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Останнім часом істотно зросла роль техногенного впливу на організм людини, що обумовлює поширення алергопатології серед дитячого населення. Серед 318 немовлят з IgE-залежними захворюваннями шкіри зареєстровано максимальний рівень гіперсенсибілізації до харчових алергенів (переважно до протеїнів курячого ембріона (34,48 %) та коров’ячого молока (25 %)) та інгаляційних алергенів (переважно до епідермальних алергенів домашніх тварин (28,7 %) та побутових алергенів (29 %)). Створення гіпосенсибілізуючого ефекту до вищезазначених облігатних алергенів дозволить запобігти розвитку атопії в дітей раннього віку. До алергенів риби, пшениці, бобових, арахісу, моркви, картоплі сенсибілізацію серед 318 дітей піддослідної групи не виявлено, що робить недоцільним елімінацію їх відповідно до загальноприйнятих рекомендацій із профілактики алергічних захворювань у дітей у Запорізькому регіоні.

Background. Atopic dermatitis (AD) is an allergodermathosis that is widespread in children and adult populations. Sensibilization to food allergens prevails in children of early age, and to airborne allergens in older age. Impairments of skin barrier lead to increase in Staphylococcus aureus colonization and finally aggravate the course of AD and the sensibilization level.Objective. The aim of the study is to estimate the sensibilization spectrum in 3-6 years old children with AD and its correlation with severity.Methods. It was cross sectional study with two independent cohorts of 3-6 years old children with and without (healthy) AD. Estimation of sensibilization spectrum and revealing of correlation with disease severity were performed.Results. The study includes 106 children aged 4.4 ± 1.2 year (58.5% boys and 41.5% girls). Polysensibilization was revealed in 28.3% of children. According to our data: 3-6 years old children with AD most often had sensibilization to the cat epithelium (34.9%), cow's milk proteins (22.6%), Dermatophagoides pteronyssinus mite (16.0%). Sensibilization to enterotoxins of Staphylococcus aureus was revealed in 7.5% children. We have recorded weak positive correlation between the AD severity and the level of specific IgE to airborne and food allergens. There was no statistically significant correlation between the AD severity and the level of specific IgE to Staphylococcus aureus enterotoxins A and B. Conclusion. The most common sensibilization type among 3-6 years old children with AD was one to airborne allergens. Sensibilization to the cat epithelium prevails among airborne allergens, to the cow's milk proteins — among food allergens. The weak positive correlation between the AD severity and the level of specific IgE to airborne and food allergens was revealed. The weak negative correlation with the level of specific IgE to Staphylococcus aureus enterotoxins A and B was revealed, thus the data was statistically insignificant.

Purpose Celiac disease (CD) is an autoimmune disorder of the small intestine caused by an abnormal immune response to gluten proteins and is often characterized by gastrointestinal symptoms. Food allergy (FA) is an adverse immune sensitivity to ingested food proteins leading to inflammation in various organs including the gastrointestinal tract. The relationship between CD and FA remains unclear. This study aimed to assess the prevalence and clinical relevance of immunoglobulin E (IgE)-mediated food sensitization in children with CD. Methods Fifty-nine children diagnosed with CD were reviewed for clinical symptoms and evidence of IgE-sensitization to food and airborne allergens using the PolyCheck method. Results IgE-mediated sensitization has been diagnosed in 20.3% of children with CD (CD/ A). In the CD/A group, 58.3% of children were sensitized to food and 66.7% to airborne allergens. Further, 41.7% of patients with CD and allergy reported gastrointestinal tract symptoms associated with the ingestion of sensitizing foods. Analysis of the clinical status revealed that the incidence of other allergic disorders in the CD/A group was as follows: atopic dermatitis (33.3%), asthma (25.0%), and allergic rhinitis (16.7%). The percentage of eosinophils was significantly higher in the CD/A group than in the CD group (0.33±0.25 vs. 0.11±0.09; p=0.006). Conclusion The diagnosis of CD does not exclude FA. The gastrointestinal symptoms in children with CD may be the result of both CD and FA; therefore, children with CD should be evaluated for the presence of FA regardless of age.

Purpose of review To provide the most recent insights in the use of biologicals in the treatment of patients with anaphylaxis. Recent findings There is evidence that biologics such as omalizumab may be safe and effective in preventing anaphylactic reactions in patients at high risk mainly because of severe food allergy or desensitization procedures to food, airborne allergen, drugs, or hymenoptera venom. Summary Further knowledge will guide the adoption and implementation of any new therapy including biologics for anaphylaxis according to the stratification of risk/benefits.

The respiratory epithelium forms the first line of defense against inhaled pathogens and acts as an important source of innate cytokine responses to environmental insults. One critical mediator of these responses is the IL-1 family cytokine IL-33, which is rapidly secreted upon acute epithelial injury as an alarmin and induces type 2 immune responses. Our recent work highlighted the importance of the NADPH oxidase dual oxidase 1 (DUOX1) in acute airway epithelial IL-33 secretion by various airborne allergens associated with H2O2 production and reduction-oxidation–dependent activation of Src kinases and epidermal growth factor receptor (EGFR) signaling. In this study, we show that IL-33 secretion in response to acute airway challenge with house dust mite (HDM) allergen critically depends on the activation of Src by a DUOX1-dependent oxidative mechanism. Intriguingly, HDM-induced epithelial IL-33 secretion was dramatically attenuated by small interfering RNA– or Ab-based approaches to block IL-33 signaling through its receptor IL1RL1 (ST2), indicating that HDM-induced IL-33 secretion includes a positive feed-forward mechanism involving ST2-dependent IL-33 signaling. Moreover, activation of type 2 cytokine responses by direct airway IL-33 administration was associated with ST2-dependent activation of DUOX1-mediated H2O2 production and reduction-oxidation–based activation of Src and EGFR and was attenuated in Duox1−/− and Src+/− mice, indicating that IL-33–induced epithelial signaling and subsequent airway responses involve DUOX1/Src–dependent pathways. Collectively, our findings suggest an intricate relationship between DUOX1, Src, and IL-33 signaling in the activation of innate type 2 immune responses to allergens, involving DUOX1-dependent epithelial Src/EGFR activation in initial IL-33 secretion and in subsequent IL-33 signaling through ST2 activation.

The house dust mite (HDM) is globally ubiquitous in human habitats. Thirty-two allergens for Dermatophagoides farinae and 21 for Dermatophagoides pteronyssinus have been detected so far. The present minireview summarizes information about the role of Der p 1 as a key coordinator of the HDM-induced allergic response and reports on a series of Italian patients who are allergic to HDMs. We studied the specific IgE profiles in a population of patients with allergic asthma and rhinitis screened for specific immunotherapy (SIT) for HDM allergies, with the aim of obtaining insights into the pathogenic role of Der p1. Patients co-sensitized to other airborne allergens showed a higher prevalence of asthma (9/12 (75%) vs. 2/7 (29%); p < 0.05) than did HDM mono-sensitized patients. The latter group showed higher Der p1 concentrations than that of the co-sensitized group (p = 0.0360), and a direct correlation between Der p1 and Der p2 (r = 0.93; p = 0.0003) was observed. In conclusion, our study offers insights into the role of Der p1 in a population of patients with allergic rhinitis and asthma who were candidates for SIT. Interestingly, Der p1 positivity was associated with bronchial asthma and co-sensitization.

