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John SM, Bonertz A, Zimmer J, Aerts O, Bauer A, Bova M, Brans R, Del Giacco S, Dickel H, Corazza M, Crépy MN, Gallo R, Garcia-Abujeta JL, Giménez-Arnau AM, Klimek L, Lepoittevin JP, Ljubojević Hadžavdić S, Matura M, Mortz CG, Özkaya E, Pesonen M, Raison-Peyron N, Rustemeyer T, Skudlik C, Spiewak R, Stingeni L, Suomela S, Symanzik C, Taylor J, Torres M, Uter W, White I, Wilkinson M, Mahler V, Johansen JD. Severely compromised supply of patch test allergens in Europe hampers adequate diagnosis of occupational and non-occupational contact allergy. A European Society of Contact Dermatitis (ESCD), European Academy of Allergy and Clinical Immunology (EAACI), European Academy of Dermatology and Venereology (EADV) task forces 'Contact Dermatitis' and 'Occupational Skin Disease' position paper. Contact Dermatitis 2024; 91:91-103. [PMID: 38812248 DOI: 10.1111/cod.14580] [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: 03/01/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 05/31/2024]
Abstract
Patch testing is the only clinically applicable diagnostic method for Type IV allergy. The availability of Type IV patch test (PT) allergens in Europe, however, is currently scarce. This severely compromises adequate diagnostics of contact allergy, leading to serious consequences for the affected patients. Against this background, the European Society of Contact Dermatitis (ESCD) has created a task force (TF) (i) to explore the current availability of PT substances in different member states, (ii) to highlight some of the unique characteristics of Type IV vs. other allergens and (iii) to suggest ways forward to promote and ensure availability of high-quality patch testing substances for the diagnosis of Type IV allergies throughout Europe. The suggestions of the TF on how to improve the availability of PT allergens are supported by the ESCD, the European Academy of Allergy and Clinical Immunology, and the European Academy of Dermatology and Venereology and intend to provide potential means to resolve the present medical crisis.
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Affiliation(s)
- Swen Malte John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) and Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
| | - Andreas Bonertz
- Paul-Ehrlich-Institut, Allergology Division, Langen, Germany
| | - Julia Zimmer
- Paul-Ehrlich-Institut, Allergology Division, Langen, Germany
| | - Olivier Aerts
- University Hospital Antwerp (UZA) and University of Antwerp, Antwerp, Belgium
| | - Andrea Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Maria Bova
- Department of Internal Medicine, A.O.R.N. Antonio Cardarelli, Naples, Italy
| | - Richard Brans
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) and Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - Heinrich Dickel
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, Germany
| | - Monica Corazza
- Section of Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marie-Noëlle Crépy
- Department of Occupational and Environmental Diseases, University Hospital of Centre of Paris, Hotel-Dieu Hospital, AP-HP, Paris, France
| | - Rosella Gallo
- Section of Dermatology, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | | | - Ana Maria Giménez-Arnau
- Department of Dermatology, Hospital del Mar Research Institute, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Suzana Ljubojević Hadžavdić
- Department of Dermatology and Venereology, University Hospital Center Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Mihaly Matura
- Department of Dermatology, Skaraborg Hospital, Skövde, Sweden
| | - Charlotte Gotthard Mortz
- Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Esen Özkaya
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Maria Pesonen
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland
| | - Nadia Raison-Peyron
- Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, France
| | - Thomas Rustemeyer
- Department of Dermatology-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Christoph Skudlik
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) and Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, Krakow, Poland
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Sari Suomela
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland
| | - Cara Symanzik
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) and Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
| | - James Taylor
- Department of Dermatology, Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Maria Torres
- Allergy Unit, IBIMA-Regional University Hospital of Malaga, UMA, RETICS ARADyAL, BIONAND, Malaga, Spain
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen, Erlangen, Germany
| | - Ian White
- Department of Cutaneous Allergy, St. John's Institute of Dermatology, Guy's Hospital, London, UK
| | | | - Vera Mahler
- Paul-Ehrlich-Institut, Allergology Division, Langen, Germany
| | - Jeanne Duus Johansen
- National Allergy Research Centre, Department of Skin and Allergy, University of Copenhagen, Gentofte Hospital, Copenhagen, Denmark
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Terlouw S, van Boven FE, Borsboom‐van Zonneveld M, de Graaf‐in ’t Veld T, Gerth van Wijk R, van Daele PLA, van Maaren MS, Kuijpers JHSAM, Veenbergen S, de Jong NW. Comparison of skin prick test and prick-to-prick test with fruits and vegetables in the diagnosis of food allergy. Clin Transl Allergy 2024; 14:e12375. [PMID: 38970153 PMCID: PMC11226404 DOI: 10.1002/clt2.12375] [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: 04/09/2024] [Revised: 05/08/2024] [Accepted: 05/26/2024] [Indexed: 07/08/2024] Open
Abstract
INTRODUCTION Prick-to-prick (PTP) test with fresh food is accepted as a reliable tool for measuring sensitization to fruits and vegetables. Not all fruits and vegetables are available throughout the year. The objective of this study was to investigate whether skin prick test (SPT) performed with frozen juice of fruits and vegetables (FJFV) is a good alternative to PTP tests performed with fresh fruits and vegetables (FFV). METHODS Adult patients suspected of having a food allergy to fruits and/or vegetables were included. A questionnaire was used to score symptoms after consumption of apple, kiwi, peach, tomato, and carrot. SPTs with FJFV, and PTP tests with FFV were performed. Intra-class correlation coefficients (ICC) between the SPT and PTP test results were calculated. The sensitivity and specificity of both diagnostic tests towards food allergen specific symptoms (FASS) were calculated. RESULTS Thirty-six patients were included. FASS was positive in 75% for apple, 53% for kiwi, 44% for peach, 25% for tomato, and 22% for carrot. ICC between SPT and PTP test results were moderate for apple (0.72) and kiwi (0.71), strong for peach (0.75) and tomato (0.89), and very strong for carrot (0.94). Sensitivity was equal for the SPT and PTP tests for apple (0.93), peach (0.81), and carrot (1.00), and comparable for kiwi (0.50 resp. 0.70), and tomato (0.44 resp. 0.56). Specificity was equal for apple (0.33), peach (0.15), and carrot (0.41), and comparable for kiwi (0.29 resp. 0.21) and tomato (0.80 resp. 0.72). CONCLUSIONS Results of SPT with FJFV and PTP test with FFV are comparable. SPT with FJFV is a good alternative in the daily practice of the allergists.
