Summary
Background
Proven IgE or T‐cell mediated drug hypersensitivity reactions (DHRs) seem less common in children compared with adults. However, this has never been proved by data.
Objective
To ...determine and compare proven DHR prevalence in children and adults.
Methods
Using the DAHD (Drug Allergy and Hypersensitivity Database) cohort, children with proven DHRs were compared with adults. The international EAACI‐ENDA recommendations were followed. Patients were divided into four groups: index reaction and test during childhood (C/C), index reaction at childhood and test at adulthood (C/A), index reactions at childhood and adulthood and test at adulthood (CA/A), index reaction and test at adulthood (A/A).
Results
A total of 3275 patients (67.9% female), comprising a total of 4370 patient‐episodes, were evaluated (74.5% belonged to the A/A group). Prevalence of positive tests was 15.2% (95%CI, 14.1–16.2) for all tested classes, 10.6% (8.3–13.0) for C/C, 10.6% (7.5–13.6) for C/A, 22.1% (12.8–31.3) for CA/A and 16.5% (15.2–17.8) for A/A. The prevalence was lower in group C/C compared with groups A/A (P < 0.0001) and CA/A (P = 0.003). It was also lower in group C/A compared with the two latter groups (respectively P = 0.003 and P = 0.005). Significant differences were found for maculopapular exanthemas only, and not for urticaria/angiœdema and anaphylaxis. The difference was mainly observed with β‐lactams and not for NSAIDs.
Conclusion and Clinical Relevance
Suspicions of DHRs are less likely to be confirmed in children.
Many studies have reported the prevalence of sensitization using skin prick tests. However, comparisons between studies and between regions are difficult because the number and the type of allergens ...tested vary widely. Using the European Community Health Respiratory Survey I data, the geographical variation of sensitization to environmental allergen as measured by skin tests was established. Adults aged 20-44 years, living in 35 centres in 15 developed countries, underwent skin tests for allergy to nine common aeroallergens: Dermatophagoides pteronyssinus, timothy grass, cat, Cladosporium herbarium, Alternaria alternata, birch, Olea europea, common ragweed and Parietaria judaica. The age-sex standardized prevalence of sensitization was determined and centres with high (95% confidence interval above and excluding study median) and low prevalence (95% confidence interval below and excluding study median) of sensitization to each allergen and to any of the nine allergens were identified. There was substantial geographical variation in the prevalence of sensitization to each of the nine allergens tested and in the prevalence of sensitization to any allergen (lowest 17.1%, median 36.8% and highest 54.8%). Sensitization to D. pteronyssinus, grass pollen and cat were usually the most prevalent (median between centre 21.7%, 16.9% and 8.8%, respectively). Timothy grass sensitization was higher than that for any other pollen species. As expected, geographical variations of sensitization to environmental allergen were observed across centres. These findings were compatible for those observed with serum-specific IgE. Skin tests can be used to assess the geographical distribution of allergens in a multicentric epidemiological survey.
Climate stabilization remains elusive, with increased greenhouse gas concentrations already increasing global average surface temperatures 1.1°C above pre-industrial levels (World Meteorological ...Organization 2019). Carbon dioxide (CO2) emissions from fossil fuel use, deforestation, and other anthropogenic sources reached ~ 43 billion metric tonnes in 2019 (Friedlingstein et al 2019, Jackson et al 2019). Storms, floods, and other extreme weather events displaced a record 7 million people in the first half of 2019 (IDMC 2019). When global mean surface temperature four million years ago was 2°C–3°C warmer than today (a likely temperature increase before the end of the century), ice sheets in Greenland and West Antarctica melted and parts of East Antarctica’s ice retreated, causing sea levels to rise 10–20 m (World Meteorological Organization 2019).
Methane (CH4) emissions have contributed almost one quarter of the cumulative radiative forcings for CO2, CH4, and N2O (nitrous oxide) combined since 1750 (Etminan et al 2016). Although methane is far less abundant in the atmosphere than CO2, it absorbs thermal infrared radiation much
more efficiently and, in consequence, has a global warming potential (GWP) ~86 times stronger per unit mass than CO2 on a 20-year timescale and 28-
times more powerful on a 100-year time scale (IPCC 2014).
Global average methane concentrations in the atmosphere reached ~1875 parts per billion (ppb) at the end of 2019, more than two-and-a-half times
preindustrial levels (Dlugokencky 2020). The largest methane sources include anthropogenic emissions from agriculture, waste, and the extraction and use of fossil fuels as well as natural emissions from wetlands, freshwater systems, and geological sources (Kirschke et al 2013, Saunois et al 2016a, Ganesan et al 2019). Here, we summarize new estimates of the global methane budget based on the analysis of Saunois et al (2020) for the year 2017, the last year of the new Global Methane Budget and the most recent year data are fully available. We compare these estimates to mean values for the reference ‘stabilization’ period of 2000–2006 when atmospheric CH4 concentrations were relatively stable. We present data for sources and sinks and provide insights for the geographical regions and economic sectors where emissions have changed the most over recent decades.
