Global availability and uptake of psychological services for adults, caregivers and children with food allergy

BACKGROUND

Food allergy (FA) is associated with poor health-related quality of life and high levels of psychological distress. Psychological support is extremely important but not always available. As part of the Global Access to Psychological Services for Food Allergy (GAPS) study, we aimed to assess psychological distress and service use among adults, caregivers and children with FA in a global survey.

METHODS

Participants (n = 1329 adults with FA; n = 1907 caregivers of children with FA) from >20 countries were recruited through patient organisations, social media advertisements and online survey panels to complete an online survey. Surveys were available in six languages.

RESULTS

A total of 67.7% of adults and 77.2% of caregivers reported direct experience, and 51.6% of caregivers said their child had experienced FA-related psychological distress. The most commonly reported issue was anxiety about having an allergic reaction. Less than 20% had been assessed for FA-related psychological distress. There were significant differences across countries for levels of distress, screening for distress, seeing a mental health professional and being diagnosed with a FA-related mental health disorder (all p < .001). The United Kingdom, Australia and Brazil had the highest number of participants reporting distress. The most commonly reported barrier to seeing a mental health professional was cost.

CONCLUSIONS

FA-related distress is common across countries, but with substantial country-to-country variability. Allergy providers are encouraged to routinely assess families for psychological distress and provide access to appropriate mental health resources. Development and implementation of evidence-based, patient-informed accessible, affordable FA interventions in multiple languages is urgently needed.

Molecular docking studies and evaluation of the antiretroviral activity and cytotoxicity of the species Lafoensia pacari Saint-Hilaire

Interest in antiviral plant species has grown exponentially and some have been reported to have anti-HIV properties. This research aims to perform the bio-guided phytochemical fractionation by antiretroviral activity of Lafoensia pacari stem barks. This in vitro experimental study involved the preparation of plant material, obtention of ethanolic extract, fractionation, purification, identification and quantification of fractions, acid-base extraction, nuclear magnetic resonance, HIV-1 RT inhibition test and molecular docking studies. From the bio-guided fractionation by the antiretroviral activity there was a higher activity in the acetanolic subfractions, highlighting the acetate subfraction - neutrals with 60.98% of RT inhibition and ellagic acid with 88.61% of RT inhibition and absence of cytotoxicity. The macrophage lineage cytotoxicity assay showed that the chloroform fraction was more toxic than the acetate fraction. The analysis of the J-resolved spectrum in the aromatic region showed a singlet at 7.48 and 6.93 ppm which was identified as ellagic acid and gallic acid, respectively. The 5TIQ enzyme obtained better affinity parameter with the ellagic acid ligand, which was confirmed by the HSQC-1H-13C spectra. Gallic acid was also favorable to form interaction with the 5TIQ enzyme, being confirmed through the HSQC-1H-13C spectrum. From the PreADMET evaluation it was found that ellagic acid is a promising molecule for its RT inhibition activity and pharmacokinetic and toxicity parameters.

Evaluation of nutritional composition of flour residue of mangaba processing

Among several fruits, mangaba (Hancornia speciosa Gomes), it aroused the interest of producers and consumers due to its attractive sensory characteristics and health beneficial properties (high nutritional value and presence of bioactive substances), thus, this work evaluates the nutritional factors of the flour residue of mangaba processing that is despised by the food industry, and the influence of temperature on its production. The mangaba processing residue was splited in two main groups: in natura sample (control), and other for preparation of flour that was dried at 50 °C and divided into two other groups: treatment A (flour with roasts at 110 °C and 130 °C) and treatment B (flour from drying at 50 °C). The nutritional characteristics of flours were analyzed considering the chemical parameters: pH, titratable total acidity and soluble solids, in addition to the determination of moisture content, total lipids, total dietary fiber and ash, total energy value, antioxidant activity, phytochemical screening, quantification of phenolic compounds and flavonoids, as well as technological functional properties (water absorption index (WAI), water solubility index (WSI), milk absorption index (MAI) and milk solubility index (MSI) and oil absorption index (OAI). The results showed that the bioactive compounds present in the extracts do not have significant properties of acting as free radical kidnappers. The heat treatment, performed in the flour of mangaba processing residues, influenced the nutritional factors and properties of absorption and solubility, which showed statistical differences. These results show that the flour is a viable alternative for the energy enrichment of diets, contributing to the development of new products, the reduction of the disposal of these residues and consequently to the minimization of the environmental impact.