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Affiliation(s)
- Severina Terlouw
- Department of AllergologyAlbert Schweitzer HospitalZwijndrechtThe Netherlands
- Internal MedicineAllergology & Clinical ImmunologyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Frank E. van Boven
- Internal MedicineAllergology & Clinical ImmunologyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | | | | | - Roy Gerth van Wijk
- Internal MedicineAllergology & Clinical ImmunologyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Paul L. A. van Daele
- Internal MedicineAllergology & Clinical ImmunologyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Maurits S. van Maaren
- Internal MedicineAllergology & Clinical ImmunologyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Jac H. S. A. M. Kuijpers
- Department of ImmunologyLaboratory Medical ImmunologyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Sharon Veenbergen
- Department of ImmunologyLaboratory Medical ImmunologyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Nicolette W. de Jong
- Internal MedicineAllergology & Clinical ImmunologyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
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Giusti D, Guemari A, Perotin JM, Fontaine JF, Tonye Libyh M, Gatouillat G, Tabary T, Pham BN, Vitte J. Molecular allergology: a clinical laboratory tool for precision diagnosis, stratification and follow-up of allergic patients. Clin Chem Lab Med 2024; 0:cclm-2024-0305. [PMID: 38815141 DOI: 10.1515/cclm-2024-0305] [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: 03/06/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024]
Abstract
Identification of the molecular culprits of allergic reactions leveraged molecular allergology applications in clinical laboratory medicine. Molecular allergology shifted the focus from complex, heterogeneous allergenic extracts, e.g. pollen, food, or insect venom, towards genetically and immunologically defined proteins available for in vitro diagnosis. Molecular allergology is a precision medicine approach for the diagnosis, stratification, therapeutic management, follow-up and prognostic evaluation of patients within a large range of allergic diseases. Exclusively available for in vitro diagnosis, molecular allergology is nonredundant with any of the current clinical tools for allergy investigation. As an example of a major application, discrimination of genuine sensitization from allergen cross-reactivity at the molecular level allows the proper targeting of the culprit allergen and thus dramatically improves patient management. This review aims at introducing clinical laboratory specialists to molecular allergology, from the biochemical and genetic bases, through immunological concepts, to daily use in the diagnosis and management of allergic diseases.
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Affiliation(s)
- Delphine Giusti
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
- University of Reims Champagne Ardenne, EA7509 IRMAIC, Reims, France
| | - Amir Guemari
- Univ Montpellier, Desbrest Institute of Epidemiology and Public Health (IDESP), INSERM, Montpellier, France
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
- University of Reims Champagne Ardenne, INSERM UMR 1250, Reims, France
| | | | - Marcelle Tonye Libyh
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
| | - Gregory Gatouillat
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
| | - Thierry Tabary
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
| | - Bach-Nga Pham
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
- University of Reims Champagne Ardenne, EA7509 IRMAIC, Reims, France
| | - Joana Vitte
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
- University of Reims Champagne Ardenne, INSERM UMR 1250, Reims, France
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Beutner C, Wrobel C, Dombrowski T, Beutner D, Forkel S, Buhl T. Inconsistent Skin Prick Tests for Allergy to Birch Homologous Trees May Result from Cross-Reacting Allergens or Technical Errors. Int Arch Allergy Immunol 2023; 184:841-848. [PMID: 37271127 DOI: 10.1159/000530201] [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: 01/31/2023] [Accepted: 03/15/2023] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION Skin prick tests (SPTs) are the gold standard for diagnosis of allergic rhinitis (AR). A decrease in the number of allergens included in standard SPT panels has recently been debated - particularly regarding the cross-reacting homologous pollen from birch, alder, and hazel trees - but has not yet been implemented in clinical guidelines. METHODS A subgroup of patients with AR (n = 69) who showed inconsistent SPT results among birch, alder, and hazel was investigated in detail. Beyond SPT, patient workup included assessment of clinical relevance and various serological parameters (total IgE, and specific IgE to birch, alder, and hazel and to Bet v 1, Bet v 2, and Bet v 4). RESULTS More than half the study group had negative SPT results for birch but positive results for alder and/or hazel, and 87% of the study group was polysensitized, showing at least one more positive SPT result for other plants. Whereas 30.4% of patients showed serological sensitization to birch pollen extract, only 18.8% displayed positive specific IgE to Bet v 1. Clinical assessment revealed that most patients with AR were polysensitized and had perennial symptoms or symptoms also occurring during times other than tree flowering times. If the SPT panel is limited to testing birch only, 52.2% of patients in this subgroup would have been overlooked. CONCLUSION Inconsistent SPT results in the birch homologous group may result from cross-reacting allergens or technical errors. If patients report convincing clinical symptoms despite negative results from a reduced SPT panel or inconsistent results for homologous allergens, SPT should be repeated, and molecular markers should be added to achieve a correct diagnosis.
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Affiliation(s)
- Caroline Beutner
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Christian Wrobel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Tobias Dombrowski
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Dirk Beutner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Susann Forkel
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
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5
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Gureczny T, Heindl B, Klug L, Wantke F, Hemmer W, Wöhrl S. Allergy screening with extract-based skin prick tests demonstrates higher sensitivity over in vitro molecular allergy testing. Clin Transl Allergy 2023; 13:e12220. [PMID: 36825518 PMCID: PMC9899493 DOI: 10.1002/clt2.12220] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/20/2022] [Accepted: 12/10/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND As extract-based skin testing as well as in vitro tests for major allergens have their own advantages, both procedures are usually performed in routine settings. In times of shortages in medical staff and supplies, we asked ourselves, how many patients would be underdiagnosed, if only one test could be used. METHODS In a retrospective analysis, we investigated a cohort of 2646 patients seen by a single physician in a large Austrian outpatient allergy clinic in 2018. Only patients with an allergen source-specific history and pairs of extract-based skin prick (SPT) and in vitro molecular allergy tests to major allergens were included. RESULTS For all tested allergen sources, sensitivity was higher for SPT than for sIgE-based molecular allergy testing. Concerning 1006 birch pollen-allergic patients, 791 (78.6%) had positive results with both tests, while 153 (15.2%) only with the SPT and 62 (6.2%) only with the sIgE to Bet v1. The other allergen sources showed similar results: For house dust mite 816/1120 (72.9%), grass pollen 1077/1416 (76.1%) and cat 433/622 (69.6%) remained test-positive with both procedures, whereas in 276 (24.6%), 224 (15.8%) and 173 (27.8%) times only the SPT and 28 (2.5%), 115 (8.1%) and 16 (2.6%) times only the sIgE to Der p1/2/23, Phl p1/5 and Fel d1 showed a positive result. Each comparison was statistically significant (each p < 0.0001, Chi-squared test). CONCLUSIONS Screening for allergy with major molecular allergens has lower sensitivity when compared with extract-based skin tests. A combination of both is required for an optimal sensitivity.
