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Abstract Immunoglobulin E (IgE)‐mediated food allergies are the most common type of food allergy, often causing rapid symptoms after exposure to allergens posing a serious health risk and a high impact on patient's and caregiver's quality of life. Omalizumab, a humanized anti‐IgE monoclonal antibody, reduces allergic reactions by binding to circulating IgE. Omalizumab has been successfully used in allergic asthma, chronic rhinosinusitis with nasal polyps, and chronic urticaria, and was recently approved for treating IgE‐mediated food allergies by the US Food and Drug Administration (FDA). This GA2LEN ANACARE Consensus Statement presents our position on the use of omalizumab for treating IgE‐mediated food allergies, based on a systematic review and meta‐analysis, experience with use for other conditions, and expert consensus achieved via an eDelphi process. Following publication of the recent OUtMATCH study (stage 1) results and subsequent FDA approval, we propose that there is now sufficient evidence to recommend omalizumab as the only drug currently available that can mechanistically reduce IgE‐mediated food allergic reactions. We acknowledge that the evidence does not reach the highest level of evidence which would be needed for a guideline recommendation.

In this paper we illustrate how novel AI methods can improve the performance of intelligence analysts. These analysts aim to make sense of — often conflicting or incomplete — information, weighing up competing hypotheses which serve to explain an observed situation. Analysts have access to numerous visual analytic tools which support the temporal and/or conceptual structuring of information and collection, and support the evaluation of alternative hypotheses. We believe, however, that there are currently no tools or methods which allow analysts to combine the recording and interpretation of information, and that there is little understanding about how software tools can facilitate the hypothesis formation process. Following the identification of these requirements, we developed the CISpaces (Collaborative Intelligence Spaces) decision support tool in collaboration with professional intelligence analysts. CISpaces combines multiple AI-based methods including argumentation theory, crowdsourced Bayesian analysis, and provenance recording. We show that CISpaces is able to provide support to analysts by facilitating the interpretation of different types of evidence through argumentation-based reasoning, provenance analysis and crowdsourcing. We undertook an experimental analysis with intelligence analysts which highlights three key points. (1) The novel, principled AI methods implemented in CISpaces advance performance in intelligence analysis. (2) While designed as a research prototype, analysts benchmarked it against their existing software tools, and we provide results suggesting intention to adopt CISpaces in analysts’ daily activities. (3) Finally, the evaluation highlights some drawbacks in CISpaces. However, these are not due to the technologies underpinning the tool, but rather in its lack of integration with existing organisational standards regarding input and output formats. Our evaluation with intelligence analysts therefore demonstrates the potential impact that an integrated tool building on state-of-the-art AI techniques can have on the process of understanding complex situations, and on how such a tool can help focus human effort on identifying more credible interpretations of evidence.

BackgroundAnaphylaxis is a life-threatening event, but it is frequently undertreated in pediatric patients with food allergies. Previous studies showed that auto-injectable adrenaline (AAI) is underused by patients and parents. This is especially troubling since fatal anaphylaxis has been associated with delayed adrenaline administration.ObjectivesThis study aimed to investigate parental practice and knowledge in anaphylaxis management, and perceived barriers and facilitators in using AAI.ResultsA retrospective survey was completed by 75 parents (41 mothers, 34 fathers) of children with food allergy and AAI prescription attending the Food Allergy Referral Center of Veneto, Italy. Results showed poor parental preparedness and reluctance to use AAI despite a high/moderate self-rated knowledge (median total score of 23–min. 3, max. 30). Most parents (77%) declared they were carrying AAI but only 20% used it in case of a severe reaction. Most reported Fear/Fear of making mistakes (46 parents) and Concern about possible side effects as barriers (35), while Poor knowledge of the correct AAI use (1) and Lack of knowledge/ incorrect assessment of symptoms (2) were reported less frequently. Theoretical-practical courses for parents on AAI use (65), Psycho-education/Psychological support (3) for better dealing with the emotional aspects of anaphylaxis and Written instructions (1) have been suggested as main facilitators.ConclusionUnderstanding parents' experience and perspective on managing anaphylaxis is crucial to implement effective educational programs. A multidisciplinary approach should be considered.

