👉Epithelial barriers in allergy and asthma
📌The respiratory epithelium provides a physical, functional, and immunologic barrier to protect the host from the potential harming effects of inhaled environmental particles and to guarantee maintenance of a healthy state of the host. When compromised, activation of immune/inflammatory responses against exogenous allergens, microbial substances, and pollutants might occur, rendering individuals prone to develop chronic inflammation as seen in allergic rhinitis, chronic rhinosinusitis, and asthma. The airway epithelium in asthma and upper airway diseases is dysfunctional due to disturbed tight junction formation. By putting the epithelial barrier to the forefront of the pathophysiology of airway inflammation, different approaches to diagnose and target epithelial barrier defects are currently being developed. Using single-cell transcriptomics, novel epithelial cell types are being unraveled that might play a role in chronicity of respiratory diseases. We here review and discuss the current understandings of epithelial barrier defects in type 2–driven chronic inflammation of the upper and lower airways, the estimated contribution of these novel identified epithelial cells to disease, and the current clinical challenges in relation to diagnosis and treatment of allergic rhinitis, chronic rhinosinusitis, and asthma.
🔗https://www.jacionline.org/article/S0091-6749(20)30553-4/abstract
#allergy #jaci #asthma
📌The respiratory epithelium provides a physical, functional, and immunologic barrier to protect the host from the potential harming effects of inhaled environmental particles and to guarantee maintenance of a healthy state of the host. When compromised, activation of immune/inflammatory responses against exogenous allergens, microbial substances, and pollutants might occur, rendering individuals prone to develop chronic inflammation as seen in allergic rhinitis, chronic rhinosinusitis, and asthma. The airway epithelium in asthma and upper airway diseases is dysfunctional due to disturbed tight junction formation. By putting the epithelial barrier to the forefront of the pathophysiology of airway inflammation, different approaches to diagnose and target epithelial barrier defects are currently being developed. Using single-cell transcriptomics, novel epithelial cell types are being unraveled that might play a role in chronicity of respiratory diseases. We here review and discuss the current understandings of epithelial barrier defects in type 2–driven chronic inflammation of the upper and lower airways, the estimated contribution of these novel identified epithelial cells to disease, and the current clinical challenges in relation to diagnosis and treatment of allergic rhinitis, chronic rhinosinusitis, and asthma.
🔗https://www.jacionline.org/article/S0091-6749(20)30553-4/abstract
#allergy #jaci #asthma
👉Dietary factors during pregnancy and atopic outcomes in childhood: a systematic review from the European Academy of Allergy and Clinical Immunology
📌Prenatal supplementation with vitamin D may have beneficial effects for prevention of asthma. Additional nutritional factors seem to be required for modulating the risk of skin and gastrointestinal outcomes. We found no consistent evidence regarding other dietary factors, perhaps due to differences in study design and host features that were not considered. Whilst confirmatory studies are required, there is also a need for performing RCTs beyond single nutrients/foods.
🔗https://onlinelibrary.wiley.com/doi/abs/10.1111/pai.13303
#allergy #AD #pai #pregnancy
📌Prenatal supplementation with vitamin D may have beneficial effects for prevention of asthma. Additional nutritional factors seem to be required for modulating the risk of skin and gastrointestinal outcomes. We found no consistent evidence regarding other dietary factors, perhaps due to differences in study design and host features that were not considered. Whilst confirmatory studies are required, there is also a need for performing RCTs beyond single nutrients/foods.
🔗https://onlinelibrary.wiley.com/doi/abs/10.1111/pai.13303
#allergy #AD #pai #pregnancy
📌Some pet foods contain allergens that can be transferred to people via pet saliva or sometimes even direct ingestion by infants and toddlers. Here are ways to stay safe.