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Affiliation(s)
- Tobias Gureczny
- Floridsdorf Allergy Center (FAZ)ViennaWienAustria
- Medical University of ViennaViennaWienAustria
| | - Benjamin Heindl
- Floridsdorf Allergy Center (FAZ)ViennaWienAustria
- Medical University of ViennaViennaWienAustria
| | - Livia Klug
- Floridsdorf Allergy Center (FAZ)ViennaWienAustria
- Medical University of ViennaViennaWienAustria
| | - Felix Wantke
- Floridsdorf Allergy Center (FAZ)ViennaWienAustria
| | | | - Stefan Wöhrl
- Floridsdorf Allergy Center (FAZ)ViennaWienAustria
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Morales-Palacios MDLP, Núñez-Córdoba JM, Tejero E, Matellanes Ó, Quan PL, Carvallo Á, Sánchez-Fernández S, Urtasun M, Larrea C, Íñiguez MT, Giménez R, Goikoetxea MJ, D'Amelio CM, Ferrer M, Gastaminza G. Reliability of a novel electro-medical device for wheal size measurement in allergy skin testing: An exploratory clinical trial. Allergy 2023; 78:299-301. [PMID: 35950712 PMCID: PMC10087902 DOI: 10.1111/all.15474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/08/2022] [Accepted: 07/23/2022] [Indexed: 12/30/2022]
Affiliation(s)
| | - Jorge M Núñez-Córdoba
- Central Clinical Trials Unit, Research Support Service, Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | - Paola Leonor Quan
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Álvaro Carvallo
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Maite Urtasun
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Carla Larrea
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain
| | - María Teresa Íñiguez
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Rosa Giménez
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Maria José Goikoetxea
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain.,Spanish Research Network on Allergy RD 1600060031 (ARADyAL: Red Nacional de Alergia -Asma, Reacciones Adversas y Alérgicas) of the Carlos III Health Institute, Madrid, Spain
| | - Carmen M D'Amelio
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain.,Spanish Research Network on Allergy RD 1600060031 (ARADyAL: Red Nacional de Alergia -Asma, Reacciones Adversas y Alérgicas) of the Carlos III Health Institute, Madrid, Spain
| | - Marta Ferrer
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain.,Spanish Research Network on Allergy RD 1600060031 (ARADyAL: Red Nacional de Alergia -Asma, Reacciones Adversas y Alérgicas) of the Carlos III Health Institute, Madrid, Spain
| | - Gabriel Gastaminza
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain.,Spanish Research Network on Allergy RD 1600060031 (ARADyAL: Red Nacional de Alergia -Asma, Reacciones Adversas y Alérgicas) of the Carlos III Health Institute, Madrid, Spain
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7
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Litovkina A, Byazrova M, Smolnikov E, Nikonova A, Elisyutina O, Fedenko E, Ilina N, Akinfenwa O, Campana R, Kudlay D, Valenta R, Khaitov M. Allergic sensitization to Mal d 1 without detectable specific serum IgE. Pediatr Allergy Immunol 2022; 33:e13891. [PMID: 36564883 PMCID: PMC10107674 DOI: 10.1111/pai.13891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/02/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Alla Litovkina
- National Research Center, Institute of Immunology FMBA of Russia, Moscow, Russian Federation.,Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Maria Byazrova
- National Research Center, Institute of Immunology FMBA of Russia, Moscow, Russian Federation.,Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation.,Lomonosov Moscow State University, Moscow, Russian Federation
| | - Evgenii Smolnikov
- National Research Center, Institute of Immunology FMBA of Russia, Moscow, Russian Federation.,Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Alexandra Nikonova
- National Research Center, Institute of Immunology FMBA of Russia, Moscow, Russian Federation.,Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Olga Elisyutina
- National Research Center, Institute of Immunology FMBA of Russia, Moscow, Russian Federation.,Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Elena Fedenko
- National Research Center, Institute of Immunology FMBA of Russia, Moscow, Russian Federation
| | - Nataliya Ilina
- National Research Center, Institute of Immunology FMBA of Russia, Moscow, Russian Federation
| | - Oluwatoyin Akinfenwa
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Raffaela Campana
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Dmitry Kudlay
- National Research Center, Institute of Immunology FMBA of Russia, Moscow, Russian Federation.,Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Rudolf Valenta
- National Research Center, Institute of Immunology FMBA of Russia, Moscow, Russian Federation.,Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.,Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russian Federation.,Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Musa Khaitov
- National Research Center, Institute of Immunology FMBA of Russia, Moscow, Russian Federation.,Pirogov Russian National Research Medical University, Moscow, Russian Federation
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8
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Agache I, Antolin‐Amerigo D, Blay F, Boccabella C, Caruso C, Chanez P, Couto M, Covar R, Doan S, Fauquert J, Gauvreau G, Gherasim A, Klimek L, Lemiere C, Nair P, Ojanguren I, Peden D, Perez‐de‐Llano L, Pfaar O, Rondon C, Rukhazde M, Sastre J, Schulze J, Silva D, Tarlo S, Toppila‐Salmi S, Walusiak‐Skorupa J, Zielen S, Eguiluz‐Gracia I. EAACI position paper on the clinical use of the bronchial allergen challenge: Unmet needs and research priorities. Allergy 2022; 77:1667-1684. [PMID: 34978085 DOI: 10.1111/all.15203] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/16/2021] [Accepted: 12/27/2021] [Indexed: 12/22/2022]
Abstract
Allergic asthma (AA) is a common asthma phenotype, and its diagnosis requires both the demonstration of IgE-sensitization to aeroallergens and the causative role of this sensitization as a major driver of asthma symptoms. Therefore, a bronchial allergen challenge (BAC) would be occasionally required to identify AA patients among atopic asthmatics. Nevertheless, BAC is usually considered a research tool only, with existing protocols being tailored to mild asthmatics and research needs (eg long washout period for inhaled corticosteroids). Consequently, existing BAC protocols are not designed to be performed in moderate-to-severe asthmatics or in clinical practice. The correct diagnosis of AA might help select patients for immunomodulatory therapies. Allergen sublingual immunotherapy is now registered and recommended for controlled or partially controlled patients with house dust mite-driven AA and with FEV1 ≥ 70%. Allergen avoidance is costly and difficult to implement for the management of AA, so the proper selection of patients is also beneficial. In this position paper, the EAACI Task Force proposes a methodology for clinical BAC that would need to be validated in future studies. The clinical implementation of BAC could ultimately translate into a better phenotyping of asthmatics in real life, and into a more accurate selection of patients for long-term and costly management pathways.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine Transylvania University Brasov Romania
| | - Dario Antolin‐Amerigo
- Servicio de Alergia Hospital Universitario Ramón y Cajal Instituto Ramón y Cajal de Investigación Sanitaria Madrid Spain
| | - Frederic Blay
- ALYATEC Environmental Exposure Chamber Chest Diseases Department Strasbourg University Hospital University of Strasbourg Strasbourg France
| | - Cristina Boccabella
- Department of Cardiovascular and Thoracic Sciences Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario A. Gemelli ‐ IRCCS Rome Italy
| | | | - Pascal Chanez
- Department of Respiratory CIC Nord INSERMINRAE C2VN Aix Marseille University Marseille France
| | - Mariana Couto
- Centro de Alergia Hospital CUF Descobertas Lisboa Portugal
| | - Ronina Covar
- Pediatrics National Jewish Health Denver Colorado USA
| | | | | | - Gail Gauvreau
- Division of Respirology Department of Medicine McMaster University Hamilton Ontario Canada
| | - Alina Gherasim
- ALYATEC Environmental Exposure Chamber Strasbourg France
