Anaphylaxis to galacto-oligosaccharides (GOS), a prebiotic, has been described in atopic patients following its supplementation in commercial milk formula in South-East Asia. The epidemiology of this usual allergy to a carbohydrate is unknown. This study evaluated the prevalence of allergy to two formulations of commercial GOS, Vivinal™ GOS (vGOS) and Oligomate™ , in an atopic cohort. Atopic subjects (n = 487) from two specialist allergy clinics were surveyed via structured questionnaire and underwent skin prick tests to GOS. Subjects with positive skin prick tests to GOS (n = 30, 6.2%) underwent basophil activation tests, and a subset (n = 13) underwent oral challenge tests to both formulations of GOS. Six subjects had positive challenges to vGOS; and none to Oligomate. By extrapolating the BAT and oral challenge results, the prevalence of allergy to vGOS is estimated at up to 3.5% (95% CI 2.2-5.5%) of our atopic population. Our findings show that GOS allergy may be common amongst atopics in Singapore.

The coronavirus disease 2019 (COVID-19) pandemic has placed an immense burden on healthcare systems worldwide. There is intensive research targeted at better understanding of the virus pathogenicity, development of effective treatment strategies and vaccines against COVID-19. It is increasingly being recognised that the pathogenicity of COVID-19 extends beyond the respiratory system. In severe cases, there can be widespread activation of the immune system, vascular injury and a resultant pro-thrombotic state. Severe COVID-19 is widely regarded as a risk factor for venous thromboembolism. Interim European and American guidelines have been created to guide anticoagulation strategies in COVID-19 patients. However, it is unclear if these guidelines can be extrapolated directly to Asians, in whom there are differences in the baseline risk of thrombosis and bleeding. Our review article aimed to summarise the current understanding of arteriovenous thromboembolic complications in COVID-19 and discuss management strategies for prevention and treatment of thrombotic events in Asian COVID-19 patients.

No abstract

No abstract

Background:COVID-19 pandemic has been devastating not only medically but also socially and economically. Selangor, an urbanised state in Malaysia, has been severely affected by COVID19. There is concern that patients with rheumatic diseases (RD) may have higher risk of infection, with increased mortality1.Objectives:To investigate patients’ characteristics which are associated with ‘feeling stressed’ among patients with RD during the second wave of COVID19 infection in Selangor.Methods:This is a cross-sectional study conducted over 3 weeks during the second wave of COVID19 infection in Malaysia. Patients with RD, scheduled for rheumatology clinic appointment in a rheumatology referral centre were invited to participate in this study.Personal and clinical data were collected by phone interview and from patients’ medical records respectively. Patients were asked to grade their disease activity by giving a score from 0 (not active) to 10 (active). All patients were asked ‘are you feeling stressed?’ and the answer was recorded as yes or no. Reasons explored for a yes answer, included financial, social disruption, physical illness and future uncertainties. Categorical and continuous data were analysed using chi-squared test and student t-test, respectively. A p-value of <0.05 is considered statistically significant.Results:Three hundred and sixty-one patients with various RD participated in this study. The mean age of these was 48.2 years (range between 16-80 years). More than half (54.3%) were Malay and other ethnicities were Chinese (25.5%), Indian (18.2%) and others (2%). A quarter of patients (24.7%) were not working (unemployed, retired and students) and a third of patients (32.1%) had unpaid work (mainly housewife). The other patients’ characteristics are shown in Table 1.Table 1.Characteristics of patients who were ‘feeling stressed’ and not ‘feeling stressed’ during the second wave of COVID19 infection.Patients’ characteristicsNo of patientsFeeling stressed (n=83), no of patients (%)Not feeling stressed (n=278), no of patients (%)p-valueAge<6027272 (26.5)200 (73.5)0.006≥608911 (12.4)78 (87.6)GenderMale6116 (26.2)45 (73.8)0.510Female30067 (22.3)233 (77.7)EthnicityMalay19638 (19.4)158 (80.6)0.076Others16545 (27.3)120 (72.7)Relationship statusMarried27559 (21.5)216 (78.5)0.215Unmarried8624 (27.9)62 (72.1)Education levelUp to secondary23348 (20.6)185 (79.4)0.145Tertiary12835 (27.3)93 (72.7)Work statusNo work8913 (14.6)76 (85.4)0.002Unpaid work11620 (17.2)96 (82.8)Paid work15650 (32.1)106 (67.9)Rheumatic diseaseSLE12530 (23.8)96 (76.2)0.259RA15030 19.4)125 (80,6)Others8023 (28.8)57 (71.3)Perceived disease activity3.14 (2.4)1.87 (2.1)<0.001Use biologicsYes257 (28)18 (72)0.537No33676 (22.6)260 (77.4)Eighty-three (23%) admitted to ‘feeling stressed’ and the stressors identified were physical illness in 34 (40.9%), social disruption in 23 (27.7%), financial problems in 23 (27.7%) and future uncertainties in 19 (22.9%). Patients’ characteristics that were significantly different between patients who were ‘feeling stressed’ and not ‘feeling stressed’ were age, employment status and perceived disease activity (Table 1).Conclusion:The COVID19 pandemic has caused mental distress in a significant number of RD patients and associations were found with older age, having paid work and perceived disease activity. Issues that may influence patients’ responses, including access to rheumatology care, medication and fear of getting infection were not explored in this study.References:[1]Williamson EJ, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature, 2020; 584: 430–436.Disclosure of Interests:None declared