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Mixed-methods evaluation of a behavioural intervention package to identify and amend incorrect penicillin allergy records in UK general practice

Por: Wanat · M. · Santillo · M. · Galal · U. · Davoudianfar · M. · Bongard · E. · Savic · S. · Savic · L. · Porter · C. · Fielding · J. · Butler · C. C. · Pavitt · S. · Sandoe · J. · Tonkin-Crine · S. · On behalf of the ALABAMA team · Boards · Bongard · Butler · Davoudianfar · East · Fieldi

About 6% of the UK general practice population has a record of a penicillin allergy but fewer than 10% of these are likely to be truly allergic. In the ALABAMA (Allergy Antibiotics and Microbial resistance) feasibility trial, primary care patients with penicillin allergy were randomised to penicillin allergy assessment pathway or usual care to assess the effect on health outcomes. A behavioural intervention package was developed to aid delabelling. This study aimed to investigate patients’ and clinicians’ views of penicillin allergy testing (PAT).


We conducted a mixed-methods process evaluation embedded within the ALABAMA trial, which included a clinician survey, a patient survey (at baseline and follow-up) and semistructured interviews with patients and clinicians.


The study was conducted in primary care, as part of the feasibility stage of the ALABAMA trial.


Patients and primary care clinicians.


Clinicians (N=53; 52.2%) were positive about PAT and its potential value but did not have previous experience of referring patients for a PAT and were unsure whether patients would take penicillin after a negative allergy test. Patients (N=36; 46%) were unsure whether they were severely allergic to penicillin and did not fear a severe allergic reaction to penicillin. Clinician interviews showed that they were already aware of the benefit of PAT. Interviews with patients suggested the importance of safety as patients valued having numerous opportunities to address their concerns about safety of the test.


This study highlights the positive effects of the ALABAMA behavioural intervention for both patients and clinicians.

Trial registration number

NCT04108637; ISRCTN20579216; Pre-results.

Associations between sensitisation to allergens and allergic diseases: a hospital-based case-control study in China

Por: Zhang · W. · Xie · B. · Liu · M. · Wang · Y.

To assess the associations of sensitisation to common allergens with atopic dermatitis, allergic rhinitis and allergic asthma in adults.


Case–control study.


Data were collected from the First Affiliated Hospital of Harbin Medical University in Harbin, China.


Cases were 5111 patients with physician-diagnosed atopic dermatitis (n=2631), allergic asthma (n=1320) and allergic rhinitis (n=1160) recruited from the department of allergy from March 2009 to December 2017. Controls were 2576 healthy adults who underwent physical examination at the same hospital during the same period.

Main outcome measures

Specific IgE levels to 16 common food, indoor and outdoor allergens were assessed in all participants. Adjusted ORs and 95% CIs for the association between allergen sensitisation and allergic diseases were estimated using multivariate logistic regression.


The prevalence of allergen sensitisation was higher in patients with atopic dermatitis (indoor=17.14%, outdoor=12.85%, food=21.44%), allergic rhinitis (indoor=23.18%, outdoor=26.81%, food=8.94%) and allergic asthma (indoor=24.65%, outdoor=16.46%, food=14.31%) compared with controls (indoor=11.03%, outdoor=6.84%, food=5.83%). After adjustment for potential confounding variables, there was a dose–response relevance between the levels of allergen-specific IgE and allergic diseases (p trend


There was a dose–response relevance between levels of allergen-specific IgE and allergic diseases’ prevalence, and multiple sensitisations increased the risk of allergic diseases. This study provides evidence for the prophylaxis of allergic diseases.

Psychometric properties of disease-specific health-related quality of life (HRQoL) instruments for food allergy and food intolerance: protocol for a COSMIN-based systematic review

Por: Chen · Q. · Li · Z. · Castro · A. · Tang · S. · Chen · J. · Huang · C. · Xiao · J. · Liu · H. · Ding · J.

Food allergies and food intolerances can bring burdens on patients and their caregivers and reduce health-related quality of life (HRQoL). An increasing number of disease-specific HRQoL instruments for food allergies and food intolerances has been developed, and some of them have been adapted for different cultures and languages. This report describes a protocol for a systematic review of the psychometric properties of these instruments. The aims of this systematic review are to: (1) formulate recommendations for the usage of existing validated disease-specific HRQoL instruments for patients with food allergies and/or food intolerances and their caregivers; and (2) identify knowledge gaps to inform future research relating to these instruments.

