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Background Methods Results Conclusion In contrast to sublingual immunotherapy (SLIT) with recombinant Mal d 1 (rMal d 1‐SLIT), SLIT with rBet v 1 (rBet v 1‐SLIT) induced Mal d 1‐cross‐reactive antibodies without IgE‐blocking activity. To elucidate whether the development of cross‐protective IgG responses depends on the degree of molecular identity of allergens we compared the cross‐reactivity, cross‐blocking activity, and affinity of SLIT‐induced antibodies with allergens of varying amino acid sequence identities to Bet v 1 and Mal d 1, namely Cor a 1.04 (hazelnut), Pru av 1 (cherry), and Dau c 1 (carrot).Allergen‐specific antibodies were quantified by ELISA. IgE blocking was analyzed by inhibition of allergen‐induced basophil activation and IgE‐facilitated allergen‐presentation to T cells. The affinity of SLIT‐induced antibodies was studied by acidic dissociation ELISA and competition ELISA. Identical surface areas on allergens were predicted using an in‐house designed script based on structural alignments.rBet v 1‐SLIT‐induced IgG antibodies cross‐reacted with all allergens except Dau c 1. rMal d 1‐SLIT‐induced antibodies predominantly cross‐reacted with Pru av 1 and displayed significantly higher IgE blocking to Pru av 1 than rBet v 1‐SLIT‐induced antibodies. rMal d 1‐SLIT‐induced IgG1 showed higher affinity to Mal d 1 and Pru av 1. Surface analysis revealed 84% identical area on Mal d 1 and Pru av 1. Furthermore, we identified two surface areas potentially containing epitopes present on these allergens and absent on Bet v 1.In summary, our findings suggest that a relatively high threshold of similarity is required to establish effective cross‐blocking antibodies to related allergens. Apparently, the structural identity between Bet v 1 and Mal d 1 is below this threshold. Therefore, this study may explain why immunotherapy with birch pollen allergen often fails to reduce birch pollen‐related apple allergy. [ABSTRACT FROM AUTHOR]

IgE-mediated allergies represent a major health problem in the modern world. Apart from allergen-specific immunotherapy (AIT), the only disease-modifying treatment, researchers focus on biologics that target different key molecules such as allergens, IgE, or type 2 cytokines to ameliorate allergic symptoms. Single-domain antibodies, or nanobodies, are the newcomers in biotherapeutics, and their huge potential is being investigated in various research fields since their discovery 30 years ago. While they are dominantly applied for theranostics of cancer and treatment of infectious diseases, nanobodies have become increasingly substantial in allergology over the last decade. In this review, we discuss the prerequisites that we consider to be important for generating useful nanobody-based drug candidates for treating allergies. We further summarize the available research data on nanobodies used as allergen monitoring and detection probes and for therapeutic approaches. We reflect on the limitations that have to be addressed during the development process, such as in vivo half-life and immunogenicity. Finally, we speculate about novel application formats for allergy treatment that might be available in the future. [ABSTRACT FROM AUTHOR]

Tree nut allergy is a lifelong and potentially life‐threatening condition. The standard of care is strictly avoiding the culprit nut and treating accidental reactions symptomatically. To evaluate potential therapeutic options for desensitizing patients with IgE‐mediated tree nut allergy, we systematically searched three bibliographic databases for studies published until January 2024. We looked for active treatments of IgE‐mediated allergy to tree nuts (walnut, hazelnut, pistachio, cashew, almond, pecan, macadamia nut, and brazil nut). We focused on allergen‐specific immunotherapy (AIT) using oral (OIT), sublingual (SLIT), epicutaneous (EPIT), or subcutaneous (SCIT) delivery, or other disease‐modifying treatments. We found 19 studies that met our criteria: 3 studies investigated sublingual immunotherapy, 5 studied oral immunotherapy to a single tree nut, and 6 used multi‐food oral immunotherapy with or without omalizumab. The remaining studies investigated the effectiveness of monoclonal antibodies or IgE‐immunoadsorption in multi‐food allergic patients, including patients with tree nut allergy. The heterogeneity of the studies prevented pooling and meta‐analysis. Oral immunotherapy, single or multi‐nut, with or without omalizumab, was the most studied approach and appears effective in conferring protection from accidental exposures. Omalizumab monotherapy is the only approved alternative management for reducing allergic reactions that may occur with accidental exposure. [ABSTRACT FROM AUTHOR]

Food allergy is a global public health problem that until recent years lacked any aetiological treatment supported by academy, industry and regulators. Food immunotherapy (AIT) is an evolving treatment option, supported by clinical practice and industry trial data. Recent AIT meta‐analyses have highlighted the difficulty in pooling safety and efficacy data from AIT trials, due to secondary heterogeneity in the study. An EAACI task force (CO‐FAITH) initiated by the Paediatric Section was created to focus on AIT efficacy outcomes for milk, egg and peanut allergy rather than in trial results. A systematic search and a narrative review of AIT controlled clinical trials and large case series was conducted. A total of 63 manuscripts met inclusion criteria, corresponding to 23, 21 and 22 studies of milk, egg and peanut AIT, respectively. The most common AIT efficacy outcome was desensitization, mostly defined as tolerating a maintenance phase dose, or reaching a particular dose upon successful exit oral food challenge (OFC). However, a large degree of heterogeneity was identified regarding the dose quantity defining this outcome. Sustained unresponsiveness and patient‐reported outcomes (e.g. quality of life) were explored less frequently, and to date have been most rigorously described for peanut AIT versus other allergens. Change in allergen threshold assessed by OFC remains the most common efficacy measure, but OFC methods suffer from heterogeneity and methodological disparity. This review has identified multiple heterogeneous outcomes related to measuring the efficacy of AIT. Efforts to better standardize and harmonize which outcomes, and how to measure them must be carried out to help in the clinical development of safe and efficacious food allergy treatments. [ABSTRACT FROM AUTHOR]