Several climate change-related predictions and observations have been documented for the Australian continent. Extreme weather events such as cycles of severe drought and damaging flooding are occurring with greater frequency and have a severe impact on human health. Two specific aspects of climate change affecting allergic and other respiratory disorders are outlined: firstly, the consequences of extreme weather events and secondly, the change in distribution of airborne allergens that results from various climate change factors.

Background: The so-called “thunderstorm asthma” (TA) is an uncommon but dramatic outbreak of asthma attacks occurring during a thunderstorm in the pollen and moulds season. Mechanisms which make the pollen able to enter the deeper airways and provoke severe asthma symptoms are still unclear. Objective: To test the hypothesis that sub-pollen particles (SPPs) originated from the rupture by an osmotic shock of pollen associated with TA contain allergens. Methods: After hydration, SPPs released from pollen grains of grass, pellitory, olive, cypress, ragweed and birch were isolated and determined by microscopy. Allergens were determined by in vitro ELISA inhibition tests indirectly using the sera from 10 polyreactive patients. An inhibition 75% complete. Results: The inhibition experiments showed that the SPPs from birch and cypress were unable to inhibit serum IgE reactivity to Bet v 1 and Cup a 1, respectively. Ragweed SPPs inhibited ragweed pollen extract and Amb a 1 by 75.8±0.11% and 81.2±0.15%, respectively. Olive and pellitory SPPs retained almost the whole IgE-binding capability in all cases tested. Grass SPPs inhibited 32±0.06% of Lolium perenne Lol p 1 and 65% of Phleum pratense extracts, but results were highly variable for individual allergens (97.5%-0.03% for Phl p 2, 45.3±0.12% for Phl p 5, 24.7±0.22% for Phl p 6, and 38.3±0.2% for Phl p 1). Conclusions: Inhibition experiments confirm the hypothesis that SSPs obtained after the osmotic shock of pollen involved in TA, namely grass, pellitory and olive tree pollen, contain allergens and therefore they can induce severe asthma attacks during thunderstorms.

At present, sensitization to airborne allergens in domestic animals is absolutely rightly considered one of the key risk factors for the development of allergic rhinitis and bronchial asthma, as well as largely determines the development of severe forms of atopic dermatitis and respiratory allergosis. Of particular importance is the fact that, unlike other triggers, the elimination of allergens in domestic animals is often associated with internal resistance from patients. Various aspects of this problem are associated with a large number of baseless statement that lead to inadequate prevention and therapy, as well as negatively affecting the social activity of patients and their families. The article presents the current data on the prevalence of sensitization, the properties and clinical significance of the allergens of domestic animals, outlines approaches to conducting elimination activities.

OBJECTIVE: Airway diseases, including allergic rhinitis, are prompted by specific IgE antibodies against airborne allergens and notably those derived from mites. The presented study focused on the specific IgE immediate response to Dermatophagoides pteronyssinus (D. pteronyssinus) mite major allergens and the corresponding pertinence of molecular diagnosis in patients bothered with severe persistent rhinitis. METHODS: Individuals exhibiting confirmed sensitization to D. pteronyssinus along with a clinical diagnosis of coexisting severe allergic rhinitis were included in the study. In vivo investigations encompassed intradermal testing with a battery of standardized allergenic extracts, concurrent with in vitro specific IgE to the crude extract of D. pteronyssinus, and associated individual molecular allergens were assessed. RESULTS: Fifty-five out of 59 subjects showed serodominant IgE responses to the major allergens Der p 1, Der p 2 and Der p 23. Both Der p 2 and Der p 23 reached a prevalence above 80%, while group 10 allergen tropomyosin was scarcely depicted (

Background: The association among the IgE responses to prevailing groups of house dust mite (HDM) allergens in the concurrent asthma phenotypes has not been determined. Objective: The aim of the present study lays on a component-resolved diagnosis (CRD) model to investigate the mite molecular signature in subjects with type-2 inflammation asthma. Methods: We selected patients showing a clinically relevant sensitization to HDMs with moderate-to-severe persistent asthma. Skin prick test (SPT) with standardized mite extracts, a broad customized CRD serum sIgE panel including 9 Dermatophagoides pteronyssinus allergens and the related protein allergenic characterization, was investigated in all serum samples. Results: Ninety out of 93 (96.77%) patients with a positive SPT to HDM showed a concordant sIgE (≥0.35 kUA/L) to the crude extract of D. pteronyssinus. Major allergens (Der p 2, Der p 23, and Der p 1) were present in >70% of all subjects, with mid-tier allergens (Der p 5, Der p 7, and Der p 21) reaching up to 51% in the present cohort. A complex pleomorphic repertoire of HDM molecules recognized by IgE was depicted, including 38 distinct profiles. Conclusions and Clinical Relevance: The proposed CRD panel approach, containing the most prevalent HDM allergens, appeared to be sufficient to obtain a precise D. pteronyssinus molecular diagnosis in asthmatics with a climate-dependent high-mite allergen exposure and coexisting sensitization. A dominant role of both major and mid-tier allergens has been confirmed in moderate and severe persistent asthmatics with the preponderant Th2-high endotype.

Background Ficus carica is an edible fruit, belonging to the Moraceae family, rarely described as cause of food allergy. We describe the first case of fig allergy that occurred as a cross-reactivity between fig and Derp 1. Case presentation We present a case of a 10-years-old-girl, with a history of no-seasonal mild intermittent rhinitis, who experienced an immediate reaction after ingestion of a fresh fig. Skin prick tests (SPT) with commercial extracts of food, airborne allergens, latex and panallergens (profilin, PR-10 and lipid transfer protein) were performed. SPT revealed a sensitization only for dermatophagoides farina and dermatophagoides pteronyssinus which was then confirmed with by specific IgE assay (UniCAP, Phadia, Uppsala, Sweden). We also carried out a positive SPT with a commercial fig allergen (Lofarma, Milan, Italy) and prick-by-prick (PBP) both with skin and pulp of green raw and cooked fig. Fig specific serum IgE levels were 1.08 U/ml and specific IgE for rDer p1 was 16.20 U/ml (total serum IgE = 377 U/ml). In contrast specific IgE levels for latex, LTP, profilin, PR-10 and pollen allergens were negative. Conclusion The ficin, the major fig allergen, belongs to cysteine protease family like Der p 1. The symptoms presented by our patient could be related to a cross reactivity between these two proteins which present a structural homology.