Phytochemical characterization, antioxidant potential and antibacterial activity of the Croton argyrophylloides Muell. Arg. (Euphorbiaceae)

Croton argyrophylloides Muell. Arg., from the Euphorbiaceae family, popularly known as marmeleiro prateado or sacatinga, is a plant from the Caatinga biome commonly found in Brazil's northeastern region. The present study aimed to evaluate the antioxidant activity of the species. The phytochemical study was performed through qualitative analysis of chemical constituents and quantitative determination of the total phenol content through the Folin-Ciocalteu test. The qualitative and quantitative antioxidant tests were performed using the DPPH method (2.2 diphenyl-1-picryl hydrazil) and ferric reducing antioxidant power (FRAP). The minimum inhibitory concentration (MIC) was determined by microdilution in 96-well plates. The ethanolic extract of the leaves of C. argyrophylloides manifested antioxidant action in the quantitative DPPH test with a significant bioactivity of 84.70 AAO% in 500 µg/mL, with an EC50 of 236.79. The content of total phenolic compounds was 946.06 mg of gallic acid equivalents/g of sample, and total flavonoids was 58.11 mg of quercetin equivalents/g of sample, the result obtained for FRAP was 15294.44 µM Trolox/g of sample and ABTS was 718 μM Trolox of sample. The prospecting of the chemical constituents of the leaves of C. argyrophylloides revealed the presence of the main compounds that manifests the antioxidant activity and it was proven by the DPPH method that there is antioxidant activity in the analyzed sample, in addition to demonstrating a significant content of phenolic compounds and total flavonoid content in the species, which corroborates the antioxidant activity of the plant sample. The leaf extracts presented growth inhibition halos of 10 and 12 mm upon Staphylococcus aureus ATCC 25923.

A Physiological behavior and tolerance of Lactuca sativa to lead nitrate and silver nitrate heavy metals

This study goal to evaluate the effects of different concentrations of lead (Pb) and silver (Ag) on germination, initial growth and anatomical alterations of Lactuca sativa L. Plants use various mechanisms to reduce the impacts caused by anthropic action, such as xenobiotic elements of soils and water contaminated by heavy metals. These metals were supplied as lead nitrate and silver nitrate and the following treatments were established: control for both metals, maximum dose of heavy metals, for arable soils, allowed by the National Council of the Environment (Ag = 25 mg. Kg-1, Pb = 180 mg. Kg-1), double (Ag = 50 mg. Kg-1, Pb = 360 mg. Kg-1) and triple (Ag = 75 mg. Kg-1, Pb = 540 mg. Kg -1) of this dosage. Vigor and germination tests of the seeds and possible anatomical changes in the leaves and roots of lettuce plants were performed. The species showed a high capacity to germinate under Pb and Ag stress, and the germination was never completely inhibited; however, the germination decreased with increasing Pb concentrations, but not under Ag stress. The use of increasing doses of metals reduced seed vigor and increased chlorophyll content. An increase in biomass was also observed in plants from treatments submitted to Pb. The phytotoxic effects of metals were more pronounced at 15 days after sowing. Anatomically, L. sativa was influenced by metal concentrations, and had a reduction of up to 79.9% in root epidermis thickness at the highest Pb concentration, although some structures did not suffer significant changes. The results suggest that L. sativa presents tolerance to high concentrations of heavy metals, showing possible mechanisms to overcome the stress caused by these metals. In this research lettuce possibly used the mechanism of exclusion of metals retaining Pb and Ag in the roots preserving the photosynthetic apparatus in the aerial part of the plants. In general, the chemical element Pb was more toxic than Ag, in these experimental conditions.

