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Angioedema is the most common adult allergy presentation at two Cape Town emergency centres. Our tertiary hospital ACARE centre consults 2-3 new referrals a week, with a high burden of angioedema without urticaria. Many practitioners feel comfortable with the work-up of possible mast-cell-mediated angioedema, which occurs together with urticaria. However, the diagnostic work-up, the availability of certain specialised testing - for example, functional C1-INH testing - and the increasing use of treatment trials is less familiar. In this article we present two cases of recurrent angioedema without urticaria which highlight the differences between bradykinin-mediated and mast-cell phenotypes and the way this has an impact on diagnosis and management. We also present an integrated algorithm that is employed at our South African ACARE centre. [ABSTRACT FROM AUTHOR]

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]

Adrenaline auto-injector prescription for patients at risk of anaphylaxis: BSACI guidance for primary care [5] BSACI recommend prescription of two adrenaline autoinjectors for those at significant risk of anaphylaxis, referral for specialist assessment and training the patient, advising them to carry the AAIs at all times. Keywords: anaphylaxis; clinical immunology; food allergy; IgE; prevention EN anaphylaxis clinical immunology food allergy IgE prevention 951 954 4 09/05/23 20230901 NES 230901 Key Points The BSACI has produced guidance for primary care for patients at risk of anaphylaxis. This guidance highlights how to identify which patients are at risk of anaphylaxis and the need for referral to a specialist allergy clinic. [Extracted from the article]

"Curriculum ideological and political education" is an important component in the whole teaching process education for vocational college teachers, which is an important way to achieve the fundamental task of "cultivating virtue and talent", and is also a requirement for the education reform and medical talent cultivation of vocational medical colleges under the background of "great country craftsmen". In order to cultivate vocational health talents who practice socialist core values and possess both ability and political integrity earlier, we have established an ideological and political teaching model that integrates Medical Immunology and Human Anatomy physiology with the core of "craftsmanship casting soul", systematically integrating moral education elements and ideological and political content from the three dimensions of patriotism, professional competence and personal cultivation. And we also intentionally integrate them into professional basic courses with higher effectiveness, which can provide students with "knowledge impartation" and "value guidance" in a "moistening and silent" manner. [ABSTRACT FROM AUTHOR]

Systemic sclerosis is a connective tissue disease of unknown origin and with an unpredictable course, with both cutaneous and internal organ manifestations. Despite the enormous progress in rheumatology and clinical immunology, the background of this disease is largely unknown, and no specific therapy exists. The therapeutic approach aims to treat and preserve the function of internal organs, and this approach is commonly referred to as organ-based treatment. However, in modern times, data from other branches of medicine may offer insight into how to treat disease-related complications, making it possible to find new drugs to treat this disease. In this review, we present therapeutic options aiming to stop the progression of fibrotic processes, restore the aberrant immune response, stop improper signalling from proinflammatory cytokines, and halt the production of disease-related autoantibodies. [ABSTRACT FROM AUTHOR]

Keywords: anaphylaxis; angioedema; clinical immunology; drug allergy; IgE EN anaphylaxis angioedema clinical immunology drug allergy IgE 781 784 4 07/05/23 20230701 NES 230701 Key messages The prevalence of unverified drug allergy labels (DALs) was 5.6%. In all, seven (6.37%) patients reported an allergy but could not recall the names of the drugs and five patients reported an allergy to anti-TB drugs and could not recall the name of the implicated drug. The most common drug classes implicated were antibiotics - 59 (53.15%), followed by nonsteroidal anti-inflammatory drugs (NSAIDs) - 20 (18.01%), radio-contrast medium - 12 (10.8%) and antihistamines - 6 (5.40%). [Extracted from the article]

During the International Union of Immunological Societies General Assembly in 1972, Portugal was represented by the immunologist that would later become the first President of SPI, Machado Caetano, who took part in this event as an observer [[3]]. Keywords: Meeting report; Portuguese Society of Immunology; SPI EN Meeting report Portuguese Society of Immunology SPI 1 4 4 07/17/23 20230701 NES 230701 Abbreviations EFIS European Federation of Societies for Immunology SPI Portuguese Society of Immunology A brief history of the Portuguese Society of Immunology In the early 1970s, the awareness of the need to promote training in immunology in Portugal emerged in connection with the evidence of the scarcity and lack of organization of teaching in the field. [Extracted from the article]

This document is a correction notice for an article titled "Type 1 interferon auto-antibodies are elevated in patients with decompensated liver cirrhosis" published in the journal Clinical and Experimental Immunology. The correction addresses errors in the originally published version of the manuscript, specifically missing significance symbols in the Graphical Abstract and Figure 4E. The corrected version of the article is now available. The article is published by Oxford University Press on behalf of the British Society for Immunology and is distributed under the terms of the Creative Commons Attribution-NonCommercial License. [Extracted from the article]

Professor Peter Valentin Tomazic, a renowned allergist and rhinosurgeon from Graz, Austria, has passed away. He was highly respected for his professional qualities and was known for his kindness, support of junior members, and dedication to his work. Professor Tomazic was an accomplished scholar, academic teacher, and a recipient of numerous awards and grants. He was a valued member of various medical societies and served on the editorial board of the journal Allergy. His loss is deeply felt by the global allergology community, and our thoughts are with his family and friends during this difficult time. [Extracted from the article]

This document is a corrigendum published in the journal Frontiers in Immunology. It corrects an error in Figure 2A of a previously published article titled "Translatability of findings from cynomolgus monkey to human suggests a mechanistic role for IL-21 in promoting immunogenicity to an anti-PD-1/IL-21 mutein fusion protein." The corrected figure is attached, and the authors state that this correction does not change the scientific conclusions of the article. The corrigendum provides the contact information for the corresponding author and acknowledges the affiliations of the authors. [Extracted from the article]

