Allergy (and clinical immunology)

The following is a summary of “Evidence-based use of antihistamines for treatment of allergic conditions,” published in the October 2023 issue of Allergy, Asthma & Immunology by Linton, et al. H1 antihistamines have been used to treat allergic diseases like allergic rhinitis and hives since the...

Childhood asthma is a major chronic non-communicable disease in infants and children, often triggered by respiratory tract infections. The nasal cavity is a reservoir for a broad variety of commensal microbes and potential pathogens associated with respiratory illnesses including asthma.

A Th2 immune response is central to allergic airway inflammation, which afflicts millions worldwide. However, the mechanisms that augment GATA3 expression in an antigen-primed developing Th2 cell are not well understood.

Drugs available for asthma treatment in the first decades of the 20th century (sympathomimetic agents such as oral ephedrine, intravenous adrenaline, or inhaled epinephrine; anticholinergics such as inhaled scopolamine; methylxanthines such as oral caffeine or theophylline1) aimed at relieving...

Abstract Background IL-5-dependent residential and IL-18-transformed pathogenic eosinophils have been reported; however, the role of IL-18-transformed CD274-expressing pathogenic eosinophils compar...

Understanding the relationship between outdoor and food allergies written and reviewed by the leading experts in allergy, asthma and immunology.

Abstract Secondary adrenal insufficiency (AI) occurs as the result of any process that disrupts normal hypothalamic and/or anterior pituitary function and causes a decrease in the secretion of ster...

