Allergy Workup in the Diagnosis of COVID-19 Vaccines-Induced Hypersensitivity Reactions and Its Impact on Vaccination

INTRODUCTION

Immediate and delayed hypersensitivity reactions (HSR) to COVID-19 vaccines are rare adverse events that need to be prevented, diagnosed, and managed in order to guarantee adherence to the vaccination campaign. The aims of our study were to stratify the risk of HSR to COVID-19 vaccines and propose alternative strategies to complete the vaccination.

METHODS

1,640 subjects were screened for vaccinal eligibility, according to national and international recommendations. Among them, we enrolled for allergy workup 152 subjects, 43 with HSR to COVID-19 vaccines and 109 at high risk of HSR to the first dose. In vivo skin tests with drugs and/or vaccines containing PEG/polysorbates were performed in all of them, using skin prick test and, when negative, intradermal tests. In a subgroup of patients resulted negative to the in vivo skin tests, the programmed dose of COVID-19 vaccine (Pfizer/BioNTech) was administered in graded doses regimen, and detection of neutralizing anti-spike antibodies was performed in these patients after 4 weeks from the vaccination, using the SPIA method.

RESULTS

Skin tests for PEG/polysorbates resulted positive in only 3% (5/152) of patients, including 2 with previous HSR to COVID-19 vaccines and 3 at high risk of HSR to the first dose. Among the 147 patients with negative skin tests, 97% (143/147) were eligible for vaccination and 87% (124/143) of them received safely the programmed COVID-19 vaccine dose. Administration of graded doses of Pfizer/BioNTech vaccine were well tolerated in 17 out of 18 patients evaluated; only 1 developed an HSR during the vaccination, less severe than the previous one, and all developed neutralizing anti-spike antibodies after 4 weeks with values comparable to those subjects who received the vaccine in unfractionated dose.

CONCLUSION

On the whole, the usefulness of the skin tests for PEG/polysorbates seems limited in the diagnosis of HSR to COVID-19 vaccines. Graded doses regimen (Pfizer/BioNTech) is a safe and effective alternative strategy to complete the vaccinal course.

Perinatal depression and developmental risk of the infant: Analysis of a clinical sample and assessment of the impact of the COVID-19 pandemic

Introduction

Studies on large samples agree on the negative impact of maternal perinatal depression (PD) on child’s cognitive development. Early experience with insensitive maternal interactions appears to be predictive of poorer cognitive functioning. These children present a higher risk for the onset of socioemotional development, nutrition, growth and sleep disorders. Research on Covid-19 pandemic suggests that families, particularly mothers, may be at increased risk of psychological distress.

Objectives

This study evaluates the effect of perinatal depression on child development and the impact of distress caused by the Covid-19 pandemic.

Methods

We designed a case-control study comparing, during Covid-19 pandemic, a group-A of children of mothers with PD (n=19), with a group-B of children of healthy mothers (n=21). The age of the children recruited was 4-35 months. Participating mothers underwent DP3-Interview and the socioemotional and adaptive-behavior Bayley’s scales by telephone and completed an online survey (IES-R).

Results

We found significantly lower scores on the Bayley socioemotional scale and in all the DP3-scales, in group-A. There is an inversely proportional correlation between the age of these children and overall development score of the DP3. On the IES-R scale, the medium scores in both groups show no psychological distress as a consequence of the Covid-19 pandemic, although mothers with PD show borderline total scores and higher hyperarousal scale values.

Conclusions

This study confirms that PD is a risk factor for the onset of disorders in all areas of the child’s development. Mothers with PD are less likely to manage psychological distress secondary to the pandemic.

Disclosure

No significant relationships.

Perinatal depression as a risk-factor for infant sleep disturbances: Subjective data from a case-control study

Introduction

Perinatal period is characterized by a broad range of physical, psychological and relational changes. Maternal perinatal depression (PD) is defined as an episode of major depression with the onset from pregnancy to the first year after delivery. Depressive symptoms influence the earlier mother-child interaction and impact on child cognitive, affective and behavioral development.

Objectives

Purpose of our study was to evaluate the consequences of PD on sleep-wake patterns in the early stages of infant development. We aim to investigate the presence of poor sleep in infants/ toddlers and also to identify differences in sleep ecology variables.

Methods

We enrolled, from December 2019 to September 2020, a clinical sample of children born from women with PD (N=19, m.a.=13,7, SD= 7,6) and a healthy control group (N=21, m.a.=15,5, SD=5,43). Infant sleep data were obtained from the Brief Infant Sleep Questionnaire (BISQ). Poor sleepers were defined by the following criteria: >3 night wakings, nocturnal wakefulness >1 hr or total sleep duration <9 hr. Maternal depression was assessed with clinical and psychometric evaluation. T-test was used for comparison between the two samples.

Results

Statistical analysis indicates that there were not significant differences between the two groups concerning night wakings (p= .678), nocturnal wakefulness (p= .815), total sleep duration (p= .209) and nocturnal sleep onset time (p= .475).

Conclusions

Our findings suggest that PD is not a risk-factor in the onset of infant sleep problems. Probably negative parentig, affective disengagement, delegation in maternal care and sedative effects of pharmacotherapy may affect mother’s perception of her infant’s sleep.

Catanionic vesicles and DNA complexes: a strategy towards novel gene delivery systems

Catanionic vesicles and DNA form complexes, the structure and composition of which depend on the DNA content. The DNA undergoes a reversible compaction process and its release can be triggered by adding an anionic surfactant to the complexes.