This document is a correction notice for an article titled "Human B-cell subset identification and changes in inflammatory diseases" published in the journal Clinical & Experimental Immunology. The correction addresses discrepancies and errors in the original manuscript, including corrections to figure 2. The correction notice is published by Oxford University Press on behalf of the British Society for Immunology. [Extracted from the article]

The article discusses the history and evolution of the British Society for Allergy and Clinical Immunology (BSACI) over the past 75 years. The society was formed in 1948 and has grown significantly since then, with over 1,000 members and almost 800 delegates at its annual conference in 2023. The article highlights major advancements in the field of allergy, including improvements in clinical practice and scientific research. It also mentions the challenges that still exist in terms of workforce constraints and the need for further development in certain areas. Overall, the article provides a comprehensive overview of the BSACI's progress and contributions to the field of allergy. [Extracted from the article]

Asthma is a common respiratory condition that affects millions of people worldwide and can be a significant burden on individuals and society. The management of asthma typically involves pharmacological intervention, but disease control remains suboptimal and there are concerns about the side effects of long-term medication. Physical activity and exercise have been recognized as beneficial for overall health, but for people with asthma, exercise can be a trigger for symptoms. The role of exercise and physical activity in asthma management is still unclear, and there is a need for further research to develop evidence-based recommendations. The European Academy of Allergy and Clinical Immunology (EAACI) has initiated a research project to address these gaps in knowledge and improve the lives of people with asthma. The project aims to establish a research network, conduct surveys, develop educational resources, and seek funding for multicenter research. [Extracted from the article]

Background: Common Variable Immunodeficiency (CVID) is a primary immunodeficiency syndrome resulting in recurrent infections, autoimmunity, and granulomatous manifestations. Methods and materials: This retrospective study was conducted on an Iranian national registry of immunodeficient patients from 2010 to 2021. The frequency of first presentations of CVID and its association with sex, age of onset, and family history of CVID was evaluated. Results: A total of 383 patients entered the study, 164 of whom were female, and the rest were male. The mean age of the patients was 25.3 ± 14.5 years. The most frequent first presentations of CVID were pneumonia (36.8%) and diarrhea (19.1%). Patient sex, age of onset, and family history did not make significant differences in first presentations of this disease. Conclusion: pneumonia is the most common first presentation of CVID. Family history of CVID, the age of symptom onset, and sex made no differences in the first presentations of CVID. Highlights: Pneumonia is the most common first presentation of CVID. Female patients developed CVID at a younger age than male patients. Sex is not a differentiating factor in first presentations of CVID. Family history does not change the first presentations of CVID. Adulthood-onset and childhood-onset CVID were not different regarding the first presentations. [ABSTRACT FROM AUTHOR]

Tumor mutation burden (TMB) is a widely recognized biomarker for predicting the efficacy of immunotherapy. However, its use still remains highly controversial. In this study, we examine the underlying causes of this controversy based on clinical needs. By tracing the source of the TMB errors and analyzing the design philosophy behind variant callers, we identify the conflict between the incompleteness of biostatistics rules and the variety of clinical samples as the critical issue that renders TMB an ambivalent biomarker. A series of experiments were conducted to illustrate the challenges of mutation detection in clinical practice. Additionally, we also discuss potential strategies for overcoming these conflict issues to enable the application of TMB in guiding decision-making in real clinical settings. [ABSTRACT FROM AUTHOR]

To the Editor, Over the last decades, systematic reviews and meta analyses of multiple double-blind randomized placebo-controlled trials have demonstrated the efficacy and safety of both subcutaneous (SCIT) and sublingual (SLIT) allergen immunotherapy (AIT) for respiratory and insect venom allergy.[1] However, there is a wide range of AIT preparations used around the globe, and AEs are not always uniformly recorded, limiting the capability to draw safe conclusions or compare reports. Though various clinical development programs[2] have generated substantial knowledge on different AIT preparations, they have been conducted in pre-defined clinical conditions, not reflecting real-life and therefore the results may not have generalized applicability.[3] Very few pragmatic trials and observational studies have evaluated AIT safety in real-life. Adverse Events Registry is the first AIT Registry for AE piloted in different countries in Europe that uses the harmonized MedDRA terminology[9] (Table 1). [Extracted from the article]

Background: Although it has been shown that allergen immunotherapy (AIT) is well‐tolerated in children, systematic and prospective surveillance of AIT safety in real life settings is needed. Methods: The multinational Allergen Immunotherapy Adverse Events Registry (ADER) was designed to address AIT safety in real life clinical practice. Data on children ≤18 years old with respiratory allergies undergoing AIT were retrieved. Patient‐ and AIT‐related features were collected and analyzed. The characteristics of adverse events (AE) and risk factors were evaluated. Results: A total of 851 patients, 11.3 ± 3.4 years old, with rhinitis only (47.6%); asthma and rhinitis (44.5%); asthma (7.9%), receiving 998 AIT courses were analyzed. Sublingual immunotherapy (SLIT) accounted for 51% of the courses. In 84.5% of patients only one AIT treatment was prescribed. Pollen was the most frequent sensitizer (57.1%), followed by mites (53.4%), molds (18.2%) and epithelia (16.7%). Local and systemic AEs were reported in 85 patients (9.9%). Most AEs (83.1%) were mild and occurred in <30 min (87%). Respiratory and cutaneous symptoms were more frequent. Only 4 patients (0.47%) had severe AE (none after 6 weeks of maintenance). The risk of AE was higher in patients undergoing SCIT. Conclusions: AIT is safe and well tolerated in children and adolescents with respiratory allergies in real‐life clinical practice. Though SCIT is more prone to AE compared to SLIT, overall severe reactions are rare and occur during build‐up and early maintenance. [ABSTRACT FROM AUTHOR]

