The best of 2018 and how allergy and gender intersect

February 11, 2019

It’s been a cold and wet winter across much of our country. The month of February holds promise for a warmer spring, and soon trees will begin blooming across our country. From my home in central Mississippi, I’m already beginning to see buds on the oak trees. And this means increased numbers of patients in our offices who will present with both seasonal and nonseasonal symptoms. The February issue of the Annals of Allergy, Asthma and Immunology contains a great deal of information for you, the practicing clinician, at whatever level of experience you have and whatever practice setting you occupy.

An excellent article for you to peruse is The Best of 2018 in the Annals, prepared by the editors. This covers all the major subdisciplines within our field and will be useful for you to recall the points made in each of these articles published in 2018. The focus for the month is ‘gender and allergy’ and there are several articles that address this topic in different clinical settings. Do not fail to read the editorial by Anna Nowak-Wegrzyn, MD, PhD, FACAAI, Anne Ellis, MD, MSc, FACAAI, and Marianna Castells, MD, PhD, FACAAI, with an interesting overview about the issues related to gender that allergists deal with.

Our CME review article this month is by William Lavery, MD, PhD, and Jonathan Bernstein, MD, FACAAI, from Cincinnati. They use a case report on cyclical hypersensitivity to describe the relatively uncommon phenomenon that is still seen in our offices and should be considered in the differential diagnosis for many female patients, even to the point of asking about the association of symptoms with menstrual cycle and/or hormonal contraceptive use.

Two other review articles that are focused on gender differences are worth mention. The first is by Allison Norton, MD, FACAAI, and Ana Broyles, MD, from Nashville. This article reviews the latest science and epidemiologic studies related to drug allergy in children and adults to explore possible mechanisms related to female propensity for drug allergy. They very interestingly demonstrate that the reasons for this gender-based prevalence for drug allergy may be more than just hormonal and is actually reversed in prepubertal patients. This is a thought-provoking article that will help you as you consider possible drug exposure-related diagnoses.

Finally, a review by Dinah Foer, MD, and Kathleen Bucheit, MD, from Boston, focused on the clinical presentation, risk factors and natural history of hypersensitivity reactions to progestogens. Their review demonstrates that progestogen hypersensitivity symptoms can be triggered by endogenous progesterone (cyclical) or by exogenous progestins used for contraception or fertility treatments. Reported symptoms are varied and include dermatitis, urticaria, asthma and anaphylaxis with significant heterogeneity in clinical presentation between patients.

These and other articles are presented for your edification in the February Annals. Please let us know your thoughts and suggestions. We welcome feedback on published material for possible publication in our Correspondence section. Feel free to email comments about any published item directly to me.

Gailen Marshall Jr., MD, PhD, FACAAI