Anti‐polyethylene glycol (PEG) antibody isotypes may predict PEG‐associated allergy and COVID‐19 protection among patients with history of suspected COVID‐19 vaccine allergy DOI Creative Commons
Andy Ka Chun Kan, Valerie Chiang,

Wai Ki Ip

et al.

Clinical and Translational Allergy, Journal Year: 2023, Volume and Issue: 13(9)

Published: Sept. 1, 2023

Different anti-polyethylene glycol (PEG) antibody isotypes develop following exposure to PEG-containing substances, including many mRNA COVID-19 vaccines.1 For example, one study of 14 patients indicated that allergic vaccines have significantly higher anti-PEG titres than controls.2 Two are available in Hong Kong—PEG-containing Pfizer-BioNTech Comirnaty (BNT) and non-PEG-containing Sinovac CoronaVac (SV). Since their introduction, cases vaccine-/PEG-associated allergy exacerbated vaccine hesitancy.3 Following suspected reactions, subsequent vaccination decisions depend on balancing the risk genuine with existing protection. However, allergist evaluation or tests for protection remain limited.4 Studies shown true exceedingly rare, most reactions unlikely be genuine.5 PEG/vaccine skin were found high specificity but low sensitivity meta-analysis.6 Therefore, markers adjunct needed aid screening confirm diagnosis. We hypothesise specific (IgE/IgG/IgM) may serve as predictors PEG among individuals who received vaccines. analysed clinical data blood samples evaluated vaccine-associated either BNT SV vaccination. Patients gave informed consent this was approved by Institutional Review Board HKU/HA HKWC. The Vaccine Allergy Safety pathway all Kong, ‘high-risk’ assigned assessment; defined those a history immediate-type reaction (onset <1 h) systemic symptoms previous vaccination.4, 7 recruited 1 dose SV, between March 2021 November 2022. Blood IgE, IgG IgM well neutralising measured, median interval sample collection 3.3 months (inter-quartile range: 2.5–4.2). Anti-PEG measured using commercial human ELISA kits respectively (Alpha Diagnostic Intl. Inc.). Results expressed Antibody Activity Threshold Index, which values ≥ 1.0 positive antibody. IgE measurement, kit modified performed according manufacturer's instructions. Human reference monoclonal obtained from Academia Sinica used standard, while horseradish peroxidase-conjugated mouse anti-human (B3102E8, Abcam) detection IgE. concentration cut-off value 7.5 ng/mL (99th percentile 79 normal subjects). neutralisation levels determined surrogate virus test (iFlash-2019-nCoV assay, Shenzhen YHLO Biotech Co. Ltd.) A ≥20 AU/mL seropositive. draws, underwent testing (skin prick intra-dermal test) both (PEG 2000, 3350 4000) (BNT SV), if negative, followed provocation (PT) SV. Confirmed PT, excluded negative PT. All IBM SPSS Statistics 27.0. Associations variables chi-square logistic regression analysis, appropriate. total 295 recruited: 179 (60.7%) 116 (39.3%) Compared more recipients had (54 [30.2%] vs. 12 [10.3%], p < 0.001) there no differences (p = 0.708) 1.000). One patient confirmed IgM. remaining isotype serology results Table S1. performance predict PEG-associated is 1, calculated recipients. associated 0.003), not 0.224 0.876, respectively). proportion having compared 9 [7.8%], 0.001). Positive seropositivity (odds ratio [OR] 2.78, 95% confidence [CI]: 1.52–5.12, 0.001), associations (Table 2). Subgroup analysis revealed association only present (OR 2.25, CI: 1.15–4.42, 0.019) S2) 0.937). Our findings demonstrate potential utility antibodies level Although vaccine- demonstrated 100% predictive study. In contrast, non-allergic do significant after vaccination.8 worse predicting these seen (i.e., non-PEG-containing) useful This has several limitations. Firstly, we identified case allergy, influence external validity our findings. Further validation studies needed. Secondly, arbitrary/manufacturer's cut-offs protection, rather prospective infection. Thirdly, postulate marker seropositivity, biological meaning correlation currently unclear warrants further studies. conclusion, Validation identification additional applications beyond context warrant Andy Ka Chun Kan researched data, statistical analyses wrote manuscript. Valerie Chiang, Wai Ki Ip Elaine Y. L. Au data. Philip H. Li supervised project critically reviewed edited authors contributed final version work supported Health Medical Research Fund (HMRF) grant, Ref: COVID-1903011. conflicts interest relation work. Fund, Grant/Award Number: COVID-1903011 support request corresponding author. publicly due privacy ethical restrictions. Please note: publisher responsible content functionality any supporting information supplied authors. Any queries (other missing content) should directed author article.