Mites are among the major sources of domestic and occupational allergens worldwide, and continuous exposure to these allergens leads to chronic airway inflammation. One of the most allergenic species is the storage mite Tyrophagus putrescentiae (Schrank). Protein extracts are produced from this mite for tests that help the clinical diagnosis (via prick test), treatment, and monitoring of disease progression in patients who had positive results for allergic reactions. Therefore, the aim of the present study was to evaluate the cell viability of RAW 264.7 and L929 cells when exposed to in-house raw protein extracts of T. putrescentiae compared to a commercial product, as well as quantify TNF-α secretion by RAW 264.7. Additionally, this study quantified the effect of these extracts in IgE secretion in total blood of people affected by this mite. The study found similarity between the in-house extract and the commercial extract as they had equivalent TNF-α secretion. Additionally, viabilities of RAW 264.7 and L929 exposed to the in-house extract were compatible with viabilities of cells exposed to the commercial extract, with no cytotoxicity at the concentrations tested. Results corroborated the hypothesis that the extract produced in-house would be equivalent to the commercial extract in allergic patients when the IgE was quantified. This study is the first to show the cytotoxicity of T. putrescentiae extracts, and to provide a quantitative analysis of TNF-α and IgE. [ABSTRACT FROM AUTHOR]

A high tumor mutation burden (TMB) is known to drive the response to immune checkpoint inhibitors (ICI) and is associated with favorable prognoses. However, because it is a one-dimensional numerical representation of non-synonymous genetic alterations, TMB suffers from clinical challenges due to its equal quantification. Since not all mutations elicit the same antitumor rejection, the effect on immunity of neoantigens encoded by different types or locations of somatic mutations may vary. In addition, other typical genomic features, including complex structural variants, are not captured by the conventional TMB metric. Given the diversity of cancer subtypes and the complexity of treatment regimens, this paper proposes that tumor mutations capable of causing various degrees of immunogenicity should be calculated separately. TMB should therefore, be segmented into more exact, higher dimensional feature vectors to exhaustively measure the foreignness of tumors. We systematically reviewed patients’ multifaceted efficacy based on a refined TMB metric, investigated the association between multidimensional mutations and integrative immunotherapy outcomes, and developed a convergent categorical decision-making framework, TMBserval (Statistical Explainable machine learning with Regression-based VALidation). TMBserval integrates a multiple-instance learning concept with statistics to create a statistically interpretable model that addresses the broad interdependencies between multidimensional mutation burdens and decision endpoints. TMBserval is a pan-cancer-oriented many-to-many nonlinear regression model with discrimination and calibration power. Simulations and experimental analyses using data from 137 actual patients both demonstrated that our method could discriminate between patient groups in a high-dimensional feature space, thereby rationally expanding the beneficiary population of immunotherapy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Clinical manifestation of secondary immunodeficiency is responsible for the decrease in life quality in cancer-treated patients, which may result in administration delays, dose reductions, even in discontinuation of treatment. The main aim of presented study was to stress the possibility of influencing secondary infections with adjunctive immuno-regulatory medicament (AIRT). METHODS: The presented real-life retrospective study involved a cohort of 94 adult female patients aged from 30 to 87 years with mean age of 58.4 (SD = 11.37). The cohort was divided into two groups. One group (54 patients; 57.45 %) was treated by using the adjunctive immuno-regulatory medicaments and the other, control group (40 patients; 42.55 %), was without any immunological interventions in relation to secondary immunodeficiency. Patients in both groups were treated by standard oncotherapy. RESULTS: The results show that in patients who were sent for immunological consultation, double incidence values of mild secondary infection frequencies were revealed. When immunologists decided to add adjunctive immunomodulatory medicament, the occurrence of infection and consumption of antibiotics decreased. The decrease was significant in the second evaluated interval (6th -- 12th month). CONCLUSIONS: Our results strongly advise regular or even preventive examination of cancer patients by immunologic specialist for the purpose of attenuating some negative consequences of applied anti-tumor therapy. [ABSTRACT FROM AUTHOR]

Nasal endoscopy is not only used for the diagnosis of chronic rhinosinusitis with nasal polyps (CRSwNP), but also for monitoring the response to therapy playing an important role in both daily practice and research. In contrast to patient‐reported outcomes, endoscopic nasal polyp scoring by independent blinded readers is an objective measurement, not influenced by the placebo effect. It is safer and cheaper compared with computed tomography imaging and therefore, better suited for regular assessments of the extent of the disease. Since the early 90s, a variety of endoscopic staging methods have been proposed and used in clinical research, making it hard to compare results from different studies. This paper resulted from a task force with experts in the field of CRSwNP, originated by the Ear, Nose and Throat section of the European Academy of Allergy and Clinical Immunology and aims to provide a unified endoscopic NP scoring system that can serve as a reference standard for researchers, but also as a useful tool for practitioners involved in the management of CRSwNP. [ABSTRACT FROM AUTHOR]

