Search

Aim: Environmental features can act as selection pressures and barriers to gene flow between populations. The genetic structuring of highly mobile but philopatric seabirds creates a paradox, and the role of oceanographic and geographic variables is still poorly understood. In this study, we investigate the influence of environmental and geographic variables in the genetic and phenotypic diversity of a pantropical seabird breeding in islands and archipelagos separated by different geographic distances, up to thousand kilometres, and which differ in environmental characteristics. Location: Islands and archipelagos in the southwestern (SW) Atlantic Ocean. Taxon: Sula dactylatra, Lesson, 1831 (masked booby). Methods: The population structure of the species was accessed through mitochondrial and nuclear DNA. To test Isolation by Environment (IBE) versus by Distance (IBD), sea surface temperature, primary productivity and salinity, as well as isotopic niche based on carbon and nitrogen, and distances between colonies and from the continent, were used. We also tested the correlation between the genetic structure and the morphometry of individuals in each colony. Results: We uncover the presence of low genetic structure between populations. Nevertheless, differences were identified between inshore and offshore colonies, with the influence of landscape characteristics of these two types of environment. The morphometric and isotopic niche variations are consistent with this segregation. Main Conclusions: Environmental variables of coastal and oceanic environments seem to influence the genetic structure of masked boobies, even though it is low in the SW Atlantic Ocean, highlighting the role of environmental heterogeneity in shaping biodiversity. [ABSTRACT FROM AUTHOR]

In this review, we compare different refractory anaphylaxis (RA) management guidelines focusing on cardiovascular involvement and best practice recommendations, discuss postulated pathogenic mechanisms underlining RA and highlight knowledge gaps and research priorities. There is a paucity of data supporting existing management guidelines. Therapeutic recommendations include the need for the timely administration of appropriate doses of aggressive fluid resuscitation and intravenous (IV) adrenaline in RA. The preferred second‐line vasopressor (noradrenaline, vasopressin, metaraminol and dopamine) is unknown. Most guidelines recommend IV glucagon for patients on beta‐blockers, despite a lack of evidence. The use of methylene blue or extracorporeal life support (ECLS) is also suggested as rescue therapy. Despite recent advances in understanding the pathogenesis of anaphylaxis, the factors that lead to a lack of response to the initial adrenaline and thus RA are unclear. Genetic factors, such as deficiency in platelet activating factor‐acetyl hydrolase or hereditary alpha‐tryptasaemia, mastocytosis may modulate reaction severity or response to treatment. Further research into the underlying pathophysiology of RA may help define potential new therapeutic approaches and reduce the morbidity and mortality of anaphylaxis. [ABSTRACT FROM AUTHOR]

This article discusses the need for a comprehensive and efficient cost tool to measure the financial burden of food allergy on households. The current tool, the Food Allergy Economic Questionnaire (FA-EcoQ), has limitations such as its length and lack of questions on economic precarity. To address these limitations, the authors propose conducting a scoping review to evaluate and compare different questionnaires assessing the household financial costs of food allergy. The review will include studies that focus on the development, validation, reliability, or applicability of questionnaires specifically designed to measure the household cost of food allergy. The findings from this review will help inform the selection of a food allergy cost questionnaire and highlight gaps and limitations in existing cost measures. [Extracted from the article]

Objective: Analysis of postmortem multiple sclerosis (MS) tissues combined with in vivo disease milestones suggests that whereas perivascular white matter infiltrates are associated with demyelinating activity in the initial stages, leptomeningeal immune cell infiltration, enriched in B cells, and associated cortical lesions contribute to disease progression. We systematically examine the association of inflammatory features and white matter demyelination at postmortem with clinical milestones. Methods: In 269 MS brains, 20 sites were examined using immunohistochemistry for active lesions (ALs) and perivenular inflammation (PVI). In a subset of 22, a detailed count of CD20+ B cells and CD3+ T cells in PVIs was performed. Results: ALs were detected in 22%, whereas high levels of PVI were detected in 52% of cases. ALs were present in 35% of cases with high levels of PVI. Shorter time from onset of progression to death was associated with increased prevalence and higher levels of PVI (both p < 0.0001). Shorter time from onset of progression to wheelchair use was associated with higher prevalence of ALs (odds ratio [OR] = 0.921, 95% confidence interval [CI] = 0.858–0.989, p = 0.0230) and higher level of PVI (OR = 0.932, 95% CI = 0.886–0.981, p = 0.0071). High levels of PVI were associated with meningeal inflammation and increased cortical demyelination and significantly higher levels of B lymphocytes within the PVI. Interpretation: ALs, a feature of early disease stage, persist up to death in a subgroup with high levels of PVI. These features link to a rapid progressive phase and higher levels of meningeal inflammation and B‐cell infiltrates, supporting the hypothesis that chronic inflammation drives progression in MS. ANN NEUROL 2024;95:706–719 [ABSTRACT FROM AUTHOR]

Background: The 2014 estimates of prevalence of food allergy (FA) in Europe published by the European Academy of Allergy and Clinical Immunology included only the eight so‐called big foods (cow's milk/egg/wheat/soy/peanut/tree nuts/fish/shellfish). Those estimates have recently been updated. Complementing this, we sought to identify and estimate the prevalence of allergy to other foods that have been reported during the last decade. Methods: Six databases were searched for studies published 2012–2021. Random‐effects meta‐analysis was performed to derive pooled prevalence of allergy to each food. Results: Twenty‐seven studies were included, containing a total of 66 FAs. Among the most frequently reported FAs, the lifetime and point prevalence range of self‐reported kiwi allergy was 0.1%–1.0% and 0.2%–8.1%, respectively, while the food challenge (FC)‐verified kiwi allergy point prevalence range was 0.01%–0.10%. The point prevalence range for self‐reported peach allergy was 0.2%–3.2%, while the range for FC‐verified peach allergy was 0.02%–0.05%. The lifetime and point prevalence range for self‐reported tomato allergy was 0.01%–1.8% and 0.2%–2.1%, respectively. Conclusion: Allergy to some foods traditionally not considered important are now emerging as relevant FAs. The focus on FA in Europe should not be limited to the so‐called eight big FA, but extended to other types of foods which need to be considered both for clinical purposes and population risk assessment. [ABSTRACT FROM AUTHOR]

In 2014, the European Academy of Allergy and Clinical Immunology (EAACI) published the first systematic review that summarized the prevalence of food allergy (FA) and food sensitization in Europe for studies published 2000–2012. However, only summary estimates for tree nut allergy (TNA) were feasible in that work. In the current update of that systematic review, we summarized the prevalence of tree nut allergy/sensitization to individual tree nuts. Six databases were searched for relevant papers published 2012–2021 and 17 eligible studies were added to the 15 studies already identified between 2000 and 2012, giving a total of 32 studies. Of the investigated tree nuts, meta‐analysis was possible for hazelnut, walnut, almond, and in few cases, for cashew, and Brazil nut. The lifetime self‐reported prevalence was 0.8% (95% CI 0.5–1.1) for hazelnut and 0.4% (0.2–0.9) for walnut. The point self‐reported prevalence was 4.0% (2.9–5.2) for hazelnut, 3.4% (2.0–4.9) for Brazil nut, 2.0% (1.1–2.9) for almond, and 1.8% (1.1–2.5) for walnut. Point prevalence of food challenge‐confirmed TNA was 0.04% (0.0–0.1) for hazelnut and 0.02% (0.01–0.1) for walnut. Due to paucity of data, we could not identify any meaningful and consistent differences across age groups and European regions. [ABSTRACT FROM AUTHOR]