Language: Английский

Identifying the most at-risk age-group and longitudinal trends of drug allergy labeling amongst 7.3 million individuals in Hong Kong DOI Creative Commons
Valerie Chiang, Andy Ka Chun Kan, Chinmoy Saha

et al.

BMC Medicine, Journal Year: 2024, Volume and Issue: 22(1)

Published: Jan. 26, 2024

Abstract Background Incorrect drug ‘allergy’ labels remain a global public health concern. Identifying regional trends of allergy labeling can guide appropriate interventions, but longitudinal or population studies scarce. We analysed the serial epidemiology to identify specific subgroups at highest risk for potential interventions. Methods Longitudinal, population-wide and clinical data from over 7,337,778 individuals in Hong Kong between 2016 2021 were analysed. Results The absolute prevalence incidence documented 5.61% 277/100,000 population, respectively. Annual new was stable 2019, until significant drop 2020 (−16.3%) during COVID19 pandemic. most common anti-infectives (245,832 [44.5%]), non-steroidal anti-inflammatory (106,843 [19.3%]), nervous system drugs (45,802 [8.3%]). labeled culprits severe immediate-type (anaphylaxis) non-immediate-type (Stevens-Johnson syndrome) reactions beta-lactams drugs, For labeling, there significantly higher overall beta-lactam amongst aged > 40 years which contributed majority newly allergies (377,004, 68.2%). Conclusions Contrary traditional dogma, we identified disproportionately older individuals, rather than paediatric age group. advocate more investigate this phenomenon other cohorts as well future preventative delabeling efforts focusing on adult population.

Language: Английский

Citations

11
Leveraging COVID-19 vaccine allergy evaluations with coincident drug allergy delabelling: Effectiveness and impact on quality of life DOI Creative Commons
Andy Ka Chun Kan, Hugo W.F. Mak, Valerie Chiang

et al.

Vaccine, Journal Year: 2025, Volume and Issue: 50, P. 126849 - 126849

Published: Feb. 5, 2025

Concerns of potential drug/vaccine-associated allergies significantly impact vaccine safety and hesitancy. Delabelling incorrect drug allergy in the general public was previously impeded by limited access to allergist services, especially among less frequent healthcare utilisers community. COVID-19 evaluation services have enabled individuals (mis)labelled with receive vaccinations safely provided opportunities expand delabeling access. We investigated effectiveness this coincident delabelling its on health-related quality life (HRQoL). recruited labelled attending for Hong Kong between 2021 2022. Demographics, comorbidities, labels, vaccination infection outcomes, as well rates were analysed. HRQoL measured before after a subgroup individuals. Among 652 individuals, 1456 labels identified, anti-infectives being most common (606, 41.6 %). Beta-lactam antibiotics accounted 55.1 % (334). Almost all (99.4 %) proceeded vaccinations, an increased number doses conferring better protection. 228 (35.0 underwent investigations, successful 223 (97.8 %), removing 317 (21.8 which 173 (51.8 beta-lactams. Subgroup analysis showed improved serial following (DrHy-Q 45.0 vs 33.3, p < 0.001). Services evaluating not only empowered safely, but also enhanced public.

Language: Английский

Citations

0
Hereditary Angioedema (HAE) in China: Advancing Awareness, Access, Advocacy and Alliances From the Greater Bay Area to the Global HAE Community DOI Creative Commons
Philip H. Li, Jinxian Huang,

C. Wang

et al.

Clinical & Experimental Allergy, Journal Year: 2025, Volume and Issue: unknown

Published: March 4, 2025

The article offers an overview of the progress in managing Hereditary Angioedema (HAE) China, with a specific focus on Greater Bay Area (GBA). Through '4As' framework-Awareness, Access, Advocacy and Alliance-the explores challenges advancements HAE care. In terms collaborative initiatives such as HAE-ASIA (Angioedema Screening Asia) collaboration GBA Alliance "Hub-and-Spoke model" aim to bridge gap between East West, providing optimal patient care advancing management. By bridging aims deliver advance Moving forward, it will be essential persist nurturing national international collaborations, not only within China but also extending beyond its borders. These partnerships encourage exchange knowledge, research, best practices, all which are critical propelling forward HAE. uniting worldwide community, we can significantly efforts improve quality life for those affected by across globe.

Language: Английский

Citations

0
NSAID Allergy Labels Associated With Mortality and Cardiovascular Outcomes in Stroke DOI
Clara Tsui, Hugo W.F. Mak, William Leung

et al.

