Background and Objectives: Drug provocation tests (DPTs) diagnose drug hypersensitivity reactions (DHRs) and identify safe alternatives. DHRs contribute to patient anxiety. The aim of this study was to evaluate anxiety and hopelessness levels before and after DPT and to examine patients’ avoidance characteristics of the tested drugs. Materials and Methods: Patients undergoing DPT were included. The State–Trait Anxiety Inventory (STAI) assessed anxiety, and the Beck Hopelessness Scale measured hopelessness. Demographic and clinical data, pre- and post-DPT scores, the status of using the medication provided after DPT, and the reason for not using it were analyzed. Results: Seventy-nine patients (60 female, 75.9%) participated. Patients’ Beck Hopelessness Scale, STAI–State, and STAI–Trait scores decreased significantly after the DPT compared to the initial scores. Among the patients who developed a reaction during the drug provocation test, the rate of those whose scale scores increased was significantly higher than the rate of those who did not develop a reaction. A total of 42 patients (53.2%) did not use the alternative safe drug. Of these, six (14.3%) reported that their reluctance stemmed from a fear of experiencing a reaction similar to their initial adverse event. Patients with concomitant allergic diseases were less likely to use alternative safe drugs. Conclusions: DPT reduces long-term anxiety and hopelessness. However, one in seven patients avoids the prescribed safe drug due to fear of recurrence. Effective communication, especially with patients who have allergic conditions or experience a reaction during DPT, and psychological support may improve adherence to the tested medication.

Background/Objectives: Children with atopic dermatitis (AD) are at increased risk of food allergy (FA). This study aimed to develop and evaluate machine learning (ML) models for predicting FA in children aged <2 years with AD and to assess feature contribution. Methods: This retrospective study included children aged 1 month to 2 years who were diagnosed with AD and underwent evaluation for FA. Demographic characteristics, clinical features, and laboratory findings were extracted from electronic medical records. Four ML algorithms—CatBoost, XGBoost, LightGBM, and logistic regression—were evaluated for predicting FA. Results: A total of 435 children with AD were included, of whom 185 (42.5%) were female. The median age at presentation was 7.4 months (IQR, 4.8–10.8), and FA was present in 101 patients (23.2%). Among all evaluated models, CatBoost using clinical features alone demonstrated the best overall performance, achieving an AUC of 0.91 (95% CI, 0.84–0.97), with a sensitivity of 0.85 and a specificity of 0.91. Using combined clinical and laboratory features, XGBoost achieved an AUC of 0.88 (95% CI, 0.79–0.95), with a sensitivity of 0.70 and a specificity of 0.96. Using clinical features alone, LightGBM and logistic regression achieved AUCs of 0.89 (95% CI, 0.82–0.96) and 0.86 (95% CI, 0.75–0.95), respectively, with sensitivities of 0.85 and 0.65 and specificities of 0.82 and 0.88. Conclusions: CatBoost demonstrated the best overall performance in predicting FA in children aged <2 years with AD using clinical features alone. ML models may help identify children with AD who require further diagnostic evaluation for FA.

Real-life studies are needed to evaluate the clinical outcomes of add-on tiotropium therapy in patients with asthma. The effects of adding tiotropium bromide to the treatment of asthmatic patients on pulmonary functions and asthma control using real-life data. In a retrospective study, spirometric measures and asthma control states were compared before and one year after of tiotropium treatment in asthmatic adults whose disease was not adequately controlled with a combination of inhaled corticosteroids and long-acting β2-agonists. One year after tiotropium treatment, mean FEV1, FEV1%, and FEV1/FVC ratio increased significantly compared to pretreatment values. Among 32 patients added tiotropium due to symptomatic asthma, 28 (87.5%) patients achieved well-controlled (ACT ≥ 20) end of the year and GINA treatment step-down in 4 (12.5%) patients. Monoclonal antibody therapies (mepolizumab or omalizumab) were initiated in 9 patients (28.1%). FEV1 values and FEV1/FVC ratios showed a statistically significant improvement from baseline measurements obtained prior to the initiation of tiotropium therapy, independent of monoclonal antibody use (p < 0.001 for each). The mean age of these patients was 48.78 ± 11.64 (range: 28 - 81) years, and 25 (78.1%) of them were female. Tiotropium bromide is an effective and reliable add-on therapy for symptomatic asthma when combined with ICS plus LABA, also leads to improvements in respiratory function and asthma control.