Background: The mechanisms driving alopecia areata (AA) are still unclear, hindering development of targeted therapeutics. Specific Th2 targeting with dupilumab in AA provides a unique opportunity to dissect its pathogenesis and explore the role of Th2 pathway. Methods: We evaluated changes in scalp biomarkers in AA patients (with and without concomitant atopy) randomized to weekly dupilumab or placebo for 24 weeks, followed by open‐label dupilumab for 24 weeks. Changes in biomarker levels were measured at weeks 12, 24, and 48 and were also correlated with clinical hair regrowth. Results: At week 24, preceding clinical hair regrowth outcomes, only dupilumab‐treated patients presented significant suppression of cellular infiltrates, and multiple Th2‐related, markers (CCL13/MCP‐4, CCL18/PARC, CCL26/eotaxin‐3, CCL24/Eotaxin‐2), coupled with significant upregulation in the hair keratins. Th1‐related suppression was evident later (week 48) when all patients received open‐label dupilumab. Results were more pronounced in atopic AA patients, that showed 48% and 97% improvements in the lesional AA scalp profile at weeks 24 and 48, respectively, while 2% worsening was seen in the placebo arm at week 24. Moreover, placebo‐treated patients presented 54% worsening in hair keratins when compared with baseline at week 24. At week 24, increases in hair keratins showed significant correlations only with decreases in Th2‐related markers. Conclusions: Scalp biomarkers provide evidence of dupilumab efficacy in AA, detected even prior to clinical response, with exclusive correlations between early suppression of Th2 markers and increased hair keratins. These findings strengthen previous reports suggesting a possible role for Th2 cytokines as AA drivers. [ABSTRACT FROM AUTHOR]

Purpose: Only some allergists/immunologists provide care throughout the lifespan despite their training. Although transition of care (TOC) guidelines exist, research on provider perspectives on TOC for pediatric primary immunodeficiency (PID) patients is lacking. We aimed to characterize knowledge, attitudes, and practices and establish clinician needs using a needs assessment survey. Methods: The 15-min online survey was adapted from an existing rheumatology TOC survey and was emailed to the American Academy of Allergy Asthma and Immunology (AAAAI) and Clinical Immunology Society (CIS) members. Our primary hypothesis was that both AAAAI and CIS providers report being underprepared for TOC and would express interest in TOC resources and consensus. Results: Forty-nine of 1250 eligible AAAAI and 67 of 698 eligible CIS participants completed the survey (4.8% vs 11.3% participation rate). Many (53.1% vs 59.7%) respondents transition their own patients but also retain adult patients (59.2% vs 52.2%). Many accepted transition patients (85.7% vs 92.5%). In total, 24.1% of respondents did not have a TOC policy while 18.9% have an informal policy. Only 25.0% were satisfied with their current practices while 43.9% agreed that a consensus statement would be useful. Conclusion: Despite a small sample size and high rate of unanswered questions, our findings show that TOC remains overlooked in our specialty and that providers want and need additional training and resources. There is a clear need to develop and evaluate the effectiveness of evidence-based TOC guidelines, resources, and best practices for PID patients. [ABSTRACT FROM AUTHOR]

Abstract Background Given the rapid development of clinical immunology technologies, students majoring in laboratory medicine should master the technological principles and application of clinical laboratory immunology. However, many are required to take online courses due to COVID-19 restrictions, which highlights the need to revisit teaching strategies. Recently, various medical education courses (such as Biochemistry, Physiology, etc.) have implemented the flipped classroom (FC) and team-based learning (TBL) methods, resulting in more positive teaching evaluations. To promote the students' mastery of the difficult knowledge effectively during the online teaching work, we evaluated the performance of online FC-TBL in a clinical laboratory immunology course. Methods Sixty-two third-year students from two classes majoring in Laboratory Medicine were recruited and divided into two groups, including one group with traditional lecture-based learning teaching strategy (LBL group) and the other group with LBL or online FC combined with TBL teaching strategy (FC-TBL group). We selected three chapters to conduct FC-TBL teaching in class. All participants took in-class quizzes and final examinations that targeted the same knowledge points. Finally, all participants completed anonymous questionnaires asking for their perceptions of the respective teaching models. In addition, we conducted a survey of teaching suggestions by a FC-TBL class of students majoring in Laboratory Medicine. Results The FC-TBL group (vs LBL group) had significantly higher scores on the in-class quizzes and final examinations, and also reported high satisfaction with the FC-TBL model. These findings indicate that FC-TBL is suitable for clinical laboratory immunology, as the participants quickly gained essential knowledge. Specifically, FC-TBL helped to “increase learning motivation,” “promote self-directed learning skills,” “extend more related knowledge,” “enhance problem-solving abilities,” “enhance clinical reasoning abilities,” and “enhance communication skills.” For participants’ suggestions, 48.38% (15/31) students held positive attitude to FC-TBL teaching strategy compared to 25.81% (8/31) students who considered FC-TBL teaching strategy still needs continuous improvement, and 25.81% (8/31) students reported that they believed FC-TBL teaching strategy was perfect and no further suggestions. Conclusions Online FC-TBL effectively enhanced learning activity among students of a clinical laboratory immunology course. This is particularly useful in the COVID-19 context.