Ethnobotanical and ethnopharmacological study of medicinal plants used by a traditional community in Brazil's northeastern

The aim of this research is to make a survey of the socio-environmental characteristics and the ethnobotanical study of medicinal plants used in a traditional community in the Brazilian Northeast, Alagoas. The study was made based on visits with the application of a questionnaire with questions related to the socio-economic element and on the diversity of plants used in herbal medicine. The research was made from March/2019 to February/2020, where families and interviewed plant exhibitors were interviewed for botanical identification. The studied community, which were 24 interviewees, was compiled by residents of the Quilombola community from Pau D'arco in Arapiraca city - Alagoas. Residents interviewed, 15 (62.5%) attended between 56 to 80 years, 11 interviewees about 46% were born in the community and 13 (54%) had a fundamentally incomplete nature. At the end, there were mentioned 30 plant species used for phytotherapeutic purposes, from which presents bigger usage as plants against arterial hypertension (Salvia rosmarinus Schleid), diabetes Mellitos (Croton heliotropiifolius Kunth), pain and inflammation (Alternanthera tenella Colla), present the biggest number of species in the community. The species cited are related to numerous medicinal uses, among which there will be predominant associations associated with cardiovascular and inflammatory processes. The tea is the main way of preparing plants. It is perceived that medicinal plants are only widely used by this Quilombola community of and growth of the crops in the backyard are considered a tradition.

Detection of enteropathogens and research of pesticide residues in Lactuca sativa from traditional and agroecological fairs

Agroecological production represents a new reality in vegetable farming. Thus, the study aimed to search for the presence of pesticides in agroecological samples and microbiological and parasitological contamination in Lactuca sativa L. of agroecological and conventional fairs in Alagoas. Thirty-two samples were collected, a hygienic-sanitary checklist was performed, along with coliform, Salmonella spp., Staphylococcus aureus research and Gas Chromatography with Mass Spectrometer (GC-MS) for pesticide research; using two methodologies for parasitological studies. Thirty-two samples were analyzed, with a sanitary adequacy level at 45% and 38% for fairs (agroecological and conventional) respectively, with three samples (9.4%) in total, being adequate to the microbiological pattern according to RDC no. 12/2001. Among the 23 samples which were tested positive for parasites, 69.5% originated from samples extracted at conventional fairs, and 53% of every positive samples presented Entamoeba coli as the main contaminant. All together, no traces of deltamethrin were detected, but in two of the samples a peak retention for diphenoconazole was detected. In conclusion, the fairs represent an adequate environment for human pathogens and indicators. Therefore greater hygiene training of vegetable traders and consumers in the state of Alagoas is required, especially in conventional fairs, which presented more critical microbiological and parasitological indexes comparing to fairs with agroecological products; however, the presence of difenoconazole in two samples of agricultural fairs suggests accidental contamination or indiscriminate use of this chemical in the production of Lactuca sativa, however, products with agroecological origin represents a better choice for the consumers.

Phytochemical characterization, antioxidant potential and antimicrobial activity of Averrhoa carambola L. (Oxalidaceae) against multiresistant pathogens

The objective of this work was to perform the phytochemical characterization, to determine total phenols, antioxidant (AAO%) and antimicrobial potential of the ethanolic extracts of carambola. The phytochemical study was carried out through a qualitative analysis of the chemical constituents and quantitative determination of the phenol content By the Folin-Ciocalteu test. Qualitative and quantitative antioxidant tests were performed using the DPPH method (2,2 diphenyl-1-picryl-hydrazila) and iron reduction (FRAP). The minimum inhibitory concentration (MIC) was determined by microdilution in 96-well plates. The presence of pyrogallic tannins, steroids and saponins has been identified. The highest total phenol content, quantified in the samples, was found in the stem bark (0.0866 mgEAG/g) and in the fruit (0.0734 mgEAG/g). In the antioxidant evaluation, the extracts of the green fruit bagasse (AAO% 71.9%,) and stem bark at 50 μg/mL (AAO% 94%) with CE50 23.7 μg/mL. Leaf extracts, stem bark, ripe fruit bagasse and green fruit bagasse presented MICs of 100 μg/mL against multiresistant pathogenic bacteria and fungi.

Situational diagnosis of the popular use of medicinal plants in pediatrics

This study aimed to describe the use of medicinal plants for the relief and treatment of pediatrics pathologies performed by parents of children registered in a Basic Health Unit. This is a cross-sectional, observational and analytical study that occurred from March until May 2016, with the participation of 176 individuals, using a semi-structured questionnaire as a research instrument. Descriptive statistics were applied for data analysis, using frequency distribution and chi-square test. Among all 177 indications of medicinal use of plants in childhood, considering the plant part and administration method, 61.6% converged with scientific data, 21.5% differed and 16.9% were new indications without a similar record in the literature. These results support the popular use of medicinal plants and show to need for greater awareness about the rational use of phytotherapy and stimulate scientific research, as they bring new elements about the therapeutic potential of different species.