The article provides an executive summary of the EAACI guidelines on the diagnosis of IgE-mediated food allergy. The guidelines were developed by a multinational and multidisciplinary group of experts and aim to provide recommendations for best clinical practice in diagnosing food allergies. The article highlights the importance of accurate diagnosis, as misdiagnosis can lead to unnecessary food exclusions or potentially severe reactions. The guidelines include recommendations for the use of various diagnostic tests, such as skin prick testing, specific IgE testing, molecular IgE testing, and the basophil activation test. The article also identifies research priorities and challenges in implementing the guidelines in clinical practice. [Extracted from the article]

In 2014, the European Academy of Allergy and Clinical Immunology published prevalence estimates for food allergy (FA) and food sensitization (FS) to the so‐called eight big food allergens (i.e. cow's milk, egg, wheat, soy, peanut, tree nuts, fish and shellfish) in Europe for studies published between 2000 and 2012. The current work provides 10‐year updated prevalence estimates for these food allergens. A protocol was registered on PROSPERO before starting the research (reference number CRD42021266657). Six databases were searched for studies published 2012–2021, added to studies published up to 2012, resulting in a total of 93 studies. Most studies were graded as at moderate risk of bias. The overall pooled estimates for all age groups of self‐reported lifetime prevalence were as follows: cow's milk (5.7%, 95% confidence interval 4.4–6.9), egg (2.4%, 1.8–3.0), wheat (1.6%, 0.9–2.3), soy (0.5%, 0.3–0.7), peanut (1.5%, 1.0–2.1), tree nuts (0.9%, 0.6–1.2), fish (1.4%, 0.8–2.0) and shellfish (0.4%, 0.3–0.6). The point prevalence of food challenge‐verified allergy were as follows: cow's milk (0.3%, 0.1–0.5), egg (0.8%, 0.5–1.2), wheat (0.1%, 0.01–0.2), soy (0.3%, 0.1–0.4), peanut (0.1%, 0.0–0.2), tree nuts (0.04%, 0.02–0.1), fish (0.02%, 0.0–0.1) and shellfish (0.1%, 0.0–0.2). With some exceptions, the prevalence of allergy to common foods did not substantially change during the last decade; variations by European regions were observed. [ABSTRACT FROM AUTHOR]

COVID-19 severity and mortality in patients with chronic lymphocytic leukemia: a joint study by ERIC, the European Research Initiative on CLL, and CLL Campus. Hybrid immunity in immunocompromised patients with CLL after SARS-CoV-2 infection followed by booster mRNA vaccination. COVID-19 vaccination: Evaluation of humoral and cellular immunity after the booster dose in chronic lymphocytic leukemia patients. [Extracted from the article]

A 24/7 expert support telephone line for patients undergoing OIT has proved to be useful to support patient and family adherence and compliance, while also minimizing hospital access. The COVID-19 outbreak has substantially impacted people's lives, especially for more vulnerable individuals.[[1]] Among patients with food allergy (FA), difficulties accessing "safe" foods and health services have been commonly reported, with significantly overall poorer subjective wellbeing.[2] Patients with FA undergoing oral immunotherapy (OIT) may have been particularly affected by the pandemic since the protocol requires many in-hospital visits to gradually increase the allergen ingestion due to the risk of severe reactions.[3] Such a risk can be a source of anxiety for patients and families.[[4]] The COVID-19 pandemic led to an unprecedented change in clinical procedures, with fast implementation of telemedicine programs.[6] Telemedicine has been reported as a beneficial means to support allergic patients, including those undergoing OIT.[1] Italy was the first European country impacted by the pandemic and Veneto was the region hit fourth hardest. A 24-h helpline for patients undergoing oral food immunotherapy: Lessons from Italian experience during the SARS-CoV-2 pandemic. [Extracted from the article]

Objectives: University students are vulnerable to unhealthy eating habits that characterize a proinflammatory diet. This study aimed to estimate the dietary inflammatory index (DII) and its association with the trajectory of body adiposity markers in university students. Methods: The study analyzed data from 685 students entering a Brazilian public university in 2016 and 2017 and followed until 2018. DII was estimated from 39 dietary parameters obtained by 24‐h dietary recall. Body adiposity was assessed by anthropometric markers and the percentage of body fat. Linear mixed‐effects models were used to estimate the trajectory of adiposity markers according to DII tertiles. Results: After adjustment for confounding variables, at baseline, DII showed a positive association with increased percentage of body fat among men (β = 0.52; 95% CI: 0.01; 1.03) and waist‐to‐height ratio (WHtR; β = 0.15; 95% CI: 0.12; 0.18) and among women with all body adiposity markers: BMI (β = 0.68; 95% CI: 0.30; 1.05), percentage of body fat (β = 1.43; 95% CI: 0.74; 2.11), WC (β = 1.15; 95% CI: 0.41; 1.89) and WHtR (β = 0.13; 95% CI:0,10; 0.16). The rate of change of the outcome variables over time was not associated with DII at baseline. Conclusions: The diet of university students in this Brazilian cohort study was characterized as proinflammatory and it was associated with body adiposity markers. [ABSTRACT FROM AUTHOR]

Food allergy (FA) is increasingly reported in Europe, however, the latest prevalence estimates were based on studies published a decade ago. The present work provides the most updated estimates of the prevalence and trends of FA in Europe. Databases were searched for studies published between 2012 and 2021, added to studies published up to 2012. In total, 110 studies were included in this update. Most studies were graded as moderate risk of bias. Pooled lifetime and point prevalence of self‐reported FA were 19.9% (95% CI 16.6–23.3) and 13.1% (95% CI 11.3–14.8), respectively. The point prevalence of sensitization based on specific IgE (slgE) was 16.6% (95% CI 12.3–20.8), skin prick test (SPT) 5.7% (95% CI 3.9–7.4), and positive food challenge 0.8% (95% CI 0.5–0.9). While lifetime prevalence of self‐reported FA and food challenge positivity only slightly changed, the point prevalence of self‐reported FA, sIgE and SPT positivity increased from previous estimates. This may reflect a real increase, increased awareness, increased number of foods assessed, or increased number of studies from countries with less data in the first review. Future studies require rigorous designs and implementation of standardized methodology in diagnosing FA, including use of double‐blinded placebo‐controlled food challenge to minimize potential biases. [ABSTRACT FROM AUTHOR]

Background: Health‐related quality of life (HRQoL) is significantly and substantially reduced in individuals with peanut allergy due to many factors associated with unanticipated or potentially fatal reactions. Further insight on the impact of peanut oral immunotherapy in managing peanut allergy on HRQoL is needed. The aim of this analysis was to assess effects of peanut (Arachis hypogaea) allergen powder‐dnfp (PTAH), a biologic drug for peanut oral immunotherapy, on HRQoL from three phase 3 and two follow‐on trials of PTAH. Methods: HRQoL assessments from participants aged 4–17 in the PALISADE (ARC003), ARC004 (PALISADE follow‐on), ARTEMIS (ARC010), RAMSES (ARC007), and ARC011 (RAMSES follow‐on) trials were included in this analysis. Responses on the Food Allergy Quality of Life Questionnaire (FAQLQ) and Food Allergy Independent Measure (FAIM) were evaluated by age group and respondent (self or caregiver proxy). Data were analyzed with descriptive statistics and Student t tests. Results: Baseline FAQLQ and FAIM total scores appeared comparable between PTAH‐ and placebo‐treated participants. Self and caregiver proxy‐reported total scores on the FAQLQ for PTAH‐treated participants generally improved at trial exit versus baseline; FAIM total scores improved throughout all trials. The tendency for improvement in FAQLQ total scores from baseline for PTAH appeared larger in self versus caregiver proxy‐reports. Between treatment groups, PTAH was generally favored in the PALISADE and ARTEMIS trials; differences varied in the RAMSES trial based on age and respondent types. Conclusions: PTAH for the management of peanut allergy in children appeared to have a beneficial effect on HRQoL in trials. Improvements were seen despite rigors of trial participation. [ABSTRACT FROM AUTHOR]