🔗https://allergyasthmanetwork.org/news/is-pet-food-a-food-allergy-risk/
#pets #allergy #dog #care
🔗https://allergyasthmanetwork.org/news/is-pet-food-a-food-allergy-risk/
#pets #allergy #dog #care
👉Sensitivity and specificity of double-blinded #penicillin skin testing in relation to oral provocation with amoxicillin in children
📌Current recommendations for the management of penicillin #allergy are to perform penicillin skin testing (PST) with penicilloyl-polylysine (PPL) and benzylpenicillin (BP) prior to drug challenge with amoxicillin. However, the role of PST is increasingly questioned in the pediatric setting. To resolve the question of PST’s diagnostic accuracy, consecutive children with a history of non-life-threatening penicillin allergy referred to a tertiary-care allergy center were recruited to undergo double-blinded PST with PPL and BP prior to drug provocation to amoxicillin. Five of 158 participants (3.2%) presented with an immediate or accelerated reaction upon amoxicillin challenge, none of which were severe. Only one of these had positive PST (20%), compared to 15 of 153 amoxicillin tolerant participants (9.8%). The sensitivity and specificity of PST with PPL and BP for reacting upon amoxicillin challenge were 20% (95% CI: 0.5–71.6%) and 90% (95% CI: 84.4–94.4%), respectively. These results argue against the routine use of PST as a preliminary step to drug provocation with amoxicillin in this population, as it is unlikely to significantly alter pre-test probability of reacting to challenge.
🔗https://aacijournal.biomedcentral.com/articles/10.1186/s13223-020-00449-7
📌Current recommendations for the management of penicillin #allergy are to perform penicillin skin testing (PST) with penicilloyl-polylysine (PPL) and benzylpenicillin (BP) prior to drug challenge with amoxicillin. However, the role of PST is increasingly questioned in the pediatric setting. To resolve the question of PST’s diagnostic accuracy, consecutive children with a history of non-life-threatening penicillin allergy referred to a tertiary-care allergy center were recruited to undergo double-blinded PST with PPL and BP prior to drug provocation to amoxicillin. Five of 158 participants (3.2%) presented with an immediate or accelerated reaction upon amoxicillin challenge, none of which were severe. Only one of these had positive PST (20%), compared to 15 of 153 amoxicillin tolerant participants (9.8%). The sensitivity and specificity of PST with PPL and BP for reacting upon amoxicillin challenge were 20% (95% CI: 0.5–71.6%) and 90% (95% CI: 84.4–94.4%), respectively. These results argue against the routine use of PST as a preliminary step to drug provocation with amoxicillin in this population, as it is unlikely to significantly alter pre-test probability of reacting to challenge.
🔗https://aacijournal.biomedcentral.com/articles/10.1186/s13223-020-00449-7
👉EAACI/GALEN task force consensus report: the autologous serum skin test in #urticaria
🔗https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1398-9995.2009.02132.x
#allergy
🔗https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1398-9995.2009.02132.x
#allergy
👉Intradermal tests (IDT) with nonirritative drug concentrations performed on the volar forearm or on the back: fixed recommended volume of 0.02 mL is injected i.d. achieving a 'bleb' of 3‐5 mm
🔗https://onlinelibrary.wiley.com/doi/pdf/10.1111/all.14122
https://onlinelibrary.wiley.com/doi/epdf/10.1111/all.13820
https://onlinelibrary.wiley.com/doi/epdf/10.1111/all.12350
https://ctajournal.biomedcentral.com/track/pdf/10.1186/2045-7022-3-3
#allergy #penicillin
🔗https://onlinelibrary.wiley.com/doi/pdf/10.1111/all.14122
https://onlinelibrary.wiley.com/doi/epdf/10.1111/all.13820
https://onlinelibrary.wiley.com/doi/epdf/10.1111/all.12350
https://ctajournal.biomedcentral.com/track/pdf/10.1186/2045-7022-3-3
#allergy #penicillin
👉Systematic Assessment of Difficult-to-Treat Asthma: Principles and Perspectives
📌Difficult-to-treat #asthma affects a minority of adults and children with asthma but represents a challenging mix of misdiagnosis, multimorbidity, inadequate self-management, severe airway pathobiology, and treatment complications. Management of these patients extends beyond asthma pharmacotherapy, because multiple other patient-related domains need to be addressed as well. Such complexity can hinder adequate clinical assessment even when performed in specialist practice. Systematic assessment undertaken by specialized multidisciplinary teams brings a broad range of resources to bear on patients with difficult-to-treat asthma. Although the concept of systematic assessment is not new, practices vary considerably and implementation is not universal. Nevertheless, assessment protocols are already in place in several institutions worldwide, and outcomes after such assessments have been highly encouraging. This review discusses the rationale, components, and benefits of systematic assessment, outlining its clinical utility and the available evidence for improved outcomes. It describes a range of service configurations and assessment approaches, drawing examples from severe asthma centers around the world to highlight common essential elements. It also provides a framework for establishing such services and discusses practical considerations for implementation.
