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Kanjanawasee D, Wattanaphichet A, Tantilipikorn P, Tantikun B. Nasal allergen provocation test: updated indications and diagnostic accuracy. Curr Opin Allergy Clin Immunol 2025; 25:157-168. [PMID: 40048355 DOI: 10.1097/aci.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2025]
Abstract
PURPOSE OF REVIEW The Nasal Allergen Provocation Test (NAPT) is a valuable diagnostic tool for allergic rhinitis, particularly in cases where conventional tests, such as the skin prick test (SPT) and serum-specific IgE (sIgE), yield inconclusive results. By replicating real-life allergen exposure in a controlled setting, NAPT enables the assessment of allergen-specific nasal reactivity. This article aims to review the current knowledge of NAPT. RECENT FINDINGS Recent studies have reinforced NAPT as the gold standard for confirming nasal allergic responses. In the past, test protocols, allergen dosages, and outcome measurements varied widely. However, advancements in allergen standardization, the combination of objective and subjective measurements, and metered nasal allergen application have led to an improved and more reliable test method, with ongoing efforts to establish a universal protocol for clinical testing. SUMMARY This review summarizes current knowledge on NAPT, including its clinical applications, indications, methodology, and recent advancements. Additionally, we compare NAPT with SPT and sIgE in terms of diagnostic accuracy. The protocols, allergen types and doses, test methodologies, and outcome measures of these studies were analyzed and compared.
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Affiliation(s)
- Dichapong Kanjanawasee
- Center of Research Excellence in Allergy & Immunology
- Biodesign Innovation Center, Department of Parasitology, Faculty of Medicine Siriraj Hospital
| | | | - Pongsakorn Tantilipikorn
- Center of Research Excellence in Allergy & Immunology
- Division of Rhinology & Allergy, Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University
| | - Bannawat Tantikun
- Department of Otolaryngology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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von der Lage P, Bächinger D, Marti S, Schmid-Grendelmeier P, Röösli C, Lang C, Soyka M. Intranasal Schirmer Test: A Useful Diagnostic Tool in Nasal Allergen Provocation Testing. Ann Allergy Asthma Immunol 2025:S1081-1206(25)00237-6. [PMID: 40389151 DOI: 10.1016/j.anai.2025.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2025] [Revised: 05/10/2025] [Accepted: 05/12/2025] [Indexed: 05/21/2025]
Abstract
BACKGROUND The intranasal Schirmer test (INSCH) is a quick method to objectify nasal secretion. This study aims to use the INSCH to assess nasal secretion change through direct nasal allergen provocation (NPT). OBJECTIVE This prospective single-center study included patients who received allergy diagnostics using NPT and anterior rhinomanometry (aRMM). METHODS The Schirmer filter paper was attached to the nasal septum bilaterally pre- and post-allergen provocation. Additionally, all participants completed the sinonasal outcome test 22 (SNOT-22). The difference in wetting length before and after allergen provocation was investigated. Moreover, a cut-off value for allergic rhinitis were calculated. RESULTS A total of n = 25 patients and n = 25 in the control group were included. Patients with a positive result in NPT showed a significantly higher secretion in the provoked nasal cavity (mean difference = 13.95 mm; p = 0.01). The increased moisture level through provocation resulted in an area under the curve (AUC) of 0.814. A cut-off value of 2.75 mm wetting length increase (Youden index = 0.532) was calculated (sensitivity = 81.8% and specificity = 71.4%). Allergy diagnostic patients scored significantly higher in the SNOT-22 than the control group (25.04 score difference; p < 0.001). CONCLUSION The INSCH represents a straightforward and cost-effective test to assess intranasal secretion changes in allergy diagnostics. The incorporation of the INSCH in the NPT protocol could particularly enhance treatment efficacy for patients with inconclusive NPT results or it could serve as a substitute for other objective measurements like aRMM or acoustic rhinometry.
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Affiliation(s)
- Paula von der Lage
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - David Bächinger
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvan Marti
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christof Röösli
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Claudia Lang
- Allergy Unit, Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Soyka
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Jamali MC, Mohamed AH, Jamal A, Kamal MA, Al Abdulmonem W, Saeed BA, Mansuri N, Ahmad F, Mudhafar M, Shafie A, Hattiwale HM. Biological mechanisms and therapeutic prospects of interleukin-33 in pathogenesis and treatment of allergic disease. J Inflamm (Lond) 2025; 22:17. [PMID: 40355878 PMCID: PMC12070619 DOI: 10.1186/s12950-025-00438-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2024] [Accepted: 02/15/2025] [Indexed: 05/15/2025] Open
Abstract
Allergic diseases significantly impact the quality of life of people around the world. Cytokines play a crucial role in regulating the immune system. Due to their importance in pro-inflammatory mechanisms, cytokines are used to understand pathogenesis and serve as biomarkers in many diseases. One such cytokine is interleukin-33, a member of the IL-1 family, including IL- 1α, IL-1β, and IL-18. The IL-33 receptor is a heterodimer of IL-1 receptor-like 1 and IL-1 receptor accessory protein. IL-33 plays a critical role in regulating innate and adaptive immune responses. The primary targets of IL-33 in vivo are tissue-resident immune cells, including mast cells, group 2 innate lymphoid cells, regulatory T cells, T helper 2 cells, eosinophils, basophils, dendritic cells, Th1 cells, CD8 + T cells, NK cells, iNKT cells, B cells, neutrophils, and macrophages. However, IL-33 appears to act as an alarm signal that is promptly released by producing cells under cellular damage or stress conditions. IL-33 regulates signaling and various biological functions, including induction of pro-inflammatory cytokines, regulation of cell proliferation, and involvement in tissue remodeling. IL-33 is fundamental in immune-related diseases and plays a critical role in the control of inflammation. Recently, IL-33 has been shown to significantly impact allergic diseases, primarily by inducing Th2 immune responses. IL-33 is a key regulator of mast cell function and a promising therapeutic target for treating allergic diseases. This review provides an overview of the current understanding of the role of IL-33 in allergy pathogenesis and potential clinical approaches.
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Affiliation(s)
| | - Asma'a H Mohamed
- Department of Optometry Techniques, Technical College Al-Mussaib, Al-Furat Al-Awsat Technical University, Najaf, Iraq.
| | - Azfar Jamal
- Department of Biology, College of Science, Al-Zulfi, Majmaah University, Al-Majmaah 11952,, Saudi Arabia
- Health and Basic Science Research Centre, Majmaah University, Al-Majmaah 11952 , Saudi Arabia
| | - Mohammad Azhar Kamal
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Waleed Al Abdulmonem
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia
| | - Bashar Abdullah Saeed
- Department of Medical Laboratory Technics, Al-Noor University College, Nineveh, Iraq
| | - Nasrin Mansuri
- Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Fuzail Ahmad
- Respiratory Care Department, College of Applied Sciences, Almaarefa University, Diriya, Riyadh 13713 , Saudi Arabia
| | - Mustafa Mudhafar
- Department of Medical Physics, Faculty of Medical Applied Sciences, University of Kerbala, 56001, Karbala, Iraq
- Department of Anesthesia Techniques and Intensive Care, Al-Taff university college, 56001, Kerbala, Iraq
| | - Alaa Shafie
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, P.O.Box 11099, Taif, 21944, Saudi Arabia
| | - Haroonrashid M Hattiwale
- Department of Basic Medical Sciences, College of Medicine, Majmaah University, Al-Majmaah 11952 , Saudi Arabia.
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Zemelka-Wiacek M, Kosowska A, Pfaar O, Agache I, Kujawa K, Jutel M. Comparative Evaluation of an Allergen Exposure Chamber and Nasal Allergen Challenge Versus In-Field Symptom Assessment in Patients With Allergic Rhinitis Triggered by Timothy Grass Pollen. Allergy 2025; 80:1286-1297. [PMID: 40059339 DOI: 10.1111/all.16518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 01/09/2025] [Accepted: 01/25/2025] [Indexed: 05/27/2025]
Abstract
BACKGROUND An allergen exposure chamber (AEC) is a specialized medical facility designed to expose individuals to allergens at precise and consistent concentrations within a controlled environment. This study aimed to correlate the assessment of clinical endpoints in patients with allergic rhinitis sensitized to timothy grass pollen (Phleum pratense) by comparing three different methods: AEC, nasal allergen challenge (NAC), and symptoms during natural exposure during the grass pollen season. METHODS Fifteen allergic subjects and twelve healthy controls were evaluated in the ALLEC AEC; allergic symptoms were measured by subjective and objective methods, including total nasal symptom score (TNSS), acoustic rhinometry (AcR), peak nasal inspiratory flow (PNIF), and nasal discharge amount. For the in-field evaluation, a combined symptom medication score (EAACI-CSMS), as proposed by the European Academy of Allergy and Clinical Immunology (EAACI), was used, which was assessed for 14 days during the peak of the pollen season. The AcR, PNIF, and TNSS were used for the NAC assessment. RESULTS Both in the AEC and NAC, all allergic individuals developed symptoms at the optimal pollen/allergen concentration across all the measured endpoints. Using Spearman's rank correlation coefficient (p < 0.05), the analysis revealed significant correlations between symptoms assessed in AEC at 120 min of the challenge, as well as in NAC after 15 min with the EAACI-CSMS in-field. The correlations between in-field assessment and AEC were stronger than those with NAC, which showed weaker or no significant correlations. This indicates that the AEC challenge correlates better with in-field assessments than NAC. CONCLUSION Clinical endpoints assessed to allergen exposure in the AEC and NAC significantly correspond to the efficacy analysis in-field (EAACI-CSMS during the peak of pollen exposure). The effect of NAC was not significant for all outcomes measured. Both methods might be considered to be an alternative to traditional assessment during natural exposure.
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Affiliation(s)
- Magdalena Zemelka-Wiacek
- Department of Clinical Immunology, Faculty of Medicine of Wroclaw Medical University, Wroclaw, Poland
| | - Anna Kosowska
- Department of Clinical Immunology, Faculty of Medicine of Wroclaw Medical University, Wroclaw, Poland
- ALL-MED Medical Research Institute, Wroclaw, Poland
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Krzysztof Kujawa
- Statistical Analysis Centre, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Jutel
- Department of Clinical Immunology, Faculty of Medicine of Wroclaw Medical University, Wroclaw, Poland
- ALL-MED Medical Research Institute, Wroclaw, Poland
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Klimek L, Brough HA, Arasi S, Toppila-Salmi S, Bergmann C, Jutel M, Bousquet J, Hox V, Gevaert P, Tomazic PV, Rondón Segovia C, Cingi C, Cuevas M, Gröger M, Huber P, Reitsma S, Rudenko M, Maza-Solano J, Gane S, Karavelia A, van Gerven L, Schiappoli M, Bozkurt B, Becker S, Chaker A, Wollenberg B, Mösges R, Huppertz T, Hagemann J, Palomares O, Bärhold F, Pfaar O, Del Giacco S, Bonadonna P, Moreira A, Agache I, Akdis CA, Fokkens W, Walusiak-Skorupa J, de Las Vecillas L, Alvaro Lozano M, Giovannini M, Untersmayr E, Feleszko W, Cianferoni A, Sahiner UM, Eguiluz-Gracia I, Shamji M, Torres Jaén MJ. Otitis Media With Effusion (OME) and Eustachian Tube Dysfunction: The Role of Allergy and Immunity-An EAACI Position Paper. Allergy 2025. [PMID: 40242889 DOI: 10.1111/all.16554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 03/13/2025] [Accepted: 03/18/2025] [Indexed: 04/18/2025]
Abstract
IgE-mediated allergies play a significant role in respiratory diseases. Given the similar mucosal epithelium of the upper and lower respiratory tracts and their shared (patho)physiological immune responses, the "unified airways" concept views these tracts as a single system. Recently, this model has been extended to include the middle ear, with studies confirming that the Eustachian tube and middle ear are both anatomically and functionally part of the upper airways. However, the relationship between allergies and middle ear disorders remains controversial, with conflicting findings regarding pathogenesis and treatment. The increasing prevalence of allergies highlights the importance of further research. In Germany, the current sensitization rate to aeroallergens is 33.6%, with similar trends across Europe, where rates commonly range up to 30%. This widespread increase underscores the urgent need for a deeper understanding of the correlation between allergies and middle ear disorders across diverse European populations. Ineffective pharmacotherapy or possibly harmful medication for acute and chronic OME, such as systemic steroids, is most likely used globally in an uninformed way, due to a lack of evidence on the connection between allergic inflammation and eustachian tube dysfunction. Further research is essential to clarify the mechanisms linking IgE-mediated allergies to middle ear pathologies and to develop effective treatment strategies. Addressing these knowledge gaps is critical for improving patient outcomes and managing the rising burden of allergic diseases.
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Affiliation(s)
- L Klimek
- Center for Allergy and Rhinology, Wiesbaden, Germany
| | - H A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital, London, UK
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - S Arasi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, Rome, Italy
| | - S Toppila-Salmi
- Department of Otorhinolaryngology, University of Eastern Finland, Joensuu and Kuopio, Finland and Wellbeing Services County of Pohjois-Savo, Kuopio, Finland
- Department of Allergology, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - C Bergmann
- Department of Otorhinolaryngology, RKM740 Interdisciplinary Clinics, Düsseldorf, Germany
| | - M Jutel
- Department of Clinical Immunology, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
- ALL-MED Medical Research Institute, Wrocław, Poland
| | - J Bousquet
- Department of Dermatology and Allergy, Charité, Universitätsmedizin Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany
- University Hospital Montpellier, France and MACVIA-France, Montpellier, France
| | - V Hox
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - P Gevaert
- Department of Otorhinolaryngology, Upper Airways Research Laboratory, Ghent University, Ghent, Belgium
| | - P V Tomazic
- Department of General Otorhinolaryngology, H&N Surgery, Medical University of Graz, Graz, Austria
| | - C Rondón Segovia
- Allergy Unit, Hospital Regional Universitario de Malága, Malaga, Spain
- Allergy Group, Biomedical Research Institute of Malaga (IBIMA)-BIONAND Platform, RICORS Inflammatory Diseases, Malaga, Spain
| | - C Cingi
- Department of Otorhinolaryngology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - M Cuevas
- Department of Otorhinolaryngology Head and Neck Surgery, Technische Universität Dresden, Faculty of Medicine (And University Hospital) Carl Gustav Carus, Dresden, Germany
| | - M Gröger
- Department of Otorhinolaryngology, Grosshadern Medical Center of the University of Munich, Munich, Germany
| | - P Huber
- Department of Otorhinolaryngology, Grosshadern Medical Center of the University of Munich, Munich, Germany
| | - S Reitsma
- Otolaryngology-HNS, University of Amsterdam, Amsterdam, the Netherlands
| | - M Rudenko
- The London Allergy and Immunology Centre, London, UK
| | - J Maza-Solano
- Rhinology Unit, Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital, Sevilla, Spain
| | - S Gane
- The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Studies, University of London, London, UK
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - A Karavelia
- ENT Department, General Hopsital of Nafplio, Nafplio, Greece
| | - L van Gerven
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Otorhinolaryngology, KU Leuven, Leuven, Belgium
| | - M Schiappoli
- Allergy Unit and Asthma Center, Integrated University Hospital of Verona, Verona, Italy
| | - B Bozkurt
- Department of Ophthalmology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - S Becker
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Tübingen, Germany
| | - A Chaker
- Technical University of Munich, TUM School of Medicine and Health, TUM University Hospital, Munich, Germany
| | - B Wollenberg
- Technical University of Munich, TUM School of Medicine and Health, TUM University Hospital, Munich, Germany
| | - R Mösges
- IMSB, Medical Faculty, University Cologne, Cologne, Germany
| | - T Huppertz
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Mainz, Germany
| | - J Hagemann
- Center for Allergy and Rhinology, Wiesbaden, Germany
| | - O Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University, Madrid, Spain
| | - F Bärhold
- Center for Allergy and Rhinology, Wiesbaden, Germany
| | - O Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - S Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - P Bonadonna
- Allergy Unit and Asthma Center, Integrated University Hospital of Verona, Verona, Italy
| | - A Moreira
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, and Laboratório de Investigação Integrativa e Translacional Em Saúde Populacional (ITR), Porto, Portugal
- Immunoallergology Service, Centro Hospitalar Universitário São João, Porto, Portugal
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - I Agache
- Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania
| | - C A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - W Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - J Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - L de Las Vecillas
- Department of Allergy, La Paz University Hospital, Madrid, Spain
- IdiPAZ, Madrid, Spain
| | - M Alvaro Lozano
- Pediatric Allergology and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - M Giovannini
- Department of Health Sciences, University of Florence, Florence, Italy
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - E Untersmayr
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - W Feleszko
- Department of Pediatric Allergy and Pneumonology, Medical University of Warsaw, Warsaw, Poland
| | - A Cianferoni
- The Children's Hospital of Philadelphia, University of Pennsylvania, Pediatrics Allergy and Immunology Division, Philadelphia, USA
| | - U M Sahiner
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - I Eguiluz-Gracia
- Allergy Unit, Hospital Regional Universitario de Malága, Malaga, Spain
- Allergy Group, Biomedical Research Institute of Malaga (IBIMA)-BIONAND Platform, RICORS Inflammatory Diseases, Malaga, Spain
| | - M Shamji
- National Heart and Lung Institute, Imperial College London, London, United Kingdom, NIHR Imperial Biomedical Research Centre, London, UK
| | - M J Torres Jaén
- Allergy Unit, Hospital Regional Universitario de Malága, Malaga, Spain
- Allergy Group, Biomedical Research Institute of Malaga (IBIMA)-BIONAND Platform, RICORS Inflammatory Diseases, Malaga, Spain
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Piotin A, Poirot A, Wurm M, Lutz C, Khayath N, de Blay F, Metz-Favre C. A case report of carboxymethylcellulose allergy: exploring tolerance based on administration route. Immunopharmacol Immunotoxicol 2025; 47:234-238. [PMID: 39980337 DOI: 10.1080/08923973.2025.2469214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 02/13/2025] [Indexed: 02/22/2025]
Abstract
BACKGROUND The management of hypersensitivity to excipients and food additives remains a significant issue for healthcare professionals and patients. Avoiding carboxymethylcellulose (CMC) can be a considerable challenge for patients allergic to CMC due to its widespread use. We assessed the tolerance of CMC through different route of administration in a patient with a confirmed CMC allergy. We conducted a literature review to analyze all relevant cases of patients allergic to CMC, focusing on tolerance through non-injectable routes. METHODS Skin tests, basophil activation tests, oral and nasal provocation tests with CMC were performed to evaluate patient's hypersensitivity. RESULTS Skin tests and basophil activation tests with CMC were positive and confirmed IgE-mediated hypersensitivity to CMC in the patient. While the patient tolerated oral administration of CMC and CMC-containing eye drops, nasal provocation test resulted in asthma exacerbation and rhinitis. CONCLUSION Tolerance of CMC appears to be route-dependent. Provocation tests with CMC through various routes of administration are essential for assessing tolerance and providing appropriate recommendations for patients with CMC allergy.