Stroke, Journal Year: 2024, Volume and Issue: 56(1), P. 30 - 38

Published: Nov. 19, 2024

BACKGROUND: Mislabeled drug allergy can restrict future prescriptions and medication use, but its prevalence impact among patients with stroke remain unknown. This study investigated the of most commonly labeled allergies, their accuracy, stroke. METHODS: In this combined longitudinal cross-sectional study, we compared labels general population ischemic between 2008 2014 from electronic health care records in Hong Kong. Outcomes or without prevalent (ie, NSAID) were compared. Rate mislabeled NSAID was confirmed by provocation testing. RESULTS: Compared (n=702 966), had more (n=235) to cardiovascular hematopoietic system (prevalence, 19.5% versus 9.2%; odds ratio [OR], 2.4 [95% CI, 1.74–3.32]; P <0.001) radiographic diagnostic agents 4.2% 0.9%; OR, 4.82 2.56–9.08]; <0.001). The common 1.8%). Patients significantly less likely be prescribed aspirin after acute (OR, 0.24 0.09–0.60]; =0.003) on follow-up 0.22 0.08–0.56]; =0.002). median duration 6.7 years (6499±2.49 patient-years). also experienced higher mortality 7.44 2.44–23.18]; <0.001), peripheral vascular disease 9.35 1.95–44.86]; =0.005), major adverse events 6.09 2.00–18.58]; =0.001) poststroke period. (who remained alive could consent) referred for allergist assessment offered majority (80%; 4/5) negative tests delabeled. CONCLUSIONS: stroke, associated excessive mortality, disease, events. Given high rate multidisciplinary neuro-allergy interventions have potential improve patient outcomes.

Language: Английский

Citations

2
Comparing pharmacists versus allergists in low-risk penicillin allergy delabelling: The Hong Kong Penicillin Allergy Pharmacist Initiative (HK-PAPI) DOI Creative Commons

Jurenne D. Hooi,

Marshall Low,

Jonathan C L To

et al.

World Allergy Organization Journal, Journal Year: 2024, Volume and Issue: 17(12), P. 101003 - 101003

Published: Nov. 21, 2024

Language: Английский

Citations

2
Delabelling multiple antibiotic allergy: Practical issues DOI Creative Commons
Philip H. Li, Bernard Yu‐Hor Thong

Frontiers in Allergy, Journal Year: 2023, Volume and Issue: 4

Published: March 16, 2023

With the growing incidence of multi-drug resistant organisms, delabelling incorrect antibiotic allergies has become an integral part antimicrobial stewardship worldwide. For example, around 90% penicillin allergy labels are found to be inaccurate following a full work-up, which deprive patients use effective first-line antibiotics and increase risk resistance with other extended spectrum non-penicillin antimicrobials. Significant numbers adult paediatric over time labelled multiple often during inappropriate use, resulting in label “multiple allergy”. In contrast where oral direct provocation tests can used for low-risk, mild reactions, sensitivity/specificity/positive negative predictive values skin have been demonstrated, diagnostic require combination in-vivo in-vitro across different classes evaluation. Shared decision making informed consent also needed when prioritising drugs delabel first, balancing risks, benefits testing vs. interim alternative antibiotics. Similar allergy, cost-effectiveness drug is unknown.

Language: Английский

Citations

3
Non-Steroidal Anti-Inflammatory Drug Allergy Labels Associated with Mortality and Adverse Cardiovascular Outcomes Among Stroke Patients: High Rate of Mislabelled Allergy and Potential for Multi-Disciplinary Intervention DOI

Cheuk Wun Tsui,

Hugo W.F. Mak, William Leung

et al.

Published: Jan. 1, 2024

Download This Paper Open PDF in Browser Add to My Library Share: Permalink Using these links will ensure access this page indefinitely Copy URL DOI

Language: Английский

Citations

0
Immunology & Allergy referral patterns in Hong Kong following the COVID-19 pandemic: A 8-year longitudinal analysis DOI Creative Commons

Gordon Kwok Ho Chu,

Emily M. Lee,

Jurenne D. Hooi

et al.

Deleted Journal, Journal Year: 2024, Volume and Issue: unknown, P. 100023 - 100023

Published: Dec. 1, 2024

Language: Английский

Citations

0
Anti‐polyethylene glycol (PEG) antibody isotypes may predict PEG‐associated allergy and COVID‐19 protection among patients with history of suspected COVID‐19 vaccine allergy DOI Creative Commons
Andy Ka Chun Kan, Valerie Chiang,

Wai Ki Ip

et al.