Background: Pediatricians are often the first point of contact for children in Primary Care (PC), but still perceive gaps in their allergy knowledge. We investigated self‐perceived knowledge gaps and educational needs in pediatricians across healthcare systems in Europe so that future educational initiatives may better support the delivery of allergy services in PC. Method: A multinational survey was circulated to pediatricians who care for children and adolescents with allergy problems in PC by the EAACI Allergy Educational Needs in Primary Care Pediatricians Task Force from February to March 2023. A 5‐point Likert scale was used to assess the level of agreement with questionnaire statements. Thirty surveys per country were the cut‐off for inclusion and statistical analysis. Results: In this study, 1991 respondents were obtained from 56 countries across Europe and 210 responses were from countries with a cut‐off below 30 participants per country. Primary care pediatricians (PCPs) comprised 74.4% of the respondents. The majority (65.3%) were contracted to state or district health services. 61.7% had awareness of guidelines for onward allergy referral in their countries but only 22.3% were aware of the EAACI competencies document for allied health professionals for allergy. Total sample respondents versus PCPs showed 52% and 47% of them have access to allergy investigations in their PC facility (mainly specific IgE and skin prick tests); 67.6% and 58.9% have access to immunotherapy, respectively. The main barrier to referral to a specialist was a consideration that the patient's condition could be diagnosed and treated in this PC facility, (57.8% and 63.6% respectively). The main reasons for referral were the need for hospital assessment, and partial response to first‐line treatment (55.4% and 59.2%, 47% and 50.7%, respectively). Learning and assessment methods preference was fairly equally divided between Traditional methods (45.7% and 50.1% respectively) and e‐learning 45.5% and 44.9%, respectively. Generalist physicians (GPs) have the poorest access to allergy investigations (32.7%, p =.000). The majority of the total sample (91.9%) assess patients with allergic pathology. 868 (43.6%) and 1117 (46.1%), received allergy training as undergraduates and postgraduates respectively [these proportions in PCPs were higher (45% and 59%), respectively]. PCPs with a special interest in allergology experienced greater exposure to allergy teaching as postgraduates. GPs received the largest amount of allergy teaching as undergraduates. Identifying allergic disease based on clinical presentation, respondents felt most confident in the management of eczema/atopic dermatitis (87.4%) and rhinitis/asthma (86.2%), and least confident in allergen immunotherapy (36.9%) and latex allergy (30.8%). Conclusion: This study exploring the confidence of PCPs to diagnose, manage, and refer patients with allergies, demonstrated knowledge gaps and educational needs for allergy clinical practice. It detects areas in need of urgent improvement especially in latex and allergen immunotherapy. It is important to ensure the dissemination of allergy guidelines and supporting EAACI documents since the majority of PCPs lack awareness of them. This survey has enabled us to identify what the educational priorities of PCPs are and how they would like to have them met. [ABSTRACT FROM AUTHOR]

The treatment of allergic conditions presents a challenge for both seasonal allergic rhinitis and perennial rhinitis sufferers. The increasing prevalence of both of these types of allergic responses requires the use of a range of treatments which can provide relief. The treatment of allergic rhinitis has been considered under the ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines. Current treatment options include medication and avoidance for those with reduced responses, but more expensive treatments include immunotherapy and the use of monoclonal antibodies (mAb). All treatments target specific parts of the inflammatory response which includes mast cells, eosinophils and basophils. Phototherapy can be a useful addition to these treatments, and combinations of UV-B (5%), UV-A (25%) and visible light (70%) in phototherapy treatments have been shown to reduce the severity of symptoms. Phototherapy consisting of visible wavelengths and infrared light (660 nm 940 nm) was shown to be particularly effective in treating perennial rhinitis. The use of a range of wavelengths in the control of allergic responses is described in this paper. Phototherapy can form part of an effective treatment regime for allergic rhinitis sufferers which can exploit synergies in the control of the condition elicited through several pathways.

Background: Virus‐like particle (VLP) Peanut is a novel immunotherapeutic vaccine candidate for the treatment of peanut allergy. The active pharmaceutical ingredient represents cucumber mosaic VLPs (CuMVTT‐VLPs) that are genetically fused with one of the major peanut allergens, Ara h 2 (CuMVTT‐Ara h 2). We previously demonstrated the immunogenicity and the protective capacity of VLP Peanut‐based immunization in a murine model for peanut allergy. Moreover, a Phase I clinical trial has been initiated using VLP Peanut material manufactured following a GMP‐compliant manufacturing process. Key product characterization studies were undertaken here to understand the role and contribution of critical quality attributes that translate as predictive markers of immunogenicity and protective efficacy for clinical vaccine development. Method: The role of prokaryotic RNA encapsulated within VLP Peanut on vaccine immunogenicity was assessed by producing a VLP Peanut batch with a reduced RNA content (VLP Peanut low RNA). Immunogenicity and peanut allergen challenge studies were conducted with VLP Peanut low RNA, as well as with VLP Peanut in WT and TLR 7 KO mice. Furthermore, mass spectrometry and SDS‐PAGE based methods were used to determine Ara h 2 antigen density on the surface of VLP Peanut particles. This methodology was subsequently applied to investigate the relationship between Ara h 2 antigen density and immunogenicity of VLP Peanut. Results: A TLR 7 dependent formation of Ara h 2 specific high‐avidity IgG antibodies, as well as a TLR 7 dependent change in the dominant IgG subclass, was observed following VLP Peanut vaccination, while total allergen‐specific IgG remained relatively unaffected. Consistently, a missing TLR 7 signal caused only a weak decrease in allergen tolerability after vaccination. In contrast, a reduced RNA content for VLP Peanut resulted in diminished total Ara h 2 specific IgG responses, followed by a significant impairment in peanut allergen tolerability. The discrepant effect on allergen tolerance caused by an absent TLR 7 signal versus a reduced RNA content is explained by the observation that VLP Peanut‐derived RNA not only stimulates TLR 7 but also TLR 3. Additionally, a strong correlation was observed between the number of Ara h 2 antigens displayed on the surface of VLP Peanut particles and the vaccine's immunogenicity and protective capacity. Conclusions: Our findings demonstrate that prokaryotic RNA encapsulated within VLP Peanut, including antigen density of Ara h 2 on viral particles, are key contributors to the immunogenicity and protective capacity of the vaccine. Thus, antigenicity and RNA content are two critical quality attributes that need to be determined at the stage of manufacturing, providing robust information regarding the immunogenicity and protective capacity of VLP Peanut in the mouse which has translational relevance to the human setting. [ABSTRACT FROM AUTHOR]