Methods and analysis

This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) 2015 checklist. The future review will follow the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline for systematic reviews of patient-reported outcome measures (PROMs) and PRISMA 2020 statement guideline. Six databases (PubMed, EMBASE, Web of Science, Scopus, CINAHL and ProQuest -Health & Medical Collection) will be searched to retrieve studies focusing on the development and psychometric properties of disease-specific HRQoL instruments for patients with food allergies and/or food intolerances and their caregivers between 1 December 2021 and 31 December 2021. Two researchers will be responsible for literature screening, data extraction and literature evaluation, independently. Disagreements will be addressed by discussion or the involvement of a third researcher. The methodological quality of the included studies and the quality of the identified instruments will be assessed based on the COSMIN guideline for systematic reviews of PROMs.

Ethics and dissemination

Ethical approval is not applicable for this study. We will disseminate the findings through publication in peer-reviewed journals and/or academic conferences.

PROSPERO registration number


Defining CD4 T helper and T regulatory cell endotypes of progressive and remitting pulmonary sarcoidosis (BRITE): protocol for a US-based, multicentre, longitudinal observational bronchoscopy study

Por: Koth · L. L. · Harmacek · L. D. · White · E. K. · Arger · N. K. · Powers · L. · Werner · B. R. · Magallon · R. E. · Grewal · P. · Barkes · B. Q. · Li · L. · Gillespie · M. · Collins · S. E. · Cardenas · J. · Chen · E. S. · Maier · L. A. · Leach · S. M. · OConnor · B. P. · Hamzeh · N. Y.

Sarcoidosis is a multiorgan granulomatous disorder thought to be triggered and influenced by gene–environment interactions. Sarcoidosis affects 45–300/100 000 individuals in the USA and has an increasing mortality rate. The greatest gap in knowledge about sarcoidosis pathobiology is a lack of understanding about the underlying immunological mechanisms driving progressive pulmonary disease. The objective of this study is to define the lung-specific and blood-specific longitudinal changes in the adaptive immune response and their relationship to progressive and non-progressive pulmonary outcomes in patients with recently diagnosed sarcoidosis.

Methods and analysis

The BRonchoscopy at Initial sarcoidosis diagnosis Targeting longitudinal Endpoints study is a US-based, NIH-sponsored longitudinal blood and bronchoscopy study. Enrolment will occur over four centres with a target sample size of 80 eligible participants within 18 months of tissue diagnosis. Participants will undergo six study visits over 18 months. In addition to serial measurement of lung function, symptom surveys and chest X-rays, participants will undergo collection of blood and two bronchoscopies with bronchoalveolar lavage separated by 6 months. Freshly processed samples will be stained and flow-sorted for isolation of CD4 +T helper (Th1, Th17.0 and Th17.1) and T regulatory cell immune populations, followed by next-generation RNA sequencing. We will construct bioinformatic tools using this gene expression to define sarcoidosis endotypes that associate with progressive and non-progressive pulmonary disease outcomes and validate the tools using an independent cohort.

Ethics and dissemination

The study protocol has been approved by the Institutional Review Boards at National Jewish Hospital (IRB# HS-3118), University of Iowa (IRB# 201801750), Johns Hopkins University (IRB# 00149513) and University of California, San Francisco (IRB# 17-23432). All participants will be required to provide written informed consent. Findings will be disseminated via journal publications, scientific conferences, patient advocacy group online content and social media platforms.

Safety and effectiveness of dose-sparing strategies for intramuscular seasonal influenza vaccine: a rapid scoping review

Por: Lunny · C. · Antony · J. · Rios · P. · Williams · C. · Ramkissoon · N. · Straus · S. E. · Tricco · A. C.

The objective of this rapid scoping review was to identify studies of dose-sparing strategies for administration of intramuscular seasonal influenza vaccines in healthy individuals of all ages.


Comprehensive literature searches were executed in MEDLINE, Embase and the Cochrane library. The grey literature was searched via international clinical trial registries for relevant studies published in English in the last 20 years. We included studies in healthy humans of any age that used any dose-sparing strategy to administer intramuscular seasonal influenza vaccines. Title/abstract and full-text screening were carried out by pairs of reviewers independently. Data extraction was conducted by a single reviewer and verified by a second reviewer. Our outcomes were influenza infections, intensive care unit admission, pneumonia, hospitalisations, adverse events and mortality. Results were summarised descriptively.


A total of 13 studies with 10 351 participants were included in the review and all studies were randomised controlled trials (RCTs) conducted between 2006 and 2019. The most common interventions were the trivalent influenza vaccine (n=10), followed by the quadrivalent influenza vaccine (n=4). Nine studies included infants/toddlers 6–36 months old and one of these studies also included children and adolescents. In these nine studies, no clinical effectiveness outcomes were reported. Of the four adult studies (≥18 years), two studies reported on effectiveness outcomes, however, only one RCT reported on laboratory-confirmed influenza.


Due to the low number of studies in healthy adults and the lack of studies assessing confirmed influenza and influenza-like illness, there remains a need for further evaluation.