Issue #12, April 2022
Spring is here at The Buzz, so we provide a break from rhinitis by featuring five new publications in the areas of peanut cross-contamination rates, the safety of second SARS-CoV-2 vaccine doses following an immediate allergic reaction to dose 1, the risk of thyroid autoimmunity in the setting of chronic urticaria, a review of cannabis-related allergy, and another scoping review about culprit drug identification. View archived issues of The Buzz at thehivecommunity.org/the-buzz.
Peanut cross-contamination in randomly selected baked goods
Miller and colleagues conducted an exploratory study to assess the presence and degree of peanut protein cross-contamination in randomly selected baked goods purchased at bakeries in New York and Miami. The bakeries sold some products that contained peanuts and foods from different ethnic cuisines. Testing was performed on products that did not intentionally contain peanut.
A total of 155 samples were collected for analysis from 18 bakeries. In all, four samples (2.6%) tested positive for peanut protein, all from NYC bakeries (7.3% of NYC samples). In the first round of sample testing, three samples tested positive for peanut protein. In repeat testing of the same products purchased at least one week later, one positive sample was found. The level of contamination would have delivered between 0.51mg and 832mg of peanut protein consumption per single eating episode.
With approximately one in 40 bakery items containing peanut contamination, the rates of accidental peanut exposure (estimated at 12% per year in Canadian children with peanut allergy) are not surprising.
Read more [Sosido link] Miller TA, Koppelman SJ, Bird JA, et al. Peanut cross-contamination in randomly selected baked goods [published online ahead of print, 2022 Feb 4]. Ann Allergy Asthma Immunol. 2022;S1081-1206(22)00082-5. doi:10.1016/j.anai.2022.01.037
Revaccination following immediate allergic reaction to SARS-CoV-2 vaccine
A new publication analyzes the risk of allergic reactions to a second SARS-CoV-2 vaccines among those who experienced an immediate allergic reaction to their first dose. A systemic review was undertaken to identify 1366 individuals reported in 22 studies, of which 78 experienced severe immediate allergic reactions (e.g., anaphylaxis). The mean age of patients was 46.1 years, with 87.8% women in the study. All revaccinations were administered under the guidance of an allergy specialist and used mRNA vaccines.
A total of six severe reactions occurred with revaccination (absolute risk, 0.16% [95% CI, 0.01%–2.94%]); while 1360 patients tolerated the dose (99.84% [95% CI, 97.09%–99.99%]). There were no deaths, and five patients recovered rapidly with epinephrine injection. Thirteen percent of patients experienced a mild immediate reaction to the second dose, including 9% of those who had a severe reaction to the first dose. Sensitivity analysis noted that graded vaccine dosing, skin testing, and premedication as riskstratification strategies did not alter the findings. Revaccination following an immediate allergic reaction to a first SARS-CoV-2 vaccine dose in a supervised setting equipped to manage severe allergic reactions can be safe.
Read more [Sosido link] Chu DK, Abrams EM, Golden DBK, et al. Risk of Second Allergic Reaction to SARSCoV-2 Vaccines: A Systematic Review and Meta-analysis [published online ahead of print, 2022 Feb 21]. JAMA Intern Med. 2022;e218515. doi:10.1001/jamainternmed.2021.8515
Meta-analysis of the association between chronic urticaria and autoimmune thyroid diseases
The association between chronic urticaria and autoimmune thyroid diseases was first described nearly forty years ago. Many small case-control studies have been published, and a new publication from Tienforti and colleagues aimed to consolidate the findings of these small studies with a systematic review and meta-analysis. Observational case-control studies were included if data permitted the calculation of an odds ratio for TPOAbs. In all, 19 articles met the inclusion criteria and provided information on 14,351 patients with chronic urticaria (cases) and 12,404 subjects without chronic urticaria (controls). There was an overall 3.8% rate of TPOAbs positivity. It should be noted that the funnel plot suggests evidence for publication bias.