Situational diagnosis of professionals of family health units on phytotherapy

The incorporation of the use of phytotherapy in the primary health care is an important gain for the Unified Health System, besides reducing the cost in the treatment of the patient, rescues the popular knowledge and promotes the rational use of the medicinal plants. To determine the situational diagnostic profile of professionals of family health units on phytotherapy. A quantitative observational study was carried out, in which forms were applied to the team of the family health units of the municipality of Marechal Deodoro da Fonseca/Alagoas. Only 23% of the interviewed professionals reported having had contact with scientific information on phytotherapy during professional training. All of them approve the implantation of the official practice of phytotherapy and routinely prescribe phytotherapics and medicinal plants, but they do not know the possible risks of drug interaction with the use of medicinal plants. Health professionals Health professionals support the official practice of phytotherapy in public health and show interest in participating in courses / training on the subject to better serve the population.

The acetylcholinesterase as indicative of intoxication for pesticide in farmers of conventional and organic cultivation

In this sense the objective of assessing the levels of pesticide poisoning in rural farmers of San Sebastian and take AL, using acetylcholinesterase enzymes Erythrocyte and plasma as biological indicator of intoxication. This is a prospective, transversal and descriptive variables analyzed were: year whose, sex, age group, education, location, condition, route of exposure. The data were acquired by collecting blood samples and socio demographic information of farmers. Was put as the determining factor the type of conventional and organic farming, and periods of drought and rainy. 56 volunteers were analyzed. The analyses were performed in the automatic biochemical Analyzer Cobas Integra 400 plus®. According to the results of the analyses, it was the largest number of individuals with reduced values of cholinesterase, specifically the Group of conventional farming, the period of greatest change index was in the rainy season, where the activity of AChE, expressive values presented in the city of São Sebastião, with 80% result of intoxicated, in the city of the foot - take, 21.73% over the same period. On analysis of the AChP, São Sebastião has obtained the highest number of contaminated with 18.75% and 30% respectively, in the District Take Foot stood between 10 and 21.73% of reduced levels of cholinesterase. This sets the organic system of cultivation, as the best alternative for prevention of future diseases, in addition to bringing quality of life for rural workers, as well as for consumers.

Ethnodirigid study of Medicinal plants used by the population assisted by the “Programa de Saúde da Família” (Family Health Program) in Marechal Deodoro - AL, Brazil

Abstract This study aimed to assess diagnosis of Unique Health System (SUS) users profile with regard to herbal medicine. This is a cross-sectional study with observational data collection conducted in the city of Marechal Deodoro, through a semi-structured questionnaire with questions related to socioeconomic data, use, and knowledge of medicinal plants and herbal medicines and satisfaction with the use of medicinal herbs (MH) and interactions of phytotherapeutic drugs (PD). Among the topics, 86.89% of users used herbal medicines often, especially lemon balm (Melissa officinalis L.). It was also observed that the plants are generally used as a sedative (21.74%) and as tea (87.84%). 82.32% of respondents claim to have acquired the knowledge of herbal medicine through a family member and 85.36% make use of medicinal plants without having received any information on the use of MH and PD. 61% of the plants described that coincided with the form of use and therapeutic properties found in the literature. With regard to satisfaction by treatment with MH and PD, it was found that 56.67% are satisfied. Therefore, it is necessary to pay attention to this aspect of usage, in order to avoid possible drug interactions or adverse reactions resulting from the incorrect use.