To cite this article: Jarvis D, Newson R, Lotvall J, Hastan D, Tomassen P, Keil T, Gjomarkaj M, Forsberg B, Gunnbjornsdottir M, Minov J, Brozek G, Dahlen SE, Toskala E, Kowalski ML, Olze H, Howarth ...P, Krämer U, Baelum J, Loureiro C, Kasper L, Bousquet PJ, Bousquet J, Bachert C, Fokkens W, Burney P. Asthma in adults and its association with chronic rhinosinusitis: The GA2LEN survey in Europe. Allergy 2012; 67: 91–98.
Background: The prevalence of asthma and its association with chronic rhinosinusitis (CRS) have not been widely studied in population‐based epidemiological surveys.
Methods: The Global Allergy and Asthma Network of Excellence (GA2LEN) conducted a postal questionnaire in representative samples of adults living in Europe to assess the presence of asthma and CRS defined by the European Position Paper on Rhinosinusitis and Nasal Polyps. The prevalence of self‐reported current asthma by age group was determined. The association of asthma with CRS in each participating centre was assessed using logistic regression analyses, controlling for age, sex and smoking, and the effect estimates were combined using standard methods of meta‐analysis.
Results: Over 52 000 adults aged 18–75 years and living in 19 centres in 12 countries took part. In most centres, and overall, the reported prevalence of asthma was lower in older adults (adjusted OR for 65–74 years compared with 15–24 years: 0.72; 95% CI: 0.63–0.81). In all centres, there was a strong association of asthma with CRS (adjusted OR: 3.47; 95% CI: 3.20–3.76) at all ages. The association with asthma was stronger in those reporting both CRS and allergic rhinitis (adjusted OR: 11.85; 95% CI: 10.57–13.17). CRS in the absence of nasal allergies was positively associated with late‐onset asthma.
Conclusion: Geographical variation in the prevalence of self‐reported asthma was observed across Europe, but overall, self‐reported asthma was more common in young adults, women and smokers. In all age groups, men and women, and irrespective of smoking behaviour, asthma was also associated with CRS.
To cite this article: Ohta K, Bousquet P‐J, Aizawa H, Akiyama K, Adachi M, Ichinose M, Ebisawa M, Tamura G, Nagai A, Nishima S, Fukuda T, Morikawa A, Okamoto Y, Kohno Y, Saito H, Takenaka H, Grouse ...L, Bousquet J. Prevalence and impact of rhinitis in asthma: SACRA, a cross‐sectional nation‐wide study in Japan. Allergy 2011; 66: 1287–1295.
Background: Asthma and rhinitis are common co‐morbidities everywhere in the world but nation‐wide studies assessing rhinitis in asthmatics using questionnaires based on guidelines are not available.
Objective: To assess the prevalence, classification, and severity of rhinitis using the Allergic Rhinitis and its Impact on Asthma (ARIA) criteria in Japanese patients with diagnosed and treated asthma.
Methods: The study was performed from March to August 2009. Patients in physicians’ waiting rooms, or physicians themselves, filled out questionnaires on rhinitis and asthma based on ARIA and Global Initiative for Asthma (GINA) diagnostic guides. The patients answered questions on the severity of the diseases and a Visual Analog Scale. Their physicians made the diagnosis of rhinitis.
Results: In this study, 1910 physicians enrolled 29 518 asthmatics; 15 051 (51.0%) questionnaires were administered by physician, and 26 680 (90.4%) patients were evaluable. Self‐ and physician‐administered questionnaires gave similar results. Rhinitis was diagnosed in 68.5% of patients with self‐administered questionnaires and 66.2% with physician‐administered questionnaires. In this study, 994 (7.6%) patients with self‐administered and 561 (5.2%) patients with physician‐administered questionnaires indicated rhinitis symptoms on the questionnaires without a physician’s diagnosis of rhinitis. Most patients with the physician’s diagnosis of rhinitis had moderate/severe rhinitis. Asthma control was significantly impaired in patients with a physician’s diagnosis of rhinitis for all GINA clinical criteria except exacerbations. There were significantly more patients with uncontrolled asthma as defined by GINA in those with a physician’s diagnosis of rhinitis (25.4% and 29.7%) by comparison with those without rhinitis (18.0% and 22.8%).
Conclusion: Rhinitis is common in asthma and impairs asthma control.
Background
Drug provocation tests (DPT) are commonly performed as part of β‐lactam (BL) allergy workup, in case of negative skin tests (ST) and in the absence of contraindications. The ...recommendations of learned societies have created a frame for DPT performance, but protocols vary widely between centres, generating various hypothesis‐driven protocols (i.e. empirical dosing, driven by both safety concerns and practical aspects).
Methods
The primary objective of this retrospective analysis was to detect eliciting dose thresholds (reactive doses) during BL DPT, using the survival analysis method, in order to suggest optimal step doses. Our secondary objective was to evaluate the safety of our 30‐min incremental 1‐day protocol. The study included all the patients explored in the Allergy Unit of the University Hospital of Montpellier (France), between September 1996 and July 2015 for a suspicion of drug hypersensitivity reaction to BLs, with negative ST and positive DPT.
