unspecified allergy vaccine (Staloral)

Raising the bar on surgical site infection bundles: Preoperative penicillin allergy testing in gynecologic oncology patients with a reported penicillin allergy - A quality improvement study.

Desravines Nerlyne N, Tschudy Megan M MM, Hazimeh Dana D, Brown Kristin K et al.

Practice guidelines advise cefazolin for surgical prophylaxis to reduce surgical site infection (SSI) in clean-contaminated procedures but recommend alternative antibiotics for patients with reported penicillin (PCN) allergy despite increased odds of SSI with alternative antibiotics. We aimed to increase use of cefazolin for SSI prophylaxis from 42% in a 3-year period (preintervention) to 80% by 34 months postintervention by implementing preoperative penicillin allergy testing (PAT) in patients with a reported PCN allergy. This was a prospective quality improvement (QI) initiative from 03/2021 to 12/2023. An EMR-embedded best practice advisory (BPA) alert prompted preoperative PAT for patients with reported PCN allergies. Our primary outcome measure was use of cefazolin for SSI prophylaxis at surgery, when indicated. We deployed iterative process modifications based on successive plan-do-study-act (PDSA) cycles using the Model for Improvement. Process and outcome data were analyzed using run charts. We identified 119 patients who initially reported a penicillin allergy during our study period. The use of cefazolin at the time of surgery significantly increased from 42% (3-year pre-intervention period) to 77.3% (2-year postintervention period), p ≤0.01. Postintervention, the median cefazolin use was 66% of cases by 34 months. 29.4% of patients completed PAT compared to none in the 12 months preceding our intervention. Following the intervention, our SSI rate was 0% (0 of 119) compared to 2.8% pre-intervention (5 of 176). Preoperative PAT is a feasible strategy for increasing the best practice use of cefazolin for SSI prophylaxis in those reporting PCN allergy. PAT as routine preoperative care may promote antimicrobial stewardship and decrease SSI risk.

Drug-induced anaphylaxis in pregnant women: a call for correct labeling antibiotic allergies.

Bassani Cintia C, Demoly Pascal P, Tanno Luciana Kase LK

Drug-induced anaphylaxis during pregnancy, although uncommon, represent potentially serious clinical situation with significant maternal-fetal impact and relevant therapeutic implications. This topic is particularly timely given the need for guidance of health professionals dealing with this challenge and correct labelling patients with drug allergy/hypersensitivity. Recent studies report a high prevalence of self-reported β-lactam allergy during pregnancy, with poor correlation with true allergy, underscoring the value of structured, safe, and effective diagnostic evaluation for appropriate delabeling. These findings highlight the need for a systematic approach to drug-induced anaphylaxis in pregnancy, including accurate diagnosis and protocol-based management. Incorporating allergological evaluation into prenatal care can reduce unnecessary risks, optimize maternal and fetal outcomes, and promote rational medication use. Important knowledge gaps remain, emphasizing the need for prospective studies with standardized methodologies and expanded immunological assessment.

Practice Trends in Allergy and Immunology in the United States from 2015 to 2023.

Witt Bryan B, Cheung Robin R, Jaffery Syed S, Rukasin Christine Rf CR

Sustainable eating for a healthy mind: Association between the EAT-Lancet diet and depression subtypes in a Swiss cohort.

Martins Laís Bhering LB, Ranjbar Setareh S, Strippoli Marie-Pierre F MF, Lasserre Aurelie M AM et al.

Higher adherence to healthy dietary patterns appears to play a role in the prevention of Major Depressive Disorder (MDD). However, the association between the EAT-Lancet diet, developed to promote both human health and environmental sustainability, and MDD remains largely unexplored. To explore the association between adherence to the EAT-Lancet diet and MDD subtypes and assess how dietary patterns among individuals with and without MDD align with EAT-Lancet recommendations. We conducted a cross-sectional analysis of 3558 adults from the CoLaus|PsyCoLaus cohort. Adherence to the EAT-Lancet diet was scored based on intake of 12 food components and categorized into tertiles (low, medium, high). Psychiatric information was obtained using the Diagnostic Interview for Genetic Studies. MDD subtypes (melancholic, atypical, and unspecified) were diagnosed according to DSM-IV specifiers. Multinomial logistic regression models assessed associations between diet adherence and MDD subtypes. High EAT-Lancet adherence was associated with a lower relative risk of atypical MDD (RRR: 0.68, 95% CI: 0.55-0.84). No clear associations were observed for melancholic or unspecified MDD. Across all groups, intake of unsaturated oils, legumes, and whole grains was insufficient, while red meat, potatoes, and added sugars exceeded recommendations. The association of a sustainable and healthy diet with MDD differs across clinical subtypes, suggesting that diet may play distinct roles in the pathophysiology of each. Improving specific dietary components may support mental health and sustainability goals.