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Catherine Lemiere
- Research Centre Centre Intégré Universitaire de santé et de services sociaux du Nord‐de‐l'île‐de‐Montréal Montréal Quebec Canada
- Faculty of Medicine Université de Montreal Montreal Quebec Canada
| | - Parameswaran Nair
- Department of Medicine Firestone Institute of Respiratory Health at St. Joseph's Healthcare McMaster University Hamilton Ontario Canada
| | - Iñigo Ojanguren
- Departament de Medicina Servei de Pneumología Hospital Universitari Valld´Hebron Universitat Autònoma de Barcelona (UAB) Institut de Recerca (VHIR) CIBER de Enfermedades Respiratorias (CIBERES) Barcelona Spain
| | - David Peden
- Division of Pediatric Allergy and Immunology Center for Environmental Medicine, Asthma and Lung Biology The School of Medicine The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Luis Perez‐de‐Llano
- Department of Respiratory Medicine University Hospital Lucus Augusti Lugo Spain
| | - Oliver Pfaar
- Section of Rhinology and Allergy Department of Otorhinolaryngology, Head and Neck Surgery University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Carmen Rondon
- Allergy Unit Hospital Regional Universitario de Malaga Instituto de Investigacion Biomedica de Malaga (IBIMA) Malaga Spain
| | - Maia Rukhazde
- Center of Allergy & Immunology Teaching University Geomedi LLC Tbilisi Georgia
| | - Joaquin Sastre
- Allergy Unit Hospital Universitario Fundación Jiménez Díaz Center for Biomedical Network of Respiratory Diseases (CIBERES) Instituto de Salud Carlos III (ISCIII) Madrid Spain
| | - Johannes Schulze
- Department for Children and Adolescents, Division of Allergology Pulmonology and Cystic Fibrosis Goethe‐University Hospital Frankfurt am Main Germany
| | - Diana Silva
- Basic and Clinical Immunology Unit Department of Pathology Faculty of Medicine University of Porto and Serviço de Imunoalergologia Centro Hospitalar São João, EPE Porto Portugal
| | - Susan Tarlo
- Respiratory Division Department of Medicine University Health Network, Toronto Western Hospital University of Toronto Department of Medicine, and Dalla Lana Department of Public Health Toronto Ontario Canada
| | - Sanna Toppila‐Salmi
- Haartman Institute, Medicum, Skin and Allergy Hospital Hospital District of Helsinki and Uusimaa Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Jolanta Walusiak‐Skorupa
- Department of Occupational Diseases and Environmental Health Nofer Institute of Occupational Medicine Łódź Poland
| | - Stefan Zielen
- Department for Children and Adolescents, Division of Allergology Pulmonology and Cystic Fibrosis Goethe‐University Hospital Frankfurt am Main Germany
| | - Ibon Eguiluz‐Gracia
- Allergy Unit Hospital Regional Universitario de Malaga Instituto de Investigacion Biomedica de Malaga (IBIMA) Malaga Spain
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Terlouw S, van Boven FE, Borsboom-van Zonneveld M, de Graaf-in ‘t Veld C, van Splunter ME, van Daele PLA, van Maaren MS, Schreurs MWJ, de Jong NW. Homemade Food Allergen Extracts for Use in Skin Prick Tests in the Diagnosis of IgE-Mediated Food Allergy: A Good Alternative in the Absence of Commercially Available Extracts? Nutrients 2022; 14:nu14030475. [PMID: 35276832 PMCID: PMC8839075 DOI: 10.3390/nu14030475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The skin prick test (SPT) is the first step in the diagnosis of an immunoglobulin E (IgE)-mediated food allergy. The availability of commercial food allergen extracts is very limited, resulting in a need for alternative extraction methods of food allergens. The objective of this study was to compare the SPT results of homemade food allergen extracts with commercially available extracts. Methods: Adult patients with a suspected food allergy were included. Food allergen-specific symptoms were scored using a questionnaire. SPTs were performed with homemade and commercially available extracts (ALK-Abelló, Kopenhagen, Denmark) from almond, apple, hazelnut, peach, peanut, and walnut. Serum-specific IgE was measured with ISAC or ImmunoCAP™. Intra-class correlation coefficients (ICC) between the SPT results of both extract methods were calculated. The proportion of agreement with food allergen-specific symptoms was analyzed. Results: Fifty-four patients (mean age 36; range 19–69 years; female/male: 42/12) were included. The intra-class correlation coefficient (ICC) between the SPT results of both extract methods were strong for hazelnut 0.79 (n = 44) and walnut 0.78 (n = 31), moderate for apple 0.74 (n = 21) and peanut 0.66 (n = 28), and weak for almond 0.36 (n = 27) and peach 0.17 (n = 23). The proportion of agreement between SPT results and food allergen-specific symptoms was comparable for homemade and commercially available extracts, except for peach; 0.77 versus 0.36, respectively. Conclusion: In the diagnostic procedures to identify an IgE-mediated food allergy, homemade extracts from hazelnut and walnut appear to be a good alternative in the absence of commercially available food allergen extracts.
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Affiliation(s)
- Severina Terlouw
- Department of Allergology, Albert Schweitzer Hospital, 3331 LZ Zwijndrecht, The Netherlands; (M.B.-v.Z.); (C.d.G.-i.‘t.V.)
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
- Correspondence: ; Tel.: +31-640149222
| | - Frank E. van Boven
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
| | - Monika Borsboom-van Zonneveld
- Department of Allergology, Albert Schweitzer Hospital, 3331 LZ Zwijndrecht, The Netherlands; (M.B.-v.Z.); (C.d.G.-i.‘t.V.)
| | - Catharina de Graaf-in ‘t Veld
- Department of Allergology, Albert Schweitzer Hospital, 3331 LZ Zwijndrecht, The Netherlands; (M.B.-v.Z.); (C.d.G.-i.‘t.V.)
| | - Marloes E. van Splunter
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
| | - Paul L. A. van Daele
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
| | - Maurits S. van Maaren
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
| | - Marco W. J. Schreurs
- Laboratory Medical Immunology, Department of Immunology, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands;
| | - Nicolette W. de Jong
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
- Department of Pediatric Allergology, Sophia Children Hospital, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands
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10
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Zhang Y, Lan F, Zhang L. Advances and highlights in allergic rhinitis. Allergy 2021; 76:3383-3389. [PMID: 34379805 DOI: 10.1111/all.15044] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022]
Abstract
Allergic rhinitis (AR) is a growing public health, medical and economic problem worldwide. The current review describes the major discoveries related to AR during the past 2 years, including risk factors for the prevalence of AR, the corresponding diagnostic strategy, precise underlying immunological mechanisms, and efficient therapies for AR during the ongoing global "coronavirus disease 2019" (COVID-19) pandemic. The review further attempts to highlight future research perspectives. Increasing evidence suggests that environmental exposures, climate changes, and lifestyle are important risk factors for AR. Consequently, detailed investigation of the exposome and the connection between environmental exposures and health in the future should provide better risk profiles instead of single predictors, and also help mitigate adverse health outcomes in allergic diseases. Although patients with dual AR, a newly defined AR phenotype, display perennial and seasonal allergens-related nasal symptoms, they are only allergic to seasonal allergens, indicating the importance of measuring inflammation at the local sites. Herein, we suggest that a combination of precise diagnosis in local sites and traditional diagnostic methods may enhance the precision medicine-based approach for management of AR; however, this awaits further investigations. Apart from traditional treatments, social distancing, washing hands, and disinfection are also required to better manage AR patients in the ongoing global COVID-19 pandemic. Despite recent advances in understanding the immune mechanisms underlying the effects of allergen immunotherapy (AIT), further understanding changes of cell profiles after AIT and accurately evaluate the efficacy of AIT are required.
