“Therefore, I would like an allergy test”

Forthcoming

Pilot study of dogs with suppurative and non-suppurative Malassezia otitis: A case series

Background Rarely, Malassezia otitis presents as a painful, erosive otitis with an otic discharge containing Malassezia and neutrophils on cytology. There are no published reports of this type of suppurative Malassezia otitis (SMO). The role of Malassezia hypersensitivity in otitis is still unknown, and no association has been demonstrated with SMO. We compared Malassezia IgE levels, intradermal test and histology changes in SMO dogs with the more conventional Malassezia otitis (MO) presentation. Results Three dogs (case 1, case 2 and case 3) were diagnosed with SMO, one dog (case 4) was diagnosed with unilateral MO and unilateral SMO, and one dog (case 5) was diagnosed with MO. Only one case (case 4) with SMO/MO had a positive Intradermal Allergy Test (IDAT) and elevated IgE levels for Malassezia. Histopathology findings from SMO revealed: interface dermatitis (case 1 and 3), lymphocytic dermatitis (case 2) and chronic hyperplastic eosinophilic and lymphoplasmacytic dermatitis (case 4). Histopathology findings from MO showed perivascular dermatitis (case 4 and 5). All the cases were treated successfully. Conclusions SMO presents with a distinct clinical phenotype in comparison with conventional MO. No consistent aetiology could be isolated. In these clinical cases it is possible that previous treatments could have influenced the results. More research is needed to understand the possible aetiologies and the pathogenesis of SMO.

30. Implementation of the PEN-FAST Penicillin Allergy Screening Tool in the Emergency Department During Medication Reconciliation

Background The purpose of this study is to implement the PEN-FAST Penicillin Allergy Screening Tool in the emergency department to identify low risk patients with inappropriate penicillin-related allergies to transition them to a beta-lactam. Newly published, validated, penicillin allergy clinician decision tool (PEN-FAST) allows healthcare providers to identify low risk penicillin allergies with a negative predictive value of 96%. This quick, five question clinical decision tool allows healthcare providers and antimicrobial stewardship programs to identify patients who would also test negative if a formal penicillin allergy test was performed, making the process to confidently identify inappropriately labeled penicillin-related allergies more efficient. Methods During routine medication reconciliations, pharmacists will identify patients who have a documented penicillin-related allergy in the EMR and use the PEN-FAST screening tool. Patients meeting inclusion criteria will have their penicillin-related allergy updated in the EMR based upon their assessed risk of very low, low, moderate, or high. The primary outcomes for this study are the percentage of patients screened that were classified as “very low and low risk” and percentage penicillin-related allergies updated. The secondary outcomes are the percentage of patients that required antibiotic therapy (post-allergy update) that were transitioned to a beta-lactam, inpatient broad-spectrum antibiotic usage before and after allergy update, and time spent interviewing each patient. Results A total of 59 patients were interviewed using the PEN-FAST Tool. The results for the primary outcomes indicate 92% (n=54) of patient allergies updated in the EMR, 24% (n=13) of patients classified as “very low risk” and 34% (n=18) of patients classified as “low risk”. Results for the secondary outcome showed out of the 36 patients that were on non-beta lactams during allergy update, 72% (n=26) of those patients were transitioned to a beta-lactam. The average time to complete the PEN-FAST Tool was 4.2 minutes. Conclusion The results of this study support the use of the PEN-FAST Tool in efficiently updating patient’s allergies in the EMR and identifying low risk patients who may be eligible for beta-lactam therapy. Disclosures All Authors: No reported disclosures

Food anaphylaxis in toddlers: own clinical experience in diagnostic measurement and identification of underlying causes

The article presents current data on the reasons for the occurrence, peculiarities of the course, and diagnostic principles of anaphylaxis in toddlers. The determination of protein group enables to prognosticate the risk of development of food anaphylaxis. A comprehensive method is the ALEX in vitro multiplex allergy test. In the first reported case, anaphylaxis appeared after the consumption of a milk formula (cutaneous and respiratory symptoms; five months) and buckwheat (cutaneous, gastrointestinal, and respiratory symptoms; 11 months). On examination, the storage proteins of buckwheat Fag e 2 were detected – 22.82 kUA/L and major components of milk Bos d 4 (α-lactalbumin) – 41.37 kUA/L, Bos d 5 (β-lactoglobulin) – 41.12 kUA/L, Bos d 8 (casein) – 32.84 kUA/L. In the second case, anaphylaxis (cutaneous, gastrointestinal, respiratory, and neurological symptoms) developed after eating cake. On examination, the following storage proteins were detected: hazelnut Cor a 14 – 6.80 kUA/L, walnut Jug r 1 – 3.76 kUA/L. In the third case, anaphylaxis (cutaneous and respiratory symptoms) occurred after contact with dried fish (carp, cod) which the affected child was holding in the hands. On examination, parvalbumins were detected, including Atlantic cod – Gad m 1 – 46.67 kUA/L, carp – Cyp c 1 – 42.61 kUA/L, Atlantic herring – Сlu h 1 – 49.05 kUA/L, Sal s 1– 45.58 kUA/L, Atlantic mackerel – Sco s 1 – 48.82 kUA/L, tuna – Thu a 1 – 43.12 kUA/L, and swordfish – Хір g 1 – 43.83 kUA/L. Based on a complex examination, the patients received thorough dietary and lifestyle recommendations, as well as information about health risks and the need for an epinephrine autoinjector.

Prick, patch or blood test? A simple guide to allergy testing

This article provides information on allergy testing and serves as a simple guide for physicians who are considering using allergy testing as a step in patient management. Basic principles of allergy testing, indications for testing, and how and when to choose a suitable allergy test are discussed. Allergy testing in general refers to evaluation of either type I or type IV hypersensitivity reactions. The type I (immediate) reaction is evaluated using the skin prick test (in vivo) or serum IgE (in vitro) test methods, while the type IV (delayed) reaction is determined via the skin patch test method. The allergens responsible for a specific reaction can be identified from allergy testing, and this information is useful in administering avoidance measures. Appropriate treatment of allergic reactions along with allergen avoidance ensure a successful treatment outcome and prevent future reactions.