Results
During the study period, 182 positive DPT (accounting for 171 hypersensitive patients) were analysed. We identified eliciting thresholds, and we suggest the following steps for DPT to BLs: 5–15–30–50% of daily therapeutic dose (with additional lower steps for index reactions of anaphylaxis). We confirm the safety of 1‐day protocol for immediate and mild nonimmediate reactors, for both children and adults, with a surveillance period of 2 h after the last administered dose, and a prolonged surveillance after discharge of 48 h.
Conclusion
This data‐driven approach in designing DPT protocols is a step forward in improving DPT standardization, starting with the most frequently tested drugs, BL antibiotics.
Background
Several studies have shown that skin tests are useful tools for the diagnosis of iodinated contrast medium (ICM) allergy, but the real number of false negative results is not known.
...Objective
To evaluate the negative predictive value of ICM skin tests.
Material and Methods
One hundred and fifty‐nine patients tested in our department because of a previous ICM reaction over the last 9 years were called and asked standardized questions about ICM re‐exposure.
Results
Twenty‐nine patients had been re‐exposed to ICM. There were 20 (69.0%) females and the median age was 55 (34–60) years. The median time interval between the reaction and skin testing was 11.9 (1.6–21.5) years. Twenty‐four patients (82%) had an immediate reaction, four a non‐immediate (13.8%) reaction and no data were available for one patient. Two patients had positive ICM skin tests previously and were re‐exposed to a negatively skin‐tested ICM and did not react. Only two patients presented a mild reaction during ICM re‐injection: one immediate (generalized urticaria lasting for 3 days) and one non‐immediate maculopapular reaction. The patient with urticaria was re‐tested and re‐challenged (negative). The other patient was unable to return for re‐testing.
Conclusion
Skin testing for ICM hypersensitivity has a negative predictive value of 96.6% (95% CI: 89.9–103.2) and none of the reactions in skin‐test‐negative patients were severe. Multi‐centric large surveys are still needed for confirmation.
Cite this as: S. Caimmi, B. Benyahia, D. Suau, L. Bousquet‐Rouanet, D. Caimmi, P.‐J. Bousquet and P. Demoly, Clinical & Experimental Allergy, 2010 (40) 805–810.
Unlike CO2, atmospheric methane concentrations are rising faster than at any time in the past two decades and, since 2014, are now approaching the most greenhouse-gas-intensive scenarios. The reasons ...for this renewed growth are still unclear, primarily because of uncertainties in the global methane budget. New analysis suggests that the recent rapid rise in global methane concentrations is predominantly biogenic-most likely from agriculture-with smaller contributions from fossil fuel use and possibly wetlands. Additional attention is urgently needed to quantify and reduce methane emissions. Methane mitigation offers rapid climate benefits and economic, health and agricultural co-benefits that are highly complementary to CO2 mitigation.
Atmospheric methane grew very rapidly in 2014 (12.7 ± 0.5 ppb/year), 2015 (10.1 ± 0.7 ppb/year), 2016 (7.0 ± 0.7 ppb/year), and 2017 (7.7 ± 0.7 ppb/year), at rates not observed since the 1980s. The ...increase in the methane burden began in 2007, with the mean global mole fraction in remote surface background air rising from about 1,775 ppb in 2006 to 1,850 ppb in 2017. Simultaneously the 13C/12C isotopic ratio (expressed as δ13CCH4) has shifted, now trending negative for more than a decade. The causes of methane's recent mole fraction increase are therefore either a change in the relative proportions (and totals) of emissions from biogenic and thermogenic and pyrogenic sources, especially in the tropics and subtropics, or a decline in the atmospheric sink of methane, or both. Unfortunately, with limited measurement data sets, it is not currently possible to be more definitive. The climate warming impact of the observed methane increase over the past decade, if continued at >5 ppb/year in the coming decades, is sufficient to challenge the Paris Agreement, which requires sharp cuts in the atmospheric methane burden. However, anthropogenic methane emissions are relatively very large and thus offer attractive targets for rapid reduction, which are essential if the Paris Agreement aims are to be attained.
Plain Language Summary
The rise in atmospheric methane (CH4), which began in 2007, accelerated in the past 4 years. The growth has been worldwide, especially in the tropics and northern midlatitudes. With the rise has come a shift in the carbon isotope ratio of the methane. The causes of the rise are not fully understood, and may include increased emissions and perhaps a decline in the destruction of methane in the air. Methane's increase since 2007 was not expected in future greenhouse gas scenarios compliant with the targets of the Paris Agreement, and if the increase continues at the same rates it may become very difficult to meet the Paris goals. There is now urgent need to reduce methane emissions, especially from the fossil fuel industry.
Key Points
Atmospheric methane is rising; its carbon isotopic ratio has become more depleted in C‐13
The possible causes of the change include an increase in emissions, with changing relative proportions of source inputs, or a decline in methane destruction, or both
If this rise continues, there are significant consequences for the UN Paris Agreement
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