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Affiliation(s)
- Yuan Zhang
- Department of Allergy Beijing TongRen HospitalCapital Medical University Beijing China
- Beijing Key Laboratory of Nasal Diseases Beijing Institute of Otolaryngology Beijing China
- Department of Otolaryngology Head and Neck Surgery Beijing TongRen HospitalCapital Medical University Beijing China
| | - Feng Lan
- Beijing Key Laboratory of Nasal Diseases Beijing Institute of Otolaryngology Beijing China
| | - Luo Zhang
- Department of Allergy Beijing TongRen HospitalCapital Medical University Beijing China
- Beijing Key Laboratory of Nasal Diseases Beijing Institute of Otolaryngology Beijing China
- Department of Otolaryngology Head and Neck Surgery Beijing TongRen HospitalCapital Medical University Beijing China
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11
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Agache I, Palmer E, Sanver D, Kirtland M, Shamji MH. Molecular allergology approach to allergic asthma. Mol Aspects Med 2021; 85:101027. [PMID: 34579961 DOI: 10.1016/j.mam.2021.101027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 07/26/2021] [Accepted: 09/15/2021] [Indexed: 12/25/2022]
Abstract
Allergic asthma is a frequently encountered and well described asthma phenotype. However, its precise mechanisms are less known. The tools for targeted selection of patients for an optimal response to intervention (prevention or treatment) are also lacking. Here we explore the potential of the molecular allergology approach to achieve a better understanding of allergic asthma mechanisms, a precise diagnosis and an optimal management of these patients.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania.
| | - Elizabeth Palmer
- Imperial College, Faculty of Medicine, National Heart & Lung Institute, London, UK
| | - Didem Sanver
- Imperial College, Faculty of Medicine, National Heart & Lung Institute, London, UK; Necmettin Erbakan University, Engineering & Architecture Faculty, Department of Food Engineering, Konya, Turkey
| | - Max Kirtland
- Imperial College, Faculty of Medicine, National Heart & Lung Institute, London, UK
| | - Mohamed H Shamji
- Imperial College, Faculty of Medicine, National Heart & Lung Institute, London, UK
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12
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Hagemann J, Onorato GL, Jutel M, Akdis CA, Agache I, Zuberbier T, Czarlewski W, Mullol J, Bedbrook A, Bachert C, Bennoor KS, Bergmann K, Braido F, Camargos P, Caraballo L, Cardona V, Casale T, Cecchi L, Chivato T, Chu DK, Cingi C, Correia‐de‐Sousa J, Giacco S, Dokic D, Dykewicz M, Ebisawa M, El‐Gamal Y, Emuzyte R, Fauquert J, Fiocchi A, Fokkens WJ, Fonseca JA, Gemicioglu B, Gomez R, Gotua M, Haahtela T, Hamelmann E, Iinuma T, Ivancevich JC, Jassem E, Kalayci O, Kardas P, Khaitov M, Kuna P, Kvedariene V, Larenas‐Linnemann DE, Lipworth B, Makris M, Maspero JF, Miculinic N, Mihaltan F, Mohammad Y, Montefort S, Morais‐Almeida M, Mösges R, Naclerio R, Neffen H, Niedoszytko M, O’Hehir RE, Ohta K, Okamoto Y, Okubo K, Panzner P, Papadopoulos NG, Passalacqua G, Patella V, Pereira A, Pfaar O, Plavec D, Popov TA, Prokopakis EP, Puggioni F, Raciborski F, Reijula J, Regateiro FS, Reitsma S, Romano A, Rosario N, Rottem M, Ryan D, Samolinski B, Sastre J, Solé D, Sova M, Stellato C, Suppli‐Ulrik C, Tsiligianni I, Valero A, Valiulis A, Valovirta E, Vasankari T, Ventura MT, Wallace D, Wang DY, Williams S, Yorgancioglu A, Yusuf OM, Zernotti M, Bousquet J, Klimek L. Differentiation of COVID-19 signs and symptoms from allergic rhinitis and common cold: An ARIA-EAACI-GA 2 LEN consensus. Allergy 2021; 76:2354-2366. [PMID: 33730365 PMCID: PMC8250633 DOI: 10.1111/all.14815] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
Background Although there are many asymptomatic patients, one of the problems of COVID‐19 is early recognition of the disease. COVID‐19 symptoms are polymorphic and may include upper respiratory symptoms. However, COVID‐19 symptoms may be mistaken with the common cold or allergic rhinitis. An ARIA‐EAACI study group attempted to differentiate upper respiratory symptoms between the three diseases. Methods A modified Delphi process was used. The ARIA members who were seeing COVID‐19 patients were asked to fill in a questionnaire on the upper airway symptoms of COVID‐19, common cold and allergic rhinitis. Results Among the 192 ARIA members who were invited to respond to the questionnaire, 89 responded and 87 questionnaires were analysed. The consensus was then reported. A two‐way ANOVA revealed significant differences in the symptom intensity between the three diseases (p < .001). Conclusions This modified Delphi approach enabled the differentiation of upper respiratory symptoms between COVID‐19, the common cold and allergic rhinitis. An electronic algorithm will be devised using the questionnaire.
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Affiliation(s)
- Jan Hagemann
- Department of Otolaryngology, Head and Neck Surgery Universitätsmedizin Mainz Mainz Germany
| | | | - Marek Jutel
- Department of Clinical Immunology Wrocław Medical University Wroclaw Poland
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | | | - Torsten Zuberbier
- Comprehensive Allergy Center Department of Dermatology and Allergy Charité, Universitätsmedizin Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - Joaquim Mullol
- Rhinology Unit & Smell Clinic ENT Department Hospital Clínic; Clinical & Experimental Respiratory Immunoallergy IDIBAPS CIBERES University of Barcelona Barcelona Spain
| | - Anna Bedbrook
- MACVIA‐France Montpellier France
- MASK‐air Montpellier France
| | - Claus Bachert
- Upper Airways Research Laboratory ENT Department Ghent University Hospital Ghent Belgium
- Sun Yat‐sen University International Airway Research Center First Affiliated Hospital Guangzou Guangzou China
- Division of ENT Diseases CLINTEC, Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
| | - Kazi S. Bennoor
- Department of Respiratory Medicine National Institute of Diseases of the Chest and Hospital Dhaka Bangladesh
| | - Karl‐Christian Bergmann
- Comprehensive Allergy Center Department of Dermatology and Allergy Charité, Universitätsmedizin Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Fulvio Braido
- Department of Internal Medicine (DiMI) and IRCCS Ospedale Policlinico San Martino University of Genoa Genoa Italy
| | - Paulo Camargos
- Department of Pediatrics Federal University of Minas Gerais Medical School Belo Horizonte Brazil
| | - Luis Caraballo
- Institute for Immunological Research University of Cartagena Campus de Zaragocilla, Edificio Biblioteca Primer piso Cartagena Colombia
- Foundation for the Development of Medical and Biological Sciences (Fundemeb) Cartagena Colombia
| | - Victoria Cardona
- Allergy Section Department of Internal Medicine Hospital Vall d'Hebron & ARADyAL Research Network Barcelona Spain
| | - Thomas Casale
- Division of Allergy/immunology University of South Florida Tampa FL USA
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology USL Toscana Centro Prato Italy
| | - Tomas Chivato
- School of Medicine University CEU San Pablo Madrid Spain
| | - Derek K. Chu
- Departments of Medicine and Health Research Methods Evidence & Impact McMaster University Hamilton ON Canada
| | - Cemal Cingi
- ENT Department Medical Faculty Eskisehir Osmangazi University Eskisehir Turkey
| | - Jaime Correia‐de‐Sousa
- Life and Health Sciences Research Institute (ICVS School of Medicine University of Minho Braga Portugal
- PT Government Associate Laboratory Braga/Guimarães Portugal
- International Primary Care Respiratory Group IPCRG London UK
| | - Stefano Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology University Hospital ‘Duilio Casula’ University of Cagliari Cagliari Italy
| | - Dejan Dokic
- University Clinic of Pulmology and Allergy Medical Faculty Skopje Skopje Republic of Macedonia
