Search Results (22)

Pantothenic acid (PA; vitamin B5) is an essential component of many key metabolic processes. Vitamin B5 deficiency causes dysfunction in various systems and organs. Humans do not produce vitamin B5, so it must be constantly replenished through diet or supplementation. Pantothenic acid is synthesized by plants, fungi, and bacteria, so a well-balanced diet is a good source of pantothenic acid. Pantothenates have beneficial effects on the skin (regenerative, healing, and anti-inflammatory effects). They are readily absorbed through the skin, making them a common active ingredient in cosmetics and medications with soothing, healing, regenerative, moisturizing, and protective properties for damaged, sensitive, or atopic skin, including topical products labeled hypoallergenic or specifically intended for people with sensitive skin. Although PA is considered non-allergenic and safe, paradoxically, frequent exposure, especially to damaged skin, appears to lead to hypersensitivity to this substance. The pathogenetic mechanisms of pantothenate hypersensitivity have not been clearly defined. The main sensitization pathway is likely a delayed cellular mechanism (type IV, contact). However, other types of hypersensitivity, including immediate (type I) and mixed mechanisms, cannot be ruled out. PA allergy is considered rare and therefore difficult to diagnose. This is due to the unexpected sensitizing factor and the lack of standard diagnostic tests. Due to the likely contact nature of the allergy, patch testing (PT) with a cosmetic (drug) provided by the patient (“as is”) and PA (5% in petrolatum; 5% PET) appears to be the best approach. It is also suggested that PA (5% PET>) be included in the standard series of allergens (haptens) used in routine PT diagnostics. It appears that PA allergy is more common than currently believed, particularly in people with atopic skin and polysensitized individuals, who are the primary users of products containing pantothenate. It is possible that in these individuals, pantothenic acid may be more harmful than beneficial. Full article

Allergic anisakiasis (AA), caused by the ingestion of fish contaminated with Anisakis larvae, has emerged as a growing global health concern due to the increasing consumption of raw or undercooked seafood. Anisakis simplex is identified as the primary etiologic species, responsible for gastrointestinal symptoms, IgE-mediated (Type I) or cell-mediated (Type IV) manifestations, and gastro-allergic anisakiasis (GAA), a unique clinical overlap between parasitic infection and acute IgE-mediated food allergy. In this review, we analyzed the epidemiology of Anisakis simplex allergy, the main diagnostic methods to confirm a diagnosis of food allergy, its clinical manifestations, and how these differ in different countries around the world. This multidisciplinary synthesis provides, for the first time, an integrated understanding of Anisakis-induced disease mechanisms across human, animal, and cellular levels. The persistence of allergenic proteins despite standard food processing underscores the need for improved diagnostic tools, public health surveillance, and preventive strategies—particularly in populations with high seafood consumption or occupational exposure. A comprehensive approach combining clinical, molecular, and immunological perspectives is essential to address the expanding global burden of allergic anisakiasis. Full article

Honeybee products (HBPs), including honey, bee pollen, bee bread, royal jelly, propolis, beeswax, and bee brood, are increasingly used in food, nutraceutical, and cosmetic contexts. Because of their natural origin, HBPs can provoke allergic reactions ranging from localised dermatitis to life-threatening, systemic anaphylaxis. As the use of bee products for health purposes grows in apitherapy (a branch of alternative medicine), raising public awareness of their potential risks is essential. This narrative review synthesises the clinical manifestations of HBP allergy, culprit allergens present in each product, immunological mechanisms, diagnostic approaches, at-risk populations, and knowledge gaps. The analysis of the available literature suggests that, although relatively rarely, HPB may trigger allergic reactions, including anaphylactic shock. The sensitisation mechanism may be associated with both primary sensitisation and cross-reactivity and can be classified into type I (IgE-mediated) and type IV (T-cell-mediated). However, bee bread appears less allergenic than other HBPs, potentially due to lactic fermentation that can degrade allergenic proteins. Severe reactions following intake of bee bread have not been reported to date. Management of HBP allergic reactions centres on avoiding the products, educating about the risks, and providing more precise product labelling, specifying the allergen content. Individuals with atopy and beekeepers are at heightened risk of developing anaphylaxis; therefore, they should be particularly aware of the potential dangerous consequences of HPB use. Further research is needed to clarify the mechanisms of HBP allergies and improve safety for all users. Full article