🔗https://doi.org/10.1016/j.jaip.2020.02.036
#allergy
📌Difficult-to-treat #asthma affects a minority of adults and children with asthma but represents a challenging mix of misdiagnosis, multimorbidity, inadequate self-management, severe airway pathobiology, and treatment complications. Management of these patients extends beyond asthma pharmacotherapy, because multiple other patient-related domains need to be addressed as well. Such complexity can hinder adequate clinical assessment even when performed in specialist practice. Systematic assessment undertaken by specialized multidisciplinary teams brings a broad range of resources to bear on patients with difficult-to-treat asthma. Although the concept of systematic assessment is not new, practices vary considerably and implementation is not universal. Nevertheless, assessment protocols are already in place in several institutions worldwide, and outcomes after such assessments have been highly encouraging. This review discusses the rationale, components, and benefits of systematic assessment, outlining its clinical utility and the available evidence for improved outcomes. It describes a range of service configurations and assessment approaches, drawing examples from severe asthma centers around the world to highlight common essential elements. It also provides a framework for establishing such services and discusses practical considerations for implementation.
🔗https://doi.org/10.1016/j.jaip.2020.02.036
#allergy
🅰️
👉Excellent resource on #penicillin #allergy testing
🔗https://edhub.ama-assn.org/jn-learning/pages/penicillin-allergy-testing
👉Excellent resource on #penicillin #allergy testing
🔗https://edhub.ama-assn.org/jn-learning/pages/penicillin-allergy-testing
👉ASCIA Guidelines - Acute management of anaphylaxis
📌These #guidelines for the acute management of severe #allergic reactions (#anaphylaxis) are intended for medical practitioners, nurses and other health professionals who provide first responder emergency care. The appendix includes additional information for health professionals working in emergency departments, ambulance services, and rural or regional areas, who provide emergency care.
🔗https://www.allergy.org.au/hp/papers/acute-management-of-anaphylaxis-guidelines
#allergy
📌These #guidelines for the acute management of severe #allergic reactions (#anaphylaxis) are intended for medical practitioners, nurses and other health professionals who provide first responder emergency care. The appendix includes additional information for health professionals working in emergency departments, ambulance services, and rural or regional areas, who provide emergency care.
🔗https://www.allergy.org.au/hp/papers/acute-management-of-anaphylaxis-guidelines
#allergy
👉Pediatric #Allergic Diseases, Food #Allergy, and Oral Tolerance
📌Pediatric allergic disease is a significant health concern worldwide, and the prevalence of childhood eczema, #asthma, allergic rhinitis, and food allergy continues to increase. Evidence to support specific interventions for the prevention of eczema, asthma, and allergic rhinitis is limited, and no consensus on prevention strategies has been reached. Randomized controlled trials investigating the prevention of food allergy via oral tolerance induction and the early introduction of allergenic foods have been successful in reducing peanut and egg allergy prevalence. Infant weaning guidelines in the United Sates were recently amended to actively encourage the introduction of peanut for prevention of peanut allergy.