Owing to the rising popularity and demand for immunoglobulins (IgG), obtaining supplies and rationalizing IgG use have become challenging. Herein, IgG consumption in Poland was analyzed through total IgG use and number of patients reported to the National Health Fund between 1 January 2016 and 31 December 2020. Total IgG used within 5 years increased by 27.48%, IgG use/1000 inhabitants/year was 23.13 g (2016) and 29.61 g (2020). In 2020, 35.5 % of IgG used was for neurological conditions, 25% for primary immunodeficiencies (PID), and 39.3% for all other indications. Within 5 years, 1,121,168.75 g IgG was used in PID; the use increased by 72%, from 783 in 2016 to 1153 patients in 2020. The proportion of patients who received subcutaneous immunoglobulin (SCIG) replacement therapy (IgRT) increased to 78% (2020). Within 5 years, 1,783,534.81 g IgG was used in neurological drug programs (+42.44%) and 2,327,513.88 g (+1.25%) outside neurological indications and outside PID. The annual IgG amount decreased in adult anesthesiology and intensive care (−46%), internal medicine (−55%), pneumonology (−50%), pediatric clinical immunology (−50%), and gynecology and obstetrics (−48%) and increased in dermatology (+178%), rheumatology (+103%), and clinical transplantation (+82%). IgG use significantly increased in Poland, mostly owing to PID. Subcutaneous IgG administration is currently the most common mode of IgRT in PID patients. An increase in SCIG administration may be expected for other indications. Implementing evidence-based clinical guidelines is key to prioritizing and rationalizing IgG use for immunomodulatory indications and secondary immune deficiencies. [ABSTRACT FROM AUTHOR]

Dr John S Najarian (1927–2020), chairman of the Department of Surgery at the University of Minnesota from 1967 to 1993, was a pioneer in surgery, clinical immunology and transplantation. A Covid‐delayed Festschrift was held in his honor on May 20, 2022. The speakers reflected on his myriad contributions to surgery, transplantation, and resident/fellow training, as well as current areas of ongoing research to improve clinical outcomes. Of note, Dr Najarian was a founder of the journal Clinical Transplantation. [ABSTRACT FROM AUTHOR]

Innate immune cells experience long lasting metabolic and epigenetic changes after an encounter with specific stimuli. This facilitates enhanced immune responses upon secondary exposition to both the same and unrelated pathogens, a process termed trained immunity. Trained immunity‐based vaccines (TIbV) are vaccines able to induce innate immune memory, thus conferring heterologous protection against a broad range of pathogens. While trained immunity has been well documented in the context of infections and multiple immune‐mediated diseases, the role of innate immune memory and its contribution to the initiation and maintenance of chronic allergic diseases remains poorly understood. Over the last years, different studies attempting to uncover the role of trained immunity in allergy have emerged. Exposition to environmental factors impacting allergy development such as allergens or viruses induces the reprogramming of innate immune cells to acquire a more pro‐inflammatory phenotype in the context of asthma or food allergy. Several studies have convincingly demonstrated that prevention of viral infections using TIbV contributes to reduce wheezing attacks in children, which represent a high‐risk factor for asthma development later in life. Innate immune cells trained with specific stimuli might also acquire anti‐inflammatory features and promote tolerance, which may have important implications for chronic inflammatory diseases such as allergies. Recent findings showed that allergoid‐mannan conjugates, which are next generation vaccines for allergen‐specific immunotherapy (AIT), are able to reprogram monocytes into tolerogenic dendritic cells by mechanisms depending on metabolic and epigenetic rewiring. A better understanding of the underlying mechanisms of trained immunity in allergy will pave the way for the design of novel trained immunity‐based allergen vaccines as potential alternative strategies for the prevention and treatment of allergic diseases. [ABSTRACT FROM AUTHOR]

Background: Severe asthma patients are those suffering from asthma exacerbations despite adherence to maximal optimized asthma treatment such as high dose inhalant corticosteroids and long-acting beta2 agonists (ICS-LABA). It is estimated that about 300 million people in the world are affected from asthma and among them a percentage between 3-10% suffer from severe asthma. The prevalence of Alexithymia in chronic illness is notably high and it is strictly related to clinical severity of chronic diseases. Methods: Pub Med and Google Scholar databases were consulted using the terms "severe asthma" AND "alexithymia" to search English-language articles. According to inclusion criteria 37 articles were finally included and analyzed. Alexithymia may interfere with the perception of the disease and the patients' awareness of the need of a strict follow-up, to adhere to the physicians' treatment plans. Results: Alexithymia and related psychological distress as anxiety and depression may compromise the patient's compliance and adherence, leading to a severe clinical presentation and pathologies' course. This review highlights a potential relationship between alexithymia and severe asthma as a chronic inflammatory disease and the ways this correlation can be assessed and managed in the Outpatient Asthma Clinic to ensure a global approach to SA patients. Findings reported in literature suggest that, among severe asthma patients, alexithymia is present even if the prevalence of this disorder has not yet been defined. Conclusions: It is likely that the introduction of a gold standard clinical psychological evaluation in medical settings, such as clinical allergy and immunology, may allow to support suffering patients helping them to adequately elaborate their particular condition developing useful strategies to control and to manage with their severe asthma. [ABSTRACT FROM AUTHOR]

During the past few years, unexpected developments have driven studies in the field of clinical immunology. One driver of immense impact was the outbreak of a pandemic caused by the novel virus SARS-CoV-2. Excellent recent reviews address diverse aspects of immunological re-search into cardiovascular diseases. Here, we specifically focus on selected studies taking advantage of advanced state-of-the-art molecular genetic methods ranging from genome-wide epi/transcriptome mapping and variant scanning to optogenetics and chemogenetics. First, we discuss the emerging clinical relevance of advanced diagnostics for cardiovascular diseases, including those associated with COVID-19—with a focus on the role of inflammation in cardiomyopathies and arrhythmias. Second, we consider newly identified immunological interactions at organ and system levels which affect cardiovascular pathogenesis. Thus, studies into immune influences arising from the intestinal system are moving towards therapeutic exploitation. Further, powerful new research tools have enabled novel insight into brain–immune system interactions at unprecedented resolution. This latter line of investigation emphasizes the strength of influence of emotional stress—acting through defined brain regions—upon viral and cardiovascular disorders. Several challenges need to be overcome before the full impact of these far-reaching new findings will hit the clinical arena. [ABSTRACT FROM AUTHOR]