Reliable quality of epicutaneous patch test (PT) preparations is a prerequisite for establishing a robust diagnosis in patients with suspected allergic contact dermatitis due to delayed-type sensitization. It is difficult to identify potential quality issues in daily practice, since confirmatory methods are lacking and assessment of PT-relevance is predominantly based on patients’ history and exposure. The quality of PT products can be affected, e.g., by the properties of the active substance, an insufficient development of the PT preparation or issues during manufacturing. Resulting quality deficiencies can cause both false-negative and false-positive test results. As PT preparations are medicinal products according to Directive 2001/83/EC, they require a marketing authorization (MA) entailing assessment of quality, safety and efficacy by the competent authorities. The corresponding product dossier is the basis for MA. It is continuously updated, e.g., upon change of a source material supplier, ensuring comparability of the respective product over time. Compliance with regulatory requirements is a crucial foundation for sustainable quality to prevent product deficiencies, ensuring reliable test results in practice. Harmonization across the EU is important to ensure the widespread availability of high-quality PT products. This review presents the MA requirements of PT preparations in the EU, as well as challenges previously reported by physicians. Full article

Background: Although allergic reactions to amide local anesthetics (LA) are rare, it is important for medical professionals to be aware of their potential occurrence. Despite the fact that articaine is one of the most commonly used LA in dentistry, a survey of documented cases of allergies to articaine is absent from the literature. The objective of this review was to ascertain how often true allergies to articaine, verified by standard allergological procedures, have been reported over the last 25 years. Methods: A comprehensive review of the literature from 1 January 2000 to 31 December 2024 was conducted using the PubMed-MEDLINE database. The search was limited to articles investigating suspected allergy to articaine. The search strategy encompassed indexing terms, keywords, and free-text words, complemented by an extensive manual search. The final determination was based on the application of skin and/or challenge tests as the gold standard for identifying articaine as the causative agent. Results: During the investigation period, 10 case reports and six case series, encompassing 29 patients with a confirmed true allergy to articaine, were identified. The age of the patients ranged from 8 to 65 years, with a median age of 34 years. Of these patients, 20 were diagnosed with an immediate type I allergy, while 5 patients exhibited a delayed type IV allergy. In four cases the specific type of allergy was not mentioned. In the majority of cases an intradermal test (IDT) was employed to ascertain the specific type of allergy. Cross-reactivity with other amide LA was reported in three cases. Conclusions: True allergies to articaine are exceedingly rare. Investigation strategies should include a combination of a thorough clinical history and a standardized allergological procedure entailing skin tests and challenge. Only a comprehensive approach ensures the accurate identification of affected patients and facilitates the selection of a tolerated LA. Full article

Background/Objectives: Functional gastrointestinal disorders (FGIDs) affect children’s daily activities and overall performance due to gastrointestinal symptoms. This study assesses the prevalence and types of FGIDs in children living in Jeddah City and its countryside. It also examines factors that contribute to the incidence of these disorders and their impact on children’s lifestyles. Methods: This cross-sectional study was conducted among 285 mothers of preschool children enrolled in kindergartens during the academic year 2020–2021. The Rome IV Diagnostic Questionnaire was sent out online through kindergartens to be filled out by the children’s mothers. The questionnaire assessed the prevalence of FGIDs subjectively through symptoms and their frequency. Results: Among the 285 participants, 9% (n = 27) fit the diagnostic criteria for FGIDs. Common FGIDs included functional constipation, 3.5% (n = 10); postprandial distress syndrome, 2.4% (n = 7); functional abdominal pain—not otherwise specified, 1% (n = 3); and functional epigastric pain, 0.7% (n = 2). Significant risk factors for developing FGIDs among the children in the sample included being a preterm baby (p < 0.01), being previously diagnosed with a gastrointestinal condition (p < 0.010), having a family history of diarrhea or nausea and vomiting (p < 0.001 and p < 0.01, respectively), skipping lunch at kindergarten (p < 0.01), and having pre-existing food allergies (p < 0.01). Conclusions: FGIDs were prevalent among 9% of children in Jeddah City and its countryside. Functional constipation was the most common disorder. Factors associated with FGIDs in children included preterm birth, being previously diagnosed with a GI condition, a family history of gastrointestinal conditions, irregular eating habits, and food allergies. Full article