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Affiliation(s)
- Anays Piotin
- Division of Asthma and Allergy, Chest Diseases Department, Strasbourg University Hospital, Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, Strasbourg, France
| | - Anh Poirot
- Division of Asthma and Allergy, Chest Diseases Department, Strasbourg University Hospital, Strasbourg, France
| | - Maxence Wurm
- Division of Asthma and Allergy, Chest Diseases Department, Strasbourg University Hospital, Strasbourg, France
| | - Celine Lutz
- Division of Asthma and Allergy, Chest Diseases Department, Strasbourg University Hospital, Strasbourg, France
| | - Naji Khayath
- Division of Asthma and Allergy, Chest Diseases Department, Strasbourg University Hospital, Strasbourg, France
- EA 3070 Federation of Translational Medicine, FHU Homicare, University of Strasbourg, Strasbourg, France
| | - Frédéric de Blay
- Division of Asthma and Allergy, Chest Diseases Department, Strasbourg University Hospital, Strasbourg, France
- EA 3070 Federation of Translational Medicine, FHU Homicare, University of Strasbourg, Strasbourg, France
| | - Carine Metz-Favre
- Division of Asthma and Allergy, Chest Diseases Department, Strasbourg University Hospital, Strasbourg, France
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7
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Sanchez‐Torralvo D, Testera‐Montes A, Bentabol‐Ramos G, Eguiluz‐Gracia I, Mösges R, Torres MJ. Algorithms in Allergy: Organ-Specific Allergen Challenges for the Phenotyping of Chronic Respiratory Diseases. Allergy 2025; 80:1187-1189. [PMID: 39775532 PMCID: PMC11969310 DOI: 10.1111/all.16470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 12/23/2024] [Accepted: 12/30/2024] [Indexed: 01/11/2025]
Affiliation(s)
| | - Almudena Testera‐Montes
- Allergy Unit. Hospital Regional Universitario de MalagaMalagaSpain
- Allergy GroupIBIMA‐Plataforma BIONAND and RICORS Enfermedades InflamatoriasMalagaSpain
| | - Guillermo Bentabol‐Ramos
- Allergy GroupIBIMA‐Plataforma BIONAND and RICORS Enfermedades InflamatoriasMalagaSpain
- Pulmonology UnitHospital Regional Universitario de MalagaMalagaSpain
| | - Ibon Eguiluz‐Gracia
- Allergy Unit. Hospital Regional Universitario de MalagaMalagaSpain
- Allergy GroupIBIMA‐Plataforma BIONAND and RICORS Enfermedades InflamatoriasMalagaSpain
| | - Ralph Mösges
- ClinCompetence Cologne GmbHCologneGermany
- Institute of Medical Statistics and Computational Biology, Faculty of MedicineUniversity of CologneCologneNorth Rhine‐WestphaliaGermany
| | - Maria J. Torres
- Allergy Unit. Hospital Regional Universitario de MalagaMalagaSpain
- Allergy GroupIBIMA‐Plataforma BIONAND and RICORS Enfermedades InflamatoriasMalagaSpain
- Universidad de MalagaMalagaSpain
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8
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Mesa-Del-Castillo M, Candela FJC, Martínez-Cañavate A, Rivas-Juesas C, Cabrera HL, Tortajada-Girbés M, Moreno JML, Folqué MDM, Morales-Tirado A, Tabar AI. A Delphi consensus on diagnosis, management, and treatment with allergen immunotherapy of polysensitized children in Spain: CAPP study, Part 1. Allergol Immunopathol (Madr) 2025; 53:124-140. [PMID: 40088031 DOI: 10.15586/aei.v53i2.1220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 11/15/2024] [Indexed: 03/17/2025]
Abstract
BACKGROUND The study aimed to evaluate the level of agreement between specialists in pediatric allergology regarding the diagnosis and indications for pollen allergen immunotherapy (AIT) of polysensitized children in Spain. MATERIALS AND METHODS A Delphi study was performed using an online survey designed by a committee of pediatric AIT experts: 46 and 44 panelists participated in rounds 1 and 2, respectively. In round 1, 204 statements on 8 dimensions were evaluated (Diagnosis; Therapeutic management; Pollens - Part I; Mites; Moulds; Animals; Hymenoptera venom; and Mixtures - Part II). A total of 148 statements were finally accepted after round 2. Panel members rated their level of agreement with assessments on a 9-point Likert scale based on acceptance by ≥ 66.7% of them. RESULTS According to the results, the polysensitization determination in allergic patients is confirmed by clinical history, skin prick test, total and specific IgE, and molecular diagnostics. Clinical assessments are recommended for the AIT effectiveness evaluation. Follow-ups should be performed 6 months after AIT initiation. According to experts, pollens are the most representative allergens in allergic rhinitis but AIT is more effective in bronchial asthma treatment. The IgE levels are positively related to the intensity of the symptomatology and the efficacy of Grass AIT. In pollen mixtures, a maximum mixture of three AIT allergens is established between Grass, Olive, and Cupressaceae. Mixing pollen from Platanus acerifolia and Parietaria is not recommended. CONCLUSIONS This study provides, where evidence is lacking, current expert-based opinions on clinical decision-making for managing pollen AIT in polysensitized children.
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Affiliation(s)
| | | | - Ana Martínez-Cañavate
- Unidad de Alergia Infantil, Hospital Materno Infantil Virgen de las Nieves de Granada, Spain
| | - Cristina Rivas-Juesas
- Unidad de Neumología y Alergología Pediátrica, Servicio de Pediatría, Hospital de Sagunto, Valencia, Spain
| | | | - Miguel Tortajada-Girbés
- Sección de Neumología y Alergología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Manuel Lucas Moreno
- Sección Alergia Pediátrica, Servicio de Pediatría, Hospital Clínico Universitario Virgen Arrixaca. Murcia, Spain
| | - Maria Del Mar Folqué
- Servicio de Alergología Pediátrica e Inmunología Clínica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ana Morales-Tirado
- Servicio de Pediatría, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain
| | - Ana I Tabar
- Servicio Alergología. Hospital Universitario de Navarra (HUN), Pamplona, Spain
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9
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Beutner C, Traidl S, Wagenmann M, Hollstein MM, Beutner D, Schön MP, Buhl T. Dupilumab Improves Clinical Symptoms and Biomarkers in Comorbid Seasonal Timothy Grass Pollen Allergic Rhinitis in Patients With CRSwNP. Clin Exp Allergy 2025; 55:196-198. [PMID: 39326865 DOI: 10.1111/cea.14572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 09/13/2024] [Accepted: 09/16/2024] [Indexed: 09/28/2024]
Affiliation(s)
- Caroline Beutner
- Department of Dermatology, Venereology and Allergology, University Medical Center, Goettingen, Germany
| | - Stephan Traidl
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Martin Wagenmann
- Department of Otorhinolaryngology, Düsseldorf University Hospital, Düsseldorf, Germany
| | | | - Dirk Beutner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Göttingen, Germany
| | - Michael Peter Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center, Goettingen, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center, Goettingen, Germany
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10
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Krzych-Fałta E, Namysłowski A, Białek S, Czerwińska ME, Furmańczyk K, Tylewicz A, Sybilski A, Samoliński B, Wojas O. Nasal food challenge with hen's egg white allergen. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2025; 21:3. [PMID: 39800752 PMCID: PMC11727154 DOI: 10.1186/s13223-024-00945-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 12/12/2024] [Indexed: 01/16/2025]
Abstract
BACKGROUND Nasal allergen provocation tests are an important part of the diagnostics of allergic diseases triggered by environmental factors. Recently, increased attention has been paid to the potential use of this method in the diagnosis of food allergy. The objective of the study was to evaluate the usefulness of the nasal allergen provocation test in a group of subjects allergic to hen's egg white allergens. METHODS The material consisted of a group of 57 subjects (32 subjects with hen's egg white allergy and 25 healthy controls). The method consisted in a nasal allergen provocation test carried out with the use of hen's egg white allergen and assessed using the visual analog scale and optical rhinometry as well as by determination of sIgE and tryptase levels in nasal lavage fluid. RESULTS Subjective nasal symptoms and objective evaluations following the application of 100 µg of hen's egg white allergen revealed a moderately positive nasal mucosal response in optical rhinometry tests (ΔE = 0.34 OD). CONCLUSIONS Nasal food challenge with hen's egg white allergen is a good diagnostic alternative in the group of food allergy patients. Due to the insufficient number of studies carried out so far, further attempts at standardization of the method are required.
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Affiliation(s)
- Edyta Krzych-Fałta
- Department of Basic Nursing, Medical University of Warsaw, Zwirki I Wigury 61, 02-097, Warsaw, Poland.
| | - Andrzej Namysłowski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Zwirki I Wigury 61, 02-097, Warsaw, Poland
| | - Sławomir Białek
- Department of Biochemistry and Pharmacogenomics, Medical University of Warsaw, Zwirki I Wigury 61, 02-097, Warsaw, Poland
| | - Monika E Czerwińska
- Department of Biochemistry and Pharmacogenomics, Medical University of Warsaw, Zwirki I Wigury 61, 02-097, Warsaw, Poland
| | - Konrad Furmańczyk
- Institute of Information Technology, Warsaw University of Life Sciences, Nowoursynowska 166 str, 02-787, Warsaw, Poland
| | - Aleksandra Tylewicz
- Second Department of Pediatrics, Centre of Postgraduate Medical Education, Wołoska 137 Str, 02-507, Warsaw, Poland
| | - Adam Sybilski
- Second Department of Pediatrics, Centre of Postgraduate Medical Education, Wołoska 137 Str, 02-507, Warsaw, Poland
| | - Bolesław Samoliński
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Zwirki I Wigury 61, 02-097, Warsaw, Poland
| | - Oksana Wojas
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Zwirki I Wigury 61, 02-097, Warsaw, Poland
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11
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Solé D, Kuschnir FC, Pastorino AC, Constantino CF, Galvão C, Chong E Silva DC, Baptistella E, Goudouris ES, Sakano E, Ejzenbaum F, Matsumoto FY, Mizoguchi FM, Aarestrup FM, Wandalsen GF, Chong Neto HJ, Brito de Oliveira JV, Lubianca Neto JF, Rizzo MCV, Silva Chavarria MLF, Urrutia-Pereira M, Filho NAR, de Paula Motta Rubini N, Mion O, Piltcher OB, Ramos RT, Francesco RD, Roithmann R, Anselmo-Lima WT, Romano FR, de Mello Júnior JF. V Brazilian Consensus on Rhinitis - 2024. Braz J Otorhinolaryngol 2025; 91:101500. [PMID: 39388827 PMCID: PMC11497470 DOI: 10.1016/j.bjorl.2024.101500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 08/17/2024] [Indexed: 10/12/2024] Open
Abstract
Since we published the "IV Brazilian Consensus on Rhinitis", in2017, several advances have been achieved and have enabled a further understanding of the different aspects of "Rhinitis". This new guideline, developed jointly by ASBAI, SBP and SBORL, represents a relevant milestone in the updated and integrated management of the different forms of the disease, and it aims to unify evidence-based approaches to improve the diagnosis and treatment of this common and often underestimated condition. The document covers a wide range of topics, including clear definitions of the different phenotypes and endotypes of rhinitis, risk factors, updated diagnostic criteria, and recommended methods for clinical and laboratory investigation. We stress the importance of detailed clinical history and objective assessment, as well as tools for control and assessing severity tools an accurate diagnostic approach to the disease. Regarding treatment, it emphasizes the treatment customization, considering the severity of symptoms, the presence of comorbidities and the impact on the patient's quality of life. We discuss different drug treatment, in addition to non-pharmacological measures, such as environmental control and specific immunotherapy; and the possible role of immunobiological agents. Furthermore, the consensus addresses issues related to patient education, prevention and management of special situations, such as rhinitis in children, in pregnant women and in the elderly. In short, the "V Brazilian Consensus on Rhinitis" represents a comprehensive and updated guide for healthcare professionals involved in the diagnosis and management of rhinitis, aiming to improve patients' quality of life through an integrated and evidence-based approach.
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Affiliation(s)
- Dirceu Solé
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Fábio Chigres Kuschnir
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Antônio Carlos Pastorino
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade de São Paulo, São Paulo, SP, Brazil
| | - Clóvis F Constantino
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade de Santo Amaro, São Paulo, SP, Brazil
| | - Clóvis Galvão
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade de São Paulo, São Paulo, SP, Brazil
| | - Débora Carla Chong E Silva
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Paraná́, Curitiba, PR, Brazil
| | - Eduardo Baptistella
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil
| | - Ekaterini Simões Goudouris
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Eulália Sakano
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil; Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Fábio Ejzenbaum
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Fausto Yoshio Matsumoto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Flavio Massao Mizoguchi
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil
| | - Fernando Monteiro Aarestrup
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Gustavo F Wandalsen
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Herberto José Chong Neto
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Paraná́, Curitiba, PR, Brazil
| | | | - José Faibes Lubianca Neto
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | | | | | - Marilyn Urrutia-Pereira
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Pampa, Uruguaiana, RS, Brazil
| | - Nelson Augusto Rosário Filho
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Paraná́, Curitiba, PR, Brazil
| | - Norma de Paula Motta Rubini
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Olavo Mion
- Universidade de São Paulo, São Paulo, SP, Brazil; Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil
| | - Otávio Bejzman Piltcher
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazi
| | - Regina Terse Ramos
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Renata Di Francesco
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renato Roithmann
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil; Universidade Luterana do Brasil, Canos, RS, Brazil
| | - Wilma Terezinha Anselmo-Lima
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Fabrizio Ricci Romano
- Universidade de São Paulo, São Paulo, SP, Brazil; Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil
| | - João Ferreira de Mello Júnior
- Universidade de São Paulo, São Paulo, SP, Brazil; Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil.
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12
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Zemelka-Wiacek M. A Modern Approach to Clinical Outcome Assessment in Allergy Management: Advantages of Allergen Exposure Chambers. J Clin Med 2024; 13:7268. [PMID: 39685727 DOI: 10.3390/jcm13237268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Revised: 11/27/2024] [Accepted: 11/28/2024] [Indexed: 12/18/2024] Open
Abstract
Allergic diseases triggered by airborne allergens such as allergic rhinitis and conjunctivitis are increasingly prevalent, posing significant challenges for both patients and healthcare systems. Assessing the efficacy of allergen immunotherapy and other anti-allergic treatments requires precise and reproducible methods. Allergen exposure chambers (AECs) have emerged as advanced tools for evaluating clinical outcomes, offering controlled conditions that address many limitations of traditional field-based studies. This review explores the advantages of AECs in allergy management, emphasizing their role in providing standardized allergen exposure for both clinical research and routine assessments. AECs deliver consistent and reproducible data comparable to the nasal allergen challenge and natural allergen exposure, making them a valuable addition to the diagnosis and treatment effectiveness of allergic diseases. Although they are well suited to early-stage clinical trials, further standardization and validation are needed to gain broader acceptance in pivotal phase III studies. Future research should focus on refining AEC protocols and integrating them into regulatory frameworks, ensuring their role in the advancement of therapeutic approaches for allergic diseases.
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Affiliation(s)
- Magdalena Zemelka-Wiacek
- Department of Clinical Immunology, Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland
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13
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Matsumoto FY, Gonçalves TRT, Solé D, Wandalsen GF. Nasal allergen challenge with Blomia tropicalis in children and adolescents. Allergol Immunopathol (Madr) 2024; 52:72-75. [PMID: 39515798 DOI: 10.15586/aei.v52i6.1193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 09/28/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Local allergic rhinitis (LAR) is a well-defined phenotype in adults, but still there is little data available on children. This scarcity of data can be partly attributed to the lack of standardized protocols for Nasal Allergen Challenges (NAC) in this demographic. METHODS 20 controls (control group) and 24 patients (rhinitis group) with allergic rhinitis diagnosis sensitized to Blomia tropicalis (Bt) underwent the NAC with Bt. The acoustic rhinometry was performed after instillation of increasing concentrations of Bt (5,000 BU/mL). RESULTS The median reduction in the volume of the nasal cavity in its first five centimeters (V5) by the conclusion of the NAC in the rhinitis group was markedly higher than that observed in the control group, at -22.9% (range: -21.1% to -26.2%) compared to -7.7% (ranging: -4.8% to +12.8%). CONCLUSIONS Our research demonstrates the efficacy and safety of the NAC protocol utilizing Bt in distinguishing allergic from non-allergic children.
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Affiliation(s)
- Fausto Yoshio Matsumoto
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil;
| | - Tessa Rachel Tranquilini Gonçalves
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Dirceu Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gustavo Falbo Wandalsen
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
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14
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Tamasauskiene L, Gradauskiene B. Profile of immune response during nasal challenge with dermatophagoides pteronyssinus in subjects with allergic airway diseases. J Inflamm (Lond) 2024; 21:41. [PMID: 39482718 PMCID: PMC11526524 DOI: 10.1186/s12950-024-00415-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 10/20/2024] [Indexed: 11/03/2024] Open
Abstract
BACKGROUND T lymphocyte helper (Th) 2 plays the main role in pathogenesis of allergic airway diseases (AAD). Recent studies showed that interleukin (IL) 33, Th17 and Th22 also may be involved in allergic inflammation. The aim is to evaluate cytokine level before and after nasal challenge with Dermatophagoides pteronyssinus in patients with AAD. METHODS Patients with persistent allergic rhinitis (AR) with or without allergic asthma (AA) allergic to house dust mite and healthy individuals underwent nasal challenge with Dermatophagoides pteronyssinus. Measurements of IL-13, IL-17, IL-22 and IL-33 in serum and nasal lavage were performed before, 2 and 22 h after nasal challenge by ELISA. RESULTS . Ten patients with AR only, 6 patients with AR and AA and 7 healthy individuals were involved in the study. Serum IL-22 level significantly increased in patients with AR and AA and nasal lavage IL-22 tended to increase in patients with AAD after nasal challenge. Serum IL-13 level tended to increase in patients with AR and AA. IL-13 level in nasal lavage fluid decreased at 22 h after nasal challenge in patients with AR only. IL-17 level in serum and nasal lavage decreased in patients with AAD. Serum IL-33 tended to increase after nasal challenge whereas IL-33 in nasal lavage significantly decreased. CONCLUSION Cytokine profile differs between local and systemic compartments and between patients with allergic rhinitis only and patients with allergic rhinitis and asthma after nasal challenge.