In vivo effect of essential oil of Mentha x villosa and its active compound against Schistosoma mansoni (Sambon, 1907)

Schistosomiasis treatment is dependent on a single drug, praziquantel (PZQ). The development of resistance of PZQ has drawn the attention of many researchers to alternative drugs. One viable and promising treatment is the study of medicinal plants as a new approach to the experimental treatment for Schistosomiasis. The present work aimed to evaluate in vivo antischistosomal activity of effect of Mentha x villosa Oil Essential (Mv-EO) and rotundifolone (ROT) against Schistosoma mansoni. Thirty-day-old female Swiss webster mice (Mus musculus) weighing 50 grams were used. Mice were infected with 80 cercariae of S. mansoni (BH strain) and orally administered Mv-EO (50, 100 and 200 mg/Kg) and ROT (35.9, 70.9 and 141.9 mg/Kg) at 45-days post infection for 5 consecutive days. All mice were euthanized 60 days after infection. Praziquantel was the positive control in the experiment. Doses of 200 mg/kg (Mv-EO) and ROT (141.9 mg/Kg) resulted in a significant reduction in fluke burden (72.44% and 74.48%, respectively). There was also marked reduction in liver, intestinal and faecal and changed oogram pattern, compared to infected untreated mice. Considering the results obtained, further biological studies are required in order to elucidate the mechanism of schistosomicidal action on against adult S. mansoni.

Phytochemical screening and in vitro antibacterial, antifungal, antioxidant and antitumor activities of the red propolis Alagoas

The study aimed to evaluate the antimicrobial activity, antioxidant, toxicity and phytochemical screening of the Red Propolis Alagoas. Antimicrobial activity was evaluated by disk diffusion method. Determination of antioxidant activity was performed using the DPPH assay (1.1-diphenyl-2-picrylhydrazyl), FTC (ferric thiocyanate) and determination of phenolic compounds by Follin method. Toxicity was performed by the method of Artemia salina and cytotoxicity by MTT method. The phytochemical screening for the detection of allelochemicals was performed. The ethanol extract of propolis of Alagoas showed significant results for antimicrobial activity, and inhibitory activity for Staphylococcus aureus and Candida krusei. The antioxidant activity of the FTC method was 80% to 108.3% hydrogen peroxide kidnapping, the DPPH method showed an EC50 3.97 mg/mL, the content of total phenolic compounds was determined by calibration curve gallic acid, resulting from 0.0005 mg/100 g of gallic acid equivalent. The extract was non-toxic by A. salina method. The propolis extract showed high activity with a higher percentage than 75% inhibition of tumor cells OVCAR-8, SF-295 and HCT116. Chemical constituents were observed as flavonones, xanthones, flavonols, and Chalcones Auronas, Catechins and leucoanthocyanidins. It is concluded that the extract can be tested is considered a potential source of bioactive metabolites.

EAACI Guidelines on allergen immunotherapy: IgE-mediated food allergy

Food allergy can result in considerable morbidity, impairment of quality of life, and healthcare expenditure. There is therefore interest in novel strategies for its treatment, particularly food allergen immunotherapy (FA-AIT) through the oral (OIT), sublingual (SLIT), or epicutaneous (EPIT) routes. This Guideline, prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Task Force on Allergen Immunotherapy for IgE-mediated Food Allergy, aims to provide evidence-based recommendations for active treatment of IgE-mediated food allergy with FA-AIT. Immunotherapy relies on the delivery of gradually increasing doses of specific allergen to increase the threshold of reaction while on therapy (also known as desensitization) and ultimately to achieve post-discontinuation effectiveness (also known as tolerance or sustained unresponsiveness). Oral FA-AIT has most frequently been assessed: here, the allergen is either immediately swallowed (OIT) or held under the tongue for a period of time (SLIT). Overall, trials have found substantial benefit for patients undergoing either OIT or SLIT with respect to efficacy during treatment, particularly for cow's milk, hen's egg, and peanut allergies. A benefit post-discontinuation is also suggested, but not confirmed. Adverse events during FA-AIT have been frequently reported, but few subjects discontinue FA-AIT as a result of these. Taking into account the current evidence, FA-AIT should only be performed in research centers or in clinical centers with an extensive experience in FA-AIT. Patients and their families should be provided with information about the use of FA-AIT for IgE-mediated food allergy to allow them to make an informed decision about the therapy.

