Summary
This guidance for the management of patients with allergic and non‐allergic rhinitis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and ...Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and paediatricians practicing in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a web‐based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are clinical classification of rhinitis, aetiology, diagnosis, investigations and management including subcutaneous and sublingual immunotherapy. There are also special sections for children, co‐morbid associations and pregnancy. Finally, we have made recommendations for potential areas of future research.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
This is an updated guideline for the diagnosis and management of allergic and non‐allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society ...of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10–15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non‐allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid‐responsive or neurogenic and non‐ inflammatory. Non‐allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Summary
The Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and ...non‐immediate allergic reactions to penicillins and other beta‐lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web‐based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta‐lactams, molecular structure, formulations available in the UK and a description of known beta‐lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross‐reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta‐lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Formation of struvite (MgNH
4PO
4·6H
2O) at sewage treatment works can cause operational problems and decrease efficiency. Struvite has a commercial value and the controlled formation and recovery of ...it would be beneficial.
A mass balance was conducted at full scale across the whole sewage treatment plant in order to identify a stream to conduct bench-scale struvite crystallisation studies. The most suitable stream was identified as the centrifuge liquors. The average flow of the liquor stream was 393
m
3
d
−1 and the composition was as follows: 167
mg
L
−1 phosphorus, 44
mg
L
−1 magnesium, 615
mg
L
−1 ammonium, 56
mg
L
−1 calcium and 2580
mg
L
−1 of alkalinity. The pH averaged at 7.6 and the stream had a predicted struvite precipitation potential of 140
mg
L
−1.
Struvite crystallisation occurred quickly during the trials, by raising the pH of the centrifuge liquors to 9.0 and dosing with magnesium. Up to 97% phosphorus removal as struvite was achieved. Struvite formation occurred when the molar ratio of magnesium: phosphorus was at least 1.05
:
1. Below this ratio phosphorus removals of 72% were observed, but not exclusively as struvite. Annual yields of struvite were calculated to be 42–100
tonnes a year, depending on the dose regime. Revenue from the sale of produced struvite could be between £8400 and £20,000 a year.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
The COVID-19 pandemic has led to more than 760,000 deaths worldwide (correct as of 16th August 2020). Studies suggest a hyperinflammatory response is a major cause of disease severity and death. ...Identitfying COVID-19 patients with hyperinflammation may identify subgroups who could benefit from targeted immunomodulatory treatments. Analysis of cytokine levels at the point of diagnosis of SARS-CoV-2 infection can identify patients at risk of deterioration.
We used a multiplex cytokine assay to measure serum IL-6, IL-8, TNF, IL-1β, GM-CSF, IL-10, IL-33 and IFN-γ in 100 hospitalised patients with confirmed COVID-19 at admission to University Hospital Southampton (UK). Demographic, clinical and outcome data were collected for analysis.
Age > 70 years was the strongest predictor of death (OR 28, 95% CI 5.94, 139.45). IL-6, IL-8, TNF, IL-1β and IL-33 were significantly associated with adverse outcome. Clinical parameters were predictive of poor outcome (AUROC 0.71), addition of a combined cytokine panel significantly improved the predictability (AUROC 0.85). In those ≤70 years, IL-33 and TNF were predictive of poor outcome (AUROC 0.83 and 0.84), addition of a combined cytokine panel demonstrated greater predictability of poor outcome than clinical parameters alone (AUROC 0.92 vs 0.77).
A combined cytokine panel improves the accuracy of the predictive value for adverse outcome beyond standard clinical data alone. Identification of specific cytokines may help to stratify patients towards trials of specific immunomodulatory treatments to improve outcomes in COVID-19.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Summary
This guidance for the management of patients with chronic urticaria and angio‐oedema has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and ...Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is aimed at both adult physicians and paediatricians practising in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a web‐based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking a consensus was reached by the experts on the committee. Included in this guideline are clinical classification, aetiology, diagnosis, investigations, treatment guidance with special sections on children with urticaria, and the use of antihistamines in women who are pregnant or breastfeeding. Finally, we have made recommendations for potential areas of future research.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Anaphylaxis has been defined as a ‘severe, life‐threatening generalized or systemic hypersensitivity reaction’. However, data indicate that the vast majority of food‐triggered anaphylactic reactions ...are not life‐threatening. Nonetheless, severe life‐threatening reactions do occur and are unpredictable. We discuss the concepts surrounding perceptions of severe, life‐threatening allergic reactions to food by different stakeholders, with particular reference to the inclusion of clinical severity as a factor in allergy and allergen risk management. We review the evidence regarding factors that might be used to identify those at most risk of severe allergic reactions to food, and the consequences of misinformation in this regard. For example, a significant proportion of food‐allergic children also have asthma, yet almost none will experience a fatal food‐allergic reaction; asthma is not, in itself, a strong predictor for fatal anaphylaxis. The relationship between dose of allergen exposure and symptom severity is unclear. While dose appears to be a risk factor in at least a subgroup of patients, studies report that individuals with prior anaphylaxis do not have a lower eliciting dose than those reporting previous mild reactions. It is therefore important to consider severity and sensitivity as separate factors, as a highly sensitive individual will not necessarily experience severe symptoms during an allergic reaction. We identify the knowledge gaps that need to be addressed to improve our ability to better identify those most at risk of severe food‐induced allergic reactions.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Mycobacteria mediate horizontal gene transfer (HGT) by a process called distributive conjugal transfer (DCT) that is mechanistically distinct from
-mediated plasmid transfer. The transfer of ...multiple, independent donor chromosome segments generates transconjugants with genomes that are mosaic blends of their parents. Previously, we had characterized contact-dependent conjugation between two independent isolates of Mycobacterium smegmatis. Here, we expand our analyses to include five independent isolates of M. smegmatis and establish that DCT is both active and prevalent among natural isolates of M. smegmatis. Two of these five strains were recipients but exhibited distinct conjugal compatibilities with donor strains, suggesting an ability to distinguish between potential donor partners. We determined that a single gene,
, was responsible for conferring mating compatibility using a combination of comparative DNA sequence analysis, bacterial genome-wide association studies (GWAS), and targeted mutagenesis.