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Affiliation(s)
- Laura Tamasauskiene
- Department of Immunology and Allergology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
- Laboratory of Immunology, Department of Immunology and Allergology, Lithuanian University of Health Sciences, Lithuanian University of Health Sciences, Eiveniu str. 2, Kaunas, Lithuania.
| | - Brigita Gradauskiene
- Department of Immunology and Allergology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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15
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Sánchez J, Álvarez L, Bedoya J, Peñaranda D, Vanegas G, Celis C, Morales E, García E, Peñaranda A. Role of specific immunoglobulin-E in chronic rhinosinusitis: Its clinical relevance according to nasal challenge test. World Allergy Organ J 2024; 17:100953. [PMID: 39435153 PMCID: PMC11491713 DOI: 10.1016/j.waojou.2024.100953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/19/2024] [Accepted: 07/31/2024] [Indexed: 10/23/2024] Open
Abstract
Background Guidelines for chronic rhinosinusitis (CRS) propose total IgE and eosinophils as important biomarkers to identify type-2 inflammation. Despite the fact that specific IgE (sIgE) have been identified as a clinical predictor in some type-2 diseases for different clinical outcomes, its role in CRS has yet to be explored in detail. Objetive To describe systemic and local sIgE in CRS and explore its possible association with clinical outcomes using nasal challenge tests (NCT). Methods In CRS patients, we measure total IgE, serum sIgE (SsIgE) and nasosinusal sIgE (NsIgE) against 9 allergenic sources; Der p, Der f, Blo t, Can f, Fel d, Per a, grasses, Staphylococcus enterotoxin A, and B. NCT was done using the allergen with the higher sIgE prevalence (Der p). Results A total of 174 patients were included. Prevalence of SsIgE was 52.8% and NsIgE 46.5%; Der p was the principal allergen for SsIgE and NsIgE. The presence of nasal polyps, asthma comorbidity, NSAID hypersensitivity, and hyposmia, were significantly associated with the presence of SsIgE and NsIgE but not with total IgE. NCT-Der p was performed in 73 CRS patients, being positive in 33 (45.2%). SsIgE have the best diagnostic accuracy (79.4%) to predict NCT results (NsIgE 67.5% total IgE 52%). Conclusion Specific IgE is a better biomarker in CRS than total IgE. Patients with clinically relevant SsIgE have a pheno-endotype associated with different clinical outcomes. Considering the clinical relevance of SsIgE demonstrated by NCT, interventions like allergen immunotherapy in CRS must be study.
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Affiliation(s)
- Jorge Sánchez
- Group of Clinical and Experimental Allergy, Hospital “Alma Mater de Antioquia”, University of Antioquia, Medellín, Colombia
| | - Leidy Álvarez
- Group of Clinical and Experimental Allergy, Hospital “Alma Mater de Antioquia”, University of Antioquia, Medellín, Colombia
- Group "ciencias de la vida y de la salud escuela de graduados", CES university, Medellín, Colombia
| | - Juan Bedoya
- Otorhinolaryngology Service, University of Antioquia, Medellín, Colombia
| | - Daniel Peñaranda
- “Fundación Universitaria Ciencias de la Salud”, Otorhinolaryngology Service, Bogotá, Colombia
| | - Gustavo Vanegas
- Otorhinolaryngology Service, University of Antioquia, Medellín, Colombia
| | - Carlos Celis
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Elizabeth García
- Otorhinolaryngology Medical Surgical Unit (UNIMEQ-ORL), Bogotá, Colombia
| | - Augusto Peñaranda
- Otorhinolaryngology Medical Surgical Unit (UNIMEQ-ORL), Bogotá, Colombia
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16
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Hurraß J, Heinzow B, Walser-Reichenbach S, Aurbach U, Becker S, Bellmann R, Bergmann KC, Cornely OA, Engelhart S, Fischer G, Gabrio T, Herr CEW, Joest M, Karagiannidis C, Klimek L, Köberle M, Kolk A, Lichtnecker H, Lob-Corzilius T, Mülleneisen N, Nowak D, Rabe U, Raulf M, Steinmann J, Steiß JO, Stemler J, Umpfenbach U, Valtanen K, Werchan B, Willinger B, Wiesmüller GA. [Medical clinical diagnostics for indoor mould exposure - Update 2023 (AWMF Register No. 161/001)]. Pneumologie 2024; 78:693-784. [PMID: 39424320 DOI: 10.1055/a-2194-6914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2024]
Abstract
This article is an abridged version of the updated AWMF mould guideline "Medical clinical diagnostics in case of indoor mould exposure - Update 2023", presented in July 2023 by the German Society of Hygiene, Environmental Medicine and Preventive Medicine (Gesellschaft für Hygiene, Umweltmedizin und Präventivmedizin, GHUP), in collaboration with German and Austrian scientific medical societies, and experts. Indoor mould growth is a potential health risk, even if a quantitative and/or causal relationship between the occurrence of individual mould species and health problems has yet to be established. There is no evidence for a causal relationship between moisture/mould damage and human diseases, mainly because of the ubiquitous presence of fungi and hitherto inadequate diagnostic methods. Sufficient evidence for an association between moisture/mould damage and the following health effects has been established for: allergic respiratory diseases, allergic rhinitis, allergic rhino-conjunctivitis, allergic bronchopulmonary aspergillosis (ABPA), other allergic bronchopulmonary mycosis (ABPM), aspergilloma, Aspergillus bronchitis, asthma (manifestation, progression, exacerbation), bronchitis (acute, chronic), community-acquired Aspergillus pneumonia, hypersensitivity pneumonitis (HP; extrinsic allergic alveolitis (EEA)), invasive Aspergillosis, mycoses, organic dust toxic syndrome (ODTS) [workplace exposure], promotion of respiratory infections, pulmonary aspergillosis (subacute, chronic), and rhinosinusitis (acute, chronically invasive, or granulomatous, allergic). In this context the sensitizing potential of moulds is obviously low compared to other environmental allergens. Recent studies show a comparatively low sensitization prevalence of 3-22,5 % in the general population across Europe. Limited or suspected evidence for an association exist with respect to atopic eczema (atopic dermatitis, neurodermatitis; manifestation), chronic obstructive pulmonary disease (COPD), mood disorders, mucous membrane irritation (MMI), odor effects, and sarcoidosis. (iv) Inadequate or insufficient evidence for an association exist for acute idiopathic pulmonary hemorrhage in infants, airborne transmitted mycotoxicosis, arthritis, autoimmune diseases, cancer, chronic fatigue syndrome (CFS), endocrinopathies, gastrointestinal effects, multiple chemical sensitivity (MCS), multiple sclerosis, neuropsychological effects, neurotoxic effects, renal effects, reproductive disorders, rheumatism, sick building syndrome (SBS), sudden infant death syndrome, teratogenicity, thyroid diseases, and urticaria.The risk of infection posed by moulds regularly occurring indoors is low for healthy persons; most species are in risk group 1 and a few in risk group 2 (Aspergillus fumigatus, A. flavus) of the German Biological Agents Act (Biostoffverordnung). Only moulds that are potentially able to form toxins can be triggers of toxic reactions. Whether or not toxin formation occurs in individual cases is determined by environmental and growth conditions, water activity, temperature and above all the growth substrates.In case of indoor moisture/mould damage, everyone can be affected by odor effects and/or mood disorders.However, this is not an acute health hazard. Predisposing factors for odor effects can include genetic and hormonal influences, imprinting, context and adaptation effects. Predisposing factors for mood disorders may include environmental concerns, anxiety, condition, and attribution, as well as various diseases. Risk groups to be protected particularly regarding infection risk are immunocompromised persons according to the classification of the German Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, KRINKO) at the Robert Koch-Institute (RKI), persons suffering from severe influenza, persons suffering from severe COVID-19, and persons with cystic fibrosis (mucoviscidosis); with regard to allergic risk, persons with cystic fibrosis (mucoviscidosis) and patients with bronchial asthma must be protected. The rational diagnostics include the medical history, physical examination, and conventional allergy diagnostics including provocation tests if necessary; sometimes cellular test systems are indicated. In the case of mould infections, the reader is referred to the specific guidelines. Regarding mycotoxins, there are currently no useful and validated test procedures for clinical diagnostics. From a preventive medical point of view, it is important that indoor mould infestation in relevant magnitudes cannot be tolerated for precautionary reasons.For evaluation of mould damage in the indoor environment and appropriate remedial procedures, the reader is referred to the mould guideline issued by the German Federal Environment Agency (Umweltbundesamt, UBA).
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Affiliation(s)
- Julia Hurraß
- Sachgebiet Hygiene in Gesundheitseinrichtungen, Abteilung Infektions- und Umwelthygiene, Gesundheitsamt der Stadt Köln
| | - Birger Heinzow
- Ehemals: Landesamt für soziale Dienste (LAsD) Schleswig-Holstein, Kiel
| | | | - Ute Aurbach
- Labor Dr. Wisplinghoff
- ZfMK - Zentrum für Umwelt, Hygiene und Mykologie, Köln
| | - Sven Becker
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Tübingen
| | - Romuald Bellmann
- Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck
| | | | - Oliver A Cornely
- Translational Research, CECAD Cluster of Excellence, Universität zu Köln
| | | | - Guido Fischer
- Landesgesundheitsamt Baden-Württemberg im Regierungspräsidium Stuttgart
| | - Thomas Gabrio
- Ehemals: Landesgesundheitsamt Baden-Württemberg im Regierungspräsidium Stuttgart
| | - Caroline E W Herr
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit München
- Ludwig-Maximilians-Universität München, apl. Prof. "Hygiene und Umweltmedizin"
| | - Marcus Joest
- Allergologisch-immunologisches Labor, Helios Lungen- und Allergiezentrum Bonn
| | - Christian Karagiannidis
- Fakultät für Gesundheit, Professur für Extrakorporale Lungenersatzverfahren, Universität Witten/Herdecke
- Lungenklinik Köln Merheim, Kliniken der Stadt Köln
| | | | - Martin Köberle
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München
| | - Annette Kolk
- Institut für Arbeitsschutz der DGUV (IFA), Bereich Biostoffe, Sankt Augustin
| | | | | | | | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Mitglied Deutsches Zentrum für Lungenforschung, Klinikum der Universität München
| | - Uta Rabe
- Zentrum für Allergologie und Asthma, Johanniter-Krankenhaus Treuenbrietzen
| | - Monika Raulf
- Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung, Institut der Ruhr-Universität Bochum (IPA)
| | - Jörg Steinmann
- Institut für Klinikhygiene, Medizinische Mikrobiologie und Klinische Infektiologie, Paracelsus Medizinische Privatuniversität Klinikum Nürnberg
| | - Jens-Oliver Steiß
- Zentrum für Kinderheilkunde und Jugendmedizin, Universitätsklinikum Gießen und Marburg GmbH, Gießen
- Schwerpunktpraxis Allergologie und Kinder-Pneumologie Fulda
| | - Jannik Stemler
- Translational Research, CECAD Cluster of Excellence, Universität zu Köln
| | - Ulli Umpfenbach
- Arzt für Kinderheilkunde und Jugendmedizin, Kinderpneumologie, Umweltmedizin, klassische Homöopathie, Asthmatrainer, Neurodermitistrainer, Viersen
| | | | | | - Birgit Willinger
- Klinisches Institut für Labormedizin, Klinische Abteilung für Klinische Mikrobiologie - MedUni Wien
| | - Gerhard A Wiesmüller
- Labor Dr. Wisplinghoff
- ZfMK - Zentrum für Umwelt, Hygiene und Mykologie, Köln
- Institut für Arbeits-, Sozial- und Umweltmedizin, Uniklinik RWTH Aachen
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17
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Cheng M, Dai Q, Liu Z, Wang Y, Zhou C. New progress in pediatric allergic rhinitis. Front Immunol 2024; 15:1452410. [PMID: 39351215 PMCID: PMC11439695 DOI: 10.3389/fimmu.2024.1452410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 08/29/2024] [Indexed: 10/04/2024] Open
Abstract
The prevalence of allergic rhinitis (AR) in children is steadily increasing, and its onset is closely associated with genetic factors, living environment, and exposure to allergens. In recent years, an increasing number of diagnostic methods have been employed to assist in diagnosing AR. In addition to pharmaceutical treatments, personalized approaches such as environmental control and allergen-specific immunotherapy are gradually gaining popularity. In this article, we reviewed recent research on the etiology, diagnostic classification, treatment methods, and health management of AR in children. These insights will benefit the implementation of personalized diagnosis and treatment for children with AR, promoting health management strategies that improve symptoms and quality of life.
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Affiliation(s)
- Miao Cheng
- Department of Ophthalmology and Otolaryngology, Jingmen Centra Hospital, Jingmen Central Hospital Affiliated to Jingchu University of Technology, Jingmen, Hubei, China
| | - Qianqian Dai
- Department of Infectious Disease, Jingmen Central Hospital, Jingmen Central Hospital Affiliated to Jingchu University of Technology, Jingmen, Hubei, China
| | - Zhi Liu
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yulin Wang
- Department of Pediatrics, Jingmen Central Hospital, Jingmen Central Hospital affiliated to Jingchu University of Technology, Jingmen, Hubei, China
| | - Cuiyun Zhou
- Department of Ophthalmology and Otolaryngology, Jingmen Centra Hospital, Jingmen Central Hospital Affiliated to Jingchu University of Technology, Jingmen, Hubei, China
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18
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Preda M, Smolinska S, Popescu FD. Diagnostic Workup in IgE-Mediated Allergy to Asteraceae Weed Pollen and Herbal Medicine Products in Europe. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1494. [PMID: 39336535 PMCID: PMC11433692 DOI: 10.3390/medicina60091494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 09/10/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024]
Abstract
Anemophilous weeds from the Asteraceae family are highly allergenic and represent a significant source of aeroallergens in late summer and autumn. Ragweed and mugwort pollen allergies have become a significant health burden in Europe. Some people with respiratory allergies to weed pollen may also suffer hypersensitivity reactions to herbal medicines obtained from certain cross-reactive plants in the Compositae family, such as chamomile, marigold, and purple coneflower. General physicians, ear, nose, and throat (ENT) specialists, and pulmonologists need to be familiar with the diagnostic tests used by allergists in clinical practice to support accurate diagnosis in such patients. Allergists must also be aware of the suggestions of the European Medicines Agency (EMA)'s Herbal Medicinal Products Committee and the broad spectrum of herbal therapies to educate their patients about potential risks.
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Affiliation(s)
- Mariana Preda
- Faculty of Medicine, Department of Allergology "Nicolae Malaxa" Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, 022441 Bucharest, Romania
| | - Sylwia Smolinska
- Faculty of Medicine, Department of Clinical Immunology, Wroclaw Medical University, 51-616 Wroclaw, Poland
| | - Florin-Dan Popescu
- Faculty of Medicine, Department of Allergology "Nicolae Malaxa" Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, 022441 Bucharest, Romania
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Huber P, Becker S, Gröger M. [Pitfalls in the diagnosis of house dust mite allergy]. HNO 2024; 72:619-625. [PMID: 38358481 DOI: 10.1007/s00106-024-01425-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/16/2024]
Abstract
House dust mite (HDM) is the most significant indoor allergen, responsible for not only many cases of rhinoconjunctivitis but also for many cases of bronchial asthma, rendering it of considerable socioeconomic relevance. Besides symptomatic treatment and avoidance measures, allergen immunotherapy (AIT) is crucial, as the only causal, disease-modifying therapeutic approach. However, high diagnostic certainty is essential for initiating AIT. The challenge in making a correct diagnosis lies in interpreting the demonstrated HDM sensitization regarding its clinical relevance (clinically silent sensitization vs. allergy). While the risk of allergy increases with the level of IgE titers against HDM extract, Der p 1, or Der p 2, as well as with the breadth of the molecular sensitization profile against HDM components (Der p 1, Der p 2, Der p 23), no threshold can be defined for the presence of allergy, nor can sensitization to a specific component be confidently considered allergy inducing. It should be noted that at least in Southern Bavaria, the prevalence of Der p 23 sensitization is too low to be considered a major allergen, and Der p 23 is not able to molecularly differentiate all HDM sensitizations when added to the two major allergens Der p 1 and Der p 2. Evidently, HDM possesses a diverse profile of allergens, with some relevant ones possibly yet to be described. Unfortunately, patient history does not provide a sufficient assessment of the clinical relevance of a demonstrated HDM sensitization, necessitating allergen provocation testing before initiating AIT with HDM, despite the relatively large effort involved.
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Affiliation(s)
- P Huber
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - S Becker
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen, Tübingen, Deutschland
| | - M Gröger
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
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20
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Berghi O, Dumitru M, Cergan R, Musat G, Serboiu C, Vrinceanu D. Local Allergic Rhinitis-A Challenge for Allergology and Otorhinolaryngology Cooperation (Scoping Review). Life (Basel) 2024; 14:965. [PMID: 39202707 PMCID: PMC11355242 DOI: 10.3390/life14080965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 07/27/2024] [Accepted: 07/29/2024] [Indexed: 09/03/2024] Open
Abstract
Local allergic rhinitis (LAR) represents a medical provocation for allergists and otorhinolaryngologists. LAR is considered to be a subtype of allergic rhinitis (AR) that affects a great percentage of patients who were, for decades, diagnosed as having chronic non-allergic rhinitis. The clinical picture is represented by rhinorrhea, sneezing, and nasal itching correlated with specific pollen season or dust, mold, or pet interior exposure. Usual assessment of AR (skin prick testing and serum IgE assessment) produces negative results. Specialized centers in allergology and ENT around the globe use a nasal allergen challenge, assessment of local IgE, basophil activation test (BAT), and nasal cytology in the diagnostic approach to the disease, taking into account their current limitations. The impact of LAR on quality-of-life indicators is the same as in AR. Treatment for LAR is similar to that for AR and is the same as for AR: allergen exposure avoidance, drug therapy, and allergen immunotherapy. This scoping review gathers the current up-to-date open access evidence available on PubMed on the subject of LAR.