Background: Recent studies have shown associations between cesarean birth and overweight. However, very few studies have evaluated weight gain or adiposity throughout life, and the majority are restricted to analysis during childhood. The purpose of this study was to analyze the effect of cesarean birth on obesity risk from birth to adolescence. Methods: The study sample was drawn from live births that occurred in 1999 and 2000 in Mato Grosso‐Brazil. Participants were evaluated once when they were between 0 and 5 years of age and again after approximately 10 years (2009–2011). To measure the association between cesarean birth and obesity (Body Mass Index/age >+2 z‐scores), we used generalized estimation equations (GEE) with binomial distribution and log‐binomial models for repeated measures, controlled by the following confounding factors: weight and length at birth, sex, gestational age, breastfeeding, maternal age and schooling, economic class in childhood, and maternal smoking during pregnancy. The exposure‐time interaction term was evaluated to verify differences in the change in the risk of obesity over time. Results: 56.8% of children in the sample were born by cesarean birth. Children born by cesarean had a higher risk of obesity from birth through adolescence (RR = 1.22, 95% CI = 1.02; 1.46), even after adjusting for covariates, when compared with those born vaginally. However, the time–exposure interaction term was not significant, which indicates that there was no increased risk of obesity over time. Conclusion: Cesarean birth was positively associated with obesity from birth to adolescence, with a persistent risk in the period evaluated. [ABSTRACT FROM AUTHOR]

The stratigraphic succession in the San Vincenzo Gorge (Saccense Domain, western Sicily) documents deposition on a vast pelagic carbonate platform, the Sciacca Plateau, during the Middle and Late Jurassic. This succession caps a peritidal limestone (Inici Formation), which underwent extension during the Western Tethyan Early Jurassic rift phase, and displays a set of unique features, which have never been previously reported on a Tethyan drowned platform. The upper part of the Bositra limestone (late Bajocian‐early Oxfordian p.p.) comprises elongate convex‐up, mound‐shaped bodies, made of thin‐shelled bivalve wacke‐ to grainstone, a few tens of metres across and producing a topographic relief of up to 10 m. Planar beds within the mound cores are seen to thin out laterally with tangential downlaps along sections perpendicular to the mounds' longer axes, and the mounds are in lateral association with concave‐up bedsets. Following halt of the Bositra‐dominated deposition and demise of mound accretion, the draping units inherited an antiformal geometry. The mounds are interpreted as being part of a sediment drift, produced by bottom currents sweeping the Plateau top, the source areas being sediment‐depleted sectors now documented by extremely condensed and hiatus‐ridden sections, with parallel‐sided beds. Following draping and partial levelling of the submarine relief by the Knobbly limestone (?middle Oxfordian/early Kimmeridgian‐late Kimmeridgian), the Coquina limestone is locally a thick (>20 m) ammonite/brachiopod rudstone (Tithonian p.p.). This unit displays evidence for lateral accretion, with large‐scale clinoforms dipping up to 12°, and is interpreted as a mud‐poor, bioclastic‐gravel drift, with the action of bottom currents being apparently linked with a bloom of cephalopods. This is an early‐cemented deposit, where clotted, micropeloidal fabrics document the calcification of microbial communities and are followed by growth of early diagenetic fibrous calcite. The description and interpretation of the mounded Bositra limestone and of the clinostratified Tithonian limestone are the main focus of this paper. The San Vincenzo Gorge outcrop displays similarities with pelagic shelves, like the Upper Chalk basin of northern Europe. [ABSTRACT FROM AUTHOR]

This rapid review summarizes the most up to date evidence about the risk factors for severe food‐induced allergic reactions. We searched three bibliographic databases for studies published between January 2010 and August 2021. We included 88 studies and synthesized the evidence narratively, undertaking meta‐analysis where appropriate. Significant uncertainties remain with respect to the prediction of severe reactions, both anaphylaxis and/or severe anaphylaxis refractory to treatment. Prior anaphylaxis, an asthma diagnosis, IgE sensitization or basophil activation tests are not good predictors. Some molecular allergology markers may be helpful. Hospital presentations for anaphylaxis are highest in young children, yet this age group appears at lower risk of severe outcomes. Risk of severe outcomes is greatest in adolescence and young adulthood, but the contribution of risk taking behaviour in contributing to severe outcomes is unclear. Evidence for an impact of cofactors on severity is lacking, although food‐dependent exercise‐induced anaphylaxis may be an exception. Some medications such as beta‐blockers or ACE inhibitors may increase severity, but appear less important than age as a factor in life‐threatening reactions. The relationship between dose of exposure and severity is unclear. Delays in symptom recognition and anaphylaxis treatment have been associated with more severe outcomes. An absence of prior anaphylaxis does not exclude its future risk. [ABSTRACT FROM AUTHOR]

Amphibians are an exemplary case of the current biodiversity crisis, being among the vertebrates suffering the fastest decline. Population dynamics of amphibians can result from processes acting at different scales. Both the local characteristics of breeding wetlands and the features of the surrounding landscape can strongly affect the temporal dynamics of amphibian populations. European newts are particularly threatened by land‐use change and invasive alien species. While it is known that newts are declining across Europe, few studies have performed broad‐scale assessments of their decline, either because abundance dynamics are more complex to analyse than presence/absence data or because they require a high sampling effort and long‐term monitoring.In this study, we show that long‐term distribution data can be combined with demographic models to quantify the decline in abundance of newt species at the regional scale, and to assess the importance of multiple factors in determining abundance dynamics. We performed multiple surveys between 1996 and 2020 and used N‐mixture models in a Bayesian framework. We then calculated abundance changes between the first and the last sampling season, which were performed with an average timespan of 13 years across all wetlands.Both Italian crested newts and smooth newts showed large declines, with an average estimated abundance loss between the first and last sampling season of 57% and 63%, respectively. Local characteristics of the wetlands were the main determinants of abundance dynamics: the abundance of both species showed a positive relationship with the area and the permanence of the wetland and a negative relationship with the presence of fish. Additionally, the abundance of Italian crested newts was negatively related to the presence of invasive crayfish. No relationship was detected between abundance and terrestrial habitat availability or connectivity measures.Despite uncertainties in the absolute values of estimated abundance, the striking regional‐scale decline of newts is evident. Among the major determinants of population dynamics, fish and crayfish presence increased their prevalence in the study area, while other factors remained more stable. Management actions aimed at eradicating or controlling invasive fish and crayfish might halt abundance loss and even revert this declining trend.The application of N‐mixture models to long‐term data from representative sites permits the analysis of temporal trends of species at the regional scale even when data come from complex monitoring schemes. We found large declines in abundance of two newt species, suggesting that European newts may be more threatened than previously thought. [ABSTRACT FROM AUTHOR]