IL-33, an IL-1 family cytokine, is constitutively expressed in mucosal tissues and other organs in healthy humans and animals, and expression levels increase in inflammatory conditions. Although IL-33–mediated promotion of type 2 immune responses has been well established, a gap in our knowledge regarding the functional diversity of this pleiotropic cytokine remains. To address this gap, we developed a new IL-33 transgenic mouse model in which overexpression of full-length IL-33 is induced in lung epithelial cells under conditional control. In adult mice, an ∼3-fold increase in the steady-state IL-33 levels produced no pathologic effects in the lungs. When exposed to airborne allergens, adult transgenic mice released more IL-33 extracellularly and exhibited robust type 2 immune responses. In neonatal transgenic mice, up to postnatal day 14, a similar increase in steady-state IL-33 levels resulted in increased mortality, enlarged alveolar spaces resembling bronchopulmonary dysplasia, and altered expression of genes associated with tissue morphogenesis. Processed 25-kDa IL-33 protein was detected in bronchoalveolar lavage fluids without any exogenous stimuli, and pathologic changes were abolished in mice deficient in the IL-33 receptor ST2. These findings suggest that adult lungs are relatively resistant to IL-33 overexpression unless they encounter environmental insults, whereas developing lungs are highly susceptible, with IL-33 overexpression resulting in detrimental and pathologic outcomes.

Summary Asthma affects three hundred million people worldwide. The effectiveness of house dust mite allergen control for asthma treatment is debatable. One aspect that has been little discussed in existing meta‐analyses is the possible role of environmental strategies. Here, we reintroduce the previously defined strategies for mite allergen control and discuss their importance to the debate on clinical effectiveness. The strategy of concurrent bedroom interventions is related to the combined use of a priori defined interventions, while the strategy of exposure‐based control relates to the treatment of relevant textiles after assessing exposure. The air purification strategy aims to purify the human breathing zone of airborne allergens. In Western European patient practice, the use of these strategies differs. A post hoc study of the dominant Cochrane review by Gøtzsche and Johansen (Cochrane Database of Systematic Reviews, 2008, Art. No: CD001187) appears to indicate that a majority of the underlying trials reported on the strategy of concurrent bedroom interventions, which were mainly executed in a minimal manner. Some trials have reported on the air purification strategy and may potentially alter the debate on effectiveness. No trial has reported on the strategy of exposure‐based control. We therefore hypothesize that the absence of evidence for the effectiveness of mite allergen control for asthma treatment applies to the strategy of concurrent bedroom interventions. The evidence‐based effectiveness of the exposure‐based control strategy appears to be undetermined. The results of our post hoc reanalysis urge that future meta‐analyses of mite allergen control should a priori define the environmental strategy under study. Future trials of mite allergen control are warranted to test the exposure‐based strategy as well as the sparsely tested strategy of air purification.

Allergic rhinitis (AR) affects 23-30% of the European population with equal prevalence reported in Belgium. Despite guidelines on the correct use of effective treatment, up to 40% of AR patients remain uncontrolled. Allergen immunotherapy (AIT) has been shown to improve the level of control up to 84% of patients being controlled by AIT. Recently, new guidelines for AIT have been published, supporting the clinical evidence for effectiveness of various subcutaneous and sublingual products for AIT in patients who are allergic to airborne allergens. AIT in AR patients not only reduces nasal and/or ocular symptoms but also induces tolerance and has preventive potential. Adoption of AIT into daily clinical practice in Belgium and other European countries is hampered primarily by reimbursement issues of each of the single products but also by several patient- and physician-related factors. Patients need to be better informed about the effectiveness of AIT and the different routes of administration of AIT. Physicians dealing with AR patients should inform patients on tolerance-inducing effects of AIT and are in the need of a harmonized and practical guide that supports them in selecting eligible patients for AIT, in choosing evidence-based AIT products and in following treatment protocols with proven efficacy. Therefore, a stepwise and holistic approach is needed for better adoption of AIT in the real-life setting in Belgium. ispartof: CLINICAL AND TRANSLATIONAL ALLERGY vol:9 issue:1 ispartof: location:England status: published

Forkhead box P3–positive regulatory T (Treg) cells are essential mediators of tolerance against self-antigens and harmless exogenous antigens. Treg cell deficiencies result in multiple autoimmune and allergic syndromes in neonates. How Treg cells affect conventional allergies against aeroantigens, which are restricted to a few specific proteins released from inhaled particles, remains controversial. The hallmarks of antigen-specific loss of tolerance are allergen-specific TH2 cells and IgE. However, difficulties in identifying the rare allergen-specific Treg cells have obscured the cellular basis of tolerance to aeroallergens, which is also a major obstacle for the rational design of novel and more efficient allergen-specific immunotherapies. Recent technological progress allowing characterization of allergen-specific effectors and Treg cells with minimal in vitro manipulation revealed their detailed contribution to tolerance. The data identified inhaled particles as immunodominant Treg cell targets in healthy and allergic subjects. Conversely, the supposed immunodominant major allergens being rapidly released from inhaled particles apparently do not actively induce tolerance but are ignored by the immune system. Here, the partially contradictory data on various allergen-specific T-cell types in healthy subjects, allergic patients, and patients undergoing allergen-specific immunotherapy are discussed and integrated into one model, postulating Treg cell–dependent and Treg cell–independent checkpoints of tolerance and allergy development.

Pollen and fungal spores are associated with seasonal and perennial allergies. However, most scientific literature thus far suggests that pollen allergy is more clinically relevant than fungal allergy. Several environmental and biological factors and the difficulty in producing reliable fungal extracts account for this. Biodiversity, taxonomy, and meteorology are responsible for the types and levels of pollen and fungal spores, their fragments, and the presence of free airborne allergens. Therefore, it is difficult to accurately measure both pollen and fungal allergen exposure. In addition, understanding the enzymatic nature of fungal and some pollen allergens, the presence of allergenic and nonallergenic substances that may modulate the allergic immune response, and allergen cross-reactivity are all necessary to appropriately evaluate both sensitivity and exposure. The raw materials and manufacturing processes used to prepare pollen versus fungal extracts differ, further increasing the complexity to properly determine allergic sensitivity and degrees of exposure. The pollen extracts used for diagnosis and treatment are relatively consistent, and some have been standardized. However, obtaining clinically relevant fungal extracts is more difficult. Doing so will allow for the proper selection of such extracts to more appropriately diagnose and treat both pollen- and fungal-induced allergic diseases.

Asthma is a highly prevalent disorder characterized by chronic lung inflammation and reversible airways obstruction. Pathophysiological features of asthma include episodic and reversible airway narrowing due to increased bronchial smooth muscle shortening in response to external and host-derived mediators, excessive mucus secretion into the airway lumen, and airway remodeling. The aberrant airway smooth muscle (ASM) phenotype observed in asthma manifests as increased sensitivity to contractile mediators (EC50) and an increase in the magnitude of contraction (Emax); collectively these attributes have been termed “airways hyper-responsiveness” (AHR). This defining feature of asthma can be promoted by environmental factors including airborne allergens, viruses, and air pollution and other irritants. AHR reduces airway caliber and obstructs airflow, evoking clinical symptoms such as cough, wheezing and shortness of breath. G-protein-coupled receptors (GPCRs) have a central function in asthma through their impact on ASM and airway inflammation. Many but not all treatments for asthma target GPCRs mediating ASM contraction or relaxation. Here we discuss the roles of specific GPCRs, G proteins, and their associated signaling pathways, in asthma, with an emphasis on endogenous mechanisms of GPCR regulation of ASM tone and lung inflammation including regulators of G-protein signaling (RGS) proteins, G-protein coupled receptor kinases (GRKs), and β-arrestin.