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Affiliation(s)
- Ovidiu Berghi
- Allergology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania;
| | - Mihai Dumitru
- ENT Department, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Romica Cergan
- Anatomy Department, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Gabriela Musat
- ENT Department, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Crenguta Serboiu
- Histology and Molecular Biology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Daniela Vrinceanu
- ENT Department, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
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21
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Kornmann J, Kramer B, Haeussler D. [Basics in diagnostics and therapy of allergic diseases for ENT consultations]. Laryngorhinootologie 2024; 103:529-541. [PMID: 38955155 DOI: 10.1055/a-2073-9474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Allergies play a pivotal role in the daily practice of ENT specialists. Allergic symptoms induced by inhalant allergens are widespread in the population and can manifest through a wide range of symptoms, including rhinorrhea, sneezing, conjunctival redness, cough and dyspnea. Inconsistent diagnosis and treatment of allergic conditions can lead to reduced quality of life, decreased work performance, and socioeconomically significant secondary diseases. In addition to the medical history, the skin prick test and serological IgE diagnostics are the most important diagnostic procedure for detecting type-I allergies. To clarify clinical relevance, molecular diagnostics and nasal provocation testing may be employed. The key to effective treatment lies in a comprehensive allergological diagnosis coupled with a detailed patient history. General treatment recommendations such as allergen avoidance and nasal irrigation should complement pharmacological therapy. In the treatment of allergic rhinitis topical steroids are first line treatment options. The primary goal of treatment is symptom control, and if control is insufficient, causal therapy through specific allergen immunotherapy is recommended. Challenges in the ENT clinic involve selecting the necessary diagnostics and appropriate, effective treatments. Hence, using diagnostic and treatment algorithms, as well as standardized patient history questionnaires, can serve as invaluable tools in daily patient interactions, especially considering limited time availability.
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Affiliation(s)
- Jonas Kornmann
- Kopf- und Halschirurgie, Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | - Benedikt Kramer
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Daniel Haeussler
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Mannheim, Germany
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22
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Ojeda P, Barjau MC, Subiza J, Moreno A, Ojeda I, Solano E, Alonso A, Caballero R, Del Pozo S, Gómez-Perosanz M, Sánchez-Trincado JL, Benito-Villalvilla C, Angelina A, Soria I, Reche PA, Palomares O, Subiza JL, Casanovas M. Grass pollen allergoids conjugated with mannan for subcutaneous and sublingual immunotherapy: a dose-finding study. Front Immunol 2024; 15:1431351. [PMID: 38989287 PMCID: PMC11233432 DOI: 10.3389/fimmu.2024.1431351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/03/2024] [Indexed: 07/12/2024] Open
Abstract
Background Polymerized allergoids conjugated with mannan represent a novel approach of allergen immunotherapy targeting dendritic cells. In this study, we aimed to determine the optimal dose of mannan-allergoid conjugates derived from grass pollen (Phleum pratense and Dactylis glomerata) administered via either the subcutaneous or sublingual route. Methods A randomized, double-blind, placebo-controlled trial with a double-dummy design was conducted, involving 162 participants across 12 centers in Spain. Subjects were randomly allocated to one of nine different treatment groups, each receiving either placebo or active treatment at doses of 500, 1,000, 3,000, or 5,000 mTU/mL over four months. Each participant received five subcutaneous (SC) doses of 0.5 mL each, every 30 days, and a daily sublingual (SL) dose of 0.2 mL. Participants who received active treatment through SC, received placebo through SL. Participants who received active treatment through SL, received placebo SC. One Group, as control, received bot SC and SL placebo. The primary efficacy outcome was the improvement in titrated nasal provocation tests (NPT) at the end of the study compared to baseline. Secondary outcomes included specific antibody (IgG4, IgE) and cellular (IL-10 producing and regulatory T cell) responses. All adverse events and side reactions were recorded and assessed. Results Post-treatment, the active groups showed improvements in NPT ranging from 33% to 53%, with the highest doses showing the greatest improvements regardless of the administration route. In comparison, the placebo group showed a 12% improvement. Significant differences over placebo were observed at doses of 3,000 mTU/mL (p=0.049 for SL, p=0.015 for SC) and 5,000 mTU/mL (p=0.011 for SL, p=0.015 for SC). A dose-dependent increase in IgG4 was observed following SC administration, and an increase in IL-10 producing cells for both routes of administration. No serious systemic or local adverse reactions were recorded, and no adrenaline was required. Conclusion Grass pollen immunotherapy with mannan-allergoid conjugates was found to be safe and efficacious in achieving the primary outcome, whether administered via the subcutaneous or sublingual routes, at doses of 3,000 and 5,000 mTU/mL. Clinical trial registration https://www.clinicaltrialsregister.eu/ctr-search (EudraCT), identifier 2014-005471-88; https://www.clinicaltrials.gov, identifier NCT02654223.
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Affiliation(s)
- Pedro Ojeda
- Clínica de Asma y Alergia Dres. Ojeda, Madrid, Spain
| | | | | | | | - Isabel Ojeda
- Clínica de Asma y Alergia Dres. Ojeda, Madrid, Spain
| | - Emilio Solano
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Sandra Del Pozo
- Inmunotek, Alcalá de Henares, Spain
- Department of Medicine and Medical Specialities, Faculty of Medicine, University of Alcalá de Henares, Alcalá de Henares, Spain
| | - Marta Gómez-Perosanz
- Inmunotek, Alcalá de Henares, Spain
- Department of Immunology & O2, School of Medicine, University Complutense of Madrid, Madrid, Spain
| | | | - Cristina Benito-Villalvilla
- Department of Biochemistry and Molecular Biology, School of Chemistry, University Complutense of Madrid, Madrid, Spain
| | - Alba Angelina
- Department of Biochemistry and Molecular Biology, School of Chemistry, University Complutense of Madrid, Madrid, Spain
| | | | - Pedro A. Reche
- Department of Immunology & O2, School of Medicine, University Complutense of Madrid, Madrid, Spain
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, University Complutense of Madrid, Madrid, Spain
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García E, Ardila JC, Crespo N, Chapman E, Ocampo J, Olivares M, Acevedo A, Aguirre N, Abreu S, Calle A, Ramírez R, Sánchez J. Selection of allergen extract for immunotherapy in polysensitized allergic rhinitis patients. Immunotherapy 2024; 16:623-634. [PMID: 39052282 PMCID: PMC11290366 DOI: 10.1080/1750743x.2024.2342225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/09/2024] [Indexed: 07/27/2024] Open
Abstract
Aim: To evaluate the criteria used by allergists in selecting an immunotherapy extract (allergen immunotherapy [AIT]-extract) in rhinitis patients with polysensitization. Methods: First, a cross-sectional study was carried out by evaluating different factors that influence the medical choice of AIT-extract. Second, a literature review was performed by evaluating the diagnostic performance of atopy tests. Results: A total of 419 patients were included (84 children, 149 adolescents and 186 adults). Anamnesis, atopy tests and exposure to pets were the main factors for choosing the AIT extract. The sensitivity and specificity of atopy tests were high for Dermatophagoides spp., (>80%), moderate for pets (60%) and indeterminate for Blomia tropicalis. Conclusion: NCTs could be necessary for AIT-extract selection in polysensitized allergic rhinitis patients.
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Affiliation(s)
- Elizabeth García
- Otolaryngology & Allergology Research Groups, “Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL)”, Bogotá, Colombia
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Juan-Camilo Ardila
- Otolaryngology & Allergology Research Groups, “Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL)”, Bogotá, Colombia
| | - Nardey Crespo
- Group of Clinical & Experimental Allergy (GACE), Hospital “Alma Mater de Antioquia”, University of Antioquia, Medellín, Colombia
- Clinic “Unidad Alergológica”, Medellín, Colombia
| | - Edgardo Chapman
- Otolaryngology & Allergology Research Groups, “Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL)”, Bogotá, Colombia
| | - Jaime Ocampo
- Otolaryngology & Allergology Research Groups, “Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL)”, Bogotá, Colombia
| | - Margarita Olivares
- Group of Clinical & Experimental Allergy (GACE), Hospital “Alma Mater de Antioquia”, University of Antioquia, Medellín, Colombia
| | - Ana Acevedo
- Clinic “Unidad Alergológica”, Medellín, Colombia
- Specialized center of allergies (CEALER), Medellín, Colombia
| | - Natalia Aguirre
- Clínica “inmunología y genética (CIGE)” & Alergo SAS, Rionegro, Colombia
| | - Steven Abreu
- Allergy Deparment, “CAYRE” clinic, Bogotá, Colombia
| | - Ana Calle
- Group of Clinical & Experimental Allergy (GACE), Hospital “Alma Mater de Antioquia”, University of Antioquia, Medellín, Colombia
| | - Ruth Ramírez
- Group of Clinical & Experimental Allergy (GACE), Hospital “Alma Mater de Antioquia”, University of Antioquia, Medellín, Colombia
| | - Jorge Sánchez
- Group of Clinical & Experimental Allergy (GACE), Hospital “Alma Mater de Antioquia”, University of Antioquia, Medellín, Colombia
- Clinic “Unidad Alergológica”, Medellín, Colombia
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24
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Berni Canani R, Caminati M, Carucci L, Eguiluz-Gracia I. Skin, gut, and lung barrier: Physiological interface and target of intervention for preventing and treating allergic diseases. Allergy 2024; 79:1485-1500. [PMID: 38439599 DOI: 10.1111/all.16092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/06/2024]
Abstract
The epithelial barriers of the skin, gut, and respiratory tract are critical interfaces between the environment and the host, and they orchestrate both homeostatic and pathogenic immune responses. The mechanisms underlying epithelial barrier dysfunction in allergic and inflammatory conditions, such as atopic dermatitis, food allergy, eosinophilic oesophagitis, allergic rhinitis, chronic rhinosinusitis, and asthma, are complex and influenced by the exposome, microbiome, individual genetics, and epigenetics. Here, we review the role of the epithelial barriers of the skin, digestive tract, and airways in maintaining homeostasis, how they influence the occurrence and progression of allergic and inflammatory conditions, how current treatments target the epithelium to improve symptoms of these disorders, and what the unmet needs are in the identification and treatment of epithelial disorders.
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Affiliation(s)
- Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Marco Caminati
- Allergy Unit and Asthma Centre, Verona Integrated University Hospital and Department of Medicine, University of Verona, Verona, Italy
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Ibon Eguiluz-Gracia
- Allergy Unit, Hospital Regional Universitario de Malága, Malaga, Spain
- Allergy Group, Biomedical Research Institute of Malaga (IBIMA)-BIONAND Platform, RICORS Inflammatory Diseases, Malaga, Spain
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Campo P, Canonica GW. Local Allergic Rhinitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1430-1433. [PMID: 38641133 DOI: 10.1016/j.jaip.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
Local allergic rhinitis (LAR) is defined by a clinical history suggestive of allergic rhinitis (AR), negativity of systemic IgE measurement and positive response to nasal allergen challenge (NAC). The term local respiratory allergy includes LAR, local allergic asthma (positive response in bronchial allergen challenge) and dual allergic rhinitis defined by the coexistence of AR and LAR. LAR worsens in severity and presence of comorbidities over time, and it is an independent entity from AR. Prevalence is higher in Mediterranean countries. LAR onset occurs during childhood in 36% of cases. Physiopathological features of LAR are: increased nasal eosinophilic inflammation, tryptase and eosinophil cationic protein, and presence of nasal specific IgE in secretions of 20-40% of subjects. A recent study demonstrated increase in sequential class switch recombination to IgE markers in mucosa of LAR with accumulation of IgE+ CD38+ plasmablasts. Moreover, there is increased expression in B cells of mucosal homing receptors CXCR3+ and CXCR4 in peripheral blood, with accumulation of Th9 and Th2 cells. NAC is the gold standard in the diagnosis of LAR. The measurement of specific IgE in nasal secretions basophil activation test or are still not suitable for diagnosis. There is ample evidence of the usefulness of allergen immunotherapy in the treatment in LAR after 4 DBPCRT in 152 patients. In conclusion, knowledge about LAR is continuously increasing, with detailed definition of physiopathological mechanisms and new phenotypes. More awareness of the disease should be promoted among different specialists, and NAC must be considered an essential diagnostic tool in any age group, including children.
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Affiliation(s)
- Paloma Campo
- U.G.C. Alergología, Hospital Regional Universitario de Málaga, Málaga, Spain.
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy; Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milano, Italy
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Olivieri B, Gil AJ, Stoenchev K, Durham SR, Scadding G. Utility of silver birch and house dust mite extracts derived from licensed sublingual tablets for nasal allergen challenge. Clin Transl Allergy 2024; 14:e12360. [PMID: 38779783 PMCID: PMC11112400 DOI: 10.1002/clt2.12360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/16/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Nasal allergen challenge (NAC) is used to investigate the effects of allergen exposure and assess treatment efficacy in allergic rhinitis (AR). This study aims to establish dose-responses to NAC using licensed silver birch (SB) pollen and house dust mite (HDM) sublingual tablets as sources of the allergen extracts in participants with AR. METHODS Sixteen volunteers with HDM-induced perennial AR and 15 volunteers with SB pollen-induced seasonal rhinitis underwent a graded up-dosing NAC with extracts derived from HDM allergen (Acarizax®) and SB (Itulazax®) tablets, respectively. Total nasal symptom score (TNSS, range 0-12) and peak nasal inspiratory flow (PNIF) were recorded before, at 10 min and at the end of the NAC. The dose of each allergen that provoked a TNSS of at least 7 ("provoking dose 7") in most allergic participants was identified. NACs using the "provoking dose 7" were performed on 5 non-allergic individuals to test for irritant effects. The "provoking dose 7" of HDM extract was used in a subgroup of two SB allergic, non-HDM allergic, volunteers, and vice versa for SB extract, to test for allergen specificity of the responses. RESULTS Most patients experienced a TNSS of at least 7/12 at a median concentration of 1500 AU/mL for both SB pollen and HDM. The average decline in PNIF at this dose was 63.15% for SB and 63.99% for HDM. NACs using the 1500 AU/mL concentrations were performed on 5 non-allergic individuals with no symptomatic or PNIF response. 1500 AU/mL of HDM extract produced no symptoms in SB allergics nor 1500 AU/mL SB extract in HDM allergics. CONCLUSION For both SB and HDM extracts, the optimal allergen dose for NAC to cause a moderate-severity response ("provoking dose 7/12") was 1500 AU/mL. Licensed sublingual allergen tablets provide a readily available and inexpensive source of SB and HDM extracts for use in future interventional studies in AR.
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Affiliation(s)
- Bianca Olivieri
- Asthma, Allergy and Clinical Immunology SectionUniversity Hospital of VeronaVeronaItaly
| | - Ana Jimenez Gil
- Department of AllergyRoyal Brompton & Harefield Hospitals NHS TrustLondonUK
- Allergy and Clinical ImmunologyNational Heart and Lung InstituteImperial College LondonLondonUK
| | - Kostadin Stoenchev
- Department of AllergyRoyal Brompton & Harefield Hospitals NHS TrustLondonUK
| | - Stephen R. Durham
- Department of AllergyRoyal Brompton & Harefield Hospitals NHS TrustLondonUK
- Allergy and Clinical ImmunologyNational Heart and Lung InstituteImperial College LondonLondonUK
| | - Guy Scadding
- Department of AllergyRoyal Brompton & Harefield Hospitals NHS TrustLondonUK
- Allergy and Clinical ImmunologyNational Heart and Lung InstituteImperial College LondonLondonUK
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Kim SJ, Moon JW, Cho Y, Lee HM. Clinical characteristics of local allergic rhinitis sensitized to house dust mites in Asia. Eur Arch Otorhinolaryngol 2024; 281:2413-2420. [PMID: 38147114 DOI: 10.1007/s00405-023-08394-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE Local allergic rhinitis (LAR) is characterized by a localized nasal allergic response without evidence of systemic atopy. LAR is an underdiagnosed entity and is a diagnostic and therapeutic challenge for clinicians. This study aimed to investigate the prevalence and clinical characteristics of patients with LAR to house dust mites (LAR-HDM) in Korea. METHODS We performed a retrospective chart review of 336 adult patients with rhinitis symptoms who visited the Rhinologic Clinic at Korea University Guro Hospital from October 2019 to April 2021. Using results of the skin prick test, serologic test, and nasal provocation test, patients were classified as allergic rhinitis (AR) to HDM (AR-HDM), AR to other allergens, non-allergic rhinitis (NAR), or LAR-HDM. We excluded patients with AR to other allergens and compared the clinical characteristics of the remaining three groups. Patient demographic data were reviewed, and patients' nasal symptoms, olfactory function, serum total IgE, and severity of accompanying rhinosinusitis were evaluated. RESULTS In total, 336 patients were examined. AR-HDM was diagnosed in 138 (41.1%) patients, AR to other allergens in 36 (10.7%) patients, NAR in 21 (42.0%) patients, and LAR-HDM in 21 (6.3%) patients. The mean age of patients with LAR-HDM was significantly higher than that of patients with AR-HDM. There were no significant differences in sex, smoking history, asthma, and family history of allergic diseases between the groups. Compared to NAR patients, there were significantly more patients with LAR-HDM who had persistent nasal symptoms. The frequency of nasal itching and sneezing was significantly higher in the LAR-HDM group than in the NAR group. The olfactory function score in the LAR-HDM group was significantly worse than that in the AR-HDM group, and the Lund-Mackay score was significantly higher in the LAR-HDM group than in the other groups. CONCLUSION Clinical history and nasal symptoms are very similar in LAR-HDM and AR-HDM. Clinicians should take more care to differentiate them. LAR-HDM should also be considered in patients with persistent and severe nasal symptoms without systemic atopy.
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Affiliation(s)
- Su-Jong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University College of Medicine, 148 Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea
| | - Jee Won Moon
- Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University College of Medicine, 148 Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea
| | - Yongmin Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University College of Medicine, 148 Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea
| | - Heung-Man Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University College of Medicine, 148 Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea.
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Grewling Ł, Ribeiro H, Antunes C, Apangu GP, Çelenk S, Costa A, Eguiluz-Gracia I, Galveias A, Gonzalez Roldan N, Lika M, Magyar D, Martinez-Bracero M, Ørby P, O'Connor D, Penha AM, Pereira S, Pérez-Badia R, Rodinkova V, Xhetani M, Šauliene I, Skjøth CA. Outdoor airborne allergens: Characterization, behavior and monitoring in Europe. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 905:167042. [PMID: 37709071 DOI: 10.1016/j.scitotenv.2023.167042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/23/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
Aeroallergens or inhalant allergens, are proteins dispersed through the air and have the potential to induce allergic conditions such as rhinitis, conjunctivitis, and asthma. Outdoor aeroallergens are found predominantly in pollen grains and fungal spores, which are allergen carriers. Aeroallergens from pollen and fungi have seasonal emission patterns that correlate with plant pollination and fungal sporulation and are strongly associated with atmospheric weather conditions. They are released when allergen carriers come in contact with the respiratory system, e.g. the nasal mucosa. In addition, due to the rupture of allergen carriers, airborne allergen molecules may be released directly into the air in the form of micronic and submicronic particles (cytoplasmic debris, cell wall fragments, droplets etc.) or adhered onto other airborne particulate matter. Therefore, aeroallergen detection strategies must consider, in addition to the allergen carriers, the allergen molecules themselves. This review article aims to present the current knowledge on inhalant allergens in the outdoor environment, their structure, localization, and factors affecting their production, transformation, release or degradation. In addition, methods for collecting and quantifying aeroallergens are listed and thoroughly discussed. Finally, the knowledge gaps, challenges and implications associated with aeroallergen analysis are described.
