Asriani Chiu

Latex hypersensitivity in Department of Veterans Affairs health care workers: glove use, symptoms, and sensitization

BACKGROUND This report of the prevalence of latex glove allergy in 3 Department of Veterans Affairs (VA) medical centers was a collaboration of the VA, the Centers for Disease Control and Prevention, and the National Institute for Occupational Safety and Health. OBJECTIVE To enroll and evaluate personnel from across the entire hospital workforce for latex hypersensitivity and to determine the type and extent of latex glove use. METHODS A questionnaire was administered that covered demographics, job category, latex glove use, and current latex glove allergic symptoms. Skin testing to aeroallergens was performed to evaluate the presence of atopy. Blood was drawn for analyses of serum antilatex IgE antibody by CAP assay. RESULTS Of 1,959 subjects, 158 (8.1%) had latex glove-allergic symptoms, a positive latex CAP assay result, or both. In 1,003 subjects who reported latex glove use, 915 (91.4%) used nonpowdered gloves. A total of 133 subjects reported latex glove allergic symptoms, and 36 subjects had positive CAP assay results. Latex sensitization was correlated with atopy, race, and latex glove exposure. Latex symptoms were correlated with atopy, a positive CAP assay result, and latex glove exposure. Of the 133 subjects with latex glove allergic symptoms, only 11 had positive CAP assay results, giving a prevalence of confirmed latex glove allergy of 0.6%. CONCLUSIONS Symptoms attributed to latex gloves and/or latex sensitization occurred in 8.1% of the employee population, with exposure, race, and atopy being the major risk factors. Few symptomatic individuals were sensitized to latex (0.6%). This low rate of confirmed latex glove allergy may have been related to nonpowdered glove use.

Nasal airway obstruction: allergy and otolaryngology perspectives.

BACKGROUND Diagnostic test preferences and management strategies for nasal airway obstruction (NAO) may vary depending on medical specialty. OBJECTIVE To discern current attitudes and practices of different medical specialties regarding diagnostic and management strategies for patients with NAO. METHODS Cross-sectional survey of all practicing otolaryngologists and medical allergists in Wisconsin and parts of northern Illinois (N = 268). Survey participants were asked to rank the tests they most commonly perform to differentiate causes of NAO and to rank the diagnostic tests they believed were most sensitive and specific (criterion standard) for NAO. The second portion of the survey provided 3 distinct patient scenarios, and participants were surveyed on their treatment plans. RESULTS The survey response rate was approximately 50% for both specialties. Nasal endoscopy was the most common diagnostic test for otolaryngologists vs allergists (58% vs 2%, P < .001), and allergy testing was most commonly used first by allergists (92% vs 0%, P < .001). Nasal endoscopy was considered the criterion standard for evaluating NAO by 70% of otolaryngologists vs 29% of allergists (P < .001), although nasal endoscopy was ranked in the top 3 for both specialties without a statistically significant difference. Patient scenario responses, however, demonstrated no statistically significant differences between the specialties. CONCLUSION Differences were demonstrated in the diagnostic workup preferences and perceptions of the criterion standard for NAO between the 2 medical specialties. Specialty bias, practitioner comfort level, and patient selection likely accounted for differences in responses. However, patient management decisions, medical or surgical, seemed to be similar between the specialties.

Allergy Testing in Children With Low-Risk Penicillin Allergy Symptoms

Our utilization of a penicillin allergy questionnaire identified children at low risk for true allergy who were subsequently tested and whose results were found to be negative. BACKGROUND: Penicillin allergy is commonly reported in the pediatric emergency department (ED). True penicillin allergy is rare, yet the diagnosis results from the denial of first-line antibiotics. We hypothesize that all children presenting to the pediatric ED with symptoms deemed to be low-risk for immunoglobulin E-mediated hypersensitivity will return negative results for true penicillin allergy. METHODS: Parents of children aged 4 to 18 years old presenting to the pediatric ED with a history of parent-reported penicillin allergy completed an allergy questionnaire. A prespecified 100 children categorized as low-risk on the basis of reported symptoms completed penicillin allergy testing by using a standard 3-tier testing process. The percent of children with negative allergy testing results was calculated with a 95% confidence interval. RESULTS: Five hundred ninety-seven parents completed the questionnaire describing their child’s reported allergy symptoms. Three hundred two (51%) children had low-risk symptoms and were eligible for testing. Of those, 100 children were tested for penicillin allergy. The median (interquartile range) age at testing was 9 years (5–12). The median (interquartile range) age at allergy diagnosis was 1 year (9 months–3 years). Rash (97 [97%]) and itching (63 [63%]) were the most commonly reported allergy symptoms. Overall, 100 children (100%; 95% confidence interval 96.4%–100%) were found to have negative results for penicillin allergy and had their labeled penicillin allergy removed from their medical record. CONCLUSIONS: All children categorized as low-risk by our penicillin allergy questionnaire were found to have negative results for true penicillin allergy. The utilization of this questionnaire in the pediatric ED may facilitate increased use of first-line penicillin antibiotics.

