BackgroundSkin prick/puncture testing (SPT) is widely accepted as a safe, dependable, convenient, and cost-effective procedure to detect allergen-specific IgE sensitivity. It is, however, prone to influence by a variety of factors that may significantly alter test outcomes, affect the accuracy of diagnosis, and the effectiveness of subsequent immunotherapy regimens. Proficiency in SPT administration is a key variable that can be routinely measured and documented to improve the predictive value of allergy skin testing.MethodsLiterature surveys were conducted to determine the adherence to repeated calls for development and implementation of proficiency testing standards in the 1990’s, the mid-2000’s and the 2008 allergy diagnostics practice parameters.ResultsAuthors publishing clinical research in peer-reviewed journals and conducting workshops at annual scientific meetings have recommended proficiency testing based primarily on its potential to reduce variability, minimize confounding test results, and promote more effective immunotherapeutic treatments. Very few publications of clinical studies, however, appear to report proficiency testing data for SPT performance. Allergen immunotherapy recommendations are updated periodically by the Joint Task Force on Practice Parameters representing the American Academy of Allergy, Asthma and Immunology (AAAAI), the American College of Allergy, Asthma and Immunology (ACAAI), and the Joint Council of Allergy, Asthma and Immunology (JCAAI).ConclusionsDespite consensus that all staff who perform SPT should meet basic quality assurance standards that demonstrate their SPT proficiency, the gap between recommendations and daily practice persists. By embracing standards, the accuracy of SPT and allergy diagnosis can be optimized, ultimately benefiting patients with allergic disease.

Background: Hereditary angioedema (HAE) is often caused by low serum levels or functional deficiency in C1 inhibitor (C1-INH); however, in some cases, C1-INH serum level and function are measured as normal (HAE-nl-C1INH). Management of HAE-nl-C1INH is similar to management of HAE with C1-INH deficiency, including on-demand therapy for angioedema attacks and, potentially, prophylaxis. Recombinant human C1 esterase inhibitor (rhC1-INH) is indicated for treatment of acute HAE attacks. This study assessed the clinical profile and treatment outcomes in an HAE-nl-C1INH population with a history of rhC1-INH treatment.Methods: Medical records containing patient-reported outcomes from ten US treatment centers were analyzed retrospectively for medical history, angioedema attack characteristics, attack treatments, and clinical outcomes.Results: Twenty-three patients were included, with wide US geographic representation. Most patients (87.0%) were female; median age was 36.0 years (range, 19-67 years). Of 20 patients with available data, 4 had their first angioedema attack during childhood (aged <12 years), 3 during adolescence (aged 12-17 years), and 13 during adulthood (aged 18-29 years, n ¼ 7; aged 30 years, n ¼ 6). Median age at HAE-nl-C1INH diagnosis was 31.5 years (range, 9-59 years). Previous failed treatments included high-dose antihistamines (n ¼ 20) and corticosteroids (n ¼ 20). Use of US Food and Drug Administration (FDA)-approved HAE therapy positively impacted patientreported assessments of angioedema attacks. Most patients were taking rhC1-INH or lanadelumab as prophylaxis and icatibant or rhC1-INH for acute management. Most patients reported improved disease control with these therapies, including reductions in angioedema attack frequency and severity. Although most patients were receiving prophylactic therapy, availability of treatment for breakthrough attacks was important. Conclusion:Findings from this retrospective study support use of FDA-approved HAE medications for prophylaxis and acute treatment of HAE attacks in patients with HAE-nl-C1INH. Individualized HAE treatment regimens were needed to optimize therapeutic outcomes.

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SARS-CoV-2, the newest coronavirus, causes COVID-19, a disease that runs the gamut of symptoms from none too mild to severe to death. The severe cases are most often due to acute respiratory distress. In addition to pulmonary symptoms, the virus causes a wide variety of pathological manifestations involving multiple other systems, including eliciting an exaggerated immune response that contributes to fatalities. The elderly are at the highest risk of severe disease. Higher mortality is seen among males, along with individuals with pre-existing comorbidities such as cardiovascular disease and diabetes, among others. Although pregnancy has not been identified as a risk factor yet, more research is needed to assess vertical transmission and strict perinatal precautions are recommended to minimize infecting newborns. Although COVID-19 in children is less likely to be severe, recent cases, albeit rare, have emerged of a multiorgan inflammatory syndrome, similar to Kawasaki disease. Early diagnosis can be done using molecular tests that detect viral genome, while cases manifesting late symptoms can be detected using serological tests looking for antibodies. Although there are no FDA-approved vaccines or therapeutics for prophylaxis, there are many viable vaccine candidates either in clinical trials or awaiting study in humans. Of the several drugs being considered for treatment, some target the virus, while others address the host factors that facilitate virus infection, from proteases that enable virus entry, to cytokines that elicit a harmful and out-of-control immune response. While we await a standardized prophylactic regimen, it is our collective responsibility to continue engaging in prevention measures.