Background: Recent reports indicate that the prevalence of food allergy is increasing, but accurate estimates remain a challenge due to cross‐reactivity and limited use of precise diagnostic methods. Molecular allergy diagnostics, in which sensitization to individual molecular allergens is measured, is emerging as a promising tool for evaluation of sensitization profiles. In this systematic review, we summarized estimates of prevalence of sensitization to molecular food allergens in the general population in Europe. Methods: Following a protocol prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO; reference CRD42021266657), we searched seven databases with no restrictions on publication date or language. Two reviewers independently screened the literature, extracted data, and appraised the risk of bias in the included studies. The findings were synthesized narratively. Results: From 4776 de‐duplicated records, five studies, with low to moderate overall risk of bias, were included. Forty‐six molecular allergens from 18 foods were investigated. Overall, the prevalence of sensitization was low, particularly for major allergens, and non‐existent for 10 molecular allergens (0% [95% CI 0–0.8]). The highest prevalence was seen for PR‐10 proteins, such as Cor a 1.04 (13.6% [95% CI 10.9–16.9]). Conclusions: Available data, primarily from North‐western Europe, indicate that sensitization to molecular food allergens is overall low. The highest estimates were found for cross‐reactive PR‐10 proteins. There were not enough studies to discern regional differences or perform meta‐analysis, highlighting the need for more population‐representative studies in order to elucidate patterns of sensitization to molecular food allergens in Europe. [ABSTRACT FROM AUTHOR]

Background: There is substantial interest in immunotherapy and biologicals in IgE‐mediated food allergy. Methods: We searched six databases for randomized controlled trials about immunotherapy alone or with biologicals (to April 2021) or biological monotherapy (to September 2021) in food allergy confirmed by oral food challenge. We pooled the data using random‐effects meta‐analysis. Results: We included 36 trials about immunotherapy with 2126 mainly child participants. Oral immunotherapy increased tolerance whilst on therapy for peanut (RR 9.9, 95% CI 4.5.–21.4, high certainty); cow's milk (RR 5.7, 1.9–16.7, moderate certainty) and hen's egg allergy (RR 8.9, 4.4–18, moderate certainty). The number needed to treat to increase tolerance to a single dose of 300 mg or 1000 mg peanut protein was 2. Oral immunotherapy did not increase adverse reactions (RR 1.1, 1.0–1.2, low certainty) or severe reactions in peanut allergy (RR 1,6, 0.7–3.5, low certainty), but may increase (mild) adverse reactions in cow's milk (RR 3.9, 2.1–7.5, low certainty) and hen's egg allergy (RR 7.0, 2.4–19.8, moderate certainty). Epicutaneous immunotherapy increased tolerance whilst on therapy for peanut (RR 2.6, 1.8–3.8, moderate certainty). Results were unclear for other allergies and administration routes. There were too few trials of biologicals alone (3) or with immunotherapy (1) to draw conclusions. Conclusions: Oral immunotherapy improves tolerance whilst on therapy and is probably safe in peanut, cow's milk and hen's egg allergy. More research is needed about quality of life, cost and biologicals. [ABSTRACT FROM AUTHOR]

Keywords: anaphylaxis; eliciting dose; food allergy; precautionary allergen labelling; reference dose; thresholds EN anaphylaxis eliciting dose food allergy precautionary allergen labelling reference dose thresholds 1661 1666 6 05/31/22 20220601 NES 220601 The disclosure of "priority" allergens when present as an (intended) ingredient in foods is, in most countries, enshrined in legislation. Are current analytical methods suitable to verify VITAL ® 2.0/3.0 allergen reference doses for EU allergens in foods? Summary report of the Ad hoc Joint FAO/WHO expert consultation on risk assessment of food allergens. part 2: review and establish threshold levels in foods of the priority allergens. "Too high, too low": The complexities of using thresholds in isolation to inform precautionary allergen ("may contain") labels. [Extracted from the article]

It remains uncertain as to whether nutrient supplementation for the general population considered healthy could be useful in the prevention of RTIs, such as COVID‐19. In this systematic review and meta‐analysis, the evidence was evaluated for primary prevention of any viral respiratory tract infection (RTI) such as SARS‐CoV‐2, through supplementation of nutrients with a recognized role in immune function: multiple micronutrients, vitamin A, folic acid, vitamin B12, C, D, E, beta‐carotene, zinc, iron and long‐chain polyunsaturated fatty acids. The search produced 15,163 records of which 93 papers (based on 115 studies) met the inclusion criteria, resulting in 199,055 subjects (191,636 children and 7,419 adults) from 37 countries. Sixty‐three studies were included in the meta‐analyses, which was performed for children and adults separately. By stratifying the meta‐analysis by world regions, only studies performed in Asia showed a significant but heterogeneous protective effect of zinc supplementation on RTIs (RR 0.86, 95% CI 0.7–0.96, I2 = 79.1%, p =.000). Vitamin D supplementation in adults significantly decreased the incidence of RTI (RR 0.89, 95% CI 0.79–0.99, p =.272), particularly in North America (RR 0.82 95% CI 0.68–0.97), but not in Europe or Oceania. Supplementation of nutrients in the general population has either no or at most a very limited effect on prevention of RTIs. Zinc supplementation appears protective for children in Asia, whilst vitamin D may protect adults in the USA and Canada. In 10/115 (8.7%) studies post‐hoc analyses based on stratification for nutritional status was performed. In only one study zinc supplementation was found to be more effective in children with low zinc serum as compared to children with normal zinc serum levels. [ABSTRACT FROM AUTHOR]

Aim: Understanding which factors determine the variation in population size across space and time is crucial to plan sound conservation interventions. Amphibians are often characterized by large demographic changes, therefore a better understanding of factors driving these changes could help mitigate their global crisis. We investigated drivers of abundance dynamics of two similar frog species to understand why they met different fates in the same study area. Location: Northern Italy. Methods: In seven different years between 2004 and 2020, we performed repeated counts of egg masses of two similar frog species, the agile frog (Rana dalmatina) and the Italian agile frog (Rana latastei), in 31 wetlands, and used Bayesian models to estimate the relationships between frog abundance and candidate drivers acting at the scale of (i) site: wetland surface, shading percentage and the presence of the invasive red swamp crayfish (Procambarus clarkii); (ii) landscape: forest cover around wetlands; (iii) climate: yearly precipitation and (iv) spatially structured population (SSP): clutch incidence of the focal species and crayfish incidence in the surrounding landscape. Results: The two species showed sharp differences in population size and trends: R. dalmatina was abundant and showed a stable trend throughout the entire study period; R. latastei showed low abundance in the first years and then almost disappeared. The abundance of R. dalmatina was positively related to forest cover, shading, wetland area and precipitation, while negatively related to the occurrence of invasive crayfish at both local and SSP level. R. latastei abundance increased with wetland area and precipitation, while models were not able to detect relationships with other factors. Main conclusions: The high sensitivity to drought and demographic stochasticity could have contributed to the quasi‐extinction of R. latastei in the study area, highlighting that similar species can meet different fates even under the same environmental conditions. [ABSTRACT FROM AUTHOR]