Confining ss-DNA/carbon nanotube complexes in ordered droplets

In 1/1 mass ratio mixtures made of single strand DNA and single-walled carbon nanotubes lyotropic nematic phases are formed. The process is assisted by segregative phase separation procedures. The liquid crystalline order occurring therein was confirmed by optical polarizing microscopy and zero-shear rheology. The resulting nematic droplets were dispersed in protein or cationic surfactant solutions, under appropriate pH and/or ionic strength conditions. The components of the hosting fluid(s) rapidly adsorb onto the droplets, form a permanent peel on their surface, and confine them. The peel resists osmotic gradients and has significant stability. The distribution of the species in the droplet and in the peel was determined by SEM. Data indicate that the peel contains protein or surfactant, depending on the titrant, when the core is rich in DNA and nanotubes. According to electron microscopy, nematic order in the droplets is partly retained.

In vivo effectiveness of lithium on impaired neutrophil chemotaxis in Shwachman-Diamond syndrome

The effect of lithium treatment on the impaired neutrophil chemotactic function of a patient affected by Shwachman-Diamond syndrome is reported. We found that (1) a cytoskeletal cellular defect seems to be involved in the impairment of neutrophil function (and perhaps of cellular secretion and chondrocyte function) in the syndrome; (2) intermittent neutropenia is always present in the syndrome, and (3) lithium seems capable, in addition to its capacity of inducing leukocytosis, of modulating leukocyte functions by modulating the microtubular system. The drug, at usual therapeutic dosage, was able to normalize neutrophil functions without side effects. As no therapy is available in this syndrome to date, our data suggest the therapeutic use of lithium in order to improve these cytoskeleton-mediated functions and the degree of neutropenia.

[Clinical aspects of celiac disease. Comparison of 2 periods: before and after the introduction of antigliadin antibody determination in clinical practice]

The clinical aspects of coeliac disease before and after anti-gliadin antibodies (AGA) assessment in clinical practice, referring to personal experience (107 cases in the period 1976-1988) are described. AGA determination has executed by two different ELISA methods. The diagnosis of coeliac disease in the period 1976-1986 has been made according to ESPGAN criteria, while in the last two years following the recent SIP advice. After 1987 with the introduction of AGA assay, the number of diagnosis/year of coeliac disease has increased three times in respect of the period 1976-1986. We have observed a more marked increase of the late beginning forms (from 2.8 to 10 diagnosis/year) in respect of the early beginning ones (from 3.7 to 7.5 diagnosis/year) and of the atypical forms (from 0.7 to 9 diagnosis/year) in respect of the typical ones (from 5.8 to 8.5 diagnosis/year). According to these data we think that prevalence of coeliac disease in our country is probably underestimated. AGA determination is at time most effective mean to make a screening of coeliac disease in the population. According to us the largest employment of this method in the next years could take a most exact estimate of the coeliac disease prevalence in our country.

[Postoperative hyperkinetic arrhythmias treated with amiodarone]

Twenty eight patients have been treated; 8 patients had atrial fibrillation (FA) and 20 supraventricular paroxysmal (SVPT) tachycardia. Both diseases followed interventions of major surgery. No patient had myocardial ischemia and/or damaged conduction system, took any heart-related drug, or showed any risk factor. The posologic plans was as follows: a) bolus i.v. (three minutes) with 2 Amiodarone vials and electrocardiographic monitoring, then b) 10-20 mg/kg/day for three days with electrocardiographic monitoring. Within 5 days, all patients attained the total recovery from SVPT; AF regressed during the bolus injection in 1 patient, on the first day in 5 patients, and on the third day in the remaining 2 patients. During the hospitalization no important side effects occurred, except for transient hypotension in three subjects. The 6 months follow up did not reveal signs of intolerance, either. Amiodarone thus showed to be useful and well tolerated in the treatment of post-surgical hyperkinetic arrhythmias in patients undergoing major surgery.

The use of nimodipine (Nimotop-Bayer) in patients with chronic ischemic cerebral vasculopathies. Twenty-eight case reports

Nimodipine therapy (30 mg x 3/die) was commenced in twenty-eight patients affected by chronic ischemic cerebral vasculopathies and continued for the 90 days in order to evaluate drug efficacy. Clinical controls were carried out 4, 8 and 12 weeks after the start of therapy using Doppler, ultrasound and neurological tests (the letter based on the SCAG neurological scale). Hemodynamic and hematochemical parameters were also monitored and controlled.

[Intolerance to cow's milk proteins: cases contribution]

The authors report their own case-report about cow's milk protein intolerance observed in the last seven years in the gastroenterology-department of Pediatric Clinic in Pisa. They underline the symptomatologic polymorphism of the illness and, analysing the laboratory data, point out the absence of absolute diagnostic assurance tests. For this reason they conclude that at the present state the diagnosis of certainty is overall committed to the resolution of the symptomatology after exclusion-diet and following clinic relapse after milk load.

[Barium peritonitis: experimental study using barium sulfate and radioactive barium]

Barium peritonites are known to be a serious complication of barium enema examinations, being accompanied by a high mortality rate. The authors made their study injecting barium and radioactive 133Ba in the peritoneum of 68 rats without causing damages to the colon, in order to verify the toxicity of barium if injected in the peritoneum, and to evaluate the various extraperitoneal locations. Moreover, they compared the alterations caused by this agent with those consequent to a similar agent, such as talcum. The results show that barium is not toxic on its own: it gives in fact origin to granulomas similar to those caused by talcum; a particular tropism for the lymphatic tissues is present as well.

[Nephrographic study with 131 iodine hippuran in surgical diseases of the uropoietic apparatus]

Personal experience with 131I-Hippuran nephrography, particularly in surgical cases, is described. The examination is a useful aid to the diagnosis diagnosis of recent colic and in the investigation of cases where a negative finding has been obtained with other radiological means. Its pre- and post-operative employment in the evaluation of renal function is also discussed.