Road map for the clinical application of the basophil activation test in food allergy

The diagnosis of IgE‐mediated food allergy based solely on the clinical history and the documentation of specific IgE to whole allergen extract or single allergens is often ambiguous, requiring oral food challenges (OFCs), with the attendant risk and inconvenience to the patient, to confirm the diagnosis of food allergy. This is a considerable proportion of patients assessed in allergy clinics. The basophil activation test (BAT) has emerged as having superior specificity and comparable sensitivity to diagnose food allergy, when compared with skin prick test and specific IgE. BAT, therefore, may reduce the number of OFC required for accurate diagnosis, particularly positive OFC. BAT can also be used to monitor resolution of food allergy and the clinical response to immunomodulatory treatments. Given the practicalities involved in the performance of BAT, we propose that it can be applied for selected cases where the history, skin prick test and/or specific IgE are not definitive for the diagnosis of food allergy. In the cases that the BAT is positive, food allergy is sufficiently confirmed without OFC; in the cases that BAT is negative or the patient has non‐responder basophils, OFC may still be indicated. However, broad clinical application of BAT demands further standardization of the laboratory procedure and of the flow cytometry data analyses, as well as clinical validation of BAT as a diagnostic test for multiple target allergens and confirmation of its feasibility and cost‐effectiveness in multiple settings.

Allergen immunotherapy for IgE-mediated food allergy: a systematic review and meta-analysis

BACKGROUND

The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines for Allergen Immunotherapy (AIT) for IgE-mediated Food Allergy. To inform the development of clinical recommendations, we sought to critically assess evidence on the effectiveness, safety and cost-effectiveness of AIT in the management of food allergy.

METHODS

We undertook a systematic review and meta-analysis that involved searching nine international electronic databases for randomized controlled trials (RCTs) and nonrandomized studies (NRS). Eligible studies were independently assessed by two reviewers against predefined eligibility criteria. The quality of studies was assessed using the Cochrane Risk of Bias tool for RCTs and the Cochrane ACROBAT-NRS tool for quasi-RCTs. Random-effects meta-analyses were undertaken, with planned subgroup and sensitivity analyses.

RESULTS

We identified 1814 potentially relevant papers from which we selected 31 eligible studies, comprising of 25 RCTs and six NRS, studying a total of 1259 patients. Twenty-five trials evaluated oral immunotherapy (OIT), five studies investigated sublingual immunotherapy, and one study evaluated epicutaneous immunotherapy. The majority of these studies were in children. Twenty-seven studies assessed desensitization, and eight studies investigated sustained unresponsiveness postdiscontinuation of AIT. Meta-analyses demonstrated a substantial benefit in terms of desensitization (risk ratio (RR) = 0.16, 95% CI 0.10, 0.26) and suggested, but did not confirm sustained unresponsiveness (RR = 0.29, 95% CI 0.08, 1.13). Only one study reported on disease-specific quality of life (QoL), which reported no comparative results between OIT and control group. Meta-analyses revealed that the risk of experiencing a systemic adverse reaction was higher in those receiving AIT, with a more marked increase in the risk of local adverse reactions. Sensitivity analysis excluding those studies judged to be at high risk of bias demonstrated the robustness of summary estimates of effectiveness and safety of AIT for food allergy. None of the studies reported data on health economic analyses.

CONCLUSIONS

AIT may be effective in raising the threshold of reactivity to a range of foods in children with IgE-mediated food allergy whilst receiving (i.e. desensitization) and post-discontinuation of AIT. It is, however, associated with a modest increased risk in serious systemic adverse reactions and a substantial increase in minor local adverse reactions. More data are needed in relation to adults, long term effects, the impact on QoL and the cost-effectiveness of AIT.

Medicinal plants profile used by the 3rd District population of Maceió-AL

Abstract Herein the use of medicinal plants by the population of the 3rd Sanitary District of Maceió-AL city is reported. Transversal description was conducted from February 2013 to January 2014, with a sample of 116 individuals of both Gender Genders aged over 18 years. The ethnobotanical information interviews ethnobotanical information were obtained through semi - structured questionnaire featuring the use of medicinal plants and social and economical data. Descriptive statistics was applied for quantitative variables as mean and standard deviation and proportions for qualitative variables in the frequency table format. The results showed that 85.34% of the interviewees used plants for medicinal purposes. As the majority of these were (73.28%) females in the age group between 30-60 years of old. Among a total of 45 identified plant species, the highest use frequency were for Boldus Peumus (bilberry), Melissa officinalis (lemon balm), and Mentha piperita (mint). The most widely used plant foliage part was (53.53%) prepared as an infusion (55.5%). The use of medicinal plants in Maceió cityis widespread, highlighting the importance of ethnobotanical knowledge for the study of medicinal plants.