To present the characteristics of drug hypersensitivity reactions (DHR) among iron preparations and to describe the outcomes of rapid drug desensitization (RDD) and drug provocation tests (DPT) of ferric carboxymaltose (FCM). The retrospective descriptive study comprised patients with hypersensitivy to iron supplements. Low-risk according to the index reaction with iron, 10 patients underwent a 4-step DPT with FCM; an 11-step RDD protocol was administered to 21 patients not classified as low-risk. RDD success was evaluated for each cycle separately, defining successful completion as the implementation of all steps in both RDD and DPT protocols without subsequent early and/or late reactions. Among the 21 patients (mean age: 41.73 ± 10.98 years, all female) hypersensitive to iron underwent FCM RDD, 20 patients (95.2%) successfully completed FCM treatment with RDD. RDD failed in only 1 patient (4.8%). The total number of desensitization cycles was 29, of which 28 (96.5%) were successful. Urticaria was the most common breakthrough hypersensitivity reaction and observed in 7 (33.3%) patients. Ten patients received FCM with DPT. The iron replacement therapy for these 10 patients was successfully completed. Urticaria developed in 2 patients after the completion of DPT. RDD is a dependable procedure facilitating the efficient delivery and completion of FCM treatments in patients with iron hypersensitivity. Additionally, FCM can be applied with DPT in low-risk patients.

Aims: This study aims to define characteristics of hypersensitivity reactions with etoposide, and outcomes of desensitizations in immediate-type hypersensitivity rections Methods: This is a retrospective observational study of patients who had hypersensitivity reactions with etoposide from January 2019 to December 2023. Results: A total of 39 patients with lung cancer were included in the study. Ten (25.6%) patients had known other drug allergies and three (7.7%) patients had previous chemotherapeutic hypersensitivity two with paclitaxel and one with docetaxel. Most of the initial hypersensitivities were in the first or second cycle (n=29, 74.4%). Ten (25.4%) patients had hypersensitivity reactions at the first application of etoposide. Thirty (76.9%) patients had immediate-type hypersensitivity reactions. There was no significant difference in terms of patient and initial hypersensitivity characteristics between patients who had immediate or non-immediate type hypersensitivity reactions. Of the 30 patients with immediate-type hypersensitivity reactions, initial reaction was mild in 16 (53.3%) and moderate in 14 (46.7%) patients. Most common symptoms were erythema in 29 (96.7%), dyspnea in 13 (43.3%), chest tightness in 8 (26.7%), discomfortness in 7 (23.3%), and hypertension in 6 (20%). Skin tests were negative in five patients who underwent skin testing. A total of 98 desensitization courses were performed in 27 patients and 3 (11.1%) patients had breakthrough reactions. Conclusion: Most of the hypersensitivity reactions to etoposide are immediate-type and not severe. Desensitization is an effective and safe procedure to manage these reactions. Further research is needed to elucidate the mechanisms of hypersensitivity reactions.

Vitamin B12 is an essential micronutrient and hypersensitivity reactions (HSR) are considered rare. To present the characteristics of HSRs to vitamin B12 preparations and to report the outcomes of desensitization and drug provocation tests (DPT) for vitamin B12. The retrospective descriptive study included patients who required treatment for vitamin B12 deficiency and were hypersensitive to vitamin B12 or hesitant to use it due to other drug allergies. Low-risk patients based on their index reaction and patients hesitant to use vitamin B12 underwent DPT, while desensitization protocols were performed for patients classified as high-risk. Successful completion defined as the execution of all steps in the desensitization and DPT protocols without any subsequent immediate or delayed reactions. Among the 44 patients, 28 patients (63.6%) had a history of HSRs following the use of cyanocobalamin. The remaining 16 patients (36.4%) had no prior history of HSR to vitamin B12-containing drugs but were hesitant to use vitamin B12 due to other drug allergies. DPT was performed in 38 patients (86.4%), while desensitization was performed in 6 patients (13.6%). The mean age was 46.34 ± 14.50 years and 32 (72.7%) of them were female. Skin prick tests (SPT) and immediate reading intradermal tests (IDTs) were administered in 20 patients (45.5%). Patch tests were conducted in 8 patients (18.1%) and delayed reading IDTs were performed in 3 (6.8%). All skin test results were negative. A total of 40 challenges were conducted and an immediate-type HSR was observed in 1 challenge (2.5%). Desensitization was performed in 8 cycle and HSR occurred in 1 (12.5%) cycle. DPT is a reliable procedure that provides the assessment of low-risk patients with vitamin B12 hypersensitivity and prevents unnecessary drug restrictions. Additionally, desensitization protocols enable the continuation of vitamin B12 treatment in high-risk patients.