Home: Reviews & News: Medical Journal Reviews: 2021: January 2021 Medical Journal Review January 2021 WAO Reviews – Editors' Choice Articles are selected for their importance to clinicians who care for patients with asthma and allergic/immunologic diseases by Juan Carlos Ivancevich, MD, and John J. Oppenheimer, MD - FACAAI - FAAAAI, WAO Reviews Editor.  Asthma and COVID-19: Do we finally have answers? Eger K, Bel EH European Respiratory Journal 2020; in press https:/doi.org/10.1183/13993003.04451-2020 In this paper, Eger and Bel explore the impact of asthma on COVID 19. While it is well known that older age, obesity, cardiovascular disease, and diabetes are risk factors of poor COVID-19 outcome, much controversy surrounds asthma’s impact. The focus of this manuscript was 2 papers published in the same edition of the ERJ (Choi et al and Izquierdo et al). In summary, these large-scale studies confirmed previous findings regarding risk for asthma patients to develop (severe) COVID-19 – specifically that asthmatics appear to be slightly more susceptible to contracting COVID-19, but severe disease progression does not seem to be related to medication use, including asthma biologics, but rather linked to older age and co-morbidities. The authors stress the fact that often when examining studies of COVID-19 and asthma, potential bias factors have not been considered, leaving many questions unanswered. Furthermore, large-scale, multinational real-life studies with detailed information on asthma phenotype and medication usage in patients with a confirmed diagnosis of COVID-19 would be ideal to aid us in resolving these questions. The Metabolomics of Childhood Atopic Diseases: A Comprehensive Pathway-Specific Review Schjødt MS, Gürdeniz G, Chawes B Metabolites 2020;10(12):511 https://doi.org/10.3390/metabo10120511 Asthma, allergic rhinitis, food allergy, and atopic dermatitis are common childhood diseases with several different underlying mechanisms, i.e., endotypes of disease. In this review, the authors stress that metabolomics has the potential to identify disease endotypes, which could beneficially promote personalized prevention and treatment. They do a wonderful job of reviewing the metabolomics literature in children with atopic diseases, focusing on tyrosine and tryptophan metabolism, lipids (particularly, sphingolipids), polyunsaturated fatty acids, microbially derived metabolites (particularly, short-chain fatty acids), and bile acids. Specifically, tyrosine, 3-hydroxyphenylacetic acid, N-acetyltyrosine, tryptophan, indolelactic acid, 5-hydroxyindoleacetic acid, p-Cresol sulfate, taurocholic acid, taurochenodeoxycholic acid, glycohyocholic acid, glycocholic acid, and docosapentaenoate n-6 were identified in at least two studies as being impactful. They stress that altered metabolic pathways highlight some of the underlying biochemical mechanisms leading to these common childhood disorders, which in the future could provide utility in clinical practice. Much further work on this topic is still needed. Helicobacter pylori and skin disorders: a comprehensive review of the available literature Guarneri C, Ceccarelli M, Rinaldi L, Cacopardo B, Nunnari G, Guarneri F European Review for Medical and Pharmacological Sciences 2020;24(23):12267-12287 https://www.doi.org/10.26355/eurrev_202012_24019 Helicobacter pylori is a Gram-negative bacterium identified for the first time about 30 years ago and commonly considered as the main pathogenic factor of gastritis and peptic ulcer. Since then, it was found to be associated with several gastrointestinal and extra-gastrointestinal diseases, including skin disorders such as chronic urticaria, rosacea, lichen planus, atopic dermatitis, psoriasis, pemphigus vulgaris, vitiligo, primary cutaneous MALT-type lymphoma, sublamina densa-type linear IgA bullous dermatosis, primary cutaneous marginal zone B-cell lymphomas, and cutaneous T-cell pseudolymphoma. The aim of this review is to summarize the available studies regarding the topic and draw possible conclusions. The authors found that, overall, further clinical and laboratory studies are needed to assess the real plausibility and relevance of these associations, as well as the possible role of Helicobacter pylori with the underlying pathogenic mechanisms. Allergy prevention: An overview of current evidence Royal C, Gray C Yale Journal of Biology and Medicine 2020;93(5):689-698 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757062/ There has been a rapid rise in allergic disorders worldwide, which has resulted in increased research into the determinants of allergy development in attempt to identify factors that may be manipulated to mitigate risk. Present literature demonstrates that an opportune window in immunological development appears to exist in early life, whereby certain exposures may promote or prevent the development of an allergic disposition. Furthermore, factors that affect the composition and diversity of the microbiome in early life may also be impactful. In this review, the authors explore the current literature and recommendations relating to exposures that may prevent allergy development or promote tolerance. They note several risk factors, including delivery by caesarean section, omission of breastfeeding, vitamin D insufficiency, and environmental exposures, such as cigarette smoke exposure, all increase the risk of an allergic predisposition. Likewise, they note several protective factors, including dietary diversity during pregnancy, lactation, and in infancy is protective. They also note that recommendations for food-allergen exposure have shifted from delayed introduction to early introduction as a tolerance-inducing strategy. Supplements such as probiotics and vitamins during pregnancy and infancy have yet to produce conclusive results for allergy prevention. Finally, they note that emollient use in infancy has not been shown to be protective against eczema or food allergy. The airways microbiome of individuals with asthma treated with high and low doses of inhaled corticosteroids Martin MJ, Zain NMM, Hearson G, Rivett DW, Koller G et al PLoS One 2020;15(12):e0244681 https://www.doi.org/10.1371/journal.pone.0244681 Inhaled corticosteroids (ICS) are the mainstay of asthma treatment, but evidence suggests a link between ICS usage and increased rates of respiratory infections. In this study, Martin and colleagues assessed the composition of the asthmatic airways microbiome in patients taking low and high dose ICS and the stability of the microbiome over a 2-week period. Sputum from each subject underwent DNA extraction, amplification and 16S rRNA gene sequencing of the bacterial component of the microbiome. Nineteen subjects returned for further sputum induction after 24 h and 2 weeks. A total of 5,615,037 sequencing reads revealed 167 bacterial taxa in the asthmatic airway samples, with the most abundant being Streptococcus spp. No significant differences in sputum bacterial load or overall community composition were seen between the low- and high-dose ICS groups; however, Streptococcus spp. showed significantly higher relative abundance in subjects taking low-dose ICS (p = 0.002). Furthermore, Haemophilus parainfluenzae was significantly more abundant in subjects on high-dose fluticasone propionate compared to those on high-dose budesonide (p = 0.047). There were no statistically significant changes in microbiota composition over a 2-week period. The authors note that the clinical implications for patients are not known, but suggest that this does provide a possible explanation for the increased risk of pulmonary infection seen in asthma and COPD, particularly with FP.  More research is needed.

Allergist Kathleen May, MD, of Augusta, GA was installed as president of the American College of Allergy, Asthma and Immunology at the ACAAI Annual Scientific M...

Respiratory syncytial virus (RSV) infects all children early in life, is the most common cause of infant lower respiratory tract infections, and causes disease exacerbations in children with asthma. Episodes of lower respiratory tract infection in early ...

Traditional farming lifestyle has been shown to be protective against asthma and allergic diseases. The individual factors that appear to be associated with this "farm-life effect" include consumption of unpasteurized farm milk and exposure to farm animals and stables.

There have been no worldwide standardised surveys of prevalence and severity of asthma, rhinoconjunctivitis and eczema in school children for 15 years.The present study aims to provide this information.Following the exact International Study of Asthma and Allergies in Childhood (ISAAC) methodology...

We are a European alliance of 39 allergy, asthma and chronic obstructive pulmonary disease (COPD) patients’ associations representing 30% of European citizens currently living with these diseases. Our mission is to convey their voice and to be actively involved in the decisions impacting their...

Abstract Background Severe asthma in horses is characterized by structural changes that thicken the lower airway wall, a change that is only partially reversible by current treatments. Increased va...

Allergic rhinitis (AR) and asthma represent global health problems for all age groups.
Asthma and rhinitis frequently coexist in the same subjects. Allergic Rhinitis and
its Impact on Asthma (ARIA) was initiated during a World Health Organization workshop
in 1999 (published in 2001).