| | - Mark Dykewicz
- Section of Allergy and Immunology Saint Louis University School of Medicine Saint Louis MO USA
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology NHO Sagamihara National Hospital Sagamihara Japan
| | - Yehia El‐Gamal
- Pediatric Allergy and Immunology Unit Children's hospital Ain Shams University Cairo Egypt
| | - Regina Emuzyte
- Clinic of Children's Diseases Institute of Clinical Medicine Faculty of Medicine Vilnius University Vilnius Lithuania
| | - Jean‐Luc Fauquert
- CHU Clermont‐Ferrand Unité d'Allergologie de l'Enfant Pole pédiatrique Hopital Estaing Clermont‐Ferrand France
| | - Alessandro Fiocchi
- Division of Allergy Department of Pediatric Medicine The Bambino Gesù Children's Research Hospital Holy see IRCCS Rome Italy
| | - Wytske J. Fokkens
- Department of Otorhinolaryngology Academic Medical Centers AMC Amsterdam The Netherlands
- EUFOREA Brussels Belgium
| | - Joao A. Fonseca
- CINTESIS Center for Health Technology and Services Research Faculdade de Medicina Universidade do Porto Porto Portugal
- Allergy Unit CUF Porto Porto Portugal
| | - Bilun Gemicioglu
- Department of Pulmonary Diseases Istanbul University‐Cerrahpasa Cerrahpasa Faculty of Medicine Istanbul Turkey
| | | | - Maia Gotua
- Center of Allergy and Immunology Georgian Association of Allergology and Clinical Immunology Tbilisi Georgia
| | - Tari Haahtela
- Skin and Allergy Hospital Helsinki University Hospital Helsinki Finland
| | - Eckard Hamelmann
- University Hospital Bielefeld Children's Center Bethel, EvKB Bielefeld Germany
| | - Tomohisa Iinuma
- Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
| | | | - Ewa Jassem
- Department of Allergology Medical University of Gdańsk Gdansk Poland
| | - Omer Kalayci
- Pediatric Allergy and Asthma Unit Hacettepe University School of Medicine Ankara Turkey
| | - Przemyslaw Kardas
- Department of Family Medicine Medical University of Lodz Lodz Poland
| | - Musa Khaitov
- National Research Center Institute of Immunology Federal Medicobiological Agency Laboratory of Molecular Immunology Moscow Russian Federation
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy Barlicki University Hospital Medical University of Lodz Lodz Poland
| | - Violeta Kvedariene
- Department of Pathology Faculty of Medicine Institute of Biomedical Sciences Vilnius University and Institute of Clinical Medicine Clinic of Chest Diseases and Allergology Faculty of Medicine Vilnius University Vilnius Lithuania
| | | | - Brian Lipworth
- Scottish Centre for Respiratory Research Cardiovascular & Diabetes Medicine Medical Research Institute Ninewells Hospital University of Dundee Dundee UK
| | - Michael Makris
- Allergy Unit ‘D Kalogeromitros’ 2nd Department of Dermatology and Venereology National & Kapodistrian University of Athens ‘Attikon’ University Hospital Athens Greece
| | - Jorge F. Maspero
- Argentine Association of Allergy and Clinical Immunology Buenos Aires Argentina
| | | | | | - Yousser Mohammad
- National Center for Research in Chronic Respiratory Diseases Tishreen University School of Medicine Latakia and Syrian Private University‐Damascus Damascus Syria
| | - Stephen Montefort
- Respiratory Physician Mater Dei Hospital Malta Medicine University of Malta Faculty of Medicine and Surgery University of Medicine La Valette Malta
| | | | - Ralph Mösges
- CRI‐Clinical Research International‐Ltd Hamburg Germany
| | | | - Hugo Neffen
- Center of Allergy Immunology and Respiratory Diseases Santa Fe Argentina
| | - Marek Niedoszytko
- Department of Allergology Medical University of Gdańsk Gdansk Poland
| | - Robyn E. O’Hehir
- Department of Allergy, Immunology and Respiratory Medicine Alfred Hospital and Central Clinical School Monash University Melbourne Vic. Australia
- Department of Immunology Monash University Melbourne Vic. Australia
| | - Ken Ohta
- National Hospital Organization Tokyo National Hospital Tokyo Japan
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
| | - Kimi Okubo
- Department of Otolaryngology Nippon Medical School Tokyo Japan
| | - Petr Panzner
- Department of Immunology and Allergology Faculty of Medicine and Faculty Hospital in Pilsen Charles University in Prague Pilsen Czech Republic
| | - Nikolaos G. Papadopoulos
- Division of Infection Immunity & Respiratory Medicine Royal Manchester Children's Hospital University of Manchester Manchester UK
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases Ospedale Policlino San Martino ‐University of Genoa Genoa Italy
| | - Vincenzo Patella
- Division of Allergy and Clinical Immunology Department of Medicine Agency of Health ASL Salerno, ‘Santa Maria della Speranza’ Hospital Salerno Italy
| | - Ana Pereira
- Center for Research in Health Technologies and Information Systems‐ CINTESIS University of Porto Porto Portugal
- Allergy Unit Instituto CUF Porto and Hospital CUF Porto Porto Portugal
- Department of Community Medicine Health Information and Decision ‐ MEDCIDsS Faculty of Medicina University of Porto Porto Portugal
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Davor Plavec
- Children's Hospital Srebrnjak Zagreb, School of Medicine University J.J. Strossmayer Osijek Croatia
| | | | - Emmanuel P. Prokopakis
- Department of Otorhinolaryngology University of Crete School of Medicine Heraklion Greece
| | - Francesca Puggioni
- Personalized Medicine Clinic Asthma & Allergy Humanitas Clinical and Research Center IRCCS Rozzano, and Department of Biomedical Sciences Humanitas University Pieve Emanuele Milan Italy
| | - Filip Raciborski
- Department of Prevention of Environmental Hazards and Allergology Medical University of Warsaw Warsaw Poland
| | - Jere Reijula
- Department of Pulmonology Helsinki University Central Hospital Helsinki, Department of Public Health University of Helsinki Helsinki Finland
| | - Frederico S. Regateiro
- Allergy and Clinical Immunology Unit Centro Hospitalar e Universitário de Coimbra Coimbra and Institute of Immunology Faculty of Medicine University of Coimbra Coimbra Portugal
| | - Sietze Reitsma
- Department of Otorhinolaryngology Amsterdam University Medical Centres AMC Amsterdam The Netherlands
| | - Antonino Romano
- Oasi Research Institute‐IRCCS Troina Italy
- bFondazione Mediterranea GB Morgagni Catania Italy
| | - Nelson Rosario
- Hospital de Clinicas University of Parana Curitiba Brazil
| | - Menachem Rottem
- Division of Allergy Asthma and Clinical Immunology Emek Medical Center Afula Israel
| | - Dermot Ryan
- Usher Institute University of Edinburgh Edinburgh UK
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards and Allergology Medical University of Warsaw Warsaw Poland
| | - Joaquin Sastre
- Fundacion Jimenez Diaz CIBERES Faculty of Medicine Autonoma University of Madrid Madrid Spain
| | - Dirceu Solé
- Division of Allergy Clinical Immunology and Rheumatology Department of Pediatrics Federal University of São Paulo São Paulo Brazil
| | - Milan Sova
- Department of Respiratory Medicine University Hospital Olomouc Olomouc Czech Republic
| | - Cristiana Stellato
- Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’ University of Salerno Salerno Italy
| | - Charlotte Suppli‐Ulrik
- Department of Respiratory Medicine Copenhagen University Hospital‐Hvidovre, and Institute of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Ioanna Tsiligianni
- Health Planning Unit Department of Social Medicine Faculty of Medicine University of Crete Greece and International Primary Care Respiratory Group IPCRG Aberdeen Scotland
| | - Antonio Valero
- Pneumology and Allergy Department CIBERES and Clinical & Experimental Respiratory Immunoallergy IDIBAPS University of Barcelona Barcelona Spain
| | - Arunas Valiulis
- Vilnius University Faculty of Medicine Institute of Clinical Medicine & Institute of Health Sciences Vilnius Lithuania
- European Academy of Paediatrics (EAP/UEMS‐SP) Brussels Belgium
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Immunology University of Turku and Terveystalo allergy clinic Turku Finland