See relatedarticle [ABSTRACT FROM AUTHOR]

This article is a reply to the European Academy of Allergy and Clinical Immunology's guidelines on anaphylaxis. The authors suggest that Kounis syndrome (KS), which is an acute coronary syndrome secondary to anaphylaxis, should be included in the clinical picture of anaphylaxis. They explain that KS can present as vasospastic angina, myocardial infarction, stent thrombosis, or stent restenosis, and it is associated with a higher mortality rate compared to anaphylaxis without KS. The authors emphasize the importance of early recognition and management of KS and recommend its inclusion in future guidelines on anaphylaxis. [Extracted from the article]

Background: Given the rapid development of clinical immunology technologies, students majoring in laboratory medicine should master the technological principles and application of clinical laboratory immunology. However, many are required to take online courses due to COVID-19 restrictions, which highlights the need to revisit teaching strategies. Recently, various medical education courses (such as Biochemistry, Physiology, etc.) have implemented the flipped classroom (FC) and team-based learning (TBL) methods, resulting in more positive teaching evaluations. To promote the students' mastery of the difficult knowledge effectively during the online teaching work, we evaluated the performance of online FC-TBL in a clinical laboratory immunology course. Methods: Sixty-two third-year students from two classes majoring in Laboratory Medicine were recruited and divided into two groups, including one group with traditional lecture-based learning teaching strategy (LBL group) and the other group with LBL or online FC combined with TBL teaching strategy (FC-TBL group). We selected three chapters to conduct FC-TBL teaching in class. All participants took in-class quizzes and final examinations that targeted the same knowledge points. Finally, all participants completed anonymous questionnaires asking for their perceptions of the respective teaching models. In addition, we conducted a survey of teaching suggestions by a FC-TBL class of students majoring in Laboratory Medicine. Results: The FC-TBL group (vs LBL group) had significantly higher scores on the in-class quizzes and final examinations, and also reported high satisfaction with the FC-TBL model. These findings indicate that FC-TBL is suitable for clinical laboratory immunology, as the participants quickly gained essential knowledge. Specifically, FC-TBL helped to "increase learning motivation," "promote self-directed learning skills," "extend more related knowledge," "enhance problem-solving abilities," "enhance clinical reasoning abilities," and "enhance communication skills." For participants' suggestions, 48.38% (15/31) students held positive attitude to FC-TBL teaching strategy compared to 25.81% (8/31) students who considered FC-TBL teaching strategy still needs continuous improvement, and 25.81% (8/31) students reported that they believed FC-TBL teaching strategy was perfect and no further suggestions. Conclusions: Online FC-TBL effectively enhanced learning activity among students of a clinical laboratory immunology course. This is particularly useful in the COVID-19 context. [ABSTRACT FROM AUTHOR]

Venom immunotherapy (VIT) is an effective treatment in the patients at high risk of anaphylaxis or life-threatening systemic reactions due to Hymenoptera venom allergy. But, systemic and large local reactions can be observed, especially during the build-up phase of VIT. We evaluated the safety of conventional and ultra-rush build-up protocols. Two protocols in 71 patients (39 conventional and 32 ultra-rush protocols) with honeybee and wasp venom allergy were evaluated retrospectively. Patients were diagnosed and selected for VIT according to the criteria established by the European Academy of Allergy and Clinical Immunology. The severity of systemic reactions was evaluated according to the criteria of Mueller. Build-up phases were tolerated in 66.2% (n = 47) without any reaction. Allergic adverse reactions were observed in 33.8% (n = 24): large local reactions 22.5% (n = 16) and systemic reactions 11.3% (n = 8). There was no significant difference in the number of adverse reactions comparing patients receiving conventional and ultra-rush protocol. In addition, no association was found between allergic adverse reactions and the following factors: sex, previous systemic sting reactions, honeybee and wasp venom extract. We found that both protocols were tolerated in patients with honeybee and wasp venom allergy. Ultra-rush protocol will be preferred for patients and clinicians because of its advantages in terms of time and costs. VIT is the only curative treatment method that reduces the risk of severe reactions after a bee sting and improves the quality of life in patients with Hymenoptera venom allergy. Ultra-rush VIT protocol has advantages such as few injection and time savings. Both ultra-rush and conventional VIT are safe treatments to prevent potentially life-threatening reactions in patients with honeybee and wasp venom allergy. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is the leading cause of skin-related disease burden worldwide, affecting a large percentage of the population. Bibliometrics is the statistical analysis of academic literature in a certain field. Objectives: We aimed to perform the latest bibliometric analysis of atopic dermatitis literature. Methods: We searched the Web of Science database on 29th Nov 2021. We used the keywords "atopic dermatitis," "atopic eczema," and "eczema" for our search. All items published between 2001 and 2021 were included. The top 100 most cited articles were identified and analyzed. Results: Our study provided a detailed bibliometric analysis of the top 100 most cited articles on atopic dermatitis. These articles were published between 2002 and 2019 and were from 15 different countries, mostly in the USA and Germany. Most articles have focused on the pathogenesis and treatment of AD. The Journal of Allergy and Clinical Immunology made the greatest contribution to the top 100 list, with 28 articles. The most cited article originated from Lancet. The highest number of citations was seen in 2006, with 9220 citations, while the highest number of publications was seen in 2006 with 12 publications. Conclusions: Our study aims to provide physicians and researchers with a historical perspective for the scientific progress of atopic dermatitis, and help clinicians effectively obtain useful articles that have a significant impact on the field of atopic dermatitis. [ABSTRACT FROM AUTHOR]