Background: The benefit of daily administration of Peanut (Arachis hypogaea) Allergen Powder‐dnfp (PTAH)—formerly AR101—has been established in clinical trials, but limited data past the first year of treatment are available. This longitudinal analysis aimed to explore the impact of continued PTAH therapeutic maintenance dosing (300 mg/day) on efficacy, safety/tolerability, and food allergy‐related quality of life. Methods: We present a subset analysis of PALISADE‐ARC004 participants (aged 4–17 years) who received 300 mg PTAH daily for a total of ~1.5 (Group A, n = 110) or ~2 years (Group B, n = 32). Safety assessments included monitoring the incidence of adverse events (AEs), accidental exposures to food allergens, and adrenaline use. Efficacy was assessed by double‐blind, placebo‐controlled food challenge (DBPCFC); skin prick testing; peanut‐specific antibody assays; and Food Allergy Quality of Life Questionnaire (FAQLQ) and Food Allergy Independent Measure (FAIM) scores. Results: Continued maintenance with PTAH increased participants' ability to tolerate peanut protein: 48.1% of completers in Group A (n = 50/104) and 80.8% in Group B (n = 21/26) tolerated 2000 mg peanut protein at exit DBPCFC without dose‐limiting symptoms. Immune biomarkers showed a pattern consistent with treatment‐induced desensitization. Among PTAH‐continuing participants, the overall and treatment‐related exposure‐adjusted AE rate decreased throughout the intervention period in both groups. Clinically meaningful improvements in FAQLQ and FAIM scores over time suggest a potential link between increased desensitization as determined by the DBPCFC and improved quality of life. Conclusions: These results demonstrate that daily PTAH treatment for peanut allergy beyond 1 year leads to an improved safety/tolerability profile and continued clinical and immunological response. [ABSTRACT FROM AUTHOR]

Background: Oral immunotherapy (OIT) is a promising treatment for food allergy (FA) however it is a challenging process for patients and parents. Induction can generate stress and anxiety. This may in turn affect their motivation and ability to cope with OIT challenges. Objective: This study aimed to investigate psychological needs and support to patients/parents undergoing food OIT assessing participants' main characteristics, reasons for seeking psychological support, OIT phase and related psychological difficulties, type and timing of treatments and patients' perception of the effectiveness of the intervention. Methods: This is an observational, retrospective study. 50 psychological interventions required for OIT related problems were selected consecutively in a Referral Centre in North‐Eastern Italy. All patients had a medical diagnosis of FA and were undergoing OIT or had just discontinued it. Data were collected from hospital records. A descriptive statistical analysis was performed. Results: 66% of patients asked for psychological support for the initial phase (e.g., oral food challenge, first maintenance doses), 20% during the up‐dosing phase, 8% during maintenance and 6% after discontinuation. 70% of treatments were required mainly because of emotional problems including dysfunctional anxiety and mood disorders, increased distress and excessive worry and/or fear related to OIT; 20% because of difficulties in managing OIT; 10% because of eating difficulties; 50% of patients reported recent anaphylaxis. All patients reported improvement and felt the psychological intervention was helpful. Conclusion: It is recommended to evaluate the psychological needs in profiling patients and families suitable to OIT and offer specific psychological support when needed. [ABSTRACT FROM AUTHOR]

Anaphylaxis is a clinical emergency which all healthcare professionals need to be able to recognize and manage. The European Academy of Allergy and Clinical Immunology Anaphylaxis multidisciplinary Task Force has updated the 2014 guideline. The guideline was developed using the AGREE II framework and the GRADE approach. The evidence was systematically reviewed and recommendations were created by weighing up benefits and harms. The guideline was peer‐reviewed by external experts and reviewed in a public consultation. The use of clinical criteria to identify anaphylaxis is suggested with blood sampling for the later measurement of tryptase. The prompt use of intramuscular adrenaline as first‐line management is recommended with the availability of adrenaline autoinjectors to patients in the community. Pharmacokinetic data should be provided for adrenaline autoinjector devices. Structured, comprehensive training for people at risk of anaphylaxis is recommended. Simulation training and visual prompts for healthcare professionals are suggested to improve the management of anaphylaxis. It is suggested that school policies reflect anaphylaxis guidelines. The evidence for the management of anaphylaxis remains mostly at a very low level. There is an urgent need to prioritize clinical trials with the potential to improve the management of patients at risk of anaphylaxis. [ABSTRACT FROM AUTHOR]

Anaphylaxis is a medical emergency with adrenaline acknowledged as the first‐line therapy. It is therefore important that patients have access to self‐injectable adrenaline in the community. Manufacturers have been requested by European Medicine Regulators to generate pharmacokinetic data for these autoinjector devices. For the first time, these data provide an insight into how individual devices work in different populations, and how they compare. We undertook a thorough literature search and also accessed grey literature, using searches of medicine regulators' websites and freedom of information requests. The data demonstrate that it takes at least 5–10 min to achieve early peak plasma concentration for most devices. The specific autoinjector device seems to be the most important determinant of pharmacokinetics, with different devices giving rise to different plasma adrenaline profiles. Needle length does not seem to be the most important factor; rather, the force and speed of injection (which varies from one device to another) is likely to be of greater importance. In general, peak plasma adrenaline concentration is lower and time‐to‐peak concentration longer with increased skin‐to‐muscle depth. However, it is difficult to draw conclusions with the current available data, due to a lack of head‐to‐head comparisons, small numbers of study participants and the failure to acknowledge the biphasic nature of intramuscular adrenaline absorption for analysis purposes. [ABSTRACT FROM AUTHOR]

Background: Alexithymia is a multifaceted personality construct described as "a lack of words to express emotions" that includes difficulty identifying feelings, difficulty describing feelings and a concrete, externally oriented cognitive style. Among patients with food allergy (FA) alexithymia has been found higher than in general population and associated with dysfunctional coping strategies. Childhood traumatic experiences and/or dysfunctional parent‐child relationship can contribute to alexithymia. The study aimed to explore possible associations between child alexithymia and mother alexithymia and anxiety, as well as previous anaphylaxis. Methods: Sixty‐five mother–child pairs have been recruited. Children had a medical diagnosis of FA. The Toronto Alexithymia Scale‐20 was used to assess alexithymia in participants. The State‐Trait Anxiety Inventory was used to assess trait anxiety in mothers. Statistical analysis was performed to investigate the influence of variables sex, previous anaphylaxis, and adrenaline auto‐injector prescription on child and mother's alexithymia and to explore possible association between maternal and child alexithymia. Results: A substantial percentage of children were alexithymic (21.5%) or borderline (33.8%), while mothers' frequencies were lower and in line with prevalence in general population. Child alexithymia was positively associated with previous anaphylaxis and mothers' trait anxiety (p <.05). Mother trait anxiety was also associated with maternal alexithymia. Furthermore, a positive association between child and mother alexithymia has been found. Conclusions: Clinicians must be aware of the role of alexithymia and its association with maternal anxiety and previous anaphylaxis in children with FA, encouraging seeking psychological support when needed. A multidisciplinary patient‐centered approach should be put in place for the effective care of FA. [ABSTRACT FROM AUTHOR]

Background: Anaphylaxis is a recognized public health issue. There is no doubt that food‐induced anaphylaxis (FIA) has tremendous impact on the quality of life of patients and their families and increases direct and indirect costs. FIA is associated with increasing rates of emergency department admissions and hospitalizations and implies the risk of death. Morbidity epidemiological data are a key to tailor public health actions to this non‐communicable disease. The aim of this article was to review published morbidity epidemiological data relating to FIA and potential risk factors, in order to provide evidence‐based recommendations to reduce the risk of severe adverse outcomes. Methods: We identified published studies available in PUBMED/MEDLINE (1966–2020), EMBASE (1980–2020) and CINAHL (1982–2020). The systematic review was carried out using MeSH terms related to FIA ED admissions and hospitalizations. Results: A total of 25 articles were selected, 80% published in the last 5 years. After critical analysis of methodological and clinical characteristics reported in the data selected, we were able to propose preventive strategies. Conclusion: Anaphylaxis is a recognized public health issue. FIA is associated with increasing rates of ED admissions and hospitalizations and imply in risk of death. More than reviewing and critically interpreting the key patterns related to FIA morbidity published data, we proposed strategies in order to promote quality care of patients suffering from FIA. Our World Health Organization Collaborative Center is deeply involved in this process, and we believe that the proposed strategies will inform future healthcare policies on anaphylaxis. The long‐term objective would be to improve clinical care and quality of life of patients and their families, and develop risk‐stratified, cost‐effective preventive measures. [ABSTRACT FROM AUTHOR]