Background: Beta-lactam (BL) antibiotics are among the most prescribed groups of drugs worldwide and have been implicated in a variety of allergic reactions. There is a paucity of literature regarding patient adherence to prescribed instructions following comprehensive allergy assessments. Objective: The objective was to follow up the clinical course of BL allergy in patients who underwent thorough allergological investigation for suspected BL allergy at a tertiary hospital and ascertain patients’ compliance with the provided written instructions. Materials: An observational study in patients referred for suspected BL allergy who underwent a comprehensive allergy workup (in vivo ± in vitro tests, DPT in culprit and/or alternative BL) and who subsequently received written instructions was conducted. Data on the nature of the reported drug hypersensitivity reaction, the culprit BL drug, the allergological workup, and the detailed instructions provided in a written drug allergy report were collected retrospectively. Patients’ compliance with the instructions was recorded by a telephone survey using a pre-defined questionnaire. Results: Among the 212 patients meeting the inclusion criteria, 87 patients (72.4% women; mean age 50.1 years; age range 6–84 years) responded to the telephone survey and were included in this study. Surprisingly, 45 out of 87 (51.7%) patients did not adhere to the written instructions. The primary factor contributing to non-compliance was the fear of re-occurrence of a drug-induced allergic reaction (personal and/or triggered by their treating physician reluctance), accounting for 77.7% of cases. The analysis demonstrated that the initial reaction’s severity and type, as well as the outcomes of skin testing, did not correlate with compliance to instructions (p > 0.05). Surprisingly enough, a drug provocation test (DPT), irrespectively of the result, emerged as a negative predictor for adherence, with only 40.6% of DPT patients complying compared to 77.8% of those who did not undergo DPT (p = 0.005; odds ratio = 0.195; 95% confidence interval: 0.058–0.655). Variables such as performing DPT with alternative or incriminated drugs or the result of the DPT (positive–negative) were not associated with patient compliance. Conversely, the type of instructions provided exhibited a noteworthy correlation with compliance. Patients who were explicitly instructed to entirely avoid all BL antibiotics demonstrated markedly higher adherence rates (83.3%) compared to those who were advised to have a partial or complete release of BLs (31.8% and 58.1%, respectively; p < 0.05). Notably, among compliant patients who received either the original culprit drug or the alternative (32 out of 87, 36.7%), no allergic reactions were reported. In contrast, among the 12 patients with written avoidance of all BLs, subsequent BL intake led to immediate reactions (Grade I and IV) in 2 patients (16.6%). Conclusions: A notable disparity in patient adherence to written instructions prohibiting or releasing beta-lactams was demonstrated. Less than half of the patients ultimately complied with the provided instructions, underscoring the need for tailored patients’ education and strategies to improve adherence in the management of suspected BL allergy. Full article

Drug hypersensitivity reactions can be classified as immediate or delayed. While diagnostic options for immediate reactions are well developed and standardized, delayed reactions (in many cases type IV according to Gell and Coombs) are a challenge for allergy work-up. In recent years, some in vitro markers have been proposed and used for delayed reactions, such as contact dermatitis. Primary strategy: Avoidance is difficult to achieve, especially for COVID-19 vaccinations, when immunity against infection is extremely important. The aim of our study was to evaluate the application of in vitro delayed hypersensitivity tests in COVID-19 vaccines. Seven patients with a positive history of severe delayed drug allergy were enrolled. Vein blood was collected to stimulate cells with the tested vaccines (Comirnaty, Janssen, Spikevax) and excipients with the assessment of CD40L, CD69, IL-2, IL-4, IL-6, IL-10, IFNgamma, TNFalfa, and intracellular markers: granulysin and INFgamma. In addition, basophile activation tests, patch tests, skin prick tests, and intradermal tests were performed with the tested vaccine. Finally, the decision was made to either administer a vaccine or resign. Two out of seven patients were considered positive for drug hypersensitivity in the in vitro test according to the high vaccine stimulation index measured with CD69 (6.91 and 12.18) and CD40L (5.38 and 15.91). All patch tests, BATs, and skin tests were negative. Serum interleukin measurements were inconclusive as the impact of the vaccine itself on the immunity system was high. Intracellular markers gave uncertain results due to the lack of stimulation on the positive control. CD69 and CD40L could be reliable in vitro markers for delayed hypersensitivity to COVID-19 vaccines. Patch tests, skin tests, BATs, and serum interleukins did not confirm their usefulness in our study. Full article