🔗https://doi.org/10.1146/annurev-cellbio-100818-125346
📌Pediatric allergic disease is a significant health concern worldwide, and the prevalence of childhood eczema, #asthma, allergic rhinitis, and food allergy continues to increase. Evidence to support specific interventions for the prevention of eczema, asthma, and allergic rhinitis is limited, and no consensus on prevention strategies has been reached. Randomized controlled trials investigating the prevention of food allergy via oral tolerance induction and the early introduction of allergenic foods have been successful in reducing peanut and egg allergy prevalence. Infant weaning guidelines in the United Sates were recently amended to actively encourage the introduction of peanut for prevention of peanut allergy.
🔗https://doi.org/10.1146/annurev-cellbio-100818-125346
👉Anaphylaxis and allergy to coconut: An Australian pediatric case series
📌#Coconut #allergy is a rare but real clinical entity, the spectrum of severity including #anaphylaxis. Coconut is a drupe, or stone fruit, not a nut. Caution for coconut-derived skincare products, particularly in children w/atopy [Pathmanandavel et al, 2020]
🔗https://doi.org/10.1016/j.jaip.2020.06.049
📌#Coconut #allergy is a rare but real clinical entity, the spectrum of severity including #anaphylaxis. Coconut is a drupe, or stone fruit, not a nut. Caution for coconut-derived skincare products, particularly in children w/atopy [Pathmanandavel et al, 2020]
🔗https://doi.org/10.1016/j.jaip.2020.06.049
👉Gal d 7—a major #allergen in primary chicken #meat allergy
📌Worldwide consumption of poultry meat has increased in the past 50 years, and the United States is the leading producer. Poultry also can cause severe IgE-mediated allergic reactions. A study identifies Gal d 7 as an eliciting allergen.
🔗https://doi.org/10.1016/j.jaci.2020.02.033
#allergy
📌Worldwide consumption of poultry meat has increased in the past 50 years, and the United States is the leading producer. Poultry also can cause severe IgE-mediated allergic reactions. A study identifies Gal d 7 as an eliciting allergen.
🔗https://doi.org/10.1016/j.jaci.2020.02.033
#allergy
👉Mechanisms of skin #autoimmunity: Cellular and soluble immune components of the #skin
📌Autoimmune diseases are driven by either T cells or antibodies reacting specifically to 1 or more self-antigens. Although a number of self-antigens associated with skin diseases have been identified, the causative antigen(s) remains unknown in the great majority of skin diseases suspected to be autoimmune driven. Model diseases such as pemphigus, dermatitis herpetiformis, and more recently psoriasis have added greatly to our understanding of skin autoimmunity. Depending on the dominant T- or B-cell phenotype, skin autoimmune diseases usually follow 1 of 6 immune response patterns: lichenoid, eczematous, bullous, psoriatic, fibrogenic, or granulomatous. Usually, skin autoimmunity develops as a consequence of several events—an altered# microbiome, inherited dysfunctional immunity, antigens activating innate immunity, epigenetic modifications, sex predisposition, and impact of antigens either as neoantigen or through molecular mimicry. This review summarizes currently known antigens of skin autoimmune diseases and discusses mechanisms of skin #autoimmunity.
🔗https://doi.org/10.1016/j.jaci.2020.05.009
#allergy
📌Autoimmune diseases are driven by either T cells or antibodies reacting specifically to 1 or more self-antigens. Although a number of self-antigens associated with skin diseases have been identified, the causative antigen(s) remains unknown in the great majority of skin diseases suspected to be autoimmune driven. Model diseases such as pemphigus, dermatitis herpetiformis, and more recently psoriasis have added greatly to our understanding of skin autoimmunity. Depending on the dominant T- or B-cell phenotype, skin autoimmune diseases usually follow 1 of 6 immune response patterns: lichenoid, eczematous, bullous, psoriatic, fibrogenic, or granulomatous. Usually, skin autoimmunity develops as a consequence of several events—an altered# microbiome, inherited dysfunctional immunity, antigens activating innate immunity, epigenetic modifications, sex predisposition, and impact of antigens either as neoantigen or through molecular mimicry. This review summarizes currently known antigens of skin autoimmune diseases and discusses mechanisms of skin #autoimmunity.