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Affiliation(s)
- Łukasz Grewling
- Laboratory of Aerobiology, Department of Systematic and Environmental Botany, Faculty of Biology, Adam Mickiewicz University, Poznań, Poland.
| | - Helena Ribeiro
- Department of Geosciences, Environment and Spatial Plannings of the Faculty of Sciences, University of Porto and Earth Sciences Institute (ICT), Portugal
| | - Celia Antunes
- Department of Medical and Health Sciences, School of Health and Human Development & ICT-Institute of Earth Sciences, IIFA, University of Évora, 7000-671 Évora, Portugal
| | | | - Sevcan Çelenk
- Department of Biology, Faculty of Arts and Sciences, Bursa Uludag University, Bursa, Turkey
| | - Ana Costa
- Department of Medical and Health Sciences, School of Health and Human Development & ICT-Institute of Earth Sciences, IIFA, University of Évora, 7000-671 Évora, Portugal
| | - Ibon Eguiluz-Gracia
- Allergy Unit, Hospital Regional Universitario de Malaga, Malaga 29010, Spain
| | - Ana Galveias
- Department of Medical and Health Sciences, School of Health and Human Development & ICT-Institute of Earth Sciences, IIFA, University of Évora, 7000-671 Évora, Portugal
| | - Nestor Gonzalez Roldan
- Group of Biofunctional Metabolites and Structures, Priority Research Area Chronic Lung Diseases, Research Center Borstel, Leibniz Lung Center, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN), Borstel, Germany; Pollen Laboratory, Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Mirela Lika
- Department of Biology, Faculty of Natural Sciences, University of Tirana, Tirana, Albania
| | - Donát Magyar
- National Center for Public Health and Pharmacy, Budapest, Hungary
| | | | - Pia Ørby
- Department of Environmental Science, Danish Big Data Centre for Environment and Health (BERTHA) Aarhus University, Aarhus, Denmark
| | - David O'Connor
- School of Chemical Sciences, Dublin City University, Dublin D09 E432, Ireland
| | - Alexandra Marchã Penha
- Water Laboratory, School of Sciences and Technology, ICT-Institute of Earth Sciences, IIFA, University of Évora. 7000-671 Évora, Portugal
| | - Sónia Pereira
- Department of Geosciences, Environment and Spatial Plannings of the Faculty of Sciences, University of Porto and Earth Sciences Institute (ICT), Portugal
| | - Rosa Pérez-Badia
- Institute of Environmental Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain
| | | | - Merita Xhetani
- Department of Biology, Faculty of Natural Sciences, University of Tirana, Tirana, Albania
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Kappen J, Diamant Z, Agache I, Bonini M, Bousquet J, Canonica GW, Durham SR, Guibas GV, Hamelmann E, Jutel M, Papadopoulos NG, Roberts G, Shamji MH, Zieglmayer P, Gerth van Wijk R, Pfaar O. Standardization of clinical outcomes used in allergen immunotherapy in allergic asthma: An EAACI position paper. Allergy 2023; 78:2835-2850. [PMID: 37449468 DOI: 10.1111/all.15817] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION In allergic asthma patients, one of the more common phenotypes might benefit from allergen immunotherapy (AIT) as add-on intervention to pharmacological treatment. AIT is a treatment with disease-modifying modalities, the evidence for efficacy is based on controlled clinical trials following standardized endpoint measures. However, so far there is a lack of a consensus for asthma endpoints in AIT trials. The aim of a task force (TF) of the European Academy of Allergy and Clinical Immunology (EAACI) is evaluating several outcome measures for AIT in allergic asthma. METHODS The following domains of outcome measures in asthmatic patients have been evaluated for this position paper (PP): (i) exacerbation rate, (ii) lung function, (iii) ICS withdrawal, (iv) symptoms and rescue medication use, (v) questionnaires (PROMS), (vi) bronchial/nasal provocation, (vii) allergen exposure chambers (AEC) and (viii) biomarkers. RESULTS Exacerbation rate can be used as a reliable objective primary outcome; however, there is limited evidence due to different definitions of exacerbation. The time after ICS withdrawal to first exacerbation is considered a primary outcome measure. Besides, the advantages and disadvantages and clinical implications of further domains of asthma endpoints in AIT trials are elaborated in this PP. CONCLUSION This EAACI-PP aims to highlight important aspects of current asthma measures by critically evaluating their applicability for controlled trials of AIT.
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Affiliation(s)
- Jasper Kappen
- Department of Pulmonology, STZ Centre of Excellence for Asthma, COPD and Respiratory Allergy, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of National Heart and Lung Institute, Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Imperial College London, London, UK
| | - Zuzana Diamant
- Departmentt of Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium
- Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | | | - Matteo Bonini
- Department of National Heart and Lung Institute, Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Imperial College London, London, UK
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Clinical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Jean Bousquet
- Charite Universitatsmedizin Berlin Campus Berlin Buch, MASK-air, Montpellier, France
| | - G Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic Humanitas University & Research Hospital-IRCCS, Milan, Italy
| | - Stephen R Durham
- Department of National Heart and Lung Institute, Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Imperial College London, London, UK
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - George V Guibas
- Department of Allergy and Clinical Immunology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- School of Biological Sciences, Medicine and Health, University of Manchester, Manchester, UK
| | - Eckard Hamelmann
- Children's Center Bethel, University Hospital Bielefeld, University Bielefeld, Bielefeld, Germany
| | - Marek Jutel
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
- ALL-MED Medical Research Institute, Wroclaw, Poland
| | | | - Graham Roberts
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Paediatric Allergy and Respiratory Medicine (MP803), Clinical & Experimental Sciences & Human Development in Health Academic Units University of Southampton Faculty of Medicine & University Hospital Southampton, Southampton, UK
| | - Mohamed H Shamji
- Department of National Heart and Lung Institute, Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Imperial College London, London, UK
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Petra Zieglmayer
- Karl Landsteiner University, Competence Center for Allergology and Immunology, Krems, Austria
| | - Roy Gerth van Wijk
- Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
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Palomares F, Testera-Montes A, Aranda CJ, Alba-Linero C, Sáenz de Santa María-García R, Bentabol-Ramos G, Mayorga C, Torres MJ, Rondon C, Eguiluz-Gracia I. Allergen exposure boosts peripheral Th9 responses in patients with local allergic rhinitis. Int Forum Allergy Rhinol 2023; 13:2086-2091. [PMID: 37150905 DOI: 10.1002/alr.23175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/09/2023]
Abstract
KEY POINTS Intranasal allergen exposure increases peripheral total Th2 and Th9 cells in patients with local allergic rhinitis (LAR). Peripheral T-cell response seems dominated by Th9 cells in patients with LAR, whereas Th2 responses prevail in patients with allergic rhinitis. Our results identify Th9 cells as potential therapeutic targets for patients with LAR.
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Affiliation(s)
- Francisca Palomares
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma BIONAND. RETICS Asma, Reacciones Adversas y Alergicas (ARADyAL), and RICORS "Enfermedades inflamatorias", Málaga, Spain
| | - Almudena Testera-Montes
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma BIONAND. RETICS Asma, Reacciones Adversas y Alergicas (ARADyAL), and RICORS "Enfermedades inflamatorias", Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Malaga, Malaga, Spain
| | - Carlos Jose Aranda
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma BIONAND. RETICS Asma, Reacciones Adversas y Alergicas (ARADyAL), and RICORS "Enfermedades inflamatorias", Málaga, Spain
| | - Carmen Alba-Linero
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma BIONAND. RETICS Asma, Reacciones Adversas y Alergicas (ARADyAL), and RICORS "Enfermedades inflamatorias", Málaga, Spain
- Ophthalmology Unit, Hospital Clinico Virgen de la Victoria, Malaga, Spain
- School of Medicine, Universidad de Málaga (UMA), Málaga, Spain
| | - Rocío Sáenz de Santa María-García
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma BIONAND. RETICS Asma, Reacciones Adversas y Alergicas (ARADyAL), and RICORS "Enfermedades inflamatorias", Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Malaga, Malaga, Spain
| | | | - Cristobalina Mayorga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma BIONAND. RETICS Asma, Reacciones Adversas y Alergicas (ARADyAL), and RICORS "Enfermedades inflamatorias", Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Malaga, Malaga, Spain
| | - Maria Jose Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma BIONAND. RETICS Asma, Reacciones Adversas y Alergicas (ARADyAL), and RICORS "Enfermedades inflamatorias", Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Malaga, Malaga, Spain
- School of Medicine, Universidad de Málaga (UMA), Málaga, Spain
| | - Carmen Rondon
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma BIONAND. RETICS Asma, Reacciones Adversas y Alergicas (ARADyAL), and RICORS "Enfermedades inflamatorias", Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Malaga, Malaga, Spain
| | - Ibon Eguiluz-Gracia
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma BIONAND. RETICS Asma, Reacciones Adversas y Alergicas (ARADyAL), and RICORS "Enfermedades inflamatorias", Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Malaga, Malaga, Spain
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Bauer RN, Xie Y, Beaudin S, Wiltshire L, Wattie J, Muñoz C, Alsaji N, Oliveria JP, Ju X, MacLean J, Sommer DD, Keith PK, Satia I, Cusack RP, O'Byrne PM, Sperinde G, Hokom M, Li O, Banerjee P, Chen C, Staton T, Sehmi R, Gauvreau GM. Evaluation of the reproducibility of responses to nasal allergen challenge and effects of inhaled nasal corticosteroids. Clin Exp Allergy 2023; 53:1187-1197. [PMID: 37794659 DOI: 10.1111/cea.14406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/14/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Similar immune responses in the nasal and bronchial mucosa implies that nasal allergen challenge (NAC) is a suitable early phase experimental model for drug development targeting allergic rhinitis (AR) and asthma. We assessed NAC reproducibility and the effects of intranasal corticosteroids (INCS) on symptoms, physiology, and inflammatory mediators. METHODS 20 participants with mild atopic asthma and AR underwent three single blinded nasal challenges each separated by three weeks (NCT03431961). Cohort A (n = 10) underwent a control saline challenge, followed by two allergen challenges. Cohort B (n = 10) underwent a NAC with no treatment intervention, followed by NAC with 14 days pre-treatment with saline nasal spray (placebo), then NAC with 14 days pre-treatment with INCS (220 μg triamcinolone acetonide twice daily). Nasosorption, nasal lavage, blood samples, forced expiratory volume 1 (FEV1), total nasal symptom score (TNSS), peak nasal inspiratory flow (PNIF) were collected up to 24 h after NAC. Total and active tryptase were measured as early-phase allergy biomarkers (≤30 min) and IL-13 and eosinophil cell counts as late-phase allergy biomarkers (3-7 h) in serum and nasal samples. Period-period reproducibility was assessed by intraclass correlation coefficients (ICC), and sample size estimates were performed using effect sizes measured after INCS. RESULTS NAC significantly induced acute increases in nasosorption tryptase and TNSS and reduced PNIF, and induced late increases in nasosorption IL-13 with sustained reductions in PNIF. Reproducibility across NACs varied for symptoms and biomarkers, with total tryptase 5 min post NAC having the highest reproducibility (ICC = 0.91). Treatment with INCS inhibited NAC-induced IL-13 while blunting changes in TNSS and PNIF. For a similar crossover study, 7 participants per treatment arm are needed to detect treatment effects comparable to INCS for TNSS. CONCLUSION NAC-induced biomarkers and symptoms are reproducible and responsive to INCS. NAC is suitable for assessing pharmacodynamic activity and proof of mechanism for drugs targeting allergic inflammation.
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Affiliation(s)
- Rebecca N Bauer
- Translational Medicine, Genentech Inc, South San Francisco, California, USA
| | - Yanqing Xie
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Suzanne Beaudin
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lesley Wiltshire
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Wattie
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Caroline Muñoz
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nadia Alsaji
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John Paul Oliveria
- Translational Medicine, Genentech Inc, South San Francisco, California, USA
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Xiaotian Ju
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan MacLean
- Department of Surgery, Otolaryngology-Head & Neck Surgery Division, McMaster University, Hamilton, Ontario, Canada
| | - Doron D Sommer
- Department of Surgery, Otolaryngology-Head & Neck Surgery Division, McMaster University, Hamilton, Ontario, Canada
| | - Paul K Keith
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Imran Satia
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ruth P Cusack
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paul M O'Byrne
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gizette Sperinde
- Translational Medicine, Genentech Inc, South San Francisco, California, USA
| | - Martha Hokom
- Translational Medicine, Genentech Inc, South San Francisco, California, USA
| | - Olga Li
- Translational Medicine, Genentech Inc, South San Francisco, California, USA
| | - Prajna Banerjee
- Translational Medicine, Genentech Inc, South San Francisco, California, USA
| | - Chen Chen
- Translational Medicine, Genentech Inc, South San Francisco, California, USA
| | - Tracy Staton
- Translational Medicine, Genentech Inc, South San Francisco, California, USA
| | - Roma Sehmi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gail M Gauvreau
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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González-Torres L, García-Paz V, Meijide A, Goikoetxea MJ, Salgado MA, Sanz ML, Vila L. Local allergic rhinitis in children: Clinical characteristics and role of basophil activation test as a diagnostic tool. Int J Pediatr Otorhinolaryngol 2023; 172:111645. [PMID: 37481991 DOI: 10.1016/j.ijporl.2023.111645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/12/2023] [Accepted: 07/02/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Local allergic rhinitis (LAR) is a condition involving a localized nasal allergic response in absence of systemic atopy. Most studies on LAR have been performed in adults. We aimed to describe clinical characteristics of LAR pediatric patients, its clinical evolution over a 7-year follow-up period and to study the role of basophil activation test (BAT), for its diagnosis. METHODS Forty-four children with non-allergic rhinitis (NAR) were included (24 males, 20 females, aged under 15 years). Nasal allergen provocation test (NAPT) and BAT were performed with Dermatophagoides pteronyssinus and Phleum pratense. RESULTS Seven patients (16%) were diagnosed of LAR. Six reacted to D pteronyssinus and one to P pratense. All LAR and 86% of NAR patients presented perennial symptoms. Fifty-seven percent of NAR and LAR patients referred persistent symptoms. Around half of NAR and LAR patients reported mild-moderate clinical manifestations. Three LAR patients associated conjunctival symptoms, proportionally more than NAR patients (19%, 7 out of 37). NAR patients presented bronchial asthma (n = 10) more frequently than LAR children (n = 1). More than half of LAR and NAR patients presented family history of atopy. BAT was negative in all LAR patients. On follow-up, 3 LAR patients and 10 of the 25 NAR patients who agreed to be retested, presented systemic sensitization. Dust mites were the most frequent allergen involved. CONCLUSIONS LAR should be ruled out in children with NAR. Almost half of children with LAR develop systemic sensitization over time. BAT shows low sensitivity for the diagnosis of LAR in children.
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Affiliation(s)
- L González-Torres
- Allergy Pediatric Unit, Complexo Hospitalario Universitario, A Coruña, Spain
| | - V García-Paz
- Allergy Pediatric Unit, Complexo Hospitalario Universitario, A Coruña, Spain
| | - A Meijide
- Allergy Unit, Complexo Hospitalario Universitario de Vigo, Spain
| | - M J Goikoetxea
- Allergy Unit, Clinica Universitaria de Navarra, Pamplona, Spain
| | - M A Salgado
- Allergy Unit, Clinica Universitaria de Navarra, Pamplona, Spain
| | - M L Sanz
- Allergy Unit, Clinica Universitaria de Navarra, Pamplona, Spain
| | - L Vila
- Allergy Pediatric Unit, Complexo Hospitalario Universitario, A Coruña, Spain.
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Krzych-Fałta E, Czerwińska ME, Białek S, Furmańczyk K, Samoliński B, Grodner B, Sybilski A, Nowicka G, Wojas O. Methodological Principles of Nasal Food Challenge. Nutrients 2023; 15:3816. [PMID: 37686848 PMCID: PMC10489609 DOI: 10.3390/nu15173816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Thanks to their valuable assessment possibilities (subjective complaints and changes in nasal patency during the examination), nasal provocation tests may serve as an alternative tool for oral food challenges in the future. However, this test requires successive attempts to regulate its methodology in order to develop a standardized lyophilisate form and determine the threshold dose for a positive result. The study objective was to present the methodological foundation for nasal food allergen provocation tests induced by freeze-dried powdered chicken egg whites. A control group of 25 individuals with no history of allergy to chicken eggs or any other allergy was included in the study. Optical rhinometry and visual analog scales were used to assess the response of nasal mucosa to local allergen challenges. Minor variations in nasal flows, as measured by optical rhinometry, were observed in the provocation tests. The mean optical density measurements (as measured regardless of the allergen dose used) varied from positive to negative values and vice versa, e.g., amounting to 0.018 OD (standard deviation 0.095) at 15 min and -0.011 OD (standard deviation 0.090) at 30 min. No significant differences were observed concerning the perceived nasal discomfort using the visual analog scale. Due to the absence of nasal mucosal reactivity, nasal challenge is an excellent methodological tool for implementing food allergen tests.
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Affiliation(s)
- Edyta Krzych-Fałta
- Department of Basic Nursing, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Monika E. Czerwińska
- Department of Biochemistry and Pharmacogenomics, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.E.C.); (B.G.); (G.N.)
| | - Sławomir Białek
- Department of Biochemistry and Pharmacogenomics, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.E.C.); (B.G.); (G.N.)
| | - Konrad Furmańczyk
- Institute of Information Technology, Warsaw University of Life Sciences, 02-776 Warsaw, Poland;
| | - Bolesław Samoliński
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, 02-097 Warsaw, Poland; (B.S.); (O.W.)
| | - Błażej Grodner
- Department of Biochemistry and Pharmacogenomics, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.E.C.); (B.G.); (G.N.)
| | - Adam Sybilski
- 2nd Department of Pediatrics, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Grażyna Nowicka
- Department of Biochemistry and Pharmacogenomics, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.E.C.); (B.G.); (G.N.)
| | - Oksana Wojas
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, 02-097 Warsaw, Poland; (B.S.); (O.W.)
