unspecified allergy vaccine (Staloral)

The impact of climatic factors on headache patterns: a 14-year time series analysis of cluster and tension-type headaches in primary care.

Cuenca-Zaldívar Juan Nicolás JN, Corral Del Villar Carmen C, García Torres Silvia S, Araujo Zamora Rafael R et al.

Weather-related influences on pain and neurological symptoms are widely discussed in biometeorology. However, the long-term impact of climatic variables on primary care headache consultations remains unclear. This study aimed to examine whether climatic variables are associated with consultations for cluster headaches, tension-type headaches (TTH), and unspecified headaches over 14 years. Data (2010-2023) were extracted from medical records using International Classification of Primary Care, Second Edition (ICPC-2) codes. Meteorological variables (temperature, rainfall, wind direction, barometric pressure, and sunshine hours) were obtained from the State Meteorological Agency. Time-series analyses used Exponential Smoothing State Space Model with External Regressors (ETSX) and AutoRegressive Integrated Moving Average Models with External Regressors (ARIMAX) using age, sex, and meteorological factors as external regressors. Model accuracy was evaluated using the Root Mean Squared Error (RMSE), Symmetric Mean Absolute Percentage Error (SMAPE), and Mean Absolute Scaled Error (MASE). A total of 5127 headache consultations were analyzed (mean age, 45.0 ± 19.9 years; 68.9% female). ETSX models best fit the overall, unspecified, and cluster headache series, whereas the ARIMAX model provided optimal performance for TTH. Sex was the strongest predictor across all models. In TTH, female sex increased consultations (p < 0.001), whereas higher temperature (p = 0.031) and wind direction (cosine component; p = 0.027) were associated with fewer consultations. For cluster headache, male sex was associated with fewer consultations (p = 0.020), and no climatic variables showed a significant association. Meteorological variables were not independently associated with unspecified headache consultations. Climatic variables showed limited, subtype-specific associations, with only temperature and wind direction independently associated with TTH. No weather variables predicted cluster headache or unspecified consultations. Demographic factors appeared to be more strongly associated with healthcare utilization than climatic variables, although ETSX and ARIMAX models may support forecasting and resource planning.

Real-World Performance of Non-Allergist-Led Penicillin Allergy Delabeling: Prospective Head-to-Head Comparison of APAAACI vs. PENFAST.

Chung Freya Kl FK, Shi Weihong W, Chong Man Yui MY, Lee Elaine E et al.

Although around 90% of penicillin allergies are mislabelled, delabeling initiatives have been hindered by limited access to drug allergy services. Asia Pacific Association of Allergy, Asthma, and Clinical Immunology (APAAACI) and PENFAST risk-stratification tools can facilitate non-allergist delabeling, but their comparative real-world performance remains unknown. The purpose of this study was to prospectively evaluate APAAACI and PENFAST against allergist assessment and drug provocation testing (DPT) outcomes. In a blinded, head-to-head study, 103 adults with penicillin allergy labels underwent independent risk stratification using both APAAACI and PENFAST tools, followed by allergist evaluation and allergy testing (skin tests, in vitro tests, and DPT). We assessed diagnostic performance (area under the curve [AUC]-receiver operating characteristic, accuracy, sensitivity, specificity, positive and negative predictive values [NPVs]) and agreement (Cohen's κ) of these tools. Overall, allergist assessment demonstrated the highest AUC of 0.82 (95% confidence interval [CI], 0.69-0.95), outperforming APAAACI (AUC, 0.79; 95% CI, 0.66-0.92; P = 0.012) and PENFAST (AUC, 0.75; 95% CI, 0.62-0.89; P = 0.010). Both APAAACI and PENFAST demonstrated high sensitivity (0.88) and NPV (APAAACI, 0.99; PENFAST, 0.98), missing only one non-severe DPT-positive case. APAAACI showed excellent agreement with allergist assessment (κ = 0.96, P < 0.001) versus moderate agreement for PENFAST (κ = 0.43). Allergist evaluation had superior specificity (0.77 vs. 0.71 [APAAACI] and 0.63 [PENFAST]) and overall accuracy (0.78 vs. 0.72 and 0.65). APAAACI and PENFAST can both effectively identify low-risk patients labelled with penicillin allergy when used by non-allergists, with comparable sensitivity to allergist assessment. APAAACI's stronger agreement with allergist assessment may suggest particular utility in Asian populations. These tools can significantly improve access to delabeling in settings lacking specialist allergy services.

Predictive Biomarker for Persistent Food Allergy in Children.

Ahn Kangmo K

Commentary on "Reported Penicillin Allergy Affects the Length of Hospital Stay in Patients with Erysipelas".

Lai Tingsong T, Li Changqiang C