🔗https://doi.org/10.1016/j.jaci.2020.05.009
#allergy
👉Biomarkers of diagnosis and resolution of food allergy
📌Food #allergy is increasing in prevalence, affecting up to 10% of children in developed countries. Food allergy can significantly affect the quality of life and well‐being of patients and their families; therefore, an accurate diagnosis is of extreme importance. Some food allergies can spontaneously resolve in 50‐60% of cow’s milk and egg allergic, 20% of peanut allergic and 9% of tree nut allergic children by school age. For that reason, food allergic status should be monitored over time to determine when to reintroduce the food back into the child’s diet. The gold‐standard to confirm the diagnosis and the resolution of food allergy is an oral food challenge; however, this involves a risk of causing an acute allergic reaction and requires clinical experience and resources to treat allergic reactions of any degree of severity. In the clinical setting, biomarkers have been used and validated to enable an accurate diagnosis when combined with the clinical history, deferring the oral food challenge, whenever possible. In this review, we cover the tools available to support the diagnosis of food allergies and to predict food allergy resolution over time. We review the latest evidence on different testing modalities and how effective they are in guiding clinical decision‐making in practice. We also evaluate predictive test cut‐offs for the more common food allergens to try and provide guidance on when challenges might be most successful in determining oral tolerance in children.
🔗https://doi.org/10.1111/pai.13389
📌Food #allergy is increasing in prevalence, affecting up to 10% of children in developed countries. Food allergy can significantly affect the quality of life and well‐being of patients and their families; therefore, an accurate diagnosis is of extreme importance. Some food allergies can spontaneously resolve in 50‐60% of cow’s milk and egg allergic, 20% of peanut allergic and 9% of tree nut allergic children by school age. For that reason, food allergic status should be monitored over time to determine when to reintroduce the food back into the child’s diet. The gold‐standard to confirm the diagnosis and the resolution of food allergy is an oral food challenge; however, this involves a risk of causing an acute allergic reaction and requires clinical experience and resources to treat allergic reactions of any degree of severity. In the clinical setting, biomarkers have been used and validated to enable an accurate diagnosis when combined with the clinical history, deferring the oral food challenge, whenever possible. In this review, we cover the tools available to support the diagnosis of food allergies and to predict food allergy resolution over time. We review the latest evidence on different testing modalities and how effective they are in guiding clinical decision‐making in practice. We also evaluate predictive test cut‐offs for the more common food allergens to try and provide guidance on when challenges might be most successful in determining oral tolerance in children.
🔗https://doi.org/10.1111/pai.13389
👉Preventing #food #allergy in infancy and childhood: Systematic review of randomised controlled trials
📌Sixty percent of the included studies were published in the last 10 years, but much still remains to be understood about preventing food allergy. In particular, there is a need to validate the potential benefits of early introduction of food allergens in a wider range of populations.
🔗https://doi.org/10.1111/pai.13273
📌Sixty percent of the included studies were published in the last 10 years, but much still remains to be understood about preventing food allergy. In particular, there is a need to validate the potential benefits of early introduction of food allergens in a wider range of populations.
🔗https://doi.org/10.1111/pai.13273
The review of the complex interplay of allergen-specific #IgE, IgG and IgA and the corresponding cell receptors in allergic diseases and its relevance for diagnosis,treatment and prevention of #allergy.
doi.org/10.1111/all.14908
*Open access
doi.org/10.1111/all.14908
*Open access
In this review, the authors present the data supporting the necessity of 1) an intact epidermal barrier to prevent epicutaneous antigen presentation, 2) the presence of specific commensal bacteria to maintain an intact mucosal immune system and 3) maternal/infant diet diversity, including vitamins and minerals, and appropriately timed allergenic food introduction to prevent FA.
#allergy
https://doi.org/10.1111/all.15006
#allergy
https://doi.org/10.1111/all.15006