Because allergic diseases are long-term conditions that commonly manifest first in early life and persist in various forms well into adulthood, the transition from paediatric to adult care is an inevitable requirement. To date there has been very little focus on the requirements and wishes of young people with long-term medical problems as they transition through health services. As a consequence, there is a paucity of guidance on the way in which their transition should be conducted to optimise the outcomes and experience of these patients. The burdens encountered by patients as they are expected to develop full independence and competence to manage their own condition are superimposed on a number of physical, psychological and social challenges. Their need to achieve educational and career goals while taking control of their allergies can be overwhelming. System specialist societies and health services are beginning to resolve this problem as outcome data show that young people are particularly vulnerable to adverse events. A disproportionate number of fatalities occur in young people with severe asthma and food-induced anaphylaxis. Recommendations on the structure of this transition are being developed by national and international allergy societies. However, regional differences in health service organisation and variations in political, sociological, environmental and financial structures mean that the transition can be optimised only through locality-based implementation. The planning must involve all stakeholders, of whom young people with allergic diseases are most important. A series of recommendations are presented here which incorporate those developed by the European Academy of Allergy and Clinical Immunology together with our own additions that respond to specific challenges raised by young people. [ABSTRACT FROM AUTHOR]

Coronavirus disease-19 (COVID-19) is an ongoing global contagious viral pandemic caused by the 'severe acute respiratory syndrome coronavirus 2' (SARS-CoV-2) that was first reported in December 2019 following a cluster of pneumonia cases in Wuhan, China. Pulmonary manifestations of the illness predominate; however, of the extrapulmonary signs associated with COVID-19, a variety of dermatological manifestations have increasingly been reported. These cutaneous manifestations may be due to the effect of the viral infection on tissues, effects on the coagulation system, the effects of medication or dysregulated immune responses. This case report describes a polymorphous rash that took several weeks to evolve, posing a diagnostic dilemma for clinicians. It presented in a young woman as a possible allergy, then progressed into a 'post-viral'-looking generalised exanthem; finally, it developed into a disease of immune dysregulation. [ABSTRACT FROM AUTHOR]

The increasing prevalence of allergic disease has resulted in the recognition of allergy as a global public health concern. Yet health services worldwide appear to be ill-equipped to deliver high-quality allergy care. Clinical guidelines have been developed to describe what high-quality care looks like for most allergic diseases. However, allergy guidelines do not describe how the delivery of such care is organised across clinicians and provider organisations with varying degrees of access to allergy expertise and clinical resources. In this article, we describe how care pathways can be used to improve the organisation and delivery of allergy care in accordance with the characteristics of allergic disease and local constraints in the health service. We then describe how quality-improvement methods can support the successful realisation of allergy care pathways in practice. Realising care pathways involves a highly complex process of changing the way care is practised and organised. This could involve developing a new service, clinical training or other interventions. Qualityimprovement methods were developed as a guide to navigate and support the process of change and improvement. [ABSTRACT FROM AUTHOR]

IgE-mediated allergies represent a major health problem in the modern world. Apart from allergen-specific immunotherapy (AIT), the only disease-modifying treatment, researchers focus on biologics that target different key molecules such as allergens, IgE, or type 2 cytokines to ameliorate allergic symptoms. Single-domain antibodies, or nanobodies, are the newcomers in biotherapeutics, and their huge potential is being investigated in various research fields since their discovery 30 years ago. While they are dominantly applied for theranostics of cancer and treatment of infectious diseases, nanobodies have become increasingly substantial in allergology over the last decade. In this review, we discuss the prerequisites that we consider to be important for generating useful nanobody-based drug candidates for treating allergies. We further summarize the available research data on nanobodies used as allergen monitoring and detection probes and for therapeutic approaches. We reflect on the limitations that have to be addressed during the development process, such as in vivo half-life and immunogenicity. Finally, we speculate about novel application formats for allergy treatment that might be available in the future.

Damp and moisture-damaged building exposure has been linked to adverse health effects, primarily related to respiratory complications from mold spore reactions. This paper describes a case of a previously healthy man who was exposed to a home with hidden mold infestation and remained symptomatic following proper remediation. The patient presented with allergies, allergic bronchopulmonary aspergillosis, and treatment resistant asthma, as well as other non-respiratory symptoms likely related to inhalational mycotoxin exposure from his home. In this case, the addition of systemic and intranasal antifungals improved both respiratory and nonrespiratory symptoms. Antifungals were used for a longer duration than customary and in combination with factors that addressed drug resistance. [ABSTRACT FROM AUTHOR]