maps within the
secretion locus, and we establish that it confers mycobacterial self-identity with parallels to kin recognition. Similar to other kin model systems, orthologs of Msmeg0070 are highly polymorphic. The identification of a kin recognition system in M. smegmatis reinforces the concept that communication between cells is an important checkpoint prior to DCT commitment and implies that there are likely to be other, unanticipated forms of social behaviors in mycobacteria.
Conjugation, unlike other forms of HGT, requires direct interaction between two viable bacteria, which must be capable of distinguishing between mating types to allow successful DNA transfer from donor to recipient. We show that the conjugal compatibility of Mycobacterium smegmatis isolates is determined by a single, polymorphic gene located within the conserved
secretion locus. This gene confers self-identity; the expression of identical Msmeg0070 proteins in both donor-recipient partners prevents DNA transfer. The presence of this polymorphic locus in many environmental mycobacteria suggests that kin identification is important in promoting beneficial gene flow between nonkin mycobacteria. Cell-cell communication, mediated by kin recognition and ESX secretion, is a key checkpoint in mycobacterial conjugation and likely plays a more global role in mycobacterial biology.
Earthquake‐driven subsidence can cause cascading hazards at the coast by exacerbating relative sea level rise, storm surges, tsunami, and tidal flooding. At Ahuriri Lagoon near Napier, Aotearoa New ...Zealand, paleoseismic uplift and subsidence are typically attributed to upper plate faults and subduction interface earthquakes, respectively. We test this assumption with elastic dislocation models of upper plate and subduction interface earthquakes informed by historical events, seismic surveys, and modern interface coupling data. We compared our surface deformation results to paleoseismic records preserved at Ahuriri Lagoon, which includes eight rapid subsidence (c. 0.5–1.2 m) and two rapid uplift events over the last c. 7 kyr. Our models demonstrate that offshore upper plate faults could cause subsidence of c. 0.5–1 m at Ahuriri Lagoon at recurrence intervals of c. 2 kyr. A range of subduction interface earthquakes can also produce subsidence at Ahuriri Lagoon, and may explain larger (>1 m) subsidence, but must rupture the currently creeping (i.e., aseismic) portions of the interface. We demonstrate that both upper plate fault and subduction interface earthquakes may have contributed to the Ahuriri Lagoon records, and that interface coupling may be more spatially or temporally heterogeneous than modern geodetic data suggest. Models of sea‐level rise and earthquake multi‐hazards that do not include the effects of upper plate faulting may mischaracterize risk at the coast.
Plain Language Summary
Earthquakes can cause land to uplift or subside. If land subsides along the coastline, it becomes more susceptible to flooding, storm waves, tsunami, and ongoing sea level rise. The geologic record at Ahuriri Lagoon near Napier, New Zealand, shows that earthquakes have caused subsidence of at least 0.5 m many times over the last 7,000 years. We modeled how earthquakes on different faults, such as the subduction zone or smaller crustal faults above it, would vertically move the coastline. We found that both types of earthquakes have likely caused subsidence at Ahuriri Lagoon, which differs from past interpretations that focus mainly on subduction zone earthquakes. Additionally, the subduction earthquakes that cause subsidence at Ahuriri Lagoon are not in the expected location based on modern instrumental data. Therefore, future hazard models may need to take into account a broader range of earthquake source faults and more complex earthquake scenarios.
Key Points
Elastic dislocation modeling shows that listric upper plate faults can cause coastal coseismic subsidence above the down‐dip rupture limit
Coseismic subsidence at a key site (Ahuriri Lagoon, central Hikurangi margin) can be caused by both upper‐plate and subduction earthquakes
Subduction seismic cycle interpretations using coseismic uplift and subsidence records should consider the influence of upper plate faults
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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