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Krzych-Fałta E, Wojas O, Samel-Kowalik P, Samoliński B, Sybilski A, Białek S. Oral and nasal provocation test in chicken egg allergy-case report. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:70. [PMID: 37580833 PMCID: PMC10426171 DOI: 10.1186/s13223-023-00829-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/25/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Allergy to chicken egg protein is a common form of food allergy. The most common clinical presentation includes gastrointestinal, skin, and respiratory symptoms. Differential diagnosis, including provocative tests, is critical in diagnosis. CASE DESCRIPTION We present a case of a 21-year-old patient with egg allergy, who underwent a double-blind food provocation test with placebo (evaluating subjective complaints from the gastrointestinal tract) and a titrated nasal provocation test using dry chicken egg content. We assessed the response of the nasal mucosa in the provocation test using the visual analogue scale (VAS), acoustic and optical rhinometry, as well as measurements of nitric oxide concentration in the exhaled air. During the provocation test, we measured the changes in the transverse section of the nasal passages, which were accompanied by subjective complaints measured with the VAS scale, using objective techniques. In the nasal provocation test with a dose of 20 µg of chicken egg protein, we observed an increase in the reactivity of the nasal mucosa and a decrease in the level of nitric oxide in the exhaled air from the upper airways (920 ppb before the provocation test and up to 867 ppb during the early stage of the allergic reaction). During the provocation tests, we recorded typical symptoms associated with the early stage of the allergic reaction; including nasal obstruction (1.2 cm), leakage of watery discharge (0.8 cm) in the food test, and itchy nose (1.1 cm) in the food test vs. the nasal test: 4.6, 2.8, and 3.5 cm, respectively. CONCLUSIONS The nasal mucosa provides convenient conditions for evaluation of the severity of allergy to common food allergens, including chicken egg allergens.
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Affiliation(s)
- E Krzych-Fałta
- Department of Basic of Nursing, Medical University of Warsaw, Warsaw, Poland
| | - O Wojas
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Banacha 1a Str, 02097, Warsaw, Poland.
| | - P Samel-Kowalik
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Banacha 1a Str, 02097, Warsaw, Poland
| | - B Samoliński
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Banacha 1a Str, 02097, Warsaw, Poland
| | - A Sybilski
- Second Department of Pediatrics, Center of Postgraduate Medical Education, Warsaw, Poland
| | - S Białek
- Department of Biochemistry and Pharmacogenomics, Medical University of Warsaw, Warsaw, Poland
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ÜNSAL H, ŞAHİNER ÜM, SOYER Ö, ŞEKEREL BE. Cupressus arizonica: an emerging aeroallergen for East Mediterranean children. Turk J Med Sci 2023; 53:1262-1270. [PMID: 38813017 PMCID: PMC10763739 DOI: 10.55730/1300-0144.5692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 10/26/2023] [Accepted: 07/11/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim Cupressus sempervirens is a tree native to the Mediterranean region. We aimed to investigate the frequency of sensitization/allergy to Cupressus arizonica pollen, which is not native to Anatolia. Materials and methods Patients aged 5-18 years who underwent respiratory allergy screening in Türkiye's largest referral center over a 1-year period were reviewed retrospectively for a diagnostic study of Cupressus allergy. Results Of 246 patients, 207 (67.6% male) with a median age of 11.7 (IQR 9.2-15) years were found to be aeroallergen-sensitive and C. arizonica (32%) was the second most common sensitivity after grass pollen (83.6%). In the C. arizonica-sensitive subgroup, only 3% (2/67) were monosensitive, and grass (77.6%), cat (38.8%), and weeds (38.8%) were the most common co-sensitivities. Cup a 1 specific IgE (sIgE) was measured in 26 patients with C. arizonica sensitivity and all were found to be positive. A nasal allergen challenge (NAC) was performed for 44 of 67 patients with C. arizonica sensitivity, and 13 of 44 patients had a positive outcome (NAC+) at the highest two extract concentrations. The Cupressus wheal sizes and Cup a 1 sIgE levels of the NAC+ subgroup were higher than those of the NAC- subgroup but reached significance only for wheal size [6 (5-7.5) vs. 4.5 (4-6), p=0.004]. The NAC+ subgroup reported more frequent nasal discharge, congestion, and eye symptoms than the NAC- subgroup during the relevant pollen season. Conclusion C. arizonica sensitivity has increased in the East Mediterranean region, similarly to North Mediterranean data, and this is associated with the presence of allergy both clinically and in laboratory findings. C. arizonica should be included in the aeroallergen screening panels of children from the East Mediterranean.
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Affiliation(s)
- Hilal ÜNSAL
- Department of Pediatric Allergy, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Ümit Murat ŞAHİNER
- Department of Pediatric Allergy, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Özge SOYER
- Department of Pediatric Allergy, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Bülent Enis ŞEKEREL
- Department of Pediatric Allergy, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
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Kim KS, Min HJ. Correlation of Multiple Allergen Simultaneous Test with Nasal Provocation Test of House Dust Mite. EAR, NOSE & THROAT JOURNAL 2023:1455613231185065. [PMID: 37421257 DOI: 10.1177/01455613231185065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2023] Open
Abstract
Objectives: Compared with the skin prick test, relationship between the multiple allergen simultaneous test (MAST) and nasal provocation test (NPT) has rarely been evaluated. We evaluated the relationship between the results of the MAST and NPT against house dust mites in the Korean population. Methods: Medical records of patients who underwent both MAST and NPT were reviewed. Positive MAST was diagnosed when the levels of immunoglobulin E (IgE) specific for Dermatophagoides farinae (DF) and Dermatophagoides pteronyssinus (DP) were ≥2 positivity or ≥0.70 IU/ml. During the NPT, changes in subjective symptoms, including nasal obstruction, rhinorrhea, sneezing, itching, ocular discomfort, and peak nasal inspiratory flow (PNIF), were measured. The correlation between NPT and MAST results was statistically analyzed. Results: A total of 96 participants were enrolled in this study: 26 were assigned to the MAST-positive group, and 70 were assigned to the MAST-negative group. Changes in subjective symptoms before and after the nasal allergen challenge were significantly associated with the MAST results. Changes in PNIF before and after the nasal allergen challenge were also significantly associated with the MAST results. We found that a cutoff value of "a subjective total nasal symptom change" of more than 17.5 had a sensitivity of 68.6% and a specificity of 69.2%, while a cutoff value of "a PNIF change" of more than 6.51 had a sensitivity of 67.1% and a specificity of 69.2%. Conclusion: NPT was significantly associated with MAST, and further studies regarding the relationship between NPT using various allergen conditions and MAST are warranted.
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Affiliation(s)
- Kyung Soo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, South Korea
| | - Hyun Jin Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, South Korea
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Gherasim A, Dietsch F, Beck M, Domis N, de Blay F. Birch-induced allergic rhinitis: Results of exposure during nasal allergen challenge, environmental chamber, and pollen season. World Allergy Organ J 2023; 16:100801. [PMID: 37520615 PMCID: PMC10384658 DOI: 10.1016/j.waojou.2023.100801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Background Pollen variation can affect field study data quality. Nasal allergen challenge (NAC) is considered the gold standard for evaluating allergic rhinitis, while environmental exposure chambers (EECs) are mainly used in phase 2 drug development studies. We aimed to study birch-induced allergic rhinitis under 3 different conditions. Methods This study included 30 participants allergic to birch pollen, based on birch skin prick test, specific immunoglobulin E (IgE), and positive NAC. Participants were exposed to placebo twice, followed by 2 consecutive 4-h birch airborne exposures, repeated on 2 occasions to evaluate reproducibility and priming effect. Nasal response was defined as total corrected nasal symptom score (ΔTNSS) ≥ 5 during NAC and EEC. The primary end-point was to measure TNSS during the last 2 h of first allergen exposure. TNSS was also analyzed during natural exposure. Results The dose most commonly yielding positive TNSS during NAC was 175.2 ng/200 μL. Eighteen participants experienced ΔTNSS ≥5 during the last 2 h of the first exposure, whereas 21 had positive responses at all 4 exposures. Mean ΔTNSS was 1 with placebo versus 6 with birch. Exposures were reproducible, with no observed priming effect. Airborne Bet v 1 was 25 ng/m3, while the pollen measurement was 279/m3 during pollen season. TNSS reached 5 in 67.9% of participants during peak pollen season. Conclusion EEC outcomes were similar to those obtained with NAC and natural exposure, suggesting the usefulness of EEC in allergic rhinitis studies. The primary end-point was reached, as 60% of participants experienced nasal responses.
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Affiliation(s)
- Alina Gherasim
- ALYATEC Environmental Exposure Chamber, 1 place de l’Hôpital, Strasbourg, France
| | - Frank Dietsch
- ALYATEC Environmental Exposure Chamber, 1 place de l’Hôpital, Strasbourg, France
| | - Marine Beck
- ALYATEC Environmental Exposure Chamber, 1 place de l’Hôpital, Strasbourg, France
| | - Nathalie Domis
- ALYATEC Environmental Exposure Chamber, 1 place de l’Hôpital, Strasbourg, France
| | - Frederic de Blay
- ALYATEC Environmental Exposure Chamber, 1 place de l’Hôpital, Strasbourg, France
- Chest Diseases Department, Strasbourg University Hospital, Strasbourg, France
- Federation of Translational Medicine EA 3070, University of Strasbourg, Strasbourg, France
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Barreto M, Tripodi S, Arasi S, Landi M, Montesano M, Pelosi S, Potapova E, Sfika I, Villella V, Travaglini A, Brighetti MA, Matricardi PM, Dramburg S. Factors predicting the outcome of allergen-specific nasal provocation test in children with grass pollen allergic rhinitis. FRONTIERS IN ALLERGY 2023; 4:1186353. [PMID: 37304166 PMCID: PMC10250668 DOI: 10.3389/falgy.2023.1186353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
Background Nasal provocation testing (NPT) is a reference methodology to identify the culprit allergen in patients with allergic rhinitis. Selecting the right allergen for NPT is particularly difficult in poly-sensitized patients with seasonal allergic rhinitis (SAR). Predictors of NPT outcomes may facilitate the proper use of this test or even substitute it. Objective To identify predictors of grass pollen NPT outcome from an array of clinical data, e-diary outcomes, and allergy test results in poly-sensitized pediatric patients with SAR. Methods Poly-sensitized, SAR patients with grass pollen allergy, participating in the @IT.2020 pilot project in Rome and Pordenone (Italy), participated in a baseline (T0) visit with questionnaires, skin prick testing (SPT), and blood sampling to measure total (ImmunoCAP, TFS, Sweden) and specific IgE antibodies to grass pollen extracts and their major allergenic molecules (ESEP, Euroimmun Labordiagnostika, Germany). During the pollen season, patients filled the AllergyMonitor® e-diary app measuring their symptoms, medication intake, and allergy-related well-being via the Visual Analogue Scale (VAS). After the pollen season (T1), patients answered clinical questionnaires and underwent a nasal provocation test (NPT) with grass pollen extract. Results We recruited 72 patients (age 14.3 ± 2.8 years, 46 males) sensitized to grass and/or other pollens, including olive (63; 87.5%) and pellitory (49; 68.1%). Patients positive to grass pollen NPT (61; 84.7%), compared to the negative ones, had worse VAS values in the e-diary, larger SPT wheal reactions, and higher IgE levels, as well as specific activity to timothy and Bermuda grass extracts, rPhl p 5 and nCyn d 1. A positive NPT to grass pollen was predicted by an index combining the specific activity of IgE towards Phl p 5 and Cyn d 1 (AUC: 0.82; p < 0.01; best cut-off ≥7.25%, sensitivity 70.5%, specificity: 90.9%). VAS results also predicted NPT positivity, although with less precision (AUC: 0.77, p < 0.01; best cut-off ≥7, sensitivity: 60.7%, specificity: 81.8%). Conclusions An index combining the specific activity of IgE to rPhl p 5 and nCyn d 1 predicted with moderate sensitivity and high specificity the outcome of a grass pollen NPT in complex, poly-sensitized pediatric patients with seasonal allergic rhinitis. Further studies are needed to improve the index sensitivity and to assess its usefulness for NPT allergen selection or as an alternative to this demanding test procedure.
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Affiliation(s)
- M. Barreto
- NESMOS Department, Faculty of Medicine and Psychology, Pediatric Unit Sant’Andrea Hospital, “Sapienza” University, Rome, Italy
| | - S. Tripodi
- Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
- Allergology Service, Policlinico Casilino, Rome, Italy
| | - S. Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - M. Landi
- Institute for Biomedical Research and Innovation, Pediatric National Healthcare System, Turin, Italy
| | - M. Montesano
- NESMOS Department, Faculty of Medicine and Psychology, Pediatric Unit Sant’Andrea Hospital, “Sapienza” University, Rome, Italy
| | | | - E. Potapova
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - I. Sfika
- Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
| | - V. Villella
- Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
| | - A. Travaglini
- Department of Biology, Tor Vergata University, Rome, Italy
| | | | - P. M. Matricardi
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - S. Dramburg
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Pfaar O, Becker S, Calabria C, Hartenstein D, Jung J, Zimmer J, Ponda P. Comparison of allergen immunotherapy practice patterns in inhalant allergies in the United States of America and Europe: Similarities and differences 2023. World Allergy Organ J 2023; 16:100766. [PMID: 37251813 PMCID: PMC10220280 DOI: 10.1016/j.waojou.2023.100766] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/16/2023] [Accepted: 03/18/2023] [Indexed: 05/31/2023] Open
Abstract
IgE-mediated atopic diseases such as allergic rhinitis and rhinoconjunctivitis are common chronic diseases in the western world. Allergen immunotherapy (AIT) plays a fundamental role in the treatment of allergic patients by modulating the underlying immune mechanisms. Though this treatment is integrated in practice-patterns globally, many differences are found in the application of AIT on the national or international level due to heterogeneous methods, and clinical recommendations are given in different parts of the world. This review from authors in Europe and the United States highlights differences and similarities in important aspects of AIT application in the 2 global regions. First, the regulatory situation differs regarding marketing authorization and licensing. Secondly, differences are elaborated in manufacturing practices, marketing distribution and formulations of AIT products. Thirdly, clinical administration patterns in the current guidelines show similarities in indications and contraindications of AIT, but also are divergent in some practical aspects. Informing the readership on similarities, as well as differences of standards in AIT in the United States and Europe, the authors highlight the unmet need of thorough harmonization of standards of AIT, as it is the only disease modifying treatment option available for patients with allergic rhinitis and rhinoconjunctivitis.
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Affiliation(s)
- Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg
| | - Sven Becker
- Department of Otorhinolaryngology, Head and Neck Surgery, Tübingen University Hospital, Germany
| | - Christopher Calabria
- Department of Allergy and Immunology, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, TX, USA
| | | | - Jenna Jung
- Division of Allergy and Immunology, Northwell Health, Great Neck, NY, USA
- Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Julia Zimmer
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - Punita Ponda
- Division of Allergy and Immunology, Northwell Health, Great Neck, NY, USA
- Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Wise SK, Damask C, Roland LT, Ebert C, Levy JM, Lin S, Luong A, Rodriguez K, Sedaghat AR, Toskala E, Villwock J, Abdullah B, Akdis C, Alt JA, Ansotegui IJ, Azar A, Baroody F, Benninger MS, Bernstein J, Brook C, Campbell R, Casale T, Chaaban MR, Chew FT, Chambliss J, Cianferoni A, Custovic A, Davis EM, DelGaudio JM, Ellis AK, Flanagan C, Fokkens WJ, Franzese C, Greenhawt M, Gill A, Halderman A, Hohlfeld JM, Incorvaia C, Joe SA, Joshi S, Kuruvilla ME, Kim J, Klein AM, Krouse HJ, Kuan EC, Lang D, Larenas-Linnemann D, Laury AM, Lechner M, Lee SE, Lee VS, Loftus P, Marcus S, Marzouk H, Mattos J, McCoul E, Melen E, Mims JW, Mullol J, Nayak JV, Oppenheimer J, Orlandi RR, Phillips K, Platt M, Ramanathan M, Raymond M, Rhee CS, Reitsma S, Ryan M, Sastre J, Schlosser RJ, Schuman TA, Shaker MS, Sheikh A, Smith KA, Soyka MB, Takashima M, Tang M, Tantilipikorn P, Taw MB, Tversky J, Tyler MA, Veling MC, Wallace D, Wang DY, White A, Zhang L. International consensus statement on allergy and rhinology: Allergic rhinitis - 2023. Int Forum Allergy Rhinol 2023; 13:293-859. [PMID: 36878860 DOI: 10.1002/alr.23090] [Citation(s) in RCA: 176] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 09/13/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. METHODS ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. RESULTS ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. CONCLUSION The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.
