Prevalence of Food Allergy among Schoolchildren in Lebanon

<b><i>Introduction:</i></b> Food allergy (FA) is a global health problem with an ongoing rise in prevalence, especially in developed countries. It has been reported to be most prevalent in children, although cases in adults have been increasing as well. FA may lead to life-threatening clinical manifestations. Data in Lebanon and the Middle East are limited. To our knowledge, few studies tackled its prevalence in children in this region. <b><i>Aim:</i></b> This study aims at determining self-reported prevalence of FA in schoolchildren (ages 3–17 years) in Lebanon and describes its characteristics. <b><i>Method:</i></b> Throughout this cross-sectional study, 5 schools from 3 different governorates in Lebanon (Beirut, Mt. Lebanon, and Beqaa) were contacted to participate and 5,312 questionnaires were sent out to be completed by the parents and sent back to the school during May 2019. <b><i>Results:</i></b> 2,610 questionnaires were collected (49.13%). A hundred and forty-eight (6%) children reported to have FA, 58% were males. 80% of them were breastfed, 51% were diagnosed between the ages of 2 and 14 years. Common allergens included cow’s milk and milk products (22.46%), fruits and vegetables (16.58%), eggs (8.02%), and nuts (5.88%). Allergic symptoms included skin reactions (45.08%), gastrointestinal (GI) symptoms (29.53%), respiratory symptoms (14.51%), and systemic symptoms (10.88%). 82% of the population with FA has sought professional advice, out of which 54% were confirmed by a physician. Common methods of diagnosis were IgE test (35.71%), food elimination (27.92%), and skin prick test (18.83%). χ² analysis has shown that a higher percentage of children with FA had skin reactions (58.8%, <i>p</i> = 0.033) and GI symptoms (30.41%, <i>p</i> = 0.047). A higher percentage of children with allergies were breastfed. No relation between the presence of FA and delivery mode was observed. <b><i>Conclusion:</i></b> This study has shown that the self-reported prevalence of FA among Lebanese schoolchildren is 6%, and it was correlated with skin and GI symptoms. The most common allergen was cow’s milk. A higher proportion of children with FA were breastfed. No association between the mode of delivery and FA was found. Larger studies are needed to confirm the above findings.

Efficacy of Beauveria bassiana and Beauveria pseudobassiana isolates against the pine processionary moth, Thaumetopoea wilkinsoni Tams, 1926 (Lepidoptera/Notodontidae)

Background The pine processionary moth, Thaumetopoea wilkinsoni Tams, 1926 (Lepidoptera/Notodontidae) is one of the most harmful insects that destroys pine ecosystems by feeding on pine leaves at its larval stage. Because of its urticating setae, the insect also causes severe skin reactions to animals and humans. Instead of chemical control, eco-friendly biological control methods are preferred to combat this species. Results The purpose of this study was to evaluate the efficacy of five different Beauveria bassiana Vuill, 1912 (Hypocreales/Cordycipitaceae) isolates (TR-SM-10, TR-SM-11, TR-SM-2, TR-SK-1 and TR-D-1) and one B. pseudobassiana Rehner & Humber (Hypocreales/Cordycipitaceae) isolate (TR-SM-1) against the fourth instar larvae of T. wilkinsoni under laboratory conditions. T. wilkinsoni larvae were collected from the Ondokuz Mayıs University Kurupelit Campus in Samsun, Turkey, in 2021, and the fourth instar larvae were used in the experiment. Two ml of spray of the six fungal isolates were applied to every ten larvae at each concentration (1 × 107 and 1 × 108 conidia ml−1). The experiment was carried out in five replicates per group, and the larvae were observed for 10 days. As a result, all isolates of B. bassiana caused 100% mortality at 1 × 108 conidia ml−1 concentration. B. pseudobassiana isolate also caused 100% mortality at both concentrations. At 1 × 107 conidia ml−1 concentration, the larvae treated with the B. pseudobassiana isolate (TR-SM-1) had the lowest LT50 (2.89 days) and LT90 values (4.79 days), while the larvae treated with TR-SM-10 isolate had the highest LT50 (5.65 days) and LT90 values (9.39 days). At 1 × 108 conidia ml−1 concentration, the larvae treated with TR-SK-1 isolate had the lowest LT50 (2.89 days) and LT90 values (4.79 days), while those treated with TR-SM-10 isolate had the highest LT50 (3.95 days) and LT90 values (8.15 days). Conclusion It has been recommended that the five different isolates of B. bassiana and B. pseudobassiana isolates were virulent to T. wilkinsoni larvae and can be used for biological control of T. wilkinsoni.