A new framework for the interpretation of IgE sensitization tests

IgE sensitization tests, such as skin prick testing and serum-specific IgE, have been used to diagnose IgE-mediated clinical allergy for many years. Their prime drawback is that they detect sensitization which is only loosely related to clinical allergy. Many patients therefore require provocation tests to make a definitive diagnosis; these are often expensive and potentially associated with severe reactions. The likelihood of clinical allergy can be semi-quantified from an IgE sensitization test results. This relationship varies though according to the patients' age, ethnicity, nature of the putative allergic reaction and coexisting clinical diseases such as eczema. The likelihood of clinical allergy can be more precisely estimated from an IgE sensitization test result, by taking into account the patient's presenting features (pretest probability). The presence of each of these patient-specific factors may mean that a patient is more or less likely to have clinical allergy with a given test result (post-test probability). We present two approaches to include pretest probabilities in the interpretation of results. These approaches are currently limited by a lack of data to allow us to derive pretest probabilities for diverse setting, regions and allergens. Also, cofactors, such as exercise, may be necessary for exposure to an allergen to result in an allergic reaction in specific IgE-positive patients. The diagnosis of IgE-mediated allergy is now being aided by the introduction of allergen component testing which may identify clinically relevant sensitization. Other approaches are in development with basophil activation testing being closest to clinical application.

NS3 protease polymorphisms and genetic barrier to drug resistance of distinct hepatitis C virus genotypes from worldwide treatment-naïve subjects

Hepatitis C virus (HCV) NS3 protease inhibitors have been primarily designed against genotype 1, the one with the lowest response to dual therapy. However, less evidence of their efficacy on non-1 genotypes is available, and any such information is mostly concentrated on genotypes 2-4. This study evaluated HCV protease resistance profiles in the major six HCV genotypes and identified genetic barrier (GB) profiles to each available protease inhibitor across HCV strains from different locations worldwide. We obtained 15 099 HCV sequences from treatment-naïve subjects retrieved at the Los Alamos HCV Sequence Database. The wild-type codons of different HCV genotypes were used to analyse the smallest number of nucleotide substitution steps required for changing that codon to the closest one associated with drug resistance. The 36L and 175L RAVs were found as genetic signatures of genotypes 2-5, while the 80K RAV was found in all genotype 5 sequences. Genotypes 4 and 6 showed a higher GB to RAV mutations conferring resistance to telaprevir, while genotypes 2-5 presented baseline resistance to that drug, carrying the 36L mutation. Genotype 4 had a higher GB to simeprevir resistance, requiring three substitutions to acquire the 155K mutation. Subtype 1b showed a higher GB than subtype 1a to resistance for most PIs, with RAVs at codons 36 and 155. Geographic disparities were also found in frequencies of certain RAVs in genotypes 2 and 3. Under a scenario of unprecedented evolution of anti-HCV direct-acting agents, the genetic composition of the circulating HCV sequences should be evaluated worldwide to choose the most appropriate/feasible therapeutic schemes with the highest genetic barriers to resistance.

The clinical utility of basophil activation testing in diagnosis and monitoring of allergic disease

The basophil activation test (BAT) has become a pervasive test for allergic response through the development of flow cytometry, discovery of activation markers such as CD63 and unique markers identifying basophil granulocytes. Basophil activation test measures basophil response to allergen cross-linking IgE on between 150 and 2000 basophil granulocytes in <0.1 ml fresh blood. Dichotomous activation is assessed as the fraction of reacting basophils. In addition to clinical history, skin prick test, and specific IgE determination, BAT can be a part of the diagnostic evaluation of patients with food-, insect venom-, and drug allergy and chronic urticaria. It may be helpful in determining the clinically relevant allergen. Basophil sensitivity may be used to monitor patients on allergen immunotherapy, anti-IgE treatment or in the natural resolution of allergy. Basophil activation test may use fewer resources and be more reproducible than challenge testing. As it is less stressful for the patient and avoids severe allergic reactions, BAT ought to precede challenge testing. An important next step is to standardize BAT and make it available in diagnostic laboratories. The nature of basophil activation as an ex vivo challenge makes it a multifaceted and promising tool for the allergist. In this EAACI task force position paper, we provide an overview of the practical and technical details as well as the clinical utility of BAT in diagnosis and management of allergic diseases.