This paper describes an novel, rapid, simple, meticulous and unerring “stability indicating HPLC method” for the assessment of montelukast (MTT) and bilastine (BLE) mix in existence of their degradation products in tablet formulation. Zorbax column XDB-C18 was utilized to separate and analyse MTT and BLE mix. The isocratic mode elution of BLE and MTT mix was made with 0.1M disodium hydrogen phosphate buffer of pH 5.8 (55 % volume ratio) and methanol (45% volume ratio) at 1.0 mL min-1 flow stream. Strong linearity was recorded within the 2.5 - 20 μg mL-1 and 5 - 40 μg mL-1 concentration ranges, with coefficient determination values of 0.9994 and 0.9997, respectively, for MTT and BLE. The recovery percentiles of MTT and BLE were 99.593 % and 99.349 %, respectively. The precision displayed values less than 0.520 % for MTT and less than 0.745 % for BLE. The robustness too was shown in the chromatographic settings by minor variations. The specificity besides stability representing feature was evidenced since the degradation products arisen in stress situations did not interlope in the determination of MTT and BLE mix. Thus, this procedure can be applied for quality regulation analysis of BLE and MTT mix in formulations of tablets. [ABSTRACT FROM AUTHOR]

Zhengshuo Jin,1,2,&ast; Zhouxian Pan,2,&ast; Ziran Wang,3,&ast; Lingjun Kong,3 Min Zhong,3 Yongshi Yang,2 Yaling Dou,3 Jin-Lyu Sun2 1Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People’s Republic of China; 2Allergy Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 3Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yaling Dou; Jin-Lyu Sun, Email douyl@pumch.cn; sunjinlv@pumch.cnBackground and Objective: Asthma and allergic rhinitis have been reported to be strongly associated with genetic factors. The aim of this study was to evaluate the accuracy of the TaqMan-MGB (minor groove binder) qPCR method for detecting CYSLTR1 rs320995 (T927C) and GSDMB rs7216389 (G1199A) gene polymorphisms as well as to explore the association of CYSLTR1 rs320995 and GSDMB rs7216389 polymorphisms with genetic susceptibility of Chinese patients with asthma and allergic rhinitis.Methods: In this study, 310 asthmatic patients and 60 healthy individuals were recruited in Peking Union Medical College Hospital. The CYSLTR1 rs320995 (T927C) and GSDMB rs7216389 (G1199A) gene polymorphisms in each group were analyzed by TaqMan-MGB qPCR and DNA sequencing which was regarded as the gold standard. After the validation of this method, additional 71 patients with allergic rhinitis and 72 patients with asthma combined with allergic rhinitis were selected and tested by using TaqMan-MGB qPCR.Results: The TaqMan-MGB qPCR results were fully consistent with DNA sequencing results (Kappa = 1, P< 0.001). In addition, the results of the TaqMan-MGB qPCR assay were not affected by bilirubin and lipids. We found differential distribution of CYSLTR1 rs320995 genotypes in female patients with asthma combined with allergic rhinitis (χ2=6.172, P=0.046, statistical power = 0.591). Specifically, the TT genotype is more frequent in women suffering from asthma with allergic rhinitis, whereas the TC genotype is more prevalent in healthy women. However, no such associations were observed in the GSDMB rs7216389 polymorphism.Conclusion: We have established a reliable TaqMan-MGB qPCR method for the detection of CYSLTR1 rs320995 and GSDMB rs7216389 polymorphisms. Moreover, the CYSLTR1 rs320995 polymorphism may be associated with genetic susceptibility of Chinese female patients with asthma and allergic rhinitis. Multicenter studies with larger sample sizes are required in the future.Keywords: asthma, allergy treatment, gene polymorphism, CYSLTR1, GSDMB

Background: Allergic rhinitis (AR) is a major non‐communicable disease that affects the health‐related quality of life (HRQoL) of patients. However, data on HRQoL and symptom control in AR patients with comorbid asthma (AR + asthma) are lacking. Methods: In this multicentre, cross‐sectional study, patients with AR were screened and administered questionnaires of demographic characteristics and health conditions (symptoms/diagnosis of AR and asthma, disease severity level, and allergic conditions). HRQoL was assessed using a modified version of the RHINASTHMA questionnaire (30, 'not at all bothered' ‐ 150 'very much bothered') and symptom control was evaluated by a modified version of the Control of Allergic Rhinitis/Asthma Test (CARAT) (0, 'no control' ‐ 30, 'very high control'). Results: Out of 643 patients with AR, 500 (78%) had asthma as a comorbidity, and 54% had moderate‐severe intermittent AR, followed by moderate‐severe persistent AR (34%). Compared to the patients with AR alone, patients with AR + asthma had significantly higher RHINASTHMA (e.g., median RHINASTHMA‐total score 48.5 vs. 84, respectively) and a significantly lower CARAT score (median CARAT‐total score 23 vs. 16.5, respectively). Upon stratifying asthma based on severity, AR patients with severe persistent asthma had worse HRQoL and control than those with mild persistent asthma. The association was significantly higher among non‐obese participants compared to obese ones, with RHINASTHMA‐upper symptoms score but not with CARAT. Conclusions: Our observation of poorer HRQoL and symptoms control in AR patients with comorbid asthma supports the importance of a comprehensive approach for the management of AR in case of a comorbid allergic condition. [ABSTRACT FROM AUTHOR]

Helicobacter pylori neutrophil-activating protein (HP-NAP), a major virulence factor of H. pylori, plays a role in bacterial protection and host inflammation. HP-NAP activates a variety of innate immune cells, including neutrophils, monocytes, and mast cells, to induce their pro-oxidant and pro-inflammatory activities. This protein also induces T-helper type 1 (Th1) immune response and cytotoxic T lymphocyte (CTL) activity, supporting that HP-NAP is able to promote gastric inflammation by activation of adaptive immune responses. Thus, HP-NAP is a potential therapeutic target for the treatment of H. pylori-induced gastric inflammation. The inflammatory responses triggered by HP-NAP are mediated by a PTX-sensitive G protein-coupled receptor and Toll-like receptor 2. Drugs designed to block the interactions between HP-NAP and its receptors could alleviate the inflammation in gastric mucosa caused by H. pylori infection. In addition, HP-NAP acts as a promising therapeutic agent for vaccine development, allergy treatment, and cancer immunotherapy. The high antigenicity of HP-NAP makes this protein a component of vaccines against H. pylori infection. Due to its immunomodulatory activity to stimulate the Th1-inducing ability of dendritic cells, enhance Th1 immune response and CTL activity, and suppress Th2-mediated allergic responses, HP-NAP could also act as an adjuvant in vaccines, a drug candidate against allergic diseases, and an immunotherapeutic agent for cancer. This review highlights the role of HP-NAP in the pathogenesis of H. pylori and the potential for this protein to be a therapeutic target in the treatment of H. pylori infection and therapeutic agents against H. pylori-associated diseases, allergies, and cancer. [ABSTRACT FROM AUTHOR]