A multi-center, cross-sectional study on the prevalence of facial dermatoses induced by mask use in the general public during the COVID-19 pandemic

Background: The use of face masks and coverings has been recommended in public settings to minimize the risk of the transmission of coronavirus. The rampant surge in the use of masks for a prolonged duration has resulted in various facial dermatoses. Materials and Methods: The present study was an outpatient, multicentric, observational survey conducted over the period of one year. A total of 350 patients were enrolled. A structured questionnaire was employed to collect data identifying adverse skin reactions that had occurred in the area covered by a face mask. Results: Most of the facial dermatoses were observed in the urban population (78.85%). Maskne was the most common facial dermatosis, detected in 62% of the participants, followed by hypopigmentation (11.42%), hyperpigmentation (8.28%), contact dermatitis (5.42%), non-specific erythema (4.28%), desquamation (3.71%), urticaria (2.57%), and cheilitis (2.28%). The mean duration of mask use was 5.76 hours. A majority of the participants reported maskne in the U zone (both on the cheeks and the chin area) of the face (34%), followed by isolated involvement of the chin (26%), cheeks (20%), mandible region (14%), and bridge of the nose (6%). Conclusion: The use of face masks for extended hours without adequate precautions causes various cutaneous adverse effects. Thus, it is important to identify the risk factors precipitating mask-related facial dermatoses.

Delayed allergic skin reactions to vaccines

Background: Recent advances in vaccination against the severe acute respiratory syndrome coronavirus 2 pandemic have brought allergists and dermatologists to the forefront because both immediate and delayed hypersensitivity reactions have been reported. Objective: This literature review focused on delayed reactions to vaccines, including possible causative agents and practical information on how to diagnose, evaluate with patch testing, and manage subsequent dose administration. Methods: Currently published reviews and case reports in PubMed, along with data on vaccines from the Centers for Disease Control and Prevention web site. Relevant case reports and reviews that focused on delayed reactions to vaccines were selected. Results: Most delayed hypersensitivity reactions to vaccines include cutaneous manifestations, which vary from local persistent pruritic nodules to systemic rashes. The onset is usually within a few days but can be delayed by weeks. Multiple excipients have been identified that have been implicated in delayed vaccine reactions, including thimerosal, formaldehyde, aluminum, antibiotics, and gelatin. Treatment with antihistamines, topical corticosteroids, or systemic corticosteroids alleviates symptoms in most patients. Such reactions are generally not contraindications to future vaccination. However, for more-severe reactions, patch testing for causative agents can be used to aid in diagnosis and approach further vaccination. Conclusion: Delayed-type hypersensitivity reactions to vaccines are not uncommon. If needed, patch testing can be used to confirm agents, including antibiotics, formaldehyde, thimerosal, and aluminum. In most cases, delayed cutaneous reactions are not contraindications to further vaccine administration.

Skin lesions associated with personal protective equipment in medical workers during the COVID-19 pandemic