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Affiliation(s)
- Sarah K Wise
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Cecelia Damask
- Otolaryngology-HNS, Private Practice, University of Central Florida, Lake Mary, Florida, USA
| | - Lauren T Roland
- Otolaryngology-HNS, Washington University, St. Louis, Missouri, USA
| | - Charles Ebert
- Otolaryngology-HNS, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joshua M Levy
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Sandra Lin
- Otolaryngology-HNS, University of Wisconsin, Madison, Wisconsin, USA
| | - Amber Luong
- Otolaryngology-HNS, McGovern Medical School of the University of Texas, Houston, Texas, USA
| | - Kenneth Rodriguez
- Otolaryngology-HNS, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmad R Sedaghat
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elina Toskala
- Otolaryngology-HNS, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Baharudin Abdullah
- Otolaryngology-HNS, Universiti Sains Malaysia, Kubang, Kerian, Kelantan, Malaysia
| | - Cezmi Akdis
- Immunology, Infectious Diseases, Swiss Institute of Allergy and Asthma Research, Davos, Switzerland
| | - Jeremiah A Alt
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fuad Baroody
- Otolaryngology-HNS, University of Chicago, Chicago, Illinois, USA
| | | | | | - Christopher Brook
- Otolaryngology-HNS, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Raewyn Campbell
- Otolaryngology-HNS, Macquarie University, Sydney, NSW, Australia
| | - Thomas Casale
- Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Mohamad R Chaaban
- Otolaryngology-HNS, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fook Tim Chew
- Allergy/Immunology, Genetics, National University of Singapore, Singapore, Singapore
| | - Jeffrey Chambliss
- Allergy/Immunology, University of Texas Southwestern, Dallas, Texas, USA
| | - Antonella Cianferoni
- Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Anne K Ellis
- Allergy/Immunology, Queens University, Kingston, ON, Canada
| | | | - Wytske J Fokkens
- Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | | | - Matthew Greenhawt
- Allergy/Immunology, Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amarbir Gill
- Otolaryngology-HNS, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashleigh Halderman
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Jens M Hohlfeld
- Respiratory Medicine, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | | | - Stephanie A Joe
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Shyam Joshi
- Allergy/Immunology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Jean Kim
- Otolaryngology-HNS, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam M Klein
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Helene J Krouse
- Otorhinolaryngology Nursing, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Edward C Kuan
- Otolaryngology-HNS, University of California Irvine, Orange, California, USA
| | - David Lang
- Allergy/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Matt Lechner
- Otolaryngology-HNS, University College London, Barts Health NHS Trust, London, UK
| | - Stella E Lee
- Otolaryngology-HNS, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Victoria S Lee
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Patricia Loftus
- Otolaryngology-HNS, University of California San Francisco, San Francisco, California, USA
| | - Sonya Marcus
- Otolaryngology-HNS, Stony Brook University, Stony Brook, New York, USA
| | - Haidy Marzouk
- Otolaryngology-HNS, State University of New York Upstate, Syracuse, New York, USA
| | - Jose Mattos
- Otolaryngology-HNS, University of Virginia, Charlottesville, Virginia, USA
| | - Edward McCoul
- Otolaryngology-HNS, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Erik Melen
- Pediatric Allergy, Karolinska Institutet, Stockholm, Sweden
| | - James W Mims
- Otolaryngology-HNS, Wake Forest University, Winston Salem, North Carolina, USA
| | - Joaquim Mullol
- Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Jayakar V Nayak
- Otolaryngology-HNS, Stanford University, Palo Alto, California, USA
| | - John Oppenheimer
- Allergy/Immunology, Rutgers, State University of New Jersey, Newark, New Jersey, USA
| | | | - Katie Phillips
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael Platt
- Otolaryngology-HNS, Boston University, Boston, Massachusetts, USA
| | | | | | - Chae-Seo Rhee
- Rhinology/Allergy, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Sietze Reitsma
- Otolaryngology-HNS, University of Amsterdam, Amsterdam, Netherlands
| | - Matthew Ryan
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Joaquin Sastre
- Allergy, Fundacion Jiminez Diaz, University Autonoma de Madrid, Madrid, Spain
| | - Rodney J Schlosser
- Otolaryngology-HNS, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore A Schuman
- Otolaryngology-HNS, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcus S Shaker
- Allergy/Immunology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Aziz Sheikh
- Primary Care, University of Edinburgh, Edinburgh, Scotland
| | - Kristine A Smith
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Soyka
- Otolaryngology-HNS, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Masayoshi Takashima
- Otolaryngology-HNS, Houston Methodist Academic Institute, Houston, Texas, USA
| | - Monica Tang
- Allergy/Immunology, University of California San Francisco, San Francisco, California, USA
| | | | - Malcolm B Taw
- Integrative East-West Medicine, University of California Los Angeles, Westlake Village, California, USA
| | - Jody Tversky
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew A Tyler
- Otolaryngology-HNS, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria C Veling
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Dana Wallace
- Allergy/Immunology, Nova Southeastern University, Ft. Lauderdale, Florida, USA
| | - De Yun Wang
- Otolaryngology-HNS, National University of Singapore, Singapore, Singapore
| | - Andrew White
- Allergy/Immunology, Scripps Clinic, San Diego, California, USA
| | - Luo Zhang
- Otolaryngology-HNS, Beijing Tongren Hospital, Beijing, China
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De Marchi S, Cecchin E, De Marchi SU, Iuri F, Sechi LA. Subendotyping of Dermatophagoides pteronyssinus-Induced Rhinitis and Its Impact on Respiratory Comorbidities. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:922-929.e2. [PMID: 36535525 DOI: 10.1016/j.jaip.2022.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The impact of delayed hypersensitivity to Dermatophagoides pteronyssinus (DP) on comorbidities of allergic rhinitis (AR) is unknown. OBJECTIVE The primary end point was to test the hypothesis that DP-induced AR could be divided into 2 subendotypes on the basis of presence or absence of a delayed-type mite sensitization detected by the positive result of atopy patch test for DP (DP-APT). The second end point was to evaluate differences in the long-term risk of respiratory comorbidities and nasal airway response to mite exposure. METHODS In a prospective observational study, we included 472 patients with DP-induced AR. A total of 343 patients had positive results of skin prick test/serum specific IgE and DP-APT and were assigned to a subendotype with both IgE- and T-cell-mediated mite sensitization (BMSS). The remaining 129 patients without delayed-type mite sensitization were included in the subendotype with only IgE-mediated mite sensitization. Nasal allergen provocation test with active anterior rhinomanometry, paranasal sinuses computed tomography scan, nasal endoscopy, and spirometry were performed. RESULTS At baseline, BMSS showed a larger increase in nasal airway resistance, total nasal score, and visual analogue scale score to mite exposure. During a 15-year follow-up, 56 patients developed chronic rhinosinusitis with nasal polyps, with higher incidence in BMSS than in the subendotype with only IgE-mediated mite sensitization (50 patients, 14.6% vs 6 patients, 12.4%; P < .001). BMSS also showed a higher incidence of conjunctivitis (25.7% vs 12.4%; P < .01). The rate of adult-onset asthma did not differ between groups, but patients with BMSS showed a more frequent link to chronic rhinosinusitis with nasal polyps (6 of 29 patients, 20.7% vs 0 of 10 patients, 0%). DP-APT independently predicted chronic rhinosinusitis with nasal polyps and conjunctivitis. CONCLUSIONS Two subendotypes with significantly different clinical outcome can be identified among patients with DP-induced AR according to the presence of delayed-type mite sensitization detected by positive DP-APT result.
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Affiliation(s)
- Sergio De Marchi
- Department of Medicine, University of Udine, School of Medicine, Udine, Italy.
| | - Emanuela Cecchin
- Department of Medicine, University of Udine, School of Medicine, Udine, Italy
| | | | - Federico Iuri
- Department of Medicine, University of Udine, School of Medicine, Udine, Italy
| | - Leonardo A Sechi
- Department of Medicine, University of Udine, School of Medicine, Udine, Italy
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42
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Dramburg S, Hilger C, Santos AF, de Las Vecillas L, Aalberse RC, Acevedo N, Aglas L, Altmann F, Arruda KL, Asero R, Ballmer-Weber B, Barber D, Beyer K, Biedermann T, Bilo MB, Blank S, Bosshard PP, Breiteneder H, Brough HA, Bublin M, Campbell D, Caraballo L, Caubet JC, Celi G, Chapman MD, Chruszcz M, Custovic A, Czolk R, Davies J, Douladiris N, Eberlein B, Ebisawa M, Ehlers A, Eigenmann P, Gadermaier G, Giovannini M, Gomez F, Grohman R, Guillet C, Hafner C, Hamilton RG, Hauser M, Hawranek T, Hoffmann HJ, Holzhauser T, Iizuka T, Jacquet A, Jakob T, Janssen-Weets B, Jappe U, Jutel M, Kalic T, Kamath S, Kespohl S, Kleine-Tebbe J, Knol E, Knulst A, Konradsen JR, Korošec P, Kuehn A, Lack G, Le TM, Lopata A, Luengo O, Mäkelä M, Marra AM, Mills C, Morisset M, Muraro A, Nowak-Wegrzyn A, Nugraha R, Ollert M, Palosuo K, Pastorello EA, Patil SU, Platts-Mills T, Pomés A, Poncet P, Potapova E, Poulsen LK, Radauer C, Radulovic S, Raulf M, Rougé P, Sastre J, Sato S, Scala E, Schmid JM, Schmid-Grendelmeier P, Schrama D, Sénéchal H, Traidl-Hoffmann C, Valverde-Monge M, van Hage M, van Ree R, Verhoeckx K, Vieths S, Wickman M, Zakzuk J, Matricardi PM, et alDramburg S, Hilger C, Santos AF, de Las Vecillas L, Aalberse RC, Acevedo N, Aglas L, Altmann F, Arruda KL, Asero R, Ballmer-Weber B, Barber D, Beyer K, Biedermann T, Bilo MB, Blank S, Bosshard PP, Breiteneder H, Brough HA, Bublin M, Campbell D, Caraballo L, Caubet JC, Celi G, Chapman MD, Chruszcz M, Custovic A, Czolk R, Davies J, Douladiris N, Eberlein B, Ebisawa M, Ehlers A, Eigenmann P, Gadermaier G, Giovannini M, Gomez F, Grohman R, Guillet C, Hafner C, Hamilton RG, Hauser M, Hawranek T, Hoffmann HJ, Holzhauser T, Iizuka T, Jacquet A, Jakob T, Janssen-Weets B, Jappe U, Jutel M, Kalic T, Kamath S, Kespohl S, Kleine-Tebbe J, Knol E, Knulst A, Konradsen JR, Korošec P, Kuehn A, Lack G, Le TM, Lopata A, Luengo O, Mäkelä M, Marra AM, Mills C, Morisset M, Muraro A, Nowak-Wegrzyn A, Nugraha R, Ollert M, Palosuo K, Pastorello EA, Patil SU, Platts-Mills T, Pomés A, Poncet P, Potapova E, Poulsen LK, Radauer C, Radulovic S, Raulf M, Rougé P, Sastre J, Sato S, Scala E, Schmid JM, Schmid-Grendelmeier P, Schrama D, Sénéchal H, Traidl-Hoffmann C, Valverde-Monge M, van Hage M, van Ree R, Verhoeckx K, Vieths S, Wickman M, Zakzuk J, Matricardi PM, Hoffmann-Sommergruber K. EAACI Molecular Allergology User's Guide 2.0. Pediatr Allergy Immunol 2023; 34 Suppl 28:e13854. [PMID: 37186333 DOI: 10.1111/pai.13854] [Show More Authors] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/05/2022] [Indexed: 05/17/2023]
Abstract
Since the discovery of immunoglobulin E (IgE) as a mediator of allergic diseases in 1967, our knowledge about the immunological mechanisms of IgE-mediated allergies has remarkably increased. In addition to understanding the immune response and clinical symptoms, allergy diagnosis and management depend strongly on the precise identification of the elicitors of the IgE-mediated allergic reaction. In the past four decades, innovations in bioscience and technology have facilitated the identification and production of well-defined, highly pure molecules for component-resolved diagnosis (CRD), allowing a personalized diagnosis and management of the allergic disease for individual patients. The first edition of the "EAACI Molecular Allergology User's Guide" (MAUG) in 2016 rapidly became a key reference for clinicians, scientists, and interested readers with a background in allergology, immunology, biology, and medicine. Nevertheless, the field of molecular allergology is moving fast, and after 6 years, a new EAACI Taskforce was established to provide an updated document. The Molecular Allergology User's Guide 2.0 summarizes state-of-the-art information on allergen molecules, their clinical relevance, and their application in diagnostic algorithms for clinical practice. It is designed for both, clinicians and scientists, guiding health care professionals through the overwhelming list of different allergen molecules available for testing. Further, it provides diagnostic algorithms on the clinical relevance of allergenic molecules and gives an overview of their biology, the basic mechanisms of test formats, and the application of tests to measure allergen exposure.
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Affiliation(s)
- Stephanie Dramburg
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christiane Hilger
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | | | - Rob C Aalberse
- Sanquin Research, Dept Immunopathology, University of Amsterdam, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Nathalie Acevedo
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia, Colombia
| | - Lorenz Aglas
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Friedrich Altmann
- Department of Chemistry, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Karla L Arruda
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Sao Paulo, Brasil, Brazil
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - Barbara Ballmer-Weber
- Klinik für Dermatologie und Allergologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Domingo Barber
- Institute of Applied Molecular Medicine Nemesio Diez (IMMAND), Department of Basic Medical Sciences, Facultad de Medicina, Universidad San Pablo CEU, CEU Universities, Madrid, Spain
- RETIC ARADyAL and RICORS Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University Munich, Munich, Germany
| | - Maria Beatrice Bilo
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
- Allergy Unit Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Torrette, Italy
| | - Simon Blank
- Center of Allergy and Environment (ZAUM), Technical University of Munich, School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, Munich, Germany
| | - Philipp P Bosshard
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Heimo Breiteneder
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Helen A Brough
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Merima Bublin
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Dianne Campbell
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia, Colombia
| | - Jean Christoph Caubet
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Giorgio Celi
- Centro DH Allergologia e Immunologia Clinica ASST- MANTOVA (MN), Mantova, Italy
| | | | - Maksymilian Chruszcz
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, South Carolina, USA
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Rebecca Czolk
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Janet Davies
- Queensland University of Technology, Centre for Immunology and Infection Control, School of Biomedical Sciences, Herston, Queensland, Australia
- Metro North Hospital and Health Service, Emergency Operations Centre, Herston, Queensland, Australia
| | - Nikolaos Douladiris
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Bernadette Eberlein
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University Munich, Munich, Germany
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Anna Ehlers
- Chemical Biology and Drug Discovery, Utrecht University, Utrecht, The Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Philippe Eigenmann
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - Gabriele Gadermaier
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Francisca Gomez
- Allergy Unit IBIMA-Hospital Regional Universitario de Malaga, Malaga, Spain
- Spanish Network for Allergy research RETIC ARADyAL, Malaga, Spain
| | - Rebecca Grohman
- NYU Langone Health, Department of Internal Medicine, New York, New York, USA
| | - Carole Guillet
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christine Hafner
- Department of Dermatology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Robert G Hamilton
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Hauser
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Thomas Hawranek
- Department of Dermatology and Allergology, Paracelsus Private Medical University, Salzburg, Austria
| | - Hans Jürgen Hoffmann
- Institute for Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Tomona Iizuka
- Laboratory of Protein Science, Graduate School of Life Science, Hokkaido University, Sapporo, Japan
| | - Alain Jacquet
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thilo Jakob
- Department of Dermatology and Allergology, University Medical Center, Justus Liebig University Gießen, Gießen, Germany
| | - Bente Janssen-Weets
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
| | - Uta Jappe
- Division of Clinical and Molecular Allergology, Priority Research Area Asthma and Allergy, Research Center Borstel, Borstel, Germany
- Leibniz Lung Center, Airway Research Center North (ARCN), Member of the German Center for Lung Research, Germany
- Interdisciplinary Allergy Outpatient Clinic, Dept. of Pneumology, University of Lübeck, Lübeck, Germany
| | - Marek Jutel
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
| | - Tanja Kalic
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
- Department of Dermatology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Sandip Kamath
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Sabine Kespohl
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr- Universität Bochum, Bochum, Germany
| | - Jörg Kleine-Tebbe
- Allergy & Asthma Center Westend, Outpatient Clinic and Clinical Research Center, Berlin, Germany
| | - Edward Knol
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - André Knulst
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jon R Konradsen
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Korošec
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Annette Kuehn
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Gideon Lack
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Thuy-My Le
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Andreas Lopata
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Olga Luengo
- RETIC ARADyAL and RICORS Enfermedades Inflamatorias (REI), Madrid, Spain
- Allergy Section, Internal Medicine Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mika Mäkelä
- Division of Allergy, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Pediatric Department, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Clare Mills
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Manchester Institute of Biotechnology, The University of Manchester, Manchester, UK
| | | | - Antonella Muraro
- Food Allergy Referral Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
| | - Anna Nowak-Wegrzyn
- Division of Pediatric Allergy and Immunology, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, New York, USA
- Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Roni Nugraha
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Department of Aquatic Product Technology, Faculty of Fisheries and Marine Science, IPB University, Bogor, Indonesia
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
| | - Kati Palosuo
- Department of Allergology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Sarita Ulhas Patil
- Division of Rheumatology, Allergy and Immunology, Departments of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Allergy and Immunology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas Platts-Mills
- Division of Allergy and Clinical Immunology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Pascal Poncet
- Institut Pasteur, Immunology Department, Paris, France
- Allergy & Environment Research Team Armand Trousseau Children Hospital, APHP, Paris, France
| | - Ekaterina Potapova
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lars K Poulsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Christian Radauer
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Suzana Radulovic
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr- Universität Bochum, Bochum, Germany
| | - Pierre Rougé
- UMR 152 PharmaDev, IRD, Université Paul Sabatier, Faculté de Pharmacie, Toulouse, France
| | - Joaquin Sastre
- Allergy Service, Fundación Jiménez Díaz; CIBER de Enfermedades Respiratorias (CIBERES); Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Sakura Sato
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Enrico Scala
- Clinical and Laboratory Molecular Allergy Unit - IDI- IRCCS, Fondazione L M Monti Rome, Rome, Italy
| | - Johannes M Schmid
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Schmid-Grendelmeier
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - Denise Schrama
- Centre of Marine Sciences (CCMAR), Universidade do Algarve, Faro, Portugal
| | - Hélène Sénéchal
- Allergy & Environment Research Team Armand Trousseau Children Hospital, APHP, Paris, France
| | - Claudia Traidl-Hoffmann
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Marcela Valverde-Monge
- Allergy Service, Fundación Jiménez Díaz; CIBER de Enfermedades Respiratorias (CIBERES); Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Marianne van Hage
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kitty Verhoeckx
- Department of Immunology and Dermatology/ Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Stefan Vieths
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - Magnus Wickman
- Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Josefina Zakzuk
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia, Colombia
| | - Paolo M Matricardi
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
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Dodi G, Di Filippo P, Ciarelli F, Porreca A, Cazzato F, Matonti L, Di Pillo S, Neri G, Chiarelli F, Attanasi M. The Role of Nasal Cytology and Serum Atopic Biomarkers in Paediatric Rhinitis. Diagnostics (Basel) 2023; 13:diagnostics13030555. [PMID: 36766659 PMCID: PMC9914856 DOI: 10.3390/diagnostics13030555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
A Nasal Provocation Test allows the differentiation of allergic and non-allergic rhinitis, but it is difficult and expensive. Therefore, nasal cytology is taking hold as an alternative. We carried out a cross-sectional study, including 29 patients with persistent rhinitis according to ARIA definition and negative skin prick tests. Nasal symptoms were scored from 0 to 5 using a visual analogue scale, and patients underwent blood tests to investigate blood cell count (particularly eosinophilia and basophilia), to analyze serum total and specific IgE and eosinophil cationic protein (ECP), and to perform nasal cytology. We performed a univariate logistical analysis to evaluate the association between total serum IgE, serum eosinophilia, basophils, and ECP and the presence of eosinophils in the nasal mucosa, and a multivariate logistic model in order to weight the single variable on the presence of eosinophils to level of the nasal mucosa. A statistically significant association between serum total IgE levels and the severity of nasal eosinophilic inflammation was found (confidence interval C.I. 1.08-4.65, odds ratio OR 2.24, p value 0.03). For this reason, we imagine a therapeutic trial with nasal steroids and oral antihistamines in patients with suspected LAR and increased total IgE levels, reserving nasal cytology and NPT to non-responders to the first-line therapy.