Highly heterogeneous cell populations require multiple flow cytometric markers for appropriate phenotypic characterization. This exponentially increases the complexity of 2D scatter plot analyses and exacerbates human errors due to variations in manual gating of flow data. We describe a semiautomated workflow, based entirely on the Flowjo Graphical User Interface (GUI), that involves the stepwise integration of several, newly available machine learning tools for the analysis of myeloid-derived suppressor cells (MDSCs) in septic and non-septic critical illness. Supervised clustering of flow cytometric data showed correlation with, but significantly different numbers of, MDSCs as compared with the cell numbers obtained by manual gating. Neither quantification method predicted 30-day clinical outcomes in a cohort of 16 critically ill and septic patients and 5 critically ill and non-septic patients. Machine learning identified a significant decrease in the proportion of PMNMDSC in critically ill and septic patients as compared with healthy controls. There was no difference between the proportion of these MDSCs in septic and non-septic critical illness. [ABSTRACT FROM AUTHOR]

Background: Comprehensive national assessments of paediatric allergy services are rarely undertaken, and have never been undertaken in the United Kingdom. A 2006 survey estimated national capacity at 30,000 adult or paediatric new allergy appointments per year and identified 58 hospital clinics offering a paediatric allergy service. Objective: The UK Paediatric Allergy Services Survey was the first comprehensive assessment of UK paediatric allergy service provision. Methods: All 450 UK hospitals responded to a survey. Paediatric allergy services are provided in 154 lead hospitals with 75 further linked hospitals. All 154 lead paediatric allergy services completed a detailed questionnaire between February 2019 and May 2020. Results: The 154 paediatric allergy services self‐define as secondary (126/154, 82%) or tertiary (28/154, 18%) level services. The annual capacity is 85,600 new and 111,400 follow‐up appointments. Fifty‐eight percent (85/146) of services offer ≤10 new appointments per week (no data provided from 8 services—2 no response, 6 unknown) and 50% (70/139) of the services undertaking challenges undertake ≤2 food or drug challenges per week (no data from 3 challenge services). Intramuscular adrenaline is rarely used during challenges—median annual frequency 0 in secondary services and 2 in tertiary services. Allergen‐specific immunotherapy is offered in 39% (60/154) of services, with 71% (41/58) of these centres treating ≤10 patients per annum (no data from 2 immunotherapy services). The 12 largest services see 31% of all new paediatric allergy appointments, undertake 51% of new immunotherapy patient provision and 33% of food or drug challenges. Seventy percent (97/126) of secondary and all tertiary services are part of a regional paediatric allergy network. Only nine services offer immunotherapy for any food (3 for peanut), 10 drug desensitization and 18 insect venom immunotherapy. Conclusions: There has been a fourfold increase in paediatric allergy clinics and an approximately sevenfold increase in new patient appointment numbers in the United Kingdom over the past 15 years. Most services are small, with significant regional variation in availability of specific services such as allergen immunotherapy. Our findings emphasize the need for national standards, local networks and simulation training to ensure consistent and safe service provision. [ABSTRACT FROM AUTHOR]

Immunotherapy for cancer is a rapidly developing treatment that modifies the immune system and enhances the antitumor immune response. B7-H3 (CD276), a member of the B7 family that plays an immunoregulatory role in the T cell response, has been highlighted as a novel potential target for cancer immunotherapy. B7-H3 has been shown to play an inhibitory role in T cell activation and proliferation, participate in tumor immune evasion and influence both the immune response and tumor behavior through different signaling pathways. B7-H3 expression has been found to be aberrantly upregulated in many different cancer types, and an association between B7-H3 expression and poor prognosis has been established. Immunotherapy targeting B7-H3 through different approaches has been developing rapidly, and many ongoing clinical trials are exploring the safety and efficacy profiles of these therapies in cancer. In this review, we summarize the emerging research on the function and underlying pathways of B7-H3, the expression and roles of B7-H3 in different cancer types, and the advances in B7-H3-targeted therapy. Considering different tumor microenvironment characteristics and results from preclinical models to clinical practice, the research indicates that B7-H3 is a promising target for future immunotherapy, which might eventually contribute to an improvement in cancer immunotherapy that will benefit patients. [ABSTRACT FROM AUTHOR]

The Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and a committee of experts and key stakeholders have developed this guideline for the evaluation and testing of patients with an unsubstantiated label of penicillin allergy. The guideline is intended for UK clinicians who are not trained in allergy or immunology, but who wish to develop a penicillin allergy de‐labelling service for their patients. It is intended to supplement the BSACI 2015 guideline "Management of allergy to penicillin and other beta‐lactams" and therefore does not detail the epidemiology or aetiology of penicillin allergy, as this is covered extensively in the 2015 guideline (1). The guideline is intended for use only in patients with a label of penicillin allergy and does not apply to other beta‐lactam allergies. The recommendations include a checklist to identify patients at low risk of allergy and a framework for the conduct of drug provocation testing by non‐allergists. There are separate sections for adults and paediatrics within the guideline, in recognition of the common differences in reported allergy history and likelihood of true allergy. [ABSTRACT FROM AUTHOR]