Aim. Analysis of the incidence of personal protective equipment (PPE)-associated dermatoses among medical workers during the COVID-19 pandemic.Materials and Methods. Screening of the papers indexed by PubMed, EMBASE, Google Scholar, eLibrary, and UpToDate databases, written in English and published from January 1, 2020 to October, 2021. The search keywords were: "medical workers", "skin", "dermatoses", "professional", and "personal protective equipment" in combination with "COVID-19" and "SARS-CoV-2".Results. Occupational contact dermatitis is responsible for 20% of all cases of contact dermatitis which accounts for 90% of all skin disease cases. During the COVID-19 pandemic, from 42.8% to 97.0% of medical workers reported about skin lesions provoked by prolonged wearing of PPE in combination with regular disinfection. About 61.7% of them noted the deterioration of a pre-existing skin disease, and 90.5% reported the appearance of new skin lesion symptoms associated with the PPE usage. The most common symptoms of skin lesions among medical workers were dryness, itching, burning, soreness, and skin rash. Irritant and allergic contact dermatitis, acne, rosacea, and seborrheic dermatitis were the most prevalent skin disorders among the interviewed medical workers. Risk factors for the development of PPE-associated dermatoses were the type and material of PPE, the duration of PPE wearing, and past medical history of skin diseases. Due to the increased incidence of PPE-associated dermatoses among the medical staff, some countries have developed recommendations on the prevention and treatment of undesirable PPE-associated skin reactions in medical professionals. Current research are focused on developing special tools and devices that would serve as a protective barrier between the skin and PPE, ameliorating the damaging effect of the latter.Conclusion. PPE-associated dermatoses are currently widespread among the medical workers, highlighting the need in novel materials for PPE manufacturing to minimise the risk of developing PPE-associated skin lesions.

Individual Radiosensitivity as a Risk Factor for the Radiation-Induced Acute Radiodermatitis

Background: Up to 95% of irradiated patients suffer from ionizing radiation (IR) induced early skin reaction, acute radiation dermatitis (ARD). Some experts think that additional skin hydration can reduce acute skin reactions. Individual radiosensitivity (IRS) determined from lymphocytes may help to predict acute radiation toxicity. The purpose of this study is to evaluate the clinical manifestation of ARD in different skincare groups during whole breast radiotherapy depending on IRS and other risk factors. Methods: A total of 108 early-stage breast cancer patients were randomized into best supportive care (BSC) and additional skincare (ASC) groups. IRS was evaluated using a G2 assay modified with caffeine-induced G2 checkpoint arrest. All patients received a 50 Gy dose to the breast planning target volume (PTV). Clinical assessment of ARD symptoms according to the CTCAE grading scale was performed once a week. Results: IRS was successfully determined for 91 out of 108 patients. A total of 10 patients (11%) had normal IRS, 47 patients (52%) were categorized as radiosensitive, and 34 (37%) as highly radiosensitive. There was no significant difference in the manifestation of ARD between patient groups by skincare or IRS. According to logistic regression, patients with bigger breasts were prone to more severe ARD (p = 0.002). Conclusions: The additional skincare did not improve skin condition during RT. A total of 89% of patients had increased radiosensitivity. IRS determined before RT did not show the predictive value for the manifestation of ARD. Logistic regression revealed that breast volume was the most significant risk factor for the manifestation of ARD.

White paper peanut allergy—part 2: Diagnosis of peanut allergy with special emphasis on molecular component diagnostics

Summary Background Peanut allergy is an immunoglobulin E (IgE)-mediated immune response that usually manifests in childhood and can range from mild skin reactions to anaphylaxis. Since quality of life maybe greatly reduced by the diagnosis of peanut allergy, an accurate diagnosis should always be made. Methods A selective literature search was performed in PubMed and consensus diagnostic algorithms are presented. Results Important diagnostic elements include a detailed clinical history, detection of peanut-specific sensitization by skin prick testing and/or in vitro measurement of peanut (extract)-specific IgE and/or molecular components, and double-blind, placebo-controlled food challenge as the gold standard. Using these tools, including published cut-off values, diagnostic algorithms were established for the following constellations: 1) Suspicion of primary peanut allergy with a history of immediate systemic reaction, 2) Suspicion of primary peanut allergy with questionable symptoms, 3) Incidental findings on sensitization testing and peanut ingestion so far or 4) Suspicion of pollen-associated peanut allergy with solely oropharyngeal symptoms. Conclusion The most important diagnostic measures in determining the diagnosis of peanut allergy are clinical history and detection of sensitizations, also via component-based diagnostics. However, in case of unclear results, the gold standard—an oral food challenge—should always be used.