Today, laws protecting the population at the global level aim to minimize the induction risk of allergies to type IV contact dermatitis. In the European population, the prevalence of nickel allergy is at 10%–15% of adult females and 1%–3% of adult males. A total of 30% of nickel-sensitive people in the general population develop hand eczema. This study concerns the possibility of assembling a bottom of nickel-free austenitic steel (Panacea^®) in a watch case middle made of a grade of austenitic steels, steel 316L (DIN 1.44359), to avoid the risks of Ni release and to develop a galvanic pile between these two dissimilar materials. Two types of methods were used: direct measurements and prediction techniques (mixed potentials theory). For the degradation of thbottom-middle watch assembly, Nielsen–Tuccillo tests were performed, and Ni release measurements according to EN 1811 completed the study. All direct electrochemical investigations and galvanic current prediction measurements show low current values of 40–400 nA. Measurements of nickel release of Panacea^® and 316L reveal small quantities of nickel, much lower than the 0.5 µg/cm² per week that the European legislation enforces. The nickel-free steel Panacea^® in the work hardening conditions 280, 427, and 510 HV0.1s were also studied. The cation extractions reveal the large quantities released from Cr, Mo, Mn, and Fe, so there is a risk of toxicity in contact with the skin. Full article

Natural rubber (NR) gloves manufactured from NR latex are widely utilized in various applications as a personal protective device due to their exceptional barrier characteristics in infection control. However, the use of NR gloves was associated with concerns on NR protein allergy. With comprehensive leaching procedures now a common practice in NR latex glove factories to eliminate latent rubber proteins and chemical allergens, occurrences and complaints of protein allergy from medical glove users have decreased drastically over the past two decades. The present work aims to eliminate further the residual rubber allergens in NR latex through effective purification of the NR latex and compounding the thus purified latex with an established formulation for allergy-free NR for glove applications. NR latex was purified by deproteinization and saponification, respectively. Several analytical techniques were used to verify rubber allergens eliminated in the purified latexes. Saponified NR (SPNR) latex was the purified NR latex of choice since it is devoid of allergenic proteins and poses the lowest risk of Type I allergy. The purified NR latex was compounded with zinc diethyldithiocarbamate (ZDEC), zinc dibutyldithiocarbamate (ZDBC), and zinc 2-mercaptobenzothiazole (ZMBT), respectively, for glove dipping. Among the investigated accelerators, only ZDBC was not detected in the artificial sweat that came into contact with the dipped articles. Thus, it is deduced that ZDBC poses the lowest risk of Type IV allergy to consumers. Additionally, the morphological and physical properties of dipped articles were assessed. It was revealed that the dipped film from the SPNR latex compounded with ZDBC provided thinner and less yellow products with a more uniform internal structure and a tensile strength comparable to those of commercial NR gloves. Full article

Background: Alongside metabolic diseases (esp. obesity), allergic disorders are becoming increasingly prevalent. Since both obesity and allergies are highly impacted by environmental determinants, with this study we assessed the potential link between metabolic implications and two distinct types of allergies. Methods: Using cross-sectional data from the German FoCus cohort, n = 385 allergy cases, either hay fever (=type I allergy, n = 183) or contact allergy (=type IV allergy, n = 202) were compared to age- and sex-matched healthy control subjects (1:1 ratio, in total n = 770) regarding their metabolic phenotype, diet, physical activity, sleep, gut microbial composition, and serum metabolite profile using suitable BMI-adjusted models. Results: Obesity and metabolic alterations were found significantly more prevalent in subjects with allergies. In fact, this relation was more pronounced in contact allergy than hay fever. Subsequent BMI-adjusted analysis reveals particular importance of co-occurring hyperlipidaemia for both allergy types. For contact allergy, we revealed a strong association to the dietary intake of poly-unsaturated fatty acids, particularly α-linolenic acid, as well as the enrichment of the corresponding metabolic pathway. For hay fever, there were no major associations to the diet but to a lower physical activity level, shorter duration of sleep, and an altered gut microbial composition. Finally, genetic predisposition for hyperlipidaemia was associated to both contact allergy and hay fever. Conclusions: Reflected by higher allergy prevalence, our findings indicate an impaired immune response in obesity and hyperlipidaemia, which is differentially regulated in type I and type IV allergies by an unfavourable lifestyle constellation and subsequent microbial and metabolic dysfunctions. Full article