Early life respiratory insults, such as viral infections or hyperoxia, often increase asthma susceptibility later in life. The mechanisms underlying this increased susceptibility are not fully understood. IL-33 has been shown to be critically involved in allergic airway diseases. IL-33 expression in the neonatal lung can be increased by various respiratory insults associated with asthma development. Therefore, we investigated whether and how early life increases in IL-33 impact allergic airway responses later in life. Using a novel IL-33 transgenic mouse model, in which full-length IL-33 was inducible overexpressed in lung epithelial cells, we transiently upregulated lung IL-33 expression in neonatal mice for one week. After resting for 4–6 weeks, mice were intranasally exposed to a single-dose of recombinant IL-33 or the airborne allergen Alternaria. Alternatively, mice were exposed to Alternaria and ovalbumin multiple times for one month. We found that a transient increase in IL-33 expression during the neonatal period promoted IL-5 and IL-13 production when mice were later exposed to a single-dose of IL-33 or Alternaria in adulthood. However, increased IL-33 expression during the neonatal period did not affect airway inflammation, type 2 cytokine production, lung mucus production, or antigen-specific antibody responses when adult mice were exposed to Alternaria and ovalbumin multiple times. These results suggest that transient increased IL-33 expression early in life may have differential effects on allergic airway responses in later life, preferentially affecting allergen-induced acute type 2 cytokine production.

Since the spread of SARS-CoV-2 became a pandemic, the number of cases has been continuously growing worldwide. Numerous recommendations and suggestions have been published to prevent the acquisition and spread of the SARS-CoV-2, especially to protect health workers and front-line caregivers. SARS-CoV-2 is transmitted by aerosol, rendering air defense with suitable ventilation and adequate mask use pivotal. Recently, locally applied antiseptic, antiviral, or structure competitive receptor blockers were suggested to attack the virus at its main point of invasion, the nasal mucosa and nasopharynx. We discuss the most plausible and safe ideas to reduce viral load at the point of entry, and subsequently the spread of SARS-CoV-2 to the lower respiratory tract, lungs, and other organs. In addition, we analyze the value and recommend clinical trials employing topical trichloroacetic acid (TCA), a substance well known from dermatologic and cosmetic procedures. It has been proven to successfully block the nasal entry for airborne allergens, preventing the development of allergic rhinitis and asthma, and to be curative for early stages of viral infections entering through the oral mucosa. For SARS-CoV-2, TCA in a single, short-time application is expected to remodel the nasal and nasopharyngeal epithelia, eliminating both the receptors and cells responsible for viral entry and subsequent viral spread to the lower respiratory tract. Moreover, this may have therapeutic benefits for those recently infected by reducing local viral replication. Such procedures are cheap, safe, and can be conducted in almost every setting, especially in regions with inadequate financial and logistic resources.

Atopic dermatitis (AD) represents a widespread chronic skin disease associated with different atopic disorders and allergies. These associations, similar to overall AD pathophysiology, are entangled, multifactorial and they are yet to be clarified. IgE and non IgE mediated pathomechanisms appear to be implicated in AD. Allergens constitute key aspects in AD pathogenesis, as they may serve as trigger factors. This review emphasizes mainly house dust mites (HDM), as they are likely the most relevant airborne allergen for AD. Here we review in a concise form the mite allergens, the role of molecular diagnosis and the treatment strategies for HDM. Strategies of avoiding allergens, with a few exceptions, are not enough to control children's AD; recent studies show HDM avoidance procedures in diagnosed AD are insufficient. Regardless, some guidelines acknowledge the benefit of mattress and pillow covers in patients with dust mite sensitization that are unresponsive to optimal AD management. Most clinical trials investigating allergen-specific immunotherapy (AIT) as a potential treatment for AD were done with adult patients; a scarce number of studies looked into the efficacy of AIT as a treatment option in children suffering from AD, with conflicting data among them. One of the most feasible of these studies showed significant improvement of AD outcomes only in the mild/moderate group, but not in the severe group. Uncontrolled studies are hard to interpret, considering the natural history of remitting and relapsing of AD, in many of the patients, without clinical interventions. More AIT studies, especially pediatric studies, are required in order to either prove the reproducibility of positive results or to deny its effectiveness.

The prevalence of allergic diseases has increased dramatically in recent years in China, affecting the quality of life in 40% of the population. The identification of allergens is the key to the diagnosis of allergic diseases. Presently, several methods of allergy diagnostics are available in China, but they have not been standardized. Additionally, cross-sensitization and co-sensitization make allergy diagnostics even more complicated. Based on 4 aspects of allergic disease (mechanism, diagnosis procedures, allergen detection in vivo and in vitro as well as the distribution map of the most important airborne allergens in China) and by referring to the consensus of the European Society of Allergy and Clinical Immunology, the World Allergy Organization, and the important literature on allergy diagnostics in China in recent years, we drafted this consensus of allergy diagnostics with Chinese characteristics. It aims to standardize the diagnostic methods of allergens and provides a reference for health care givers. The current document was prepared by a panel of experts from the main stream of professional allergy associations in China.

Cupressaceae pollen is one of the major airborne allergens of the Mediterranean region and in other regions around the world. Pollen production of these species causes considerable allergic problems during winter, being this type of pollen the most abundant in this period of the year. This work aims to relate phenology, meteorology and airborne pollen records in these species. Aerobiological sampling was carried out in Badajoz (SW Spain) from 2016 to 2018 using Hirst-type volumetric sampler. Pollination phenology was studied in 50 specimens, ten of Cupressus macrocarpa, ten of Cupressus arizonica, 15 of Cupressus sempervirens and 15 of Platycladus orientalis with a frequency of 3–4 days on average during the months of January to March. In all cases, five specimens were in the surrounding of pollen station and at least five of them 4 km apart. For phenology, BBCH methodology was used. Daily data for the whole period and hourly data for the last 2 years were analyzed, including pollen records and meteorology. Comparison between pollen records and sources distribution was assessed. Main pollen season lasted on average 91 (89–94) days. In all the years, the peaks of phenology of the different species can be matched with peaks of airborne pollen records, considering that rain can prevent a more precise correspondence.

Background Allergen-specific immunotherapy (ASIT) has the potential to modify allergic diseases, and it is also considered a potential therapy for allergic asthma. House dust mite (HDM) allergens, a common source of airborne allergen in human diseases, have been developed as an immunotherapy for patients with allergic asthma via the subcutaneous and sublingual routes. Oral immunotherapy with repeated allergen ingestion is emerging as another potential modality of ASIT. The aim of this study was to evaluate the therapeutic efficacy of the oral ingestion of HDM extracts in a murine model of allergic asthma. Methods BABL/c mice were sensitized twice by intraperitoneal injection of HDM extracts and Al(OH)3 on day 1 and day 8. Then, the mice received challenge to induce airway inflammation by intratracheal instillation of HDM extracts on days 29–31. The treatment group received immunotherapy with oral HDM extracts ingestion before the challenge. All the mice were sacrificed on day 32 for bronchoalveolar inflammatory cytokines, mediastinal lymph node T cells, lung histology, and serum HDM-specific immunoglobulins analyses. Results Upon HDM sensitization and following challenge, a robust Th2 cell response and eosinophilic airway inflammation were observed in mice of the positive control group. The mice treated with HDM extracts ingestion had decreased eosinophilic airway inflammation, suppressed HDM-specific Th2 cell responses in the mediastinal lymph nodes, and attenuated serum HDM-specific IgE levels. Conclusions Oral immunotherapy with HDM extracts ingestion was demonstrated to have a partial therapeutic effect in the murine model of allergic asthma. This study may serve as the basis for the further development of oral immunotherapy with HDM extracts in allergic asthma.