Background: Infection with rhinovirus (RV) is a major risk factor for disease exacerbations in patients with allergic asthma. This study analysed a broad set of cytokines in the noses of children and adults with asthma during RV infection in order to identify immunophenotypes that may link to virus‐induced episodes. Methods: Nasal wash specimens were analysed in children (n = 279 [healthy, n = 125; stable asthma, n = 64; wheeze, n = 90], ages 2–12) who presented to a hospital emergency department, and in adults (n = 44 [healthy, n = 13; asthma, n = 31], ages 18–38) who were experimentally infected with RV, including a subset who received anti‐IgE. Cytokines were measured by multiplex bead assay and data analysed by univariate and multivariate methods to test relationships to viral load, allergic status, airway inflammation, and clinical outcomes. Results: Analysis of a core set of 7 cytokines (IL‐6, CXCL8/IL‐8, IL‐15, EGF, G‐CSF, CXCL10/IP‐10 and CCL22/MDC) revealed higher levels in children with acute wheeze versus those with stable asthma or controls. Multivariate analysis identified two clusters that were enriched for acutely wheezing children; one displaying high viral load ("RV‐high") with robust secretion of CXCL10, and the other displaying high IgE with elevated EGF, CXCL8 and both eosinophil‐ and neutrophil‐derived mediators. Broader assessment of 39 cytokines confirmed that children with acute wheeze were not deficient in type 1 anti‐viral responses. Analysis of 18 nasal cytokines in adults with asthma who received RV challenge identified two clusters; one that was "RV‐high" and linked to robust induction of anti‐viral cytokines and anti‐IgE; and the other associated with more severe symptoms and a higher inflammatory state featuring eosinophil and neutrophil factors. Conclusions: The results confirm the presence of different immunophenotypes linked to parameters of airway disease in both children and adults with asthma who are infected with RV. Such discrepancies may reflect the ability to regulate anti‐viral responses. [ABSTRACT FROM AUTHOR]

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To look for the spectrum of infections and the factors predisposing to infection in patients with systemic sclerosis (SSc). In this retrospective study, demographic, clinical features, details of infections, immunosuppressive therapy, and outcomes of patients with SSc attending clinics at department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India from 1990 to 2022 were captured. Multivariable-adjusted logistic regression was applied to identify independent predictors of infection. Data of 880 patients, mean age 35.5 ± 12 years, and female: male ratio 7.7:1, were analyzed. One hundred and fifty-three patients had at least 1 infection with a total of 233 infectious episodes. Infections were most common in lung followed by skin and soft tissue. Tuberculosis was diagnosed in 45 patients (29.4%). Klebsiella was the commonest non-tubercular organism in lung and Escherichia coli in urinary tract infections. In comparison to matched control group, patients with infection had a greater number of admissions due to active disease, odds ratio (OR) 6.27 (CI 3.23–12.18), were receiving immunosuppressive medication OR, 5.05 (CI 2.55–10.00), and had more digital ulcers OR, 2.53 (CI 1.17–5.45). Patients who had infection had more likelihood for death OR, 13.63 (CI 4.75 -39.18). Tuberculosis is the commonest infection and lung remains the major site of infection in patients with SSc. Number of hospital admissions, digital ulcers and immunosuppressive therapy are predictors of serious infection in patients with SSc. Patients with infections had more likelihood of death. [ABSTRACT FROM AUTHOR]

This document is a letter to the editor in response to a research publication titled "Aetiological profile of acute encephalitis syndrome in Assam, India, during a 4-year period from 2019 to 2022." The objective of the research was to determine the frequency of Japanese encephalitis (JE) and identify the causes of non-JE cases of acute encephalitis syndrome (AES) in India. The study found that 14.5% of the samples tested positive for JE, while the majority of AES cases not caused by JE were attributed to other infectious diseases such as measles, mumps, and scrub typhus. The authors suggest that a more comprehensive testing procedure and enhanced surveillance system may improve the diagnosis and treatment of AES cases. However, the study's reliance on testing algorithms and limited examination of pathogens may have overlooked other potential causes of AES. The authors also recommend customizing the testing algorithm based on the geographic distribution of patients and conducting further research to broaden the testing panel and investigate treatment plans and preventive methods for AES cases. [Extracted from the article]

The impact of the Sema-3E/PlexinD1 axis on DC phenotype and function in DCs. [Display omitted] This comprehensive research review explores the complex interplay between the Sema-3E/PlexinD1 axis and dendritic cells (DCs), highlighting its critical role in immune modulation with implications for clinical application Critical regulators of immune responses Dendritic cells are central to adaptive immunity, and the Sema-3E /PlexinD1 axis emerges as a key modulator affecting their phenotypes and functions Review delineates the impact of this signaling axis on DC maturation, migration, antigen presentation, and cytokine production, unravels its multifaceted role in shaping the immune response. Recognizing the limitations and gaps in current knowledge, the study highlights the need for further studies to condition downstream signaling events and related information experienced by the Sema-3E/PlexinD1 axis emphasizes the clarity of the immune system. The review concludes by identifying opportunities for translation, focusing on therapeutic and diagnostic potential. It highlights the importance of collaborative, interdisciplinary efforts to address the challenges and harness the therapeutic and pathological potential of targeting the Sema-3E/PlexinD1 axis, thus opening the way for transformative advances in immunology and clinical medicine. [ABSTRACT FROM AUTHOR]

This article features an interview with Dr. Raj Chovatiya, a Clinical Associate Professor at the Rosalind Franklin University of Chicago Medical School. Dr. Chovatiya discusses the importance of moisturizing in combination with topical or systemic therapy for atopic dermatitis. He explains that moisturization is a barrier-directed approach that works well alongside immune system-based therapies. Dr. Chovatiya emphasizes that moisturization practices are important for all patients, regardless of the severity of their disease. [Extracted from the article]