Clinical and Translational Allergy, Journal Year: 2023, Volume and Issue: 13(9)

Published: Sept. 1, 2023

Different anti-polyethylene glycol (PEG) antibody isotypes develop following exposure to PEG-containing substances, including many mRNA COVID-19 vaccines.1 For example, one study of 14 patients indicated that allergic vaccines have significantly higher anti-PEG titres than controls.2 Two are available in Hong Kong—PEG-containing Pfizer-BioNTech Comirnaty (BNT) and non-PEG-containing Sinovac CoronaVac (SV). Since their introduction, cases vaccine-/PEG-associated allergy exacerbated vaccine hesitancy.3 Following suspected reactions, subsequent vaccination decisions depend on balancing the risk genuine with existing protection. However, allergist evaluation or tests for protection remain limited.4 Studies shown true exceedingly rare, most reactions unlikely be genuine.5 PEG/vaccine skin were found high specificity but low sensitivity meta-analysis.6 Therefore, markers adjunct needed aid screening confirm diagnosis. We hypothesise specific (IgE/IgG/IgM) may serve as predictors PEG among individuals who received vaccines. analysed clinical data blood samples evaluated vaccine-associated either BNT SV vaccination. Patients gave informed consent this was approved by Institutional Review Board HKU/HA HKWC. The Vaccine Allergy Safety pathway all Kong, ‘high-risk’ assigned assessment; defined those a history immediate-type reaction (onset <1 h) systemic symptoms previous vaccination.4, 7 recruited 1 dose SV, between March 2021 November 2022. Blood IgE, IgG IgM well neutralising measured, median interval sample collection 3.3 months (inter-quartile range: 2.5–4.2). Anti-PEG measured using commercial human ELISA kits respectively (Alpha Diagnostic Intl. Inc.). Results expressed Antibody Activity Threshold Index, which values ≥ 1.0 positive antibody. IgE measurement, kit modified performed according manufacturer's instructions. Human reference monoclonal obtained from Academia Sinica used standard, while horseradish peroxidase-conjugated mouse anti-human (B3102E8, Abcam) detection IgE. concentration cut-off value 7.5 ng/mL (99th percentile 79 normal subjects). neutralisation levels determined surrogate virus test (iFlash-2019-nCoV assay, Shenzhen YHLO Biotech Co. Ltd.) A ≥20 AU/mL seropositive. draws, underwent testing (skin prick intra-dermal test) both (PEG 2000, 3350 4000) (BNT SV), if negative, followed provocation (PT) SV. Confirmed PT, excluded negative PT. All IBM SPSS Statistics 27.0. Associations variables chi-square logistic regression analysis, appropriate. total 295 recruited: 179 (60.7%) 116 (39.3%) Compared more recipients had (54 [30.2%] vs. 12 [10.3%], p < 0.001) there no differences (p = 0.708) 1.000). One patient confirmed IgM. remaining isotype serology results Table S1. performance predict PEG-associated is 1, calculated recipients. associated 0.003), not 0.224 0.876, respectively). proportion having compared 9 [7.8%], 0.001). Positive seropositivity (odds ratio [OR] 2.78, 95% confidence [CI]: 1.52–5.12, 0.001), associations (Table 2). Subgroup analysis revealed association only present (OR 2.25, CI: 1.15–4.42, 0.019) S2) 0.937). Our findings demonstrate potential utility antibodies level Although vaccine- demonstrated 100% predictive study. In contrast, non-allergic do significant after vaccination.8 worse predicting these seen (i.e., non-PEG-containing) useful This has several limitations. Firstly, we identified case allergy, influence external validity our findings. Further validation studies needed. Secondly, arbitrary/manufacturer's cut-offs protection, rather prospective infection. Thirdly, postulate marker seropositivity, biological meaning correlation currently unclear warrants further studies. conclusion, Validation identification additional applications beyond context warrant Andy Ka Chun Kan researched data, statistical analyses wrote manuscript. Valerie Chiang, Wai Ki Ip Elaine Y. L. Au data. Philip H. Li supervised project critically reviewed edited authors contributed final version work supported Health Medical Research Fund (HMRF) grant, Ref: COVID-1903011. conflicts interest relation work. Fund, Grant/Award Number: COVID-1903011 support request corresponding author. publicly due privacy ethical restrictions. Please note: publisher responsible content functionality any supporting information supplied authors. Any queries (other missing content) should directed author article.

Language: Английский

Citations

0