Anaphylaxis to dill

BACKGROUND Allergic symptoms caused by spices and herbs are infrequent and usually mild, although occasionally, severe allergic reactions do occur. Symptoms of pruritus, rhinitis, cough, and edema have been reported to spices including curry, paprika, pepper, and mustard. To our knowledge, this is the first case of confirmed dill allergy, and the patient had severe allergic symptoms. OBJECTIVE It is important to alert physicians to the possibility of allergic reactions caused by dill. METHODS AND RESULTS The patient, who has a history of allergic rhinitis, developed symptoms of oral pruritus, tongue and throat swelling, urticaria, and immediate vomiting and diarrhea following ingestion of foods cooked with dill and subsequently with inhalation of foods prepared with dill. Skin testing with fresh dill preparation was positive. CONCLUSION These findings confirm that dill can cause IgE-mediated reactions.

Parent-Reported Penicillin Allergy Symptoms in the Pediatric Emergency Department

OBJECTIVE Children often present to the pediatric emergency department (ED) with a reported penicillin allergy. The true incidence of pediatric penicillin allergy is low, and patients may be inappropriately denied first-line antibiotics. We hypothesized that more than 70% of reported penicillin allergies in the pediatric ED are low risk for true allergy. METHODS Parents of children presenting to the pediatric ED with parent-reported penicillin allergy completed an allergy questionnaire. The questionnaire included age at allergy diagnosis, symptoms of allergy, and time to allergic reaction from first dose. The allergy symptoms were dichotomized into high and low risk in consultation with a pediatric allergist before questionnaire implementation. RESULTS A total of 605 parents were approached; 500 (82.6%) completed the survey. The median (interquartile range) age of the children at diagnosis was 1 year (7 months, 2 years); 75% were diagnosed before their third birthday. Overall, 380 (76%) (95% confidence interval 72.3, 79.7) children had exclusively low-risk symptoms. The most commonly reported symptoms were rash (466, 92.8%) and itching (203, 40.6%). Of the 120 children with one or more high-risk symptom, facial swelling (50, 10%) was the most common. Overall, 354 children (71%) were diagnosed after their first exposure to penicillin. Symptom onset within 24 hours of medication administration occurred in 274 children (54.8%). CONCLUSIONS Seventy-six percent of patients with parent-reported penicillin allergy have symptoms unlikely to be consistent with true allergy. Determination of true penicillin allergy in patients with low-risk symptoms may permit the increased use of first-line penicillin antibiotics.

Recurrent vaginitis as a manifestation of inhaled latex allergy.

Recurrent vaginitis with eosinophilic infiltration was determined to be related to IgE‐mediated latex sensitivity in a hospital worker.

Antibiotic Use After Removal of Penicillin Allergy Label

Children with penicillin allergy were tested, found to receive negative test results, and, subsequently, tolerated penicillin without serious adverse or allergic reactions. BACKGROUND: Penicillin allergy is commonly reported in the pediatric emergency department. We previously performed 3-tier penicillin allergy testing on children with low-risk symptoms, and 100% tolerated a penicillin challenge without an allergic reaction. We hypothesized that no serious allergic reactions would occur after re-exposure to penicillin and that prescription practices would change after testing. METHODS: We performed a follow-up case series of 100 children whose test results were negative for penicillin allergy. Research staff administered a brief follow-up phone survey to the parent and primary care provider of each patient tested. We combined the survey data and summarized baseline patient characteristics and questionnaire responses. We then completed a 3-tier economic analysis from the prescription information gathered from surveys in which cost savings, cost avoidance, and potential cost savings were calculated. RESULTS: A total of 46 prescriptions in 36 patients were reported by the primary care provider and/or parents within the year after patients were tested for penicillin allergy. Twenty-six (58%) of the prescriptions filled were penicillin derivatives. One (4%) child developed a rash 24 hours after starting the medication; no child developed a serious adverse reaction after being given a penicillin challenge. We found that the cost savings of delabeling patients as penicillin allergic was

The changing face of allergy/immunology fellowship programs

1368.13, the cost avoidance was

The value of an allergy and clinical immunology rotation at an academic tertiary medical center

1812.00, and the total potential cost savings for the pediatric emergency department population was

The treatment of allergic bronchopulmonary aspergillosis.

192 223.00. CONCLUSIONS: Children with low-risk penicillin allergy symptoms whose test results were negative for penicillin allergy tolerated a penicillin challenge without a severe allergic reaction developing. Delabeling children changed prescription behavior and led to actual health care savings.