| | - Tuula Vasankari
- Filha, Finnish Lung Health Association Helsinki Finland
- University of Turku Turku Finland
| | - Maria Teresa Ventura
- University of Bari Medical School Unit of Geriatric Immunoallergology Bari Italy
| | - Dana Wallace
- Nova Southeastern University Fort Lauderdale FL USA
| | - De Yun Wang
- Department of Otolaryngology Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Siân Williams
- International Primary Care Respiratory Group IPCRG London UK
| | | | | | - Mario Zernotti
- Universidad Católica de Córdoba Universidad Nacional de Villa Maria Córdoba Argentina
| | - Jean Bousquet
- MACVIA‐France Montpellier France
- Comprehensive Allergy Center Department of Dermatology and Allergy Charité, Universitätsmedizin Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- University Hospital Montpellier Montpellier France
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery Universitätsmedizin Mainz Mainz Germany
- Center for Rhinology and Allergology Wiesbaden Germany
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13
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Abstract
Diagnostics in type-1 allergy rely on medical history and clinical examination. Extent and severity of signs and symptoms can be documented by standardized scores and questionnaires. Both skin prick test and intradermal test are useful for search of immunoglobulin E-mediated sensitizations but the availability of commercially available diagnostic extracts has been markedly reduced during the last years. Investigation of total and of specific serum IgE is the most important in vitro diagnostic analyte in type-1 allergy. Identification of the individual molecules to which patients are sensitized, known as molecular or component-resolved diagnostics (CRD), has recently markedly improved management of type-1 allergy to pollen, food and hymenoptera venoms. Main features of CRD are increased analytic sensitivity, detection of cross-reactivity and determination of individual sensitization profiles which allow for risk assessment and facilitate decisions for or against allergen immunotherapy. Basophil activation test as well as determination of selected biomarkers (e.g. tryptase) may also be helpful in some cases. If any allergy test is positive, one will have to distinguish reactions, which are clinically relevant, from those, which are not. In vivo provocation tests (e.g. nasal provocation, oral drug or food challenge) may help to clarify the relevance of a sensitization.
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Affiliation(s)
- Regina Treudler
- Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Allergy Centre - Comprehensive Allergy Centre, University Medicine Leipzig, Leipzig, Germany.
| | - Jan-Christoph Simon
- Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Allergy Centre - Comprehensive Allergy Centre, University Medicine Leipzig, Leipzig, Germany
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14
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Ebo DG, Decuyper II, Rihs HP, Mertens C, Van Gasse AL, van der Poorten MLM, De Puysseleyr L, Faber MA, Hagendorens MM, Bridts CH, Sabato V, Elst J. IgE-binding and mast cell–activating capacity of the homologue of the major birch pollen allergen and profilin from Cannabis sativa. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2509-2512.e3. [DOI: 10.1016/j.jaip.2021.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 01/01/2023]
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15
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Mahler V. [New allergens for occupational dermatology?]. Hautarzt 2021; 72:474-483. [PMID: 33950272 DOI: 10.1007/s00105-021-04825-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The environment is continuously subject to change. Exposures in the work environment and therefore the importance of occupational type I and type IV allergens may change. OBJECTIVES The most important trends concerning occupational allergens, new occupational allergens/allergen exposures, the diagnostic procedure to detect new allergens in practice and regulatory developments are presented. MATERIALS AND METHODS Building on known relevant allergen exposures in occupational dermatology, published trends from clinical cohorts are evaluated and a systematic literature search (PubMed 2016-2021) for new occupational allergens is also performed RESULTS: Occupations with the highest incidence of occupational allergic contact urticaria and/or protein contact dermatitis include bakers, farmers and farm workers, veterinary technicians, veterinarians, cooks, dairy and livestock workers, gardeners, and hairdressers. The highest risk of developing occupational contact dermatitis is in health care, agriculture, metalworking occupations and machine operators, the food sector, service industries, and construction occupations. The search strategy "new occupational allerg*" yielded 603 hits and "novel occupational allerg*" 158 hits. A total of 25 papers included results relevant to the research question and were processed. New protein-based immediate-type allergens, as well as contact allergens (haptens) relevant for occupational dermatology, are presented. CONCLUSIONS Current trends on known occupational allergens and new occupational allergens in the period 2016-2021 can be identified. Only a thorough individual workplace history and testing of patients' own materials can identify new allergens in occupational dermatology.
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Affiliation(s)
- Vera Mahler
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, 63225, Langen, Deutschland. .,Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Deutschland.
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16
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Reaction frequency to the skin prick test of inhalant and food allergens in children. North Clin Istanb 2021; 8:275-279. [PMID: 34222809 PMCID: PMC8240235 DOI: 10.14744/nci.2020.46656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/27/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE: When applied by well-trained personnel, skin prick test (SPT) for a variety of inhalant and/or food allergens is a safe procedure although it may rarely cause systemic reaction. In this article, our aim was to evaluate the reactions after SPTs for the past 6 years in Turkish children having various allergic symptoms brought to our clinic. METHODS: The results of the SPTs, performed between May 2013 and March 2019, of 12.529 patients whose ages vary from 2 months to 18 years have been retrospectively evaluated. RESULTS: The average age of the patients who were included in this study was 6.12±4.38 years and 46.4% of them were female. When the patients were categorized according to the diagnosis, it was observed that 4.858 of them with symptoms suggesting asthma; 2.720 of them having symptoms suggesting allergic rhinitis; 1.795 of them having rashes; 906 of them with atopic dermatitis; 352 of them having symptoms suggesting food allergy and the remaining 1.898 with symptoms suggesting various diagnoses. In this study, which reflects our 6-year experience from the results of 12.529 patients, post-SPT reactions have been observed in 9 out of 12.529 patients (0.07%). They were three females and six males. These reactions were observed in 3 eczemas, 2 urticaria, 2 allergic rhinitis, and 2 suggested diagnosis of asthma patients. Their mean age was 5.9±3.5 years. SPT reactions were mostly seen in our five patients having skin disorder (eczema and rashes). The most frequent symptom of vasovagal reaction was syncope, occuring between 1 and 20 min after SPT, in eight of nine patients. CONCLUSION: During our study, any systemic reaction or anaphylaxis to SPT was not observed. The non-systemic reaction (vasovagal reaction) rate was 7/10.000, similar to the literature.