BACKGROUND Fall armyworm, Spodoptera frugiperda (J. E. Smith), is a relevant global pest due to severe damage caused on agricultural crops and its capacity to evolve resistance to insecticides. Here, we selected a strain of S. frugiperda resistant to emamectin benzoate under laboratory conditions to understand the inheritance patterns, cross‐resistance and synergism involved in the resistance. RESULTS: The emamectin benzoate‐resistant (Ben‐R) strain was isolated by using F2 screen in a field population collected in Lucas do Rio Verde, Mato Grasso state, Brazil. After ten generations of selection pressure with emamectin benzoate, the estimated LC50 of the Ben‐R strain was 678.38 μg a.i. mL−1 whereas that of the susceptible (Sus) strain was 0.29 μg a.i.mL−1, resulting in a resistance ratio (RR) of ~ 2340‐fold. The LC50 values of the offspring from reciprocal crosses of Sus and Ben‐R strains were 93.37 and 105.32 μg a.i. mL−1, suggesting that resistance is an autosomal incompletely dominant trait. The high survival of heterozygous and Ben‐R strains (>92%) on non‐Bt maize sprayed with the field rate of emamectin benzoate confirmed that resistance is functionally dominant. The minimum number of segregations influencing resistance was 3.55, suggesting a polygenic effect. Low cross‐resistance was detected between emamectin benzoate and the insecticides methomyl, chlorpyrifos, lambda‐cyhalothrin, spinetoram, indoxacarb and chlorantraniliprole (RR <5.75‐fold). There was no effect of synergists piperonyl butoxide, diethyl maleate and S, S, S‐tributyl phosphorotrithiotate on the Ben‐R strain, suggesting a minor role of metabolic resistance. CONCLUSIONS: Our results showed a high risk of resistance evolution of S. frugiperda to emamectin benzoate, based on incompletely dominant inheritance. Rotation of insecticides with different modes of action can be one of the resistance management strategies to be implemented to delay the evolution of resistance of S. frugiperda to emamectin benzoate in Brazil. [ABSTRACT FROM AUTHOR]

Burkholderia cenocepacia complex is associated with high transmissibility, virulence, and poor prognosis in cystic fibrosis (CF) patients. However, extrapulmonary infections are rare. We investigated the genome of a B. cenocepacia IIIA isolated from a liver abscess in a Brazilian CF patient and compared it to strain J2315. The whole genome was sequenced, and contigs were annotated by Rapid Annotation using Subsystem Technology. The Pathosystems Resource Integration Center was used to map antimicrobial and virulence genes. The genomic island (GIs) analysis was performed using two prediction methods, and the presence of putative plasmids and insertion sequences (ISs) was investigated. The isolate was confirmed as B. cenocepacia IIIA to ST‐28 (ET12 lineage). A total of 64 genes for antimicrobial resistance and 47 genes related to virulence were identified. Among the virulence factors, there was a predominance of factors related to the invasion mechanism, to the flagellar biosynthesis protein, and to the RNA polymerase sigma factor for flagellar operon (cdpA). Two IS families (IS3 and IS5) and only one plasmid were found. On average 56 GIs were predicted by at least one of the methods applied. Comparative analysis showed resistance mechanisms and virulence factors revealing invasive determinants used by B. cenocepacia IIIA (ET12) in the process of disease spread to other infection sites (extrapulmonary) of highly virulent strains in CF patients. [ABSTRACT FROM AUTHOR]

Summary: The objective of this study was to evaluate changes in the bacterial community in sugarcane silage, in distinct soil types along the storage period. We depicted the bacterial community associated with sugarcane, before and after ensiling, through a massive sequencing of the gene 16S rRNA using MiSeq platform. The ensilage process shifted the composition of the bacterial community from the heterofermentative lactic acid bacteria Leuconostoc to bacteria belonging to the genera Acinetobacter, Ralstonia and Novosphingobium. However, this shift did not convey statically significant differences in alfa diversity metrics. In addition, similarity percentage analysis showed that the bacterial Operational Taxonomic Units that were primarily responsible for the observed differences were Leuconostoc, Pseudomonas, Acinetobacter, Ralstonia, Fructobacillus, Novosphingobium, Lactobacillus, Burkholderia and Clostridium sensu stricto 1. The storage period was the most important factor responsible for changes in the bacterial community of silages. Results confirmed that the type of soil did not influence the dissimilarity found among samples. [ABSTRACT FROM AUTHOR]

Background: Peanut allergy (PA), a common food allergy, is increasing in prevalence and is associated with high rates of anaphylaxis. Prevalence of food‐related anaphylaxis is higher in children and adolescents than in adults, and the pediatric incidence is increasing. We conducted a systematic literature review and meta‐analysis to determine the incidence of peanut‐induced anaphylaxis in children and/or adolescents with PA. Methods: Literature searches were conducted using the PubMed database and through supplemental methods. Eligible articles for inclusion were peer‐reviewed studies published in English that reported the incidence of anaphylaxis in pediatric PA using the 2006 National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network criteria, sample size, and follow‐up duration. Incidence rates were calculated as person‐years at risk or a crude incidence rate was calculated. Meta‐analyses of pooled data were conducted using the I2 statistic as the measure of heterogeneity. Results: A total of 830 citations were screened; 8 met the study inclusion criteria and were selected for review. Pooled meta‐analysis estimates of the incidence of (1) anaphylaxis among children/adolescents with food allergies, (2) anaphylaxis among children/adolescents with PA, and (3) accidental exposure to peanuts among children/adolescents with PA were 3.72 cases per 100 person‐years (95% confidence interval [CI] = 2.35, 5.10), 2.74 cases per 100 person‐years (95% CI = 1.42, 4.05), and 12.28 cases per 100 person‐years (95% CI = 11.51, 13.05), respectively. Conclusions: The risks of anaphylaxis among children with food allergies and those with PA contribute to the serious overall burden of PA and food allergy for children and their families. [ABSTRACT FROM AUTHOR]

Keywords: biological invasions; dynamic occupancy models; extinction; invasive alien species; meta-analysis; metapopulation dynamics; Procambarus clarkii; dinámicas metapoblacionales; especies exóticas invasoras; extinción; invasiones biológicas; meta-análisis; modelos de ocupación dinámica; ; ; ; ; ; ; (Procambarus clarkii) EN biological invasions dynamic occupancy models extinction invasive alien species meta-analysis metapopulation dynamics Procambarus clarkii dinámicas metapoblacionales especies exóticas invasoras extinción invasiones biológicas meta-análisis modelos de ocupación dinámica (Procambarus clarkii) 1530 1539 10 10/05/21 20211001 NES 211001 Introduction Studying the factors that influence species distribution is a cornerstone of conservation science because it allows assessing how environmental modifications determine population declines and extinctions. For each amphibian species, species incidence represents the potential influence of the presence of the focal species in other wetlands, whereas crayfish incidence represents the influence of the presence of the crayfish in other wetlands. Non-native species are among the greatest threat to amphibians and are involved in many declines and extinctions at the population and species levels (Stuart et al. 2004; Bellard et al. 2016; Falaschi et al. 2019). Conservation Implications Assessing the drivers of extinctions and colonizations across more than 20 years allowed us to identify strategies for amphibian persistence in human-dominated landscapes and suggested that amphibian communities can greatly benefit from integrated management of hydroperiod, connectivity, and non-native species. [Extracted from the article]