IgE-mediated allergic diseases have increased in the last decades. The most prevalent allergens from these seeds are Ric c1 and Ric c3, isoforms of 2S albumin. These allergenic proteins cross-react with allergens from peanut, shrimp, fish, corn, gramineous, house dust, and tobacco. The usual allergy treatment employs antihistaminic, immunotherapies and, omalizumab (Xolair)-based anti-IgE therapy. However, antihistaminics relieve symptoms, and the high cost of omalizumab limits its use for continuous treatment. We propose an alternative immunotherapeutic approach, denoted "IgE-blockage" by L-glutamic acid or modifiedglutamic acid. Six compounds, D-glutamic acid, L-glutamic acid, N-methyl-L-glutamic acid, N-acetyl-Lglutamic acid, N-(4-nitrobenzoyl)-L-glutamic acid, and N-carbamyl-L-glutamic, were tested as a blocker. To evaluate motor coordination and the sedative/hypnotic activity of L-glutamic acid, a rota-rod test and a thiopental sodium-induced sleeping test were used. The compounds, L-glutamic acid and L-nitrobenzoyl glutamic acid, were the most active compounds to block the interaction of castor allergens with IgE. These compounds also prevent cross-responses with allergens from food sources and inhalants that cross-react with them. In the sleeping test, the groups that received L-glutamic acid at doses of 10 and 30 mg/kg had a sleeping time similar to the vehicle control group. No changes in the animals' behavior were observed and there was no difference between the L-glutamic acid groups and the vehicle control groups in the rota-rod test. L-glutamic acid and L-nitrobenzoyl glutamic acid can used as IgE blocker to prevent allergic diseases. [ABSTRACT FROM AUTHOR]

Allergy diagnosis, allergy treatment, education, healthcare, learning methods, primary care, primary care pediatricians Keywords: allergy diagnosis; allergy treatment; education; healthcare; learning methods; primary care; primary care pediatricians EN allergy diagnosis allergy treatment education healthcare learning methods primary care primary care pediatricians 1 4 4 01/31/23 20230101 NES 230101 Pediatricians are often the first point of contact for children in primary care (PC). [Extracted from the article]

Anna Langenbruch,1 Eike Wüstenberg,2,3 Hendrik Wolf,2 Matthias Augustin1 1German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; 2ALK-Abelló Arzneimittel GmbH, Hamburg, Germany; 3Clinic for Otorhinolaryngology, University Hospital Dresden, Dresden, GermanyCorrespondence: Anna Langenbruch, German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg, 20246, Germany, Tel +49 40 7410-53942, Fax +49 40 7410-55348, Email a.langenbruch@uke.dePurpose: Allergic rhinoconjunctivitis (ARC) is one of the most common diseases worldwide. Allergen immunotherapy (AIT) is the only causal treatment available so far. Due to health policy provisions, the assessment of treatment benefit from the patient’s perspective is of high relevance. To date, no instrument for assessing treatment needs and benefits of patients with ARC who receive AIT has been published. The aim of the study was to validate an instrument to assess the patient-relevant treatment benefit of patients with ARC who receive AIT.Methods: We developed the Patient Benefit Index questionnaire for AIT (PBI-AIT), consisting of 33 items. Longitudinal data of patients with ARC were used to test feasibility, reliability and validity. The PBI was compared between the beginning of the study (t1) and the end of the study (t5).Results: N = 279 patients with AIT completed the PBI-AIT at t1, n = 333 at t5; n = 226 at both timepoints. Mean number of missing values per patient was 0.7 in the Patient Needs Questionnaire (PNQ) at t1 and 1.2 in the Patient Benefit Questionnaire (PBQ) at t5. The internal consistencies measured by Cronbach’s alpha were 0.98 (PNQ) and 0.99 (PBQ). The mean PBI of the patients with AIT was significantly lower at t1 and improved at t5. The PBI-AIT correlated with all tested external criteria at t5. The correlation between PBI-AIT and satisfaction with previous treatment (r = − 0.57, p < 0.001) was higher than the correlation between PBI-AIT and current disease severity (r = − 0.26, p < 0.001).Conclusion: The results indicate feasibility, reliability, convergent and discriminant validity as well as sensitivity to change of the PBI-AIT.Keywords: allergy treatment, immunotherapy and tolerance induction, patient reported outcome, prevention, quality of life

IgE-mediated allergic diseases have increased in the last decades. The most prevalent allergens from these seeds are Ric c1 and Ric c3, isoforms of 2S albumin. These allergenic proteins cross-react with allergens from peanut, shrimp, fish, corn, gramineous, house dust, and tobacco. The usual allergy treatment employs antihistaminic, immunotherapies and, omalizumab (Xolair)-based anti-IgE therapy. However, antihistaminics relieve symptoms, and the high cost of omalizumab limits its use for continuous treatment. We propose an alternative immunotherapeutic approach, denoted “IgE-blockage” by L-glutamic acid or modified-glutamic acid. Six compounds, D-glutamic acid, L-glutamic acid, N-methyl-L-glutamic acid, N-acetyl-L-glutamic acid, N-(4-nitrobenzoyl)-L-glutamic acid, and N-carbamyl-L-glutamic, were tested as a blocker. To evaluate motor coordination and the sedative/hypnotic activity of L-glutamic acid, a rota-rod test and a thiopental sodium-induced sleeping test were used. The compounds, L-glutamic acid and L-nitrobenzoyl glutamic acid, were the most active compounds to block the interaction of castor allergens with IgE. These compounds also prevent cross-responses with allergens from food sources and inhalants that cross-react with them. In the sleeping test, the groups that received L-glutamic acid at doses of 10 and 30 mg/kg had a sleeping time similar to the vehicle control group. No changes in the animals' behavior were observed and there was no difference between the L-glutamic acid groups and the vehicle control groups in the rota-rod test. L-glutamic acid and L-nitrobenzoyl glutamic acid can used as IgE blocker to prevent allergic diseases. DOI: http://dx.doi.org/10.5281/zenodo.7686100