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Huang HJ, Campana R, Akinfenwa O, Curin M, Sarzsinszky E, Karsonova A, Riabova K, Karaulov A, Niespodziana K, Elisyutina O, Fedenko E, Litovkina A, Smolnikov E, Khaitov M, Vrtala S, Schlederer T, Valenta R. Microarray-Based Allergy Diagnosis: Quo Vadis? Front Immunol 2021; 11:594978. [PMID: 33679689 PMCID: PMC7928321 DOI: 10.3389/fimmu.2020.594978] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/08/2020] [Indexed: 12/24/2022] Open
Abstract
More than 30% of the world population suffers from allergy. Allergic individuals are characterized by the production of immunoglobulin E (IgE) antibodies against innocuous environmental allergens. Upon allergen recognition IgE mediates allergen-specific immediate and late-phase allergic inflammation in different organs. The identification of the disease-causing allergens by demonstrating the presence of allergen-specific IgE is the key to precision medicine in allergy because it allows tailoring different forms of prevention and treatment according to the sensitization profiles of individual allergic patients. More than 30 years ago molecular cloning started to accelerate the identification of the disease-causing allergen molecules and enabled their production as recombinant molecules. Based on recombinant allergen molecules, molecular allergy diagnosis was introduced into clinical practice and allowed dissecting the molecular sensitization profiles of allergic patients. In 2002 it was demonstrated that microarray technology allows assembling large numbers of allergen molecules on chips for the rapid serological testing of IgE sensitizations with small volumes of serum. Since then microarrayed allergens have revolutionized research and diagnosis in allergy, but several unmet needs remain. Here we show that detection of IgE- and IgG-reactivity to a panel of respiratory allergens microarrayed onto silicon elements is more sensitive than glass-based chips. We discuss the advantages of silicon-based allergen microarrays and how this technology will allow addressing hitherto unmet needs in microarray-based allergy diagnosis. Importantly, it described how the assembly of silicon microarray elements may create different microarray formats for suiting different diagnostic applications such as quick testing of single patients, medium scale testing and fully automated large scale testing.
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Affiliation(s)
- Huey-Jy Huang
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Raffaela Campana
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Oluwatoyin Akinfenwa
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Mirela Curin
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Eszter Sarzsinszky
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Antonina Karsonova
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ksenja Riabova
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alexander Karaulov
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Katarzyna Niespodziana
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Olga Elisyutina
- Department of Allergology and Clinical Immunology, NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Elena Fedenko
- Department of Allergology and Clinical Immunology, NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Alla Litovkina
- Department of Allergology and Clinical Immunology, NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Evgenii Smolnikov
- Department of Allergology and Clinical Immunology, NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Musa Khaitov
- Department of Allergology and Clinical Immunology, NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Susanne Vrtala
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Thomas Schlederer
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.,Laboratory of Immunopathology, Department of Clinical Immunology and Allergology, Sechenov First Moscow State Medical University, Moscow, Russia.,Department of Allergology and Clinical Immunology, NRC Institute of Immunology FMBA of Russia, Moscow, Russia.,Karl Landsteiner University of Health Sciences, Krems, Austria
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Abstract
Allergic rhinitis (AR) is caused by immunoglobulin E (IgE)-mediated reactions to inhaled allergens and is one of the most common chronic conditions globally. AR often co-occurs with asthma and conjunctivitis and is a global health problem causing major burden and disability worldwide. Risk factors include inhalant and occupational allergens, as well as genetic factors. AR impairs quality of life, affects social life, school and work, and is associated with substantial economic costs. The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative classified AR into intermittent or persistent and mild or moderate/severe. The diagnosis is based on the clinical history and, if needed in patients with uncontrolled rhinitis despite medications or with long-lasting symptoms, on skin tests or the presence of serum-specific IgE antibodies to allergens. The most frequently used pharmacological treatments include oral, intranasal or ocular H1-antihistamines, intranasal corticosteroids or a fixed combination of intranasal H1-antihistamines and corticosteroids. Allergen immunotherapy prescribed by a specialist using high-quality extracts in stratified patients is effective in patients with persistent symptoms. Real-world data obtained by mobile technology offer new insights into AR phenotypes and management. The outlook for AR includes a better understanding of novel multimorbid phenotypes, health technology assessment and patient-centred shared decision-making.
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New guidance on the regulation of allergen products: key aspects and outcomes. Curr Opin Allergy Clin Immunol 2020; 20:624-630. [PMID: 32826400 DOI: 10.1097/aci.0000000000000687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Key aspects and outcomes from the recently published guidance on the regulation of allergen products are summarized. RECENT FINDINGS A new regulatory guideline has been published to enhance harmonized national approaches on the regulation of allergen products and thereby strengthen the availability of high-quality products across the European Union (EU). As the guideline was developed, critical aspects for allergen products regulation were identified and are discussed in the document, including recommendations on the regulatory procedures to be applied for diagnostics, allergen immunotherapy products and named-patient products. SUMMARY The new guidance is expected to provide clarifications on and support harmonization of the regulation of allergen products in the EU.
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Does the principle of homologous groups allow a reduction of allergens in the skin prick test panel? Eur Arch Otorhinolaryngol 2020; 278:117-125. [PMID: 32767165 DOI: 10.1007/s00405-020-06264-5] [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] [Received: 06/04/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Regulatory and economic conditions drive the application of the concept of homologous groups on therapeutic and diagnostic formulations. In this context, a possible reduction of allergens in the skin prick test panel in the clinical routine should be investigated for the grass, birch and Dermatophagoides homologous group. METHODS Grass and cultivated rye skin prick test results of 1101 patients, birch/hazel/alder skin prick test results of 1131 patients and 1068 Dermatophagoides pteronyssinus and farinae skin prick tests were retrospectively evaluated with regard to sensitivity and false-negative rate detecting sensitization against cultivated rye with grass skin prick test, sensitization against hazel and/or alder with birch skin prick test and sensitization towards Dermatophagoides farinae with Dermatophagoides pteronyssinus skin prick test. RESULTS Skin prick test results in all groups highly correlated in Spearman Rank Order correlation. Sensitivity of grass skin prick test detecting sensitization against cultivated rye was highest with 98.9%, sensitivity of birch skin prick test detecting sensitization toward hazel and alder was 95.6 and 90.0%, respectively. Sensitivity of skin prick test with Dermatophagoides pteronyssinus detecting sensitization towards Dermatophagoides farinae was 93.6%. Only 26 patients with positive rye, hazel, alder or Dermatophagoides farinae skin prick test that were overlooked by grass, birch or Dermatophagoides pteronyssinus skin prick test reported allergic symptoms. CONCLUSION In routine clinical practice, sensitization against cultivated rye can safely be detected by skin prick test with grass allergen. In addition, the sensitivity of birch skin prick test is high in terms of sensitization towards hazel, but lower for alder. Sensitivity of Dermatophagoides pteronyssinus skin prick test also is high to detect sensitization towards Dermatophagoides farinae. Further research will indicate if several skin prick test allergens will disappear and be completely replaced by a single skin prick test based on the principle of homologous groups.
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