Background: This guideline from the European Academy of Allergy and Clinical Immunology (EAACI) recommends approaches to prevent the development of immediate‐onset / IgE‐mediated food allergy in infants and young children. It is an update of a 2014 EAACI guideline. Methods: The guideline was developed using the AGREE II framework and the GRADE approach. An international Task Force with representatives from 11 countries and different disciplinary and clinical backgrounds systematically reviewed research and considered expert opinion. Recommendations were created by weighing up benefits and harms, considering the certainty of evidence and examining values, preferences and resource implications. The guideline was peer‐reviewed by external experts, and feedback was incorporated from public consultation. Results: All of the recommendations about preventing food allergy relate to infants (up to 1 year) and young children (up to 5 years), regardless of risk of allergy. There was insufficient evidence about preventing food allergy in other age groups. The EAACI Task Force suggests avoiding the use of regular cow's milk formula as supplementary feed for breastfed infants in the first week of life. The EAACI Task Force suggests introducing well‐cooked, but not raw egg or uncooked pasteurized, egg into the infant diet as part of complementary feeding. In populations where there is a high prevalence of peanut allergy, the EAACI Task Force suggests introducing peanuts in an age‐appropriate form as part of complementary feeding. According to the studies, it appears that the most effective age to introduce egg and peanut is from four to 6 months of life. The EAACI Task Force suggests against the following for preventing food allergy: (i) avoiding dietary food allergens during pregnancy or breastfeeding; and (ii) using soy protein formula in the first 6 months of life as a means of preventing food allergy. There is no recommendation for or against the following: use of vitamin supplements, fish oil, prebiotics, probiotics or synbiotics in pregnancy, when breastfeeding or in infancy; altering the duration of exclusive breastfeeding; and hydrolysed infant formulas, regular cow's milk–based infant formula after a week of age or use of emollients. Conclusions: Key changes from the 2014 guideline include suggesting (i) the introduction of peanut and well‐cooked egg as part of complementary feeding (moderate certainty of evidence) and (ii) avoiding supplementation with regular cow's milk formula in the first week of life (low certainty of evidence). There remains uncertainty in how to prevent food allergy, and further well‐powered, multinational research using robust diagnostic criteria is needed. [ABSTRACT FROM AUTHOR]

Background: As an evidence resource for the currently planned European Academy of Allergy and Clinical Immunology (EAACI) clinical practice guideline "systemic treatment of atopic dermatitis (AD)," we critically appraised evidence on systemic treatments for moderate‐to‐severe AD. Methods: We systematically identified randomized controlled trials (RCTs) investigating the safety and efficacy of systemic treatments for AD up to February 2020. Primary efficacy outcomes were clinical signs, AD symptoms and health‐related quality of life. Primary safety outcomes included cumulative incidence rates for (serious) adverse events. Trial quality was assessed applying the Cochrane Risk of Bias Tool 2.0. Meta‐analyses were conducted where appropriate. Results: 50 RCTs totalling 6681 patients were included. Trial evidence was identified for apremilast, azathioprine (AZA), baricitinib, ciclosporin A (CSA), corticosteroids, dupilumab, interferon‐gamma, intravenous immunoglobulins (IVIG), mepolizumab, methotrexate (MTX), omalizumab, upadacitinib and ustekinumab. Meta‐analyses were indicated for the efficacy of baricitinib [EASI75 RD 0.16, 95% CI (0.10;0.23)] and dupilumab [EASI75, RD 0.37, 95% CI (0.32;0.42)] indicating short‐term (ie 16‐week treatment) superiority over placebo. Furthermore, efficacy analyses of AZA and CSA indicated short‐term superiority over placebo; however, nonvalidated scores were used and can therefore not be compared to EASI. Conclusion: The most robust, replicated high‐quality trial evidence is present for the efficacy and safety of dupilumab for up to 1 year in adults. Robust trial evidence was further revealed for AZA, baricitinib and CSA. Methodological restrictions led to limited evidence‐based conclusions for all other systemic treatments. Head‐to‐head trials with novel systemic treatments are required to clarify the future role of conventional therapies. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) causes coronavirus disease 2019 (COVID‐19), which may result in acute respiratory distress syndrome (ARDS), multiorgan failure, and death. The alveolar epithelium is a major target of the virus, but representative models to study virus host interactions in more detail are currently lacking. Here, we describe a human 2D air–liquid interface culture system which was characterized by confocal and electron microscopy and single‐cell mRNA expression analysis. In this model, alveolar cells, but also basal cells and rare neuroendocrine cells, are grown from 3D self‐renewing fetal lung bud tip organoids. These cultures were readily infected by SARS‐CoV‐2 with mainly surfactant protein C‐positive alveolar type II‐like cells being targeted. Consequently, significant viral titers were detected and mRNA expression analysis revealed induction of type I/III interferon response program. Treatment of these cultures with a low dose of interferon lambda 1 reduced viral replication. Hence, these cultures represent an experimental model for SARS‐CoV‐2 infection and can be applied for drug screens. Synopsis: In vitro investigation of human lung alveolar physiology has remained difficult. Here, establishment and profiling of an organoid‐derived bronchioalveolar tissue culture allows analysis of SARS‐CoV‐2 cellular tropism and testing of treatment strategies for respiratory syndromes. Bronchioalveolar‐like cells derived from self‐renewing human fetal lung organoids give rise to a 2D human bronchioalveolar‐like model with air‐exposed apical side.In these cultures, alveolar type‐2‐like cells are particularly permissive to SARS‐CoV‐2 infection.SARS‐CoV‐2 infection induces a type‐I/III interferon host response in vitro.SARS‐CoV‐2 viral titers are sensitive to low dose interferon lamda 1 treatment. [ABSTRACT FROM AUTHOR]

The placebo (Latin "I will please") effect commonly occurs in clinical trials. The psychological and physiological factors associated with patients' expectations about a treatment's positive and negative effects have yet to be well characterized, although a functional prefrontal cortex and intense bidirectional communication between the central nervous system and the immune system appear to be prerequisites for a placebo effect. The use of placebo raises certain ethical issues, especially if patients in a placebo group are denied an effective treatment for a long period of time. The placebo effect appears to be relatively large (up to 77%, relative to pretreatment scores) in controlled clinical trials of allergen immunotherapy (AIT), such as the pivotal, double‐blind, placebo‐controlled (DBPC) randomized clinical trials currently required by regulatory authorities worldwide. The European Academy of Allergy and Clinical Immunology (EAACI) therefore initiated a Task Force, in order to better understand the placebo effect in AIT and its specific role in comorbidities, blinding issues, adherence, measurement time points, variability and the natural course of the disease. In this Position Paper, the EAACI Task Force highlights several important topics regarding the placebo effect in AIT such as a) regulatory aspects, b) neuroimmunological and psychological mechanisms, c) placebo effect sizes in AIT trials, d) methodological limitations in AIT trial design and e) potential solutions in future AIT trial design. In conclusion, this Position Paper aims to examine the methodological problem of placebo in AIT from different aspects and also to highlight unmet needs and possible solutions for future trials. [ABSTRACT FROM AUTHOR]