Abstract Background Allergic rhinitis (AR) is a major non‐communicable disease that affects the health‐related quality of life (HRQoL) of patients. However, data on HRQoL and symptom control in AR patients with comorbid asthma (AR + asthma) are lacking. Methods In this multicentre, cross‐sectional study, patients with AR were screened and administered questionnaires of demographic characteristics and health conditions (symptoms/diagnosis of AR and asthma, disease severity level, and allergic conditions). HRQoL was assessed using a modified version of the RHINASTHMA questionnaire (30, ‘not at all bothered’ ‐ 150 ‘very much bothered’) and symptom control was evaluated by a modified version of the Control of Allergic Rhinitis/Asthma Test (CARAT) (0, ‘no control’ ‐ 30, ‘very high control’). Results Out of 643 patients with AR, 500 (78%) had asthma as a comorbidity, and 54% had moderate‐severe intermittent AR, followed by moderate‐severe persistent AR (34%). Compared to the patients with AR alone, patients with AR + asthma had significantly higher RHINASTHMA (e.g., median RHINASTHMA‐total score 48.5 vs. 84, respectively) and a significantly lower CARAT score (median CARAT‐total score 23 vs. 16.5, respectively). Upon stratifying asthma based on severity, AR patients with severe persistent asthma had worse HRQoL and control than those with mild persistent asthma. The association was significantly higher among non‐obese participants compared to obese ones, with RHINASTHMA‐upper symptoms score but not with CARAT. Conclusions Our observation of poorer HRQoL and symptoms control in AR patients with comorbid asthma supports the importance of a comprehensive approach for the management of AR in case of a comorbid allergic condition.

Objectives: The aims of presenting study were trying to expose the course of SARS-CoV-2 (severe acute respiratory syndrome-related coronavirus) in patients with allergic rhinitis (AR), to compare the prevalence of SARS-CoV-2 infection, hospitalization and pneumonia rates in patients with AR receiving allergen immunotherapy (AIT) and patients did not receiving AIT (non-receivers) and to define possible risk factors for SARS-CoV-2 positivity in patients with AR. Methods: A total of 419 patients with AR who were being followed-up in a tertiary allergy clinic between June 1, 2020 and December 31, 2020, were selected for the study. Results: Seventy-nine (18.9%) patients became infected with the SARS-CoV-2 [32 (19.6%) patients in AR patients with AIT and 47 (18.4%) patients in non-receivers] and the rate of pneumonia was 2.4% [12.7% of SARS-CoV-2 (+) patients]. There was no significant difference was determined between the AR patients with AIT and the non-receivers in regard of the rate of SARS-CoV-2 infection, pneumonia and hospitalization (p = 0.864, p = 0.055 and p = 0.075; respectively). There was a significant difference between the groups in terms of gender, duration of disease, sensitivity to allergens (atopy) and serum IgE levels (p = 0.009, p = 0.001, p = 0.001 and p = 0.001; respectively). The accompanying comorbidities, eosinophil cout, AIT and duration of AIT were not found to be associated with an increased risk SARS-CoV-2 PCR positivity. However, female gender was shown to be associated with an decreased risk for SARS-CoV-2 PCR positivity (OR, 0.571; 95% confidence interval, 0.330-0.987; p = 0.045) Conclusions: The course of SARS-CoV-2 is similar in patients with AR who underwent AIT and patients with AR who did not undergo AIT, and AIT does not seem to increase the risk for SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Introduction Understanding sensitization patterns helps clinicians tailor care more effectively. Most clinical studies with positive results used single allergens, but many patients are sensitized to multiple allergens. Aim This study was planned to assess the correlation between different allergen sensitization patterns (the presence of sensitization to some but not other allergens) and clinical effectiveness of subcutaneous allergen-specific immunotherapy. Patients and methods This ex post facto study was conducted on patients with already diagnosed allergic disorders, who were attending our allergy and immunotherapy clinic and receiving subcutaneous allergen-specific immunotherapy. Data collected include patient's demographic data, diagnosis of allergic disorders, and sensitization pattern duration of subcutaneous immunotherapy. The outcome of subcutaneous allergen-specific immunotherapy was assessed based on symptom score, medication score, and overall clinical outcome. Results A total of 100 patients were included. The frequencies of allergens, to which the patients were sensitized, were pollen (1 and 2) (63%), mold (61%), mite (59%), hay dust (41%), and chicken feather (23%). There were no significant association between sensitization patterns and the preimmunotherapy symptom and medication. Apart from cotton pollen, all other allergens were not associated with improvement in symptom score, and apart from chicken feather and dog sensitization all other allergens were not associated with improvement in medication score. Conclusion Allergen sensitization pattern could affect clinical outcome of subcutaneous allergen-specific immunotherapy in polysensitized patients. Cotton pollen sensitization is associated with less improvement in symptoms score. Chicken feather sensitization is associated with significant improvement in medication score in contrast to dog hair sensitization. The number of allergens in each patient is not significantly associated with the clinical outcome of subcutaneous immunotherapy. [ABSTRACT FROM AUTHOR]