Douglas Walton’s work is extremely vast, multifaceted, and interdisciplinary. He developed theoretical proposals that have been used in disciplines that are not traditionally related to philosophy, such as law, education, discourse analysis, artificial intelligence, or medical communication. Through his papers and books, Walton redefined the boundaries not only of argumentation theory, but also logic and philosophy. He was a philosopher in the sense that his interest was developing theoretical models that can help explain reality, and more importantly interact with it. For this reason, he proposed methods that have been used for analyzing different types of dialogical interactions, and modeling procedures for regulating them.

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

Models of deliberative dialogue are fundamental for developing autonomous systems that support human practical reasoning. The question discussed in this paper is whether existing models are able to capture the complexity and richness of natural deliberation. In real-world contexts, circumstances relevant to the decision can change rapidly. We reflect on today’s leading model of deliberation dialogue and we propose an extension to capture how newly exchanged information about changing circumstances may shape the dialogue. Moreover, in natural deliberation, a dialogue may be successful even if a decision on what to do has not been made. A set of criteria is proposed to address the problem of when to close off the practical reasoning phase of dialogue. We discuss some measures for evaluating the success of a dialogue after closure and we present some initial efforts to introduce the new deliberation features within an existing model of agent dialogue. We believe that our extended model of dialogue may contribute to representing that richness of natural deliberative dialogue that is yet to be addressed in existing models of agent deliberation.

This study aimed at evaluating the relative contribution of endothelial cyclooxygenase-1 and -2 (COX-1 and COX-2) to prostacyclin (PGI(2)) production in the presence of mild oxidative stress resulting from autooxidation of polyphenols such as (-)-epigallocatechin 3-gallate (EGCG), using both endothelial cells in culture and isolated blood vessels. EGCG treatment resulted in an increase in hydrogen peroxide formation in human umbilical vein endothelial cells. In the presence of exogenous arachidonic acid and EGCG, PGI(2) production was preferentially inhibited by a selective COX-1 inhibitor. This effect of selective inhibition was also substantially reversed by catalase. In addition, EGCG caused vasorelaxation of rat aortic ring only partially abolished by a nitric oxide synthase inhibitor. Concomitant treatment with a selective COX-1 inhibitor completely prevented the vasorelaxation as well as the increase in PGI(2) accumulation in the perfusate observed in EGCG-treated aortic rings, while a selective COX-2 inhibitor was completely uneffective. Our data strongly support the notions that H(2)O(2) generation affects endothelial PGI(2) production, making COX-1, and not COX-2, the main source of endothelial PGI(2) under altered oxidative tone conditions. These results might be relevant to the reappraisal of the impact of COX inhibitors on vascular PGI(2) production in patients undergoing significant oxidative stress.

Sirtuins enzymes are a conserved family of nicotinamide adenine dinucleotide (NAD)-dependent deacetylases and ADP-ribosyltransferases that mediate responses to oxidative stress, fasting and dietary restriction in mammals. Vascular smooth muscle cells (VSMCs) are involved in many mechanisms that regulate vascular biology in vivo but the role of SIRT1 has not been explored in much detail. Therefore, we investigated the regulation of SIRT1 in cultured VSMCs under various stress conditions including diabetes. Sprague-Dawley rats were made diabetic by injecting a single dose of streptozotocin (65 mg/Kg), and aortic VSMCs were isolated after 4 weeks. Immunocytochemistry showed that SIRT1 was localized predominantly in the nucleus, with lower staining in VSMCs from STZ-diabetic as compared with normoglycemic rats. Previous diabetes induction in vivo and high glucose concentrations in vitro significantly downregulated SIRT1 amounts as detected in Western blot assays, whereas TNF-α (30 ng/ml) stimulation failed to induce significant changes. Because estrogen signaling affects several pathways of oxidative stress control, we also investigated SIRT1 modulation by 17β-estradiol. Treatment with the hormone (10 nM) or a selective estrogen receptor-α agonist decreased SIRT1 levels in VSMCs from normoglycemic but not in those from STZ-diabetic animals. 17β-estradiol treatment also enhanced activation of AMP-dependent kinase, which partners with SIRT1 in a signaling axis. SIRT1 downregulation by 17β-estradiol could be observed as well in human peripheral blood mononuclear cells, a cell type in which SIRT1 downregulation is associated with insulin resistance and subclinical atherosclerosis. These data suggest that SIRT1 protein levels are regulated by diverse cellular stressors to a variable extent in VSMCs from diabetic and normoglycemic rats, warranting further investigation on SIRT1 as a modulator of VSMC activity in settings of vascular inflammation.