At present, sensitization to airborne allergens in domestic animals is absolutely rightly considered one of the key risk factors for the development of allergic rhinitis and bronchial asthma, as well as largely determines the development of severe forms of atopic dermatitis and respiratory allergosis. Of particularimportance isthe fact that, unlike othertriggers, the elimination of allergensin domestic animals is often associated with internal resistance from patients. The article presents the current data on the prevalence of sensitization, the properties and clinical significance of the main allergens of cats and dogs, outlines approaches to conducting elimination activities.

Background The pathogenesis of eosinophilic esophagitis (EoE) is currently unknown, but evidence suggests that allergic sensitization to food and airborne allergens may play a key role. This retrospective study examines the rate of sensitization to both food and airborne allergens in EoE patients, and compares their sensitivity patterns to control groups. Methods We identified 103 patients with a diagnosis of EoE via esophageal eosinophilia (≥15 eosinophils/high-power field [hpf]), who had undergone comprehensive food and/or airborne allergen testing through either skin or in vitro methods. Food and airborne allergen sensitization was defined as positive testing in at least 1 food subgroup (milk, peanut, tree nut, seafood/fish, soy, grain, egg) or airborne subgroup (tree, grass, weed, mite/cockroach, animal, mold), respectively. The same sensitization criterion was applied to allergic rhinitis (AR) patients, with and without a clinical suspicion of food allergy (FA), in order to create control groups. Results Sensitization in the EoE group to at least 1 subgroup of food allergen and airborne allergen was seen in 77.1% (64/83) and 71.7% (38/53), respectively (p = 0.82). There were significant differences in sensitization between EoE and control groups for tree nut, soy, grain, and egg, but no differences noted in any of the other food or airborne allergen subgroups, even after accounting for age and gender. Conclusion EoE and control groups had similar airborne allergen sensitization patterns, yet dissimilar food allergen sensitization patterns, suggesting that specific allergens may play a more prominent role in the pathogenesis of EoE. The EoE group had a more uniform distribution pattern for food allergens, compared to controls.

The oral mucosa, which is the lining tissue of the oral cavity, is a gateway to the body and it offers first-line protection against potential pathogens, exogenous chemicals, airborne allergens, etc. by means of its physical and microbiological-immune barrier functions. For this reason, oral mucosa is considered as a mirror to the health of the individual as well as a guard or early warning system. It is organized in two main components: a physical barrier, which consists of stratified epithelial cells and cell–cell junctions, and a microbiological-immune barrier that keeps the internal environment in a condition of homeostasis. Different factors, including microorganism, saliva, proteins and immune components, have been considered to play a critical role in disruption of oral epithelial barrier. Altered mucosal structure and barrier functions results in oral pathologies as well as systemic diseases. About 700 kinds of microorganisms exist in the human mouth, constituting the oral microbiota, which plays a significant role on the induction, training and function of the host immune system. The immune system maintains the symbiotic relationship of the host with this microbiota. Crosstalk between the oral microbiota and immune system includes various interactions in homeostasis and disease. In this review, after reviewing briefly the physical barriers of oral mucosa, the fundamentals of oral microbiome and oral mucosal immunity in regard to their barrier properties will be addressed. Furthermore, their importance in development of new diagnostic, prophylactic and therapeutic strategies for certain diseases as well as in the application for personalized medicine will be discussed.

Background In early childhood, the allergen-specific IgG repertoire is mainly directed to animal and vegetable food molecules and infrequently to airborne molecules. It is unknown whether this early pattern is maintained throughout childhood. Objective To investigate the evolution of IgG and IgE responses to a broad panel of allergenic molecules from birth to age 10yrs. Methods We examined the sera collected between birth and age 10yrs from participants in the German Multicentre Allergy Study, a birth cohort born in 1990. The IgE (cut-off ≥0.30 ISU) and IgG (cut-off ≥0.10 ISU) responses to 35 genuine allergenic molecules were measured with a multiplex microarray approach (ImmunoCAP ISAC™). Results IgE responses were mostly directed against a restricted group of airborne molecules, with a sequence and prevalence hierarchy (Phl p 1 > Bet v 1 > Fel d 1 > Phl p 5 > Der p 2 > Der p 1) largely maintained over time. Conversely, the IgG repertoire was much broader, starting with animal foodborne, then spreading to vegetable foodborne and finally to airborne molecules. A strong and persistent IgG response to a given airborne molecule almost invariably preceded or accompanied an IgE response to that molecule. Conclusions The evolution of IgG and IgE responses throughout childhood differs widely at population level. IgG responses are mostly directed to animal food allergens while IgE responses are dominated by airborne allergens. However, a strong IgG response almost invariably precedes or accompanies the appearance of IgE to the same molecule in specifically sensitized subjects. This article is protected by copyright. All rights reserved.

Atopic sensitization belongs to the most common risk factors for bronchial asthma. However, in clinical practice, it is not clear whether sensitization against pollen and perennial allergens is differently associated with the severity of bronchial hyperresponsiveness (BHR). To find out whether patients sensitized to perennial allergens differ in severity of bronchial hyperresponsiveness from patients sensitized to pollen allergens. The study includes 109 patients. Based on the results of skin prick tests, patients were divided into three groups: sensitivity to pollen allergens – group A; sensitivity to perennial allergens – group B; sensitivity to both pollen and perennial allergens – group C. Based on the histamine bronchoprovocation test, we compared the values of histamine provocative concentration causing a 20% drop in FEV1 (PC20) among particular groups of patients. Mild bronchial hyperresponsiveness was determined if the value of PC20 was >4 mg/ml, while if the value of PC20 was

BACKGROUND AND OBJECTIVE Eosinophilic esophagitis (EoE) is an increasingly prevalent chronic inflammatory disease of the esophagus with an immunoallergic etiology. Few studies have been published on EoE in children and adolescents. The objective of this study was to analyze the demographic, clinical, serologic, endoscopic-histologic, and atopic characteristics of pediatric patients with EoE and to identify atopic and digestive comorbidities. METHODS We conducted a prospective observational study in children and adolescents (

Olive and grass pollen grains are the major causes of hay fever in the Mediterranean region. A number of samplers and methods have been developed in recent years in order to obtain reliable data regarding airborne allergen concentrations. This paper reports on a detailed comparison of two samplers—Cyclone and ChemVol—and on the parameters that could influence their efficiency. Airborne concentrations of two key olive and grass allergens, Ole e 1 and Phl p 5, respectively, were monitored over two years with different weather patterns, 2012 and 2014. Allergenic particles were quantified by ELISA assay, and results were compared with pollen concentrations monitored using a Hirst-type volumetric spore trap over the same study periods. The influence of weather-related parameters on local airborne pollen and allergen concentrations was also analysed. Although a positive correlation was detected between results obtained using the two samplers during the pollen season, results for the cumulative annual Allergen Index varied considerably. The two samplers revealed a positive correlation between pollen concentrations and both minimum temperature during the warmer year (2012) and maximum temperature during the cooler year (2014); a negative significant correlation was observed in both cases with rainfall and relative humidity. In summary, although some differences were observed between the two samplers studied, both may be regarded as suitable for allergen detection.

Background: A high level of house dust mite (HDM) allergens in a living environment is a risk factor for both sensitization to these allergens and asthmatic attacks. We previously showed that plasma cluster ions (PCIs) impaired the IgE-binding capacity of atomized crude allergens prepared from Japanese cedar pollen and fungus under experimental conditions. Objective: We evaluated the capacity of PCIs to impair the IgE-binding capacity of airborne HDM allergens under a simulated indoor environmental condition. Methods: For the determination of the effects of PCIs on HDM allergens under an experimental condition, HDM extract was atomized as aqueous mist into a cylindrical experimental apparatus filled with PCIs. For the evaluation of the effects of PCIs under a simulated natural indoor environmental condition, dried HDM allergens were floated as airborne particles in an acryl cubic apparatus in the presence of PCIs. The IgE-binding capacities of the PCI- and sham-treated HDM allergens were analyzed by an ELISA. Results: The IgE-binding capacity of the HDM allergens was significantly impaired after PCI treatment compared to that after sham treatment under both experimental and simulated environmental conditions. The ELISA results demonstrated that the IgE-binding capacities of HDM allergens after PCI treatment showed 68 and 74% reductions compared to those after sham treatment under the experimental and simulated environmental conditions, respectively. Conclusions: PCIs have the capacity to impair the IgE-binding capacity of airborne HDM allergens in a simulated environmental condition.

In allergic asthma, inhalation of airborne allergens such as the house dust mite (HDM) effectively activates both innate and adaptive immunity in the lung mucosa. To determine the role of the eicosanoid PGI2 and its receptor IP during allergic airway sensitization, HDM responses in mice lacking a functional IP receptor (i.e., PGI2 IP receptor–deficient [IP−/−]) were compared with wild type (WT) mice. Surprisingly, IP−/− mice had increased numbers of pulmonary CD3−NK1.1+Ly49b+ NK cells producing IFN-γ that was inversely associated with the number of type 2 innate lymphoid cells (ILC2s) expressing IL-33Rα and IL-13 compared with WT animals. This phenomenon was associated with elevated CX3CL1 levels in the airways of IP−/− mice and treatment with a neutralizing Ab to CX3CL1 reduced IFN-γ production by the lung NK cells. Remarkably, IP−/− mice were less responsive to HDM challenge than WT counterparts because intranasal instillation of the allergen induced markedly reduced levels of airway eosinophils, CD4+ lymphocyte infiltration, and mucus production, as well as depressed levels of CCL2 chemokine and Th2 cytokines. NK cells were responsible for such attenuated responses because depletion of NK1.1+ cells in IP−/− mice restored both the HDM-induced lung inflammation and ILC2 numbers, whereas transfer of CD3−NK1.1+ NK cells into the airways of WT hosts suppressed the inflammatory response. Collectively, these data demonstrate a hitherto unknown role for PGI2 in regulating the number and properties of NK cells resident in lung tissue and reveal a role for NK cells in limiting lung tissue ILC2s and preventing allergic inflammatory responses to inhaled HDM allergen.

Local allergic rhinitis (LAR) forms a subset of allergic rhinitis (AR), in which systemic antibodies (sIgE) to the triggering allergen cannot be detected or do not exist in the blood or skin, but within the nasal mucosa, they are present and trigger the response. In LAR individuals, the NAPT (nasal allergen provocation test) is positive. It is implicit within allergic rhinitis that the nasal and sinusal mucosa contain sIgE, otherwise a Type I hypersensitivity reaction could not occur, but a specific check for this is seldom undertaken if the symptomatology fits allergic rhinitis and systemic testing (skin and serum) for sIgE is positive. LAR is a frequent component within chronic rhinosinusitis. It is highly probable that patients with LAR or AR show severe symptoms of a chronic nature such as those found in conjunctivitis, asthma or sensitisation to multiple allergens. Where a patient has a clinical picture fitting AR, but cutaneous tests and serum sIgE levels are negative, further investigations are recommended, since otherwise all such cases will be classified as non-allergic rhinitis. Where local sIgE is detectable following naturally occurring exposure to airborne allergens and NAPT is positive, resulting in raised levels of localised tryptase, eosinophil cationic protein (ECP) and sIgE, this helps to make the diagnosis of LAR.

BACKGROUND AND OBJECTIVE An increasing number of studies have recently discussed whether provocation tests might be replaced by specific IgE serology in patients sensitized to airborne allergens. Objective: Our study aimed to analyze the concordance between a nasal provocation test with Dermatophagoides pteronyssinus and specific IgE measurements based on real-life data. METHODS We retrospectively analyzed concordance between the result of the provocation test and the IgE titer for house dust mite components and extracts in 223 patients with proven sensitization to D pteronyssinus. RESULTS In contrast to findings from other studies, the anti-Der p 1 level alone was not sufficient to distinguish between silent sensitization and allergy to D pteronyssinus. ROC curve analysis revealed that the sum of sIgE against Der p 1 and Der p 2 is-after adjustment for total serum IgE-the best parameter for discriminating between clinically silent and relevant sensitization. However, it does not have sufficient validity to confirm a diagnosis. CONCLUSIONS Despite the high correlation between sIgE levels and symptoms, no serologic parameter is sufficiently accurate to distinguish between silent sensitization and clinically relevant allergy. Therefore, nasal provocation tests remain the gold standard for assessing clinical relevance in sensitization to D pteronyssinus.

Background There is a strong and consistent association between IgE sensitization and allergy, wheeze, eczema and food hypersensitivity. These conditions are also found in non-sensitized humans, and sensitization is found among individuals without allergy-related diseases. The aim of this study was to analyse the sensitization profile in a representative sample of the population, and to relate patterns of allergens and allergen components to allergic symptoms. Methods A population of 195 adolescents took part in this clinical study, which included a self-reported questionnaire and in vitro IgE testing. Results Sensitization to airborne allergens was significantly more common than sensitization to food allergens, 43% vs. 14%, respectively. IgE response was significantly higher in airborne allergens among adolescents with rhinitis (p

Several murine models have been established to mimic human eosinophilic chronic rhinosinusitis (ECRS). However, in most of these models, ECRS was induced using ovalbumin, which does not cause sinusitis in humans. Thus, we aimed to develop a more clinically relevant murine model of ECRS using multiple airborne allergens. We also investigated the effects of exposure duration of the allergens on ECRS development. C57BL/6 mice were intranasally administered multiple airborne allergens (house dust mite, Aspergillus fumigatus, Alternaria alternata, and protease from Staphylococcus aureus) three times weekly for 4, 8, 12, and 16 consecutive weeks. Histopathological changes, the levels of cytokines and chemokines in the nasal lavage fluid, and immune cells of the blood and spleen were analyzed. The mice administered multiple allergens showed significantly increased eosinophil infiltration, epithelial thickening and disruption, and subepithelial collagen deposition from 8 weeks compared to the control group. Goblet cell hyperplasia, polyp-like lesions, and blood eosinophils, as well as the levels of interleukin-5 and eotaxin in the nasal lavage fluid were considerably increased in the ECRS group from 12 weeks compared to those of controls. Instillation of allergens for 16 weeks exacerbated the eosinophil infiltration and eotaxin increase in the nasal lavage fluid. We successfully established a new murine model of ECRS using more clinically relevant multiple airborne allergens. Prolonged exposure to airborne allergens for 12 weeks or more, corresponding to the definition of human ECRS, strongly induced eosinophil infiltration as well as epithelial remodeling.

Environmental allergens, such as pollens and house dust mite allergens, cause sensitization and lead to allergic diseases, which make people suffer from asthma or rhinitis. These environmental allergens often become airborne in a living space, and residents are endangered to be exposed to and inhale the airborne allergens. Therefore, prevention of the exposure directly connects to prevention of allergic diseases. One of the possible ways to avoid the exposure is monitoring of airborne allergens in a living space and making a resident become aware of the environmental quality. Such a system requires a sensor, and especially with high selectivity along with a sensitivity to the allergens. For this purpose, immunosensors are the candidates due to their high selectivity, which relies on the specificity of an antibody. A challenge to use immunosensors for monitoring is difficulty of sensor surface regeneration—breaking down a formed immunocomplex and removing them from the sensor surface for a next measurement. In this chapter, we describe a reusable immunosensor for monitoring of a HDM allergen, Dermatophagoides farinae group 1 (Der f 1). The immunosensor utilizes a surface acoustic wave device and surface modification with pH-tolerant protein scaffold (ORLA85 protein) for capture antibody immobilization. Der f 1 is measured by detecting viscoelastic change induced by sandwich assay with detection antibodies. In addition, the use of gold nanoparticles for amplification of the sensor’s output signal is also discussed.

Summary Background and Objective. Sensitization and allergy to shrimp among Italian house dust mite allergic patients are not well defined and were investigated in a large multicenter study. Methods. Shrimp sensitization and allergy were assessed in 526 house dust mite (HDM)-allergic patients submitted to the detection of IgE to Der p 10 and 100 atopic control not sensitized to HDM. Results. Shrimp allergy occurred in 9% of patients (vs 0% of 100 atopic controls not sensitized to HDM; p minor 0.001). Shrimp-allergic patients were less frequently hypersensitive to airborne allergens other than HDM than crustacean-tolerant subjects (35% vs 58.8%; p minor 0.005). Only 51% of tropomyosin-sensitized patients had shrimp allergy, and these showed significantly higher Der p 10 IgE levels than shrimp-tolerant ones (mean 22.2 KU/l vs 6.2 KU/l; p minor 0.05). Altogether 53% of shrimp-allergic patients did not react against tropomyosin. Conclusions. Shrimp allergy seems to occur uniquely in association with hypersensitivity to HDM allergens and tropomyosin is the main shrimp allergen but not a major one, at least in Italy. Along with tropomyosin-specific IgE levels, monosensitization to HDM seems to represent a risk factor for the development of shrimp allergy among HDM allergic patients.

Purpose of review To describe and understand the links and interactions between food allergy and asthma Recent findings Food allergy and asthma are characterized by an increasing prevalence. Moreover, food allergy and asthma often coexist. Both conditions are associated with each other in different ways. It has been shown that food allergy is a risk factor of developing asthma. Atopic dermatitis appears to be the common denominator in this interaction. Loss-of-function variants of the filaggrin mutation result in an impaired epidermal barrier function and have been shown to be a risk factor for the development of atopic dermatitis, allergies, and asthma. Early introduction of food allergens and optimal treatment of the skin barrier are preventive interventions for the development of food allergy and asthma. Asthma is also a risk factor for the development of severe or even fatal anaphylaxis in patients with food allergy. Isolated asthma is not a feature of a food allergic reaction; however, respiratory symptoms may be part of anaphylactic reactions. In addition, during an allergic reaction to food, non-specific bronchial hyperreactivity may increase. Cross-reactive allergens may be responsible for asthma-associated food allergy. This is particularly true for severe asthma upon ingestion of snail in patients allergic to house-dust mites. Finally, airborne allergens from occupational sources such as wheat, fish, and seafood may induce asthmatic reactions. This phenomenon is sometimes seen in non-occupational settings. Summary Food allergy and asthma are interconnected with each other beyond the presence of simple comorbidity. Food allergy precedes and predisposes to asthma, and mutual interactions range from respiratory symptoms and bronchial hyperreactivity during food-induced anaphylaxis to severe asthma due to cross-reactive food allergens and to occupational asthma upon exposure to airborne allergens. Moreover, coexisting asthma in food allergies may result in severe and sometimes fatal anaphylactic reactions.

Allergic respiratory disease, which includes allergic rhinoconjunctivitis and asthma, is one of the most common diseases, with a major impact on a patient's quality of life. Air pollution is one of the main factors associated with the development of allergic respiratory disease, it has been shown to impair lung development in children and adolescents. The origins of particulate matter produced from various sources, including those issued by traffic and the burning of fuels such as coal, gasoline and diesel. Diesel emissions represent the majority of the particulate matter in urban air pollution. It has been found that the co-exposure of diesel emissions and airborne allergens increases allergen-specific IgE levels, severity of asthma, inflammation and airway hyper-responsiveness. In vivo and in vitro studies have reported the activation of anti-transcription and pro-inflammatory mediators. Polycyclic aromatic hydrocarbons, metal components or metabolites may increase due to the formation of oxygen reactive species that interact with DNA, producing different types of damage as oxidative damage.

A 1-year study was conducted, with the aim to investigate the airborne allergens around the Dead Sea (DS), identify and quantify airborne pollen and spores in the DS region, and determine the different sensitization prevalence among various population groups to these aeroallergens. According to results, we also aimed to define “safe seasons” when there are no or only few aeroallergens in the atmosphere that surrounds the Dead Sea. A Rotorod and a Hirst trap were used for continuous monitoring of pollen and spores which were then identified. Sensitization to aeroallergens was assessed by skin prick tests (SPT) in three groups of allergic residents: foreign tourists, Israeli tourists, and local workers from the hotel industry. Air around the DS is by no means free of aeroallergens, 50 pollen and 43 mold types were identified. Pollen was from native plants, imported ornamentals, and others transported by winds from long distances. Overall pollen concentrations were lower around the Dead Sea than in the Tel Aviv region, but in certain months, they were higher around the DS. Marked seasonal variations in pollen and spore dispersal were observed. By SPT, hypersensitivity to Chenopodiaceae, Amaranthaceae, Cupressus, Solidago, Poaceae, Olea, Artemisia as well as molds such as Alternaria and Aspergillus, was found. As assessed by SPT, some of tourists and permanent residents are allergic to pollen, molds, and house dust mites. The presented study enables one to denote “safe” seasons when the concentration of airborne allergens is below “allergenic risk”: June–August and November–February. These seasons are the most suitable for allergic medical tourists.

Background Efficacy testing of immunotherapy in field studies is often hampered by variation of airborne allergens. Standardized allergen exposure in challenge chamber settings might be an alternative. Therefore, we developed a universal technique to create an atmosphere loaded with allergen particles of adjustable size from aqueous solutions of licensed allergen extracts. Objective The aim of this study was to apply this technique and test the safety and efficacy of challenges with house dust mite (HDM) allergen in the Fraunhofer allergen challenge chamber. Methods Aerosol particles carrying HDM allergen were produced by spray-drying of an aqueous solution containing HDM allergen and lactose. In a monocenter, placebo-controlled, single-blind, dose-escalation pilot study, 18 subjects with perennial allergic rhinitis and sensitization to HDM were exposed to HDM allergen for 4 h at either 250, 500, 1000 SQE/m3 or lactose alone (0 SQE/m3 ) 7 days apart. The dose of 500 SQE/m³ was repeated to investigate reproducibility. Total nasal symptom score (TNSS) was the primary endpoint. Results Exposure to HDM increased TNSS (mean ± SD) to 3.4 ± 1.8, 3.3 ± 2.1, and 3.6 ± 2.0 at 250, 500 and 1000 SQE/m3 , respectively, while lactose alone did not change TNSS (0.7 ± 0.6). The results were reproducible at 500 SQE/m3 . Pulmonary function and adverse event frequency did not change with escalation of allergen dose. Conclusion This HDM allergen particle generation is safe, specific and reproducible and can therefore be used for efficacy testing of immunotherapy and for basic clinical research.

ANTECEDENTES: como parte de la etiología de la alergia respiratoria está la genética, los factores prenatales y la sensibilidad a diversos aeroalérgenos, entre estos los hongos. Existe relación entre la sensibilización a hongos en pruebas cutáneas, la patogénesis y el agravamiento de la alergia. En México hay poca bibliografía en relación a la sensibilización a hongos y en el norte del país no existen datos publicados a este respecto.OBJETIVO: evaluar la prevalencia de sensibilización a hongos en pacientes con alergia respiratoria y pruebas cutáneas para aeroalérgenos; determinar el hongo más prevalente, la prevalencia de sensibilización a cada especie de hongo por año y evaluar la prevalencia de sensibilización a hongos por edades.MATERIAL Y MÉTODO: estudio transversal, observacional y descriptivo efectuado del 1 de enero de 2010 al 31 de diciembre de 2014 en pacientes atendidos en el Centro Regional de Alergia e Inmunología Clínica (Monterrey, NL, México). Se revisó una base de datos de pacientes a quienes se realizaron pruebas cutáneas, se valoró la sensibilización a seis especies de hongos. Se realizaron tablas de captura de datos y análisis estadístico.RESULTADOS: la prevalencia de sensibilización a hongos en 4880 pruebas cutáneas practicadas a igual número de pacientes con alergia respiratoria es de 17.1%. La especie de hongo más prevalente fue Alternaria alternata con 5.5%. El límite de edad con mayor prevalencia a sensibilización fue el de 0-10 años con 6.7%.CONCLUSIÓN: la prevalencia de sensibilización a hongos fue mayor que la prevalencia mundial reportada, pero menor que la encontrada en los demás estudios efectuados en México.

Antecedentes: La relación de IgE total en suero y alergia ha sido estudiada para determinar si podría ser un complemento útil para diagnóstico de alergia.Objetivo: conocer si la IgE sérica total es una herramienta útil en el diagnostico de alergia en la población pediátrica que acuden a la consulta externa de alergología pediátrica del Hospital General Regional No.1. Material y Métodos: Estudio epidemiológico, observacional, retrospectivo, transversal y analítico de prueba diagnóstica, se revisaron 248 expedientes de niños entre 3 a 15 años 11 meses atendidos en alergología pediátrica, para el análisis estadístico, se utilizo SPSS V-22 y por medio de una tabla tetracórica se determino la sensibilidad, especificidad de IgE para diagnóstico de alergias, tomando pruebas cutáneas como estándar de oro para diagnostico alergias, determino valor de P entre las variables de estudio mediante el uso T de Student. Resultados: Se estudiaron 248 expedientes, el género masculino fue más frecuente 58.9%. La sensibilidad de IgE fue 85% y especificidad 20 %, punto de corte encontrado 148 UI/ml, niveles elevados de IgE en pruebas cutáneas para aeroalergenos y presencia de síntomas respiratorios. Conclusiones: prueba útil de tamizaje inicial la IgE en pacientes con sospecha de alergia.

Background There has been a growing interest in measuring allergen-specific immunoglobulin E (sIgE) directly from the nasal mucosal epithelium of individuals with sinonasal disease. However, there is currently no normative data with which to estimate sensitivity, specificity, and the appropriate positive cutoff level for new testing methods. Methods Twenty individuals with no history of sinonasal disease or food allergies underwent serum IgE testing and nasal mucosal brush biopsy (MBB) testing for total and sIgE to 7 common airborne allergens and 1 food allergen. The correlation between sIgE in serum and nasal samples was determined at both the 0.10-kU/L and 0.35-kU/L positive cutoff levels. Results sIgE at the 0.35-kU/L cutoff level was detected for at least 1 allergen in 7 of 20 (35%) participants in both the serum and nose. At the 0.10-kU/L cutoff level, 8 of 20 (40%) and 19 of 20 (95%) participants had sIgE to at least 1 allergen in the serum and nose, respectively. At the 0.35-kU/L cutoff level, total serum IgE levels were significantly higher when at least 1 allergen was detected in the nose (p = 0.01). There was a strong association between sIgE in the serum and nasal mucosa (p < 0.0001) at both cutoff levels. Conclusion The significant association between serum and nasal samples for both total and sIgE suggests that nasal IgE and serum IgE are not independent of one another. Understanding levels of IgE in the nonallergic population will help answer the questions surrounding sensitization as new diagnostic tests for locally-present IgE become available.

Allergen immunotherapy (AIT) is presently the only treatment able to modify the natural history of respiratory allergic disease. The essential condition for AIT to be effective is that the right allergen(s) is/are administered. The proportion of allergic patients showing multiple sensitizations to distinct airborne allergen sources has dramatically increased during the last decades, and this fact, along with the frequent co-recognition of highly cross-reacting pollen panallergens (i.e., profilin and polcalcin), may make a correct diagnosis virtually impossible by using the traditional allergen extracts for diagnosis. Many purified recombinant or natural allergens are currently available for the in vitro diagnosis of respiratory allergy. These represent an invaluable tool to prevent the inclusion of inappropriate allergens in AIT extracts, and the present article provides some suggestions for their rational use in everyday clinical practice.