Besides, MUC1 deficiency has been demonstrated to reduce CLDN1 expression in AR pathogenesis.3 Taken together, these results suggest that CLDN1 ubiquitination regulated by RBFOX3 may be involved in MUC1-mediated AR pathogenesis. MUC1 deficiency induces the nasal epithelial barrier dysfunction via RBFOX3 shortage augment ubiquitin-proteasomal degradation in allergic rhinitis pathogenesis In conclusion, our study demonstrates MUC1 deficiency inhibits CLDN1 expression I via i RBFOX3 shortage augment ubiquitin-proteasomal degradation in AR. [Extracted from the article]

Nutraceuticals are products that are also used as medicine other than nutrition. A nutraceutical product may be defined as a substance, which have physiological benefits nor gives protection against chronic diseases. Nutraceuticals may also be used to improve health, delay the aging process, prevent chronic disease, increase life expectancy, or support the structure or function of the body. Nowadays, nutraceuticals has gained considerable interest due to potential nutritional safety and therapeutic effects. Recent studies have shown promising results for those compounds in various complications. Emphasis has been made to present herbal nutraceuticals effective on hard curative disorders related to oxidative stress including allergy, Alzheimer, cardiovascular, cancer, diabetes, and Parkinson's diseases as well as obesity. [ABSTRACT FROM AUTHOR]

Aim: Adrenaline auto‐injector (AAI) dispensing data, a community‐based proxy for number of individuals at risk of anaphylaxis, provides complementary information on time trends of anaphylaxis risk in addition to hospital admission data. We examined trends of AAI dispensing over a 10‐year period (from January 2005 to December 2014) in Australia. Methods: Individuals with dispensed AAI were identified from a 10% random sample of Australian Pharmaceutical Benefits Scheme (PBS) data. PBS is the Australian national drug subsidy programme covering all Australians. Cumulative incidence and incidence rates of individuals with AAI were calculated. We assessed difference by age, sex, state and time trends. Results: The cumulative incidence of individuals with AAI in 2005–2014 was 75.43/100 000 (95%CI 75.07–75.80/100 000). Incidence rate of individuals with AAI increased from 2005 to 2014 (from 71.47 to 82.07 per 100 000 person‐years) although this varied by state. Over the time assessed, there was a shift to more prescriptions being provided by general practitioners (GP) rather than specialists. Children (0–19 years) were more likely to have been prescribed an AAI from a specialist and adults from a GP. Conclusion: Overall, an increase in dispensed AAI mirrored other evidence for a rising prevalence of allergy. This increase could also reflect changes in prescribing practices or increased awareness and education of health‐care professionals on anaphylaxis and indications for prescribing AAI. The rising rate of AAI prescribed by GPs compared to decreasing rates by specialists suggests a changing response of the Australian health‐care system to the increased burden of anaphylaxis. [ABSTRACT FROM AUTHOR]

The aim of this survey was to explore the specific educational needs of a cohort of European GPs with regards to allergy training so that future educational initiatives may better support the delivery of allergy services in primary care. Method: This study took the form of a cross‐sectional observational study in which a structured electronic questionnaire was distributed to primary care providers, in eight languages, across 8 European countries between September 2019 and November 2019. Data associated with demographic parameters, professional qualifications, type of employment, level of confidence regarding competencies for diagnosis and treatment of allergic diseases, referral of patients to allergist and preferred method of learning and assessment were collected. A 5‐point Likert scale was used to assess level of confidence. Exploratory analysis was carried out. Results: A total of 687 responses were available for analysis, with 99.3% of responders working within Europe. 70.1% of participants were female; and 48.0% and 48.0% of participants respectively had received some undergraduate and/or postgraduate allergy education. Confidence in dealing with different aspect of allergy management differed between countries. The main reason for specialist referral was a perceived need for tertiary assessment (54.3%), and the main barrier for referral was the consideration that the patient's condition could be appropriately diagnosed and treated in a primary care facility. Up to 44.7% and 55.3% of participants reported that they preferred e‐Learning over traditional learning. Conclusions: This study identified the specific areas of skills training and educational needs of GPs in managing allergic conditions in primary care, and provided insights into possible strategies for more feasible and cost‐effective approaches. [ABSTRACT FROM AUTHOR]

Background: To determine the proportion and reproducibility of cat‐allergic mild asthmatics with early asthmatic response (EAR) during cat allergen exposure in a naturalistic exposure chamber (NEC). Methods: This was a prospective, observational study in 30 cat‐allergic mild asthmatics who received two 180‐min cat‐allergen (Felis domesticus allergen 1 [Fel d 1]) challenges 27 days apart in an NEC. Results: An EAR (≥20% reduction from baseline in forced expiratory volume in 1 s [FEV1]) was observed in 67% and 52% of subjects at first and second NEC exposure, respectively, with similar median time to EAR; 44% of subjects had an EAR on days 1 and 28. Late asthmatic response (≥15% reduction in FEV1 within 24 h of NEC exit) was observed in 33% of subjects following either exposure. Average FEV1 and total nasal symptom score during NEC exposure were highly correlated within subjects between NEC exposures (r = 0.91, p < 0.0001; r = 0.73, p < 0.001), but total ocular symptom score was not. Time to EAR, but not average FEV1, was significantly associated with NEC Fel d 1 concentration, which was variable. There were no serious adverse events; 12/30 subjects experienced 20 adverse events (including asthma, 10%; headache, 10%). Conclusions: The NEC model demonstrates that average FEV1 change is highly reproducible and has a low correlation with cat allergen levels. However, time to EAR and incidence of EAR are less reproducible and are highly correlated with NEC allergen levels. Average FEV1, rather than incidence of EAR or time to EAR, could be considered as an endpoint for interventional trials testing cat‐specific anti‐allergy therapies using an NEC. [ABSTRACT FROM AUTHOR]