The pooled estimate indicated an increased risk of exhibiting TPOAbs positivity in the group with chronic urticaria (OR 5.18, 95% CI 3.27- 8.22; P < 0.00001). A sensitivity analysis that attempted to reduce study heterogeneity by including the 16 studies with highest quality scores revealed a nearly seven-fold increased risk of TPOAbs positivity in patients with chronic urticaria compared to controls (OR 6.72 (95% CI 4.56-9.89; P < 0.00001). The authors recommend offering chronic urticaria patients screening for thyroid autoimmunity.
Read more [Sosido link] Tienforti D, Di Giulio F, Spagnolo L, et al. Chronic urticaria and thyroid autoimmunity: a meta-analysis of case-control studies [published online ahead of print, 2022 Feb 18]. J Endocrinol Invest. 2022;10.1007/s40618-022-01761-2. doi:10.1007/s40618-022-01761-2
Review of cannabis-related allergies
Members of allergy and clinical immunology groups from the US, Canada, and Europe have convened a Cannabis Allergy Interest Group (CAIG) to address the unmet need of cannabis allergy and the challenges of research given its variable legal status across jurisdictions. They have published a new review that details the rising prevalence of both medical and recreational cannabis use. They describe the four allergens accepted by the WHO (profilin, nonspecific lipid transfer protein, oxygen-evolving enhancer protein 2, and pathogenesis-related protein 10 homologue) as well as other proteins that may be allergenic. The authors highlight several homologous food plant proteins that could cross-react with cannabis allergens, including proven cross-reactivity with other nonspecific lipid transfer proteins found in a wide range of fruits, vegetables, and cereals, wine, beer, Hevea latex, and tobacco. Cannabis can provoke both type 1 and type 4 allergic reactions.
Diagnosing cannabis allergy can be challenging, with potential reluctance to admit consumption and no standard commercial extracts available for skin-prick testing. Prick-prick testing with a variety of strains is usually the only testing method available. Avoidance is the main treatment for cannabis allergy. If this is not possible, second-generation antihistamines, intranasal and inhaled corticosteroids, and ophthalmic antihistamine/mast cell stabilizers may be an acceptable option. For unavoidable occupational exposure, a combination of administrative, engineering, and protective measures may help. A single report of omalizumab treatment in unavoidable occupational exposure with anaphylaxis was successful. The review concludes highlighting the need for both HCP and patient education.
Read more: [Sosido link] Skypala IJ, Jeimy S, Brucker H, et al. Cannabis-related allergies: An international overview and consensus recommendations [published online ahead of print, 2022 Jan 31]. Allergy. 2022;10.1111/all.15237. doi:10.1111/all.15237
Scoping review of lab-based methods to identify the causative agent in adverse cutaneous drug reactions
Adverse drug reactions commonly involve the skin, pose significant risks, and are costly to the healthcare system. As a follow-up to their publication featured in Issue 10 of The Buzz, Bose and colleagues conduct a new scoping review of lab-based methods to identify the culprit drug. The literature was searched for publications describing lab-based methods since 1993. There were nine lab-based culprit drug investigations published across 11 observational studies and 14 reviews included in the scope. Methods included measurement of immune cells or inflammatory cytokines/chemokines. Clinical assessment and operational algorithms were used most often to validate the lab-based method being studied.
Morbilliform drug eruption was the most common cutaneous eruption investigated, followed by Stevens-Johnson syndrome/toxic epidermal necrolysis, and drug rash eosinophilia and systemic symptoms. Lymphocyte transformation test (specificity 30%–100%, sensitivity 27%–73%) and cytokine
measurement (specificity 76%–100%, sensitivity 20%–84%) were the most common methods studied.
Read more [Sosido link] Bose R, Finstad A, Ogbalidet S, Boshra M, Fahim S. Lab-Based Culprit Drug Identification Methods for Cutaneous Drug Eruptions: A Scoping Review [published online ahead of print, 2022 Jan 28]. J Cutan Med Surg. 2022;12034754211073667. doi:10.1177/12034754211073667
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