Background Sars‐CoV‐2 infections are hazardous, especially to the elderly and patients with comorbidities. With no efficient treatment available, newly developed vaccines are the only way to change the course of the pandemic. However, reports of allergic reactions resulted in some patients and practicing physicians being concerned about the safety of vaccine administration, particularly in people with severe anaphylactic reactions to multiple or unknown factors in their medical history. This study aimed to develop an allergic work‐up protocol based on skin prick tests (SPT), intradermal testing (IDT) and intramuscular provocations, and desensitisation which may contribute to diagnosis and management of anti‐COVID‐19 vaccine allergy. Methods Two hundred and eighty‐five patients were enrolled. Two hundred and five of them entered the study based on severe anaphylactic reaction to unknown or multiple factors in their medical history which disqualified them for standard treatment. Another 80 patients were enrolled after developing an allergic reaction to the first dose of one such vaccine. In all subjects, SPT and IDT were performed. Serum tryptase was assessed in 79 patients randomly chosen from the study group. Results Two hundred and seventy‐seven patients with negative tests were given a vaccine without complications. Seven patients had positive skin tests. In two cases, tests confirmed Comirnaty allergy, while the other five confirmed solely skin sensitisation with no exposure prior to the study. Six patients with positive tests received titrated challenge using desensitisation protocol with a reasonable tolerance. One patient did not consent to desensitisation and one patient resigned despite negative tests. Overall, 283 (99%) patients were vaccinated using this newly developed protocol. Patients with adverse reactions to the first dose of the vaccine before the study had a significantly lower basal serum tryptase concentration (p = 0.001). Conclusion Skin tests with anti‐COVID‐19 vaccines are a useful tool in the vaccination protocol. This protocol enables safe immunisation of high‐allergy‐risk patients even in cases of positive skin tests.
In the face of increasing prevalence of hypersensitivity reactions, introduction of effective, reliable and safe methods plays a crucial role in their diagnosing. Among the currently available laboratory (in vitro) methods is basophil activation test (BAT). It is a flow- cytometry based assay that allows to identificate in the blood sample basophils and additionally to asses the degree of cell activation after exposure to an antigen. The most common superficial identification markers are CD63 and CD203c, which increase in number after activation. Basophil actvation test can be applied to confirm diagnosis of allergy to Hymenoptera venoms, food, pollens and hypersensitivity to drugs. The aim of present paper is to present theoretical methods of this test as well as its pros and cons. We focus also on presentation of clinical case where BAT seemed to be a necessary addition to a routine diagnostic pathway. We present a case of identification of the culprit drug which caused an anaphylactic reaction.
Background: Sodium metabisulfite is a recognized, but rare, trigger of urticaria, wherein the IgE mechanism has been sporadically proven. The aim of this study was to identify the potential reaction to sodium metabisulfite (MBS) based on a placebo-controlled oral challenge in patients with urticaria and suspected hypersensitivity to food additives. Materials and Methods: A total of 110 adult patients (76 females and 34 males with a mean age of 46 years) were included in the study between 2017 and 2019. All subjects underwent MBS skin prick tests (SPT) and patch tests (PT). Patients with a positive skin test or suspected MBS hypersensitivity were qualified for a placebo-controlled oral challenge (OC). Results: Skin testing was positive in 24 patients: SPT in 20% (n = 22), PT in 5% (n = 6). Out of 64 oral challenges, 13 positive results were obtained. Patients with a positive challenge typed sulfite foods twice as often as a culprit compared to those with a negative OC. Conclusions: In patients with urticaria, both the IgE and non-IgE mechanism of MBS hypersensitivity has been demonstrated. Skin tests with a detailed medical history of potentially guilty foods may be helpful in determining sulfite hypersensitivity.
Introduction The role of azo dyes in urticaria is not fully understood. Aim To assess the incidence rate of hypersensitivity reactions to food azo dyes based on a placebo-controlled oral challenge in a group of patients with suspected urticaria exacerbation after consuming food additives. Material and methods The study included patients over 18 years of age with chronic urticaria, in whom hypersensitivity to food additives was suspected based on a questionnaire and medical history. Patients suspected of urticaria exacerbations after ingestion of azo dyes were enrolled in a placebo-controlled single-blind oral challenge (OC) with a mixture of azo food dyes: tartrazine, Quinoline Yellow, Sunset Yellow, Cochineal Red, Allura Red, and azorubine. Results Out of 110 patients (76 women and 34 men, mean age 46.1 (20–76 years), 39 patients were qualified for the oral challenge. We observed two subjects (5.1%) with a positive result. Conclusions Azo dyes ingested in food or medications incidentally cause urticaria but may exacerbate its course. Oral challenge-confirmed hypersensitivity to azo dyes is much less common than reported by patients.
Introduction Carmine, a commonly used natural red dye, can cause immediate and delayed allergic reactions, which are frequently overlooked. Aim To assess the incidence of carmine allergy and its clinical significance based on the placebo-controlled oral challenge in urticaria patients and suspected hypersensitivity to food additives. Material and methods Patients’ histories were recorded by means of a standardized questionnaire. The subjects underwent skin prick tests and patch tests for carmine, while the level of specific IgE was measured in 52 patients. The patients with at least one positive carmine test or with suspected hypersensitivity to carmine were suggested to undergo a placebo-controlled oral challenge test. Results One hundred and ten patients were enrolled in the study. Carmine skin testing was positive in 22 patients: skin prick tests were positive in 17% ( n = 19), while patch tests were doubtful in 6% ( n = 6). In 25/52 patients, the level of specific IgE was min. 0.01 kU/l. Oral challenge was performed in 33 subjects. Allergy to carmine was diagnosed in 9 (8%) patients; all of them suffered from chronic inducible urticaria. Conclusions Carmine is a potential allergen in patients with chronic inducible urticaria especially with concomitant systemic symptoms. Skin tests and specific IgE level measurement may be helpful tools to diagnose E120 hypersensitivity.
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