Immunoglobulin E (IgE)‐mediated allergy is the most common hypersensitivity disease affecting more than 30% of the population. Exposure to even minute quantities of allergens can lead to the production of IgE antibodies in atopic individuals. This is termed allergic sensitization, which occurs mainly in early childhood. Allergen‐specific IgE then binds to the high (FcεRI) and low‐affinity receptors (FcεRII, also called CD23) for IgE on effector cells and antigen‐presenting cells. Subsequent and repeated allergen exposure increases allergen‐specific IgE levels and, by receptor cross‐linking, triggers immediate release of inflammatory mediators from mast cells and basophils whereas IgE‐facilitated allergen presentation perpetuates T cell–mediated allergic inflammation. Due to engagement of receptors which are highly selective for IgE, even tiny amounts of allergens can induce massive inflammation. Naturally occurring allergen‐specific IgG and IgA antibodies usually recognize different epitopes on allergens compared with IgE and do not efficiently interfere with allergen‐induced inflammation. However, IgG and IgA antibodies to these important IgE epitopes can be induced by allergen‐specific immunotherapy or by passive immunization. These will lead to competition with IgE for binding with the allergen and prevent allergic responses. Similarly, anti‐IgE treatment does the same by preventing IgE from binding to its receptor on mast cells and basophils. Here, we review the complex interplay of allergen‐specific IgE, IgG and IgA and the corresponding cell receptors in allergic diseases and its relevance for diagnosis, treatment and prevention of allergy. [ABSTRACT FROM AUTHOR]

Background: The standardized quality (SQ) tree sublingual immunotherapy (SLIT)‐tablet has recently been approved for treatment of tree pollen allergy. Healthcare workers should be provided with detailed safety data for clinical use. Objective: To assess the tolerability and safety of the SQ tree SLIT‐tablet (12 SQ‐Bet) in adults and adolescents. Methods: Safety data were pooled from three double‐blinded, randomized, placebo‐controlled trials (2 phase‐II/1 phase‐III) including adults and adolescents 12–65 years with allergic rhinitis and/or conjunctivitis treated before and during one pollen season once‐daily with 12 SQ‐Bet (n = 471) or placebo (n = 458): EudraCT no: 2012‐000031‐59; NCT02481856; EudraCT 2015‐004821‐15. Results: The most frequently reported investigational medicinal product (IMP)‐related AEs with 12 SQ‐Bet were oral pruritis (39% of subjects) and throat irritation (29%). IMP‐related AEs were mainly mild or moderate in severity, and the majority resolved without treatment and did not lead to treatment interruption/discontinuation. With 12 SQ‐Bet, oral pruritus was more frequent among subjects with pollen food syndrome (PFS) (45%) than without PFS (29%). The 12 SQ‐Bet did not seem to induce an increased risk of asthma: 7 events were reported in 7 subjects with 12 SQ‐Bet and 11 in 10 subjects with placebo. No differences were seen in the risk of moderate‐to‐severe IMP‐related AEs regardless of age, PFS status and asthma medical history. Conclusions: The 12 SQ tree SLIT‐tablet was well tolerated in tree pollen allergic subjects with no major safety concerns detected. This safety profile supports daily at‐home sublingual administration once the first dose is tolerated when administered under medical supervision. [ABSTRACT FROM AUTHOR]

Allergic and related diseases have a substantial epidemiological impact on the pediatric population. Small molecule-based medicines have been traditionally used to manage the diseases. Omalizumab is the first monoclonal antibody-based medicine used in children's allergy and shows great promises. It binds to free IgE and prevents it from binding to IgE receptors, thus interrupting the IgE-dependent allergic inflammatory cascade. Vast amounts of data demonstrate its effectiveness and well tolerance by patients, including the children. However, the drug was only approved to use in allergic asthma and chronic spontaneous urticaria (CSU), though other applications were explored in clinical trials. In this review, we summarized current pediatric applications of omalizumab in allergic diseases, focusing on its usages beyond asthma and CSU, including allergic rhinitis, allergic bronchopulmonary aspergillosis, vernal keratoconjunctivitis, food allergy and atopic dermatitis. In addition, we highlighted the unmet needs and controversial issues of anti-IgE therapy.

This article emphasizes the importance of involving patients and their caregivers in allergy practice. It suggests that healthcare providers should focus on optimizing healthcare delivery and addressing the basics of medicine rather than relying solely on expensive and specialized treatments. The article also highlights the need for integrated care pathways and education for healthcare professionals and the general public. It mentions the importance of patient involvement in research and the development of core outcome sets. The article concludes by discussing the potential adverse effects of placebo treatments and the ethical considerations of offering expensive treatments to patients with limited financial resources. The article references a clinical study that found exposure to common allergens in the home can contribute to the development of asthma in children. It also mentions a guidebook from the James Lind Alliance that provides information on conducting research and is available online. [Extracted from the article]

Introduction: Urticaria and angioedema belong to heterogeneous group of disease and it is often very difficult to determine the specific cause of clinical symptoms. Coagulation factors play an important role, and patients with chronic urticaria have elevated plasma concentrations of coagulation factor VII, prothrombin fragment 1 + 2 and D-dimers. Aims: To assess the relationship between the severity of clinical symptoms of chronic urticaria and serum D-dimer levels. Material and methods: Sixty patients with a diagnosis of chronic spontaneous urticaria, diagnosed and treated in the Dermatology Department of the Poznan University of Medical Sciences were qualified for the tests. The control group consisted of 35 healthy volunteers. All patients with chronic spontaneous urticaria were previously subjected to individual stages of the diagnostic process, in accordance with the guidelines of EAACI and the Polish team of specialists in the field of dermatology and venereology and, allergology. The dermatological condition was assessed using the UAS scale. The serum D-dimer concentration was determined by immunoturbidimetry. Result: In the basic group, statistically significant positive and hign correlations between the serum D-dimer concentration and the severity of urticaