009), patients with prior history of anaphylaxis to triggers other than NSAIDs or other COXi and Hymenoptera venom (p = 0.009), presence of baseline flushing (p = 0.02), baseline serum tryptase ≥48 ng/ml (p = 0.005) and multilineage KIT mutation (p = 0.02). In contrast, tolerance to NSAIDs and other COXi was more frequent among males (p = 0.02), in patients with anaphylaxis caused by Hymenoptera venom (p = 0.02), among individuals who had skin lesions due to mastocytosis (p = 0.01), and in cases that had no baseline pruritus (p = 0.006). Based on these parameters, a score model was designed to stratify mastocytosis patients who have never received NSAIDs or other COXi apart from paracetamol, according to their risk of DHR. Conclusions: Our results suggest that despite the frequency of MC mediator related symptoms elicited by NSAIDs and other COXi apart from paracetamol is increased among mastocytosis patients versus the general population, it is lower than previously estimated and associated with unique disease features. Patients that tolerated NSAIDs and other COXi following disease onset should keep using them. In turn, adults with unknown tolerance to such drugs and a positive score should be challenged with a preferential/selective COX-2 inhibitor, while the remaining may be challenged with ibuprofen. © 2022 The Authors. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.Funding text 1: This work was supported by grants from the Carlos III Health Institute co‐financed by the European Regional Development Fund (PI19/01166) and CIBERONC CB16/12/00400, Ministerio de Ciencia e Innovación (Madrid, Spain), Asociación Española de Mastocitosis y Enfermedades Relacionadas (AEDM 2019), Fondos de Investigación para Enfermedades Raras del Ministerio de Sanidad, Servicios Sociales e Igualdad (Madrid, Spain). ; Funding text 2: This work was supported by grants from the Carlos III Health Institute co-financed by the European Regional Development Fund (PI19/01166) and CIBERONC CB16/12/00400, Ministerio de Ciencia e Innovación (Madrid, Spain), Asociación Española de Mastocitosis y Enfermedades Relacionadas (AEDM 2019), Fondos de Investigación para Enfermedades Raras del Ministerio de Sanidad, Servicios Sociales e Igualdad (Madrid, Spain)

Counterfactual thinking in cooperation dynamics

Counterfactual Thinking is a human cognitive ability studied in a wide variety of domains. It captures the process of reasoning about a past event that did not occur, namely what would have happened had this event occurred, or, otherwise, to reason about an event that did occur but what would ensue had it not. Given the wide cognitive empowerment of counterfactual reasoning in the human individual, the question arises of how the presence of individuals with this capability may improve cooperation in populations of self-regarding individuals. Here we propose a mathematical model, grounded on Evolutionary Game Theory, to examine the population dynamics emerging from the interplay between counterfactual thinking and social learning (i.e., individuals that learn from the actions and success of others) whenever the individuals in the population face a collective dilemma. Our results suggest that counterfactual reasoning fosters coordination in collective action problems occurring in large populations, and has a limited impact on cooperation dilemmas in which coordination is not required. Moreover, we show that a small prevalence of individuals resorting to counterfactual thinking is enough to nudge an entire population towards highly cooperative standards.Comment: 18 page

Bone and Cytokine Markers Associated With Bone Disease in Systemic Mastocytosis

Background Mastocytosis encompasses a heterogeneous group of diseases characterized by tissue accumulation of clonal mast cells, which frequently includes bone involvement. Several cytokines have been shown to play a role in the pathogenesis of bone mass loss in systemic mastocytosis (SM), but their role in SM-associated osteosclerosis remains unknown. Objective To investigate the potential association between cytokine and bone remodeling markers with bone disease in SM, aiming at identifying biomarker profiles associated with bone loss and/or osteosclerosis. Methods A total of 120 adult patients with SM, divided into 3 age and sex-matched groups according to their bone status were studied: (1) healthy bone (n = 46), (2) significant bone loss (n = 47), and (3) diffuse bone sclerosis (n = 27). Plasma levels of cytokines and serum baseline tryptase and bone turnover marker levels were measured at diagnosis. Results Bone loss was associated with significantly higher levels of serum baseline tryptase (P = .01), IFN-γ (P = .05), IL-1β (P = .05), and IL-6 (P = .05) versus those found in patients with healthy bone. In contrast, patients with diffuse bone sclerosis showed significantly higher levels of serum baseline tryptase (P < .001), C-terminal telopeptide (P < .001), amino-terminal propeptide of type I procollagen (P < .001), osteocalcin (P < .001), bone alkaline phosphatase (P < .001), osteopontin (P < .01), and the C-C Motif Chemokine Ligand 5/RANTES chemokine (P = .01), together with lower IFN-γ (P = .03) and RANK-ligand (P = .04) plasma levels versus healthy bone cases. Conclusions SM with bone mass loss is associated with a proinflammatory cytokine profile in plasma, whereas diffuse bone sclerosis shows increased serum/plasma levels of biomarkers related to bone formation and turnover, in association with an immunosuppressive cytokine secretion profile.This study was supported by grants from the Instituto de Salud Carlos III (ISCIII, Spain) (PI19/01166, CIBERONC: CB16/12/00400) and Fondo Europeo de Desarrollo Regional (FEDER) (EQC2019-005419-P), within the Subprograma Estatal de Infraestructuras de Investigación y Equipamiento Científico Técnico de 2019 del Ministerio de Ciencia, Innovación y Universidades, Fundación Española de Mastocitosis (FEM, Madrid, Spain ref.: FEM2019-MAGPIX and FEM2021-SAM); Asociación Española de Mastocitosis y Enfermedades Relacionadas (AEDM-CTMC-2019). We also thank the Biobank at the Hospital Virgen de la Salud (BioB-HVS) No. B.0000520, Toledo, Spain. TAR was supported by the 2019 European Academy of Allergy and Clinical Immunology Research Fellowship award. We thank our patients for their willingness to participate in this study

A method for studying decision-making by guideline development groups

Background: Multidisciplinary guideline development groups (GDGs) have considerable influence on UK healthcare policy and practice, but previous research suggests that research evidence is a variable influence on GDG recommendations. The Evidence into Recommendations (EiR) study has been set up to document social-psychological influences on GDG decision-making. In this paper we aim to evaluate the relevance of existing qualitative methodologies to the EiR study, and to develop a method best-suited to capturing influences on GDG decision-making.Methods: A research team comprised of three postdoctoral research fellows and a multidisciplinary steering group assessed the utility of extant qualitative methodologies for coding verbatim GDG meeting transcripts and semi-structured interviews with GDG members. A unique configuration of techniques was developed to permit data reduction and analysis.Results: Our method incorporates techniques from thematic analysis, grounded theory analysis, content analysis, and framework analysis. Thematic analysis of individual interviews conducted with group members at the start and end of the GDG process defines discrete problem areas to guide data extraction from GDG meeting transcripts. Data excerpts are coded both inductively and deductively, using concepts taken from theories of decision-making, social influence and group processes. These codes inform a framework analysis to describe and explain incidents within GDG meetings. We illustrate the application of the method by discussing some preliminary findings of a study of a National Institute for Health and Clinical Excellence (NICE) acute physical health GDG.Conclusion: This method is currently being applied to study the meetings of three of NICE GDGs. These cover topics in acute physical health, mental health and public health, and comprise a total of 45 full-day meetings. The method offers potential for application to other health care and decision-making groups