Vaccines constitute the most effective medications in public health as they control and prevent the spread of infectious diseases and reduce mortality. Similar to other medications, allergic reactions can occur during vaccination. While most reactions are neither frequent nor serious, anaphylactic reactions are potentially life-threatening allergic reactions that are encountered rarely, but can cause serious complications. The allergic responses caused by vaccines can stem from activation of mast cells via Fcε receptor-1 type I reaction, mediated by the interaction between immunoglobulin E (IgE) antibodies against a particular vaccine, and occur within minutes or up to four hours. The type IV allergic reactions initiate 48 h after vaccination and demonstrate their peak between 72 and 96 h. Non-IgE-mediated mast cell degranulation via activation of the complement system and via activation of the Mas-related G protein-coupled receptor X2 can also induce allergic reactions. Reactions are more often caused by inert substances, called excipients, which are added to vaccines to improve stability and absorption, increase solubility, influence palatability, or create a distinctive appearance, and not by the active vaccine itself. Polyethylene glycol, also known as macrogol, in the currently available Pfizer-BioNTech and Moderna COVID-19 mRNA vaccines, and polysorbate 80, also known as Tween 80, in AstraZeneca and Johnson & Johnson COVID-19 vaccines, are excipients mostly incriminated for allergic reactions. This review will summarize the current state of knowledge of immediate and delayed allergic reactions in the currently available vaccines against COVID-19, together with the general and specific therapeutic considerations. These considerations include: The incidence of allergic reactions and deaths under investigation with the available vaccines, application of vaccination in patients with mast cell disease, patients who developed an allergy during the first dose, vasovagal symptoms masquerading as allergic reactions, the COVID-19 vaccination in pregnancy, deaths associated with COVID-19 vaccination, and questions arising in managing of this current ordeal. Careful vaccine-safety surveillance over time, in conjunction with the elucidation of mechanisms of adverse events across different COVID-19 vaccine platforms, will contribute to the development of a safe vaccine strategy. Allergists’ expertise in proper diagnosis and treatment of allergic reactions is vital for the screening of high-risk individuals. Full article

The main food-origin antigens that the infant’s body is in contact with are cow’s milk proteins (CMP). Still, CMP are one of the main sources of beneficial biologically active peptides that play a role in treatment of non-communicable diseases. Safe methods to quickly predict the sensitizing potential of food proteins among their range of health-promoting properties are essential. The aim of study was to adapt an integrated approach combining several in silico (IS) studies and in vitro (IV) assays to screen the multifunctionality of CMP-derived peptides. Major histocompatability complex type II MHC II-binders, interleukin-4 and -10 inducers, interferon γ -inducers and immunobioactivity tools were used to predict the peptide-power of inducing allergies or tolerance. A comparison of the peptide profiless revealed the presence of one identical and one overlapping sequence in IS and IV hydrolysate. By IS analysis, four of 24 peptides were found to have high affinity and stimulate IL-4 expression, and by IV, one of seven peptides had this potential (Bos d9 peptide DIPNPIGSENSEK (195–208)). Three IV peptides may induce IL-10 expression. The IV/IS assessment seems promising agents for peptides’ potential determination dedicated only to preliminary screening of peptides. The IV verification is still crucial in further steps of studies. Full article

Sesame allergy is a life-threatening disease that has been growing globally with poorly understood mechanisms. To protect sensitive consumers, sesame is regulated in many countries. There were four research goals for this work on sesame allergy: (i) to map the timeline, and the extent of its global rise; (ii) to dissect the complexity of the disease, and its mechanisms; (iii) to analyze the global regulation of sesame; and (iv) to map the directions for future research and regulation. We performed a literature search on PubMed and Google Scholar, using combinations of key words and analyzed the output. Regulatory information was obtained from the government agencies. Information relevant to the above goals was used to make interpretations. We found that: (i) the reports appeared first in 1950s, and then rapidly rose globally from 1990s; (ii) sesame contains protein and lipid allergens, a unique feature not found in other allergenic foods; (iii) it is linked to five types of diseases with understudied mechanisms; and (iv) it is a regulated allergen in 32 advanced countries excluding the USA. We also provide directions for filling gaps in the research and identify implications of possible regulation of sesame in the USA. Full article

Biologic drugs are widely used in pediatric medicine. Monoclonal antibodies (mAbs) in particular are a therapeutic option for rheumatic, autoinflammatory and oncologic diseases. Adverse drug reactions and hypersensitivity reactions (HSR) to mAbs may occur in children. Clinical presentation of HSRs to mAbs can be classified according to phenotypes in infusion-related reactions, cytokine release syndrome, both alpha type reactions and type I (IgE/non-IgE), type III, and type IV reactions, all beta-type reactions. The aim of this review is to focus on HSRs associated with the most frequent mAbs in childhood, with particular attention to beta-type reactions. When a reaction to mAbs is suspected a diagnostic work-up including in-vivo and in-vitro testing should be performed. A drug provocation test is recommended only when no alternative drugs are available. In selected patients with immediate IgE-mediated drug allergy a desensitization protocol is indicated. Despite the heavy use of mAbs in childhood, studies evaluating the reliability of diagnostic test are lacking. Although desensitization may be effective in reducing the risk of reactions in children, standardized pediatric protocols are still not available. Full article