Rationale: Allergic diseases are an increasing public health concern, and early life environment is critical to immune development. Maternal diet during pregnancy has been linked to offspring allergy risk. In turn, maternal diet is a potentially modifiable factor, which could be targeted as an allergy prevention strategy. In this systematic review, we focused on non‐allergen‐specific modifying factors of the maternal diet in pregnancy on allergy outcomes in their offspring. Methods: We undertook a systematic review of studies investigating the association between maternal diet during pregnancy and allergic outcomes (asthma/wheeze, hay fever/allergic rhinitis/seasonal allergies, eczema/atopic dermatitis (AD), food allergies, and allergic sensitization) in offspring. Studies evaluating the effect of food allergen intake were excluded. We searched three bibliographic databases (MEDLINE, EMBASE, and Web of Science) through February 26, 2019. Evidence was critically appraised using modified versions of the Cochrane Collaboration Risk of Bias tool for intervention trials and the National Institute for Clinical Excellence methodological checklist for cohort and case‐control studies and meta‐analysis performed from RCTs. Results: We identified 95 papers: 17 RCTs and 78 observational (case‐control, cross‐sectional, and cohort) studies. Observational studies varied in design and dietary intakes and often had contradictory findings. Based on our meta‐analysis, RCTs showed that vitamin D supplementation (OR: 0.72; 95% CI: 0.56‐0.92) is associated with a reduced risk of wheeze/asthma. A positive trend for omega‐3 fatty acids was observed for asthma/wheeze, but this did not reach statistical significance (OR: 0.70; 95% CI: 0.45‐1.08). Omega‐3 supplementation was also associated with a non‐significant decreased risk of allergic rhinitis (OR: 0.76; 95% CI: 0.56‐1.04). Neither vitamin D nor omega‐3 fatty acids were associated with an altered risk of AD or food allergy. Conclusions: Prenatal supplementation with vitamin D may have beneficial effects for prevention of asthma. Additional nutritional factors seem to be required for modulating the risk of skin and gastrointestinal outcomes. We found no consistent evidence regarding other dietary factors, perhaps due to differences in study design and host features that were not considered. While confirmatory studies are required, there is also a need for performing RCTs beyond single nutrients/foods. [ABSTRACT FROM AUTHOR]

Background: This systematic review of ways to prevent immediate‐onset/IgE‐mediated food allergy will inform guidelines by the European Academy of Allergy and Immunology (EAACI). Methods: The GRADE approach was used. Eleven databases were searched from 1946 to October 2019 for randomized controlled trials (and large prospective cohort studies in the case of breastfeeding). The studies included heterogeneous interventions, populations, and outcomes and so were summarized narratively. Results: Forty‐six studies examined interventions to reduce the risk of food allergy in infancy (up to 1 year) or early childhood. The following interventions for pregnant or breastfeeding women and/or infants may have little to no effect on preventing food allergy, but the evidence is very uncertain: dietary avoidance of food allergens, vitamin supplements, fish oil, probiotics, prebiotics, synbiotics, and emollients. Breastfeeding, hydrolyzed formulas, and avoiding cow's milk formula may not reduce the risk of cow's milk protein allergy; however, temporary supplementation with cow's milk formula in the first week of life may increase the risk of cow's milk allergy. Introducing well‐cooked egg, but not pasteurized raw egg, from 4 to 6 months probably reduces the risk of hen's egg allergy. Introducing regular peanut consumption into the diet of an infant at increased risk beginning from 4 to 11 months probably results in a large reduction in peanut allergy in countries with a high prevalence. These conclusions about introducing peanut are based on moderate certainty evidence, from single trials in high‐income countries. Conclusions: Sixty percent of the included studies were published in the last 10 years, but much still remains to be understood about preventing food allergy. In particular, there is a need to validate the potential benefits of early introduction of food allergens in a wider range of populations. [ABSTRACT FROM AUTHOR]

The International Classification of Diseases (ICD) provides a common language for use worldwide as a diagnostic and classification tool for epidemiology, clinical purposes and health management. Since its first edition, the ICD has maintained a framework distributing conditions according to topography, with the result that some complex conditions, such as allergies and hypersensitivity disorders (A/H) including anaphylaxis, have been poorly represented. The change in hierarchy in ICD‐11 permitted the construction of the pioneer section addressed to A/H, which may result in more accurate mortality and morbidity statistics, including more accurate accounting for mortality due to anaphylaxis, strengthen classification, terminology and definitions. The ICD‐11 was presented and adopted by the 72nd World Health Assembly in May 2019, and the implementation is ongoing worldwide. We here present the outcomes from an online survey undertaken to reach out the allergy community worldwide in order to peer review the terminology, classification and definitions of A/H introduced into ICD‐11 and to support their global implementation. Data are presented here for 406 respondents from 74 countries. All of the subsections of the new A/H section of the ICD‐11 had been considered with good accuracy by the majority of respondents. We believe that, in addition to help during the implementation phase, all the comments provided will help to improve the A/H classification and to increase awareness by different disciplines of what actions are needed to ensure more accurate epidemiological data and better clinical management of A/H patients. [ABSTRACT FROM AUTHOR]

Diagnostic allergens are defined as medicinal products in the EU. Marketing authorization by national authorities is necessary; however, diagnostic allergens are not homogeneously regulated in different EU member states. Allergen manufacturers argue with increasing costs forcing them to continuously reduce the diagnostic allergen portfolios offered to allergists. In contrast, EAACI and national European Allergy Societies see the need for the availability of a wide range of high‐quality diagnostic allergens for in vivo diagnosis of IgE‐mediated allergies not only covering predominant but also less frequent allergen sources. In a recent EAACI task force survey, the current practice of allergy diagnosis was shown to rely on skin tests as first option in almost 2/3 of all types of allergic diseases and in 90% regarding respiratory allergies. With the need to ensure the availability of high‐quality diagnostic allergens in the EU, an action plan has been set up by EAACI to analyse the current regulatory demands in EU member states and to define possible solutions stated in this document: (a) simplification of authorization for diagnostic allergens; (b) specific regulation of special types of diagnostic allergens; (c) new models beyond the current model of homologous groups; (d) simplification of pharmacovigilance reporting; (e) reduction of regulation fees for diagnostic allergens; (f) reimbursement for diagnostic allergens. Joining forces of allergists, manufacturers and authorities are of high importance to ensure remaining relevant allergens in the EU markets to facilitate a sustainable and comprehensive service for the diagnosis and treatment of allergic diseases. [ABSTRACT FROM AUTHOR]

Concerning development of medicinal products, children belong to a so-called "special population" for which additional legislation applies: Regulation (EC) No 1901/2006 on medicinal products for paediatric use sets up a system of requirements, rewards and incentives to ensure that medicinal products are researched, developed and authorized to meet the therapeutic needs of children. Allergen Immunotherapy (AIT) is believed to contain a strong potential for immunomodulatory effects inducing sustained clinical efficacy after cessation of treatment (disease modifying effect) and thereby may prevent the progression of the atopic march towards asthma manifestation. However, to this day only few data on long-term effects in general exist and even fewer in children. These are predominantly data from open studies, which are strongly influenced in their validity by the known placebo effect of AIT. Furthermore, there are no studies allowing for the conclusion that efficacy in adults are mirrored by a similar efficacy in children and thus, up to now, it is not possible to extrapolate data from adults to children. The Paediatric Committee (PDCO)—European Medicines Agency's (EMA) scientific committee responsible for activities on medicines for children—initiated a Multi-Stakeholder Meeting on AIT for Children held at the Paul-Ehrlich-Institut in Langen, Germany, to provide a platform for discussion and exchange of thoughts to this topic between allergy experts from academia, regulators and AIT-manufacturers. The consented meeting minutes, conclusions and participants are presented. [ABSTRACT FROM AUTHOR]