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Affiliation(s)
- Giulia Dodi
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
- Correspondence:
| | - Paola Di Filippo
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Francesca Ciarelli
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Annamaria Porreca
- Department of Economic Studies, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Fiorella Cazzato
- Department of Otolaryngology, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Lorena Matonti
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sabrina Di Pillo
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Giampiero Neri
- Department of Otolaryngology, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Chiarelli
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Marina Attanasi
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy
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44
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Brehler R. Klinik und Diagnostik der Hausstaubmilbenallergie. ALLERGO JOURNAL 2023. [DOI: 10.1007/s15007-022-5642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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45
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Kumar R, Gaur S, Agarwal M, Menon B, Goel N, Mrigpuri P, Spalgais S, Priya A, Kumar K, Meena R, Sankararaman N, Verma A, Gupta V, Sonal, Prakash A, Safwan MA, Behera D, Singh A, Arora N, Prasad R, Padukudru M, Kant S, Janmeja A, Mohan A, Jain V, Nagendra Prasad K, Nagaraju K, Goyal M. Indian Guidelines for diagnosis of respiratory allergy. INDIAN JOURNAL OF ALLERGY, ASTHMA AND IMMUNOLOGY 2023. [DOI: 10.4103/0972-6691.367373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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46
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Jiang Z, Xiao H, Zhang H, Jia Q, Lin H, Zhang L, Lidholm J, Borres MP, Meng J, Wang L. Broussonetia papyrifera (paper mulberry) pollen is an important cause of allergic rhinitis in Southwest China. Clin Exp Allergy 2022; 52:1448-1451. [PMID: 36165984 DOI: 10.1111/cea.14236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/07/2022] [Accepted: 09/25/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Zihan Jiang
- Department of Otorhinolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Xiao
- Department of Otorhinolaryngology, West China Hospital, Sichuan University, Chengdu, China.,Allergy Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hongting Zhang
- Department of Otorhinolaryngology, West China Hospital, Sichuan University, Chengdu, China.,Allergy Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qiaoru Jia
- Department of Otorhinolaryngology, West China Hospital, Sichuan University, Chengdu, China.,Allergy Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Lin
- Department of Otorhinolaryngology, West China Hospital, Sichuan University, Chengdu, China.,Allergy Center, West China Hospital, Sichuan University, Chengdu, China
| | - Li Zhang
- Department of Otorhinolaryngology, West China Hospital, Sichuan University, Chengdu, China.,Allergy Center, West China Hospital, Sichuan University, Chengdu, China
| | | | - Magnus P Borres
- Thermo Fisher Scientific, Uppsala, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Juan Meng
- Department of Otorhinolaryngology, West China Hospital, Sichuan University, Chengdu, China.,Allergy Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lianglu Wang
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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47
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Bozek A, Kozłowska R, Misiołek M, Ścierski W, Gawlik R. Omalizumab added to allergen immunotherapy increased the effect of therapy in patients with severe local allergic rhinitis. Hum Vaccin Immunother 2022; 18:2097818. [PMID: 35816437 DOI: 10.1080/21645515.2022.2097818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Allergen immunotherapy (AIT) is effective in patient with local allergic rhinitis (LAR). However, AIT may not always achieve the optimal treatment effect. OBJECTIVE To present short study with clinical cases of LAR combined therapy with sublingual immunotherapy (SLIT) and omalizumab in patients with house dust mite (HDM) allergy and compared it to therapy with omalizumab alone. METHODS Patients with severe LAR and hypersensitivity to HDMs were included. SLIT for HDMs was launched in a perennial protocol using SQ-HDM SLIT tablets with omalizumab. The total rhinitis symptom score (TRSS), total medication score (TMS) and combined total score (CTS) were assessed after one year. RESULTS After 12 months, significant improvements in all analyzed parameters in the patients on SLIT+ omalizumab therapy were observed: a reduction in the TRSS from 1.21 ± 0.33 to 0.6 ± 0.28 (p < .05), a reduction in the TMS from 2.25 ± 1.05 to 0.88 ± 0.31 (p < .05) and a reduction in the CTS from 3.46 ± 0.57 to 1.48 ± 0.51 (p < .05). This improvement in TRSS, TMS also in CTS was significantly greater than in the rest of the group with SLIT alone or omalizumab alone. CONCLUSION Omalizumab may be a valuable treatment that increases the effectiveness of immunotherapy in patients with severe LAR.
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Affiliation(s)
- Andrzej Bozek
- Clinical Department of Internal Diseases, Dermatology and Allergology in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Renata Kozłowska
- Clinical Department of Internal Diseases, Dermatology and Allergology in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Maciej Misiołek
- Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Wojciech Ścierski
- Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Radosław Gawlik
- Clinical Department of Internal Diseases, Allergology and Clinical Immunology in Zabrze, Medical University of Silesia, Katowice, Poland
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48
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Wang C, Bao Y, Chen J, Chen X, Cheng L, Guo YS, Hao C, Lai H, Li H, Li J, Liu C, Liu Y, Liu Z, Lou H, Lv W, Nong G, Qiu Q, Ren X, Shao J, Shen YH, Shi L, Song XC, Song Y, Tang S, Wang H, Wang X, Wang X, Wang Z, Wei Q, Xie H, Xing Z, Xu R, Xu Y, Yang Q, Yao H, Ye J, You Y, Yu H, Yu Y, Zhang H, Zhang G, Zhang Y, Zhi Y, Zhou W, Zhu L, Zhu X, Chai R, Chen D, Guan K, Huang Z, Huang Y, Ma T, Ma Y, Meng Y, Ren L, Wang J, Wang N, Xian M, Xiang R, Zheng M, Zhang L. Chinese Guideline on Allergen Immunotherapy for Allergic Rhinitis: The 2022 Update. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:604-652. [PMID: 36426395 PMCID: PMC9709690 DOI: 10.4168/aair.2022.14.6.604] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/23/2022] [Accepted: 11/06/2022] [Indexed: 09/16/2023]
Abstract
In the last few decades, there has been a progressive increase in the prevalence of allergic rhinitis (AR) in China, where it now affects approximately 250 million people. AR prevention and treatment include allergen avoidance, pharmacotherapy, allergen immunotherapy (AIT), and patient education, among which AIT is the only curative intervention. AIT targets the disease etiology and may potentially modify the immune system as well as induce allergen-specific immune tolerance in patients with AR. In 2017, a team of experts from the Chinese Society of Allergy (CSA) and the Chinese Allergic Rhinitis Collaborative Research Group (C2AR2G) produced the first English version of Chinese AIT guidelines for AR. Since then, there has been considerable progress in basic research of and clinical practice for AIT, especially regarding the role of follicular regulatory T (TFR) cells in the pathogenesis of AR and the use of allergen-specific immunoglobulin E (sIgE) in nasal secretions for the diagnosis of AR. Additionally, potential biomarkers, including TFR cells, sIgG4, and sIgE, have been used to monitor the incidence and progression of AR. Moreover, there has been a novel understanding of AIT during the coronavirus disease 2019 pandemic. Hence, there was an urgent need to update the AIT guideline for AR by a team of experts from CSA and C2AR2G. This document aims to serve as professional reference material on AIT for AR treatment in China, thus improving the development of AIT across the world.
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Affiliation(s)
- Chengshuo Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases, Beijing Institute of Otorhinolaryngology, Beijing, China
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | | | - Jianjun Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Xiaoyang Chen
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospitial of Fujian Medical University, Respiratory Medicine Center of Fujian Province, Quanzhou, China
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Yin Shi Guo
- Department of Allergy & Immunology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chuangli Hao
- Department of Respiratory Diseases, Children's Hospital of Soochow University, Suzhou, China
| | - He Lai
- Department of Allergy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huabin Li
- Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Jing Li
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Changshan Liu
- Department of Pediatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yun Liu
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongfei Lou
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Lv
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Beijing, China
| | - Guangmin Nong
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qianhui Qiu
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiumin Ren
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jie Shao
- Department of Pediatrics, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Hong Shen
- Department of Respiratory Diseases, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Li Shi
- Department of Otolaryngology,The Second Hospital of Shandong University, Jinan, China
| | - Xi-Cheng Song
- Department of Otorhinolaryngology Head and Neck Surgery, Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yuxin Song
- Department of Allergy, Harbin Children's Hospital, Harbin, China
| | - Suping Tang
- Department of Allergy, Fuzhou Children's Hospital Affiliated to Fujian Medical University, Fuzhou, China
| | - Hongtian Wang
- Department of Allergy, Beijing ShiJiTan Hospital, Capital Medical University, Beijing, China
| | - Xiangdong Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases, Beijing Institute of Otorhinolaryngology, Beijing, China
| | - Xueyan Wang
- Department of Allergy, Beijing ShiJiTan Hospital, Capital Medical University, Beijing, China
| | - Zhenlin Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingyu Wei
- Department of Allergy, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hua Xie
- Department of Allergy, Northern Theatre General Hospital, Shenyang, China
| | - Zhimin Xing
- Department of Otolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Rui Xu
- Department of Allergy of Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yu Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qintai Yang
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hongmei Yao
- Department of Respiratory and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jing Ye
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yiwen You
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Hongmeng Yu
- Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yongmei Yu
- Department of Otorhinolaryngology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Huanping Zhang
- Department of Allergy, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Gehua Zhang
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yuan Zhang
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Yuxiang Zhi
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Weikang Zhou
- Department of Allergy, Chongqing General Hospital, Chongqing, China
| | - Li Zhu
- Department of Otorhinolaryngology, The Third Hospital of Peking University, Beijing, China
| | - Xinhua Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ruonan Chai
- Department of Allergy, Northern Theatre General Hospital, Shenyang, China
| | - Dehua Chen
- Department of Allergy of Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Kai Guan
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zizhen Huang
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yanran Huang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Tingting Ma
- Department of Allergy, Beijing ShiJiTan Hospital, Capital Medical University, Beijing, China
| | - Yuemei Ma
- Department of Allergy, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yifan Meng
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Lei Ren
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Jianxing Wang
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Nan Wang
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mo Xian
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rong Xiang
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ming Zheng
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
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49
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Radzikowska U, Baerenfaller K, Cornejo‐Garcia JA, Karaaslan C, Barletta E, Sarac BE, Zhakparov D, Villaseñor A, Eguiluz‐Gracia I, Mayorga C, Sokolowska M, Barbas C, Barber D, Ollert M, Chivato T, Agache I, Escribese MM. Omics technologies in allergy and asthma research: An EAACI position paper. Allergy 2022; 77:2888-2908. [PMID: 35713644 PMCID: PMC9796060 DOI: 10.1111/all.15412] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 01/27/2023]
Abstract
Allergic diseases and asthma are heterogenous chronic inflammatory conditions with several distinct complex endotypes. Both environmental and genetic factors can influence the development and progression of allergy. Complex pathogenetic pathways observed in allergic disorders present a challenge in patient management and successful targeted treatment strategies. The increasing availability of high-throughput omics technologies, such as genomics, epigenomics, transcriptomics, proteomics, and metabolomics allows studying biochemical systems and pathophysiological processes underlying allergic responses. Additionally, omics techniques present clinical applicability by functional identification and validation of biomarkers. Therefore, finding molecules or patterns characteristic for distinct immune-inflammatory endotypes, can subsequently influence its development, progression, and treatment. There is a great potential to further increase the effectiveness of single omics approaches by integrating them with other omics, and nonomics data. Systems biology aims to simultaneously and longitudinally understand multiple layers of a complex and multifactorial disease, such as allergy, or asthma by integrating several, separated data sets and generating a complete molecular profile of the condition. With the use of sophisticated biostatistics and machine learning techniques, these approaches provide in-depth insight into individual biological systems and will allow efficient and customized healthcare approaches, called precision medicine. In this EAACI Position Paper, the Task Force "Omics technologies in allergic research" broadly reviewed current advances and applicability of omics techniques in allergic diseases and asthma research, with a focus on methodology and data analysis, aiming to provide researchers (basic and clinical) with a desk reference in the field. The potential of omics strategies in understanding disease pathophysiology and key tools to reach unmet needs in allergy precision medicine, such as successful patients' stratification, accurate disease prognosis, and prediction of treatment efficacy and successful prevention measures are highlighted.
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Affiliation(s)
- Urszula Radzikowska
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland,Christine‐Kühne Center for Allergy Research and Education (CK‐CARE)DavosSwitzerland
| | - Katja Baerenfaller
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland,Swiss Institute of Bioinformatics (SIB)DavosSwitzerland
| | - José Antonio Cornejo‐Garcia
- Research LaboratoryIBIMA, ARADyAL Instituto de Salud Carlos III, Regional University Hospital of Málaga, UMAMálagaSpain
| | - Cagatay Karaaslan
- Department of Biology, Molecular Biology SectionFaculty of ScienceHacettepe UniversityAnkaraTurkey
| | - Elena Barletta
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland,Swiss Institute of Bioinformatics (SIB)DavosSwitzerland
| | - Basak Ezgi Sarac
- Department of Biology, Molecular Biology SectionFaculty of ScienceHacettepe UniversityAnkaraTurkey
| | - Damir Zhakparov
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland,Swiss Institute of Bioinformatics (SIB)DavosSwitzerland
| | - Alma Villaseñor
- Centre for Metabolomics and Bioanalysis (CEMBIO)Department of Chemistry and BiochemistryFacultad de FarmaciaUniversidad San Pablo‐CEU, CEU UniversitiesMadridSpain,Institute of Applied Molecular Medicine Nemesio Diaz (IMMAND)Department of Basic Medical SciencesFacultad de MedicinaUniversidad San Pablo CEU, CEU UniversitiesMadridSpain
| | - Ibon Eguiluz‐Gracia
- Allergy UnitHospital Regional Universitario de MálagaMálagaSpain,Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain
| | - Cristobalina Mayorga
- Allergy UnitHospital Regional Universitario de MálagaMálagaSpain,Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain,Andalusian Centre for Nanomedicine and Biotechnology – BIONANDMálagaSpain
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland,Christine‐Kühne Center for Allergy Research and Education (CK‐CARE)DavosSwitzerland
| | - Coral Barbas
- Centre for Metabolomics and Bioanalysis (CEMBIO)Department of Chemistry and BiochemistryFacultad de FarmaciaUniversidad San Pablo‐CEU, CEU UniversitiesMadridSpain
| | - Domingo Barber
- Institute of Applied Molecular Medicine Nemesio Diaz (IMMAND)Department of Basic Medical SciencesFacultad de MedicinaUniversidad San Pablo CEU, CEU UniversitiesMadridSpain
| | - Markus Ollert
- Department of Infection and ImmunityLuxembourg Institute of HealthyEsch‐sur‐AlzetteLuxembourg,Department of Dermatology and Allergy CenterOdense Research Center for AnaphylaxisOdense University Hospital, University of Southern DenmarkOdenseDenmark
| | - Tomas Chivato
- Institute of Applied Molecular Medicine Nemesio Diaz (IMMAND)Department of Basic Medical SciencesFacultad de MedicinaUniversidad San Pablo CEU, CEU UniversitiesMadridSpain,Department of Clinic Medical SciencesFacultad de MedicinaUniversidad San Pablo CEU, CEU UniversitiesMadridSpain
| | | | - Maria M. Escribese
- Institute of Applied Molecular Medicine Nemesio Diaz (IMMAND)Department of Basic Medical SciencesFacultad de MedicinaUniversidad San Pablo CEU, CEU UniversitiesMadridSpain
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50
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Price OJ, Walsted ES, Bonini M, Brannan JD, Bougault V, Carlsen K, Couto M, Kippelen P, Moreira A, Pite H, Rukhadze M, Hull JH. Diagnosis and management of allergy and respiratory disorders in sport: An EAACI task force position paper. Allergy 2022; 77:2909-2923. [PMID: 35809082 PMCID: PMC9796481 DOI: 10.1111/all.15431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 01/27/2023]
Abstract
Allergy and respiratory disorders are common in young athletic individuals. In the context of elite sport, it is essential to secure an accurate diagnosis in order to optimize health and performance. It is also important, however, to consider the potential impact or consequences of these disorders, in recreationally active individuals engaging in structured exercise and/or physical activity to maintain health and well-being across the lifespan. This EAACI Task Force was therefore established, to develop an up-to-date, research-informed position paper, detailing the optimal approach to the diagnosis and management of common exercise-related allergic and respiratory conditions. The recommendations are informed by a multidisciplinary panel of experts including allergists, pulmonologists, physiologists and sports physicians. The report is structured as a concise, practically focussed document, incorporating diagnostic and treatment algorithms, to provide a source of reference to aid clinical decision-making. Throughout, we signpost relevant learning resources to consolidate knowledge and understanding and conclude by highlighting future research priorities and unmet needs.
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Affiliation(s)
- Oliver J. Price
- School of Biomedical SciencesFaculty of Biological Sciences, University of LeedsLeedsUK
- Leeds Institute of Medical Research at St James'sUniversity of LeedsLeedsUK
| | - Emil S. Walsted
- Department of Respiratory MedicineRoyal Brompton HospitalLondonUK
- Department of Respiratory MedicineBispebjerg HospitalCopenhagenDenmark
| | - Matteo Bonini
- Fondazione Policlinico Universitario A. Gemelli – IRCCSUniversità Cattolica del Sacro CuoreRomeItaly
- National Heart and Lung Institute (NHLI)Imperial College LondonLondonUK
| | | | | | - Kai‐Håkon Carlsen
- Division of Paediatric and Adolescent MedicineOslo University HospitalOsloNorway
- Faculty of Medicine, University of OsloInstitute of Clinical MedicineOsloNorway
| | - Mariana Couto
- Allergy CenterCUF Descobertas HospitalLisbonPortugal
| | - Pascale Kippelen
- Division of Sport, Health and Exercise SciencesCollege of Health, Medicine and Life Sciences, Brunel University LondonUK
| | - André Moreira
- Centro Hospitalar Universitário de São JoãoPortoPortugal
- Epidemiology Unit (EPIUnit)Laboratory for Integrative and Translational Research in Population Health (ITR)Basic and Clinical Immunology, Department of Pathology, Faculty of MedicineUniversity of PortoPortoPortugal
| | - Helena Pite
- Allergy Center, CUF Descobertas Hospital and CUF Tejo HospitalCEDOC, NOVA University, Universidade NOVA de LisboaLisbonPortugal
| | | | - James H. Hull
- Department of Respiratory MedicineRoyal Brompton HospitalLondonUK
- Institute of Sport, Exercise and Health (ISEH)Division of Surgery and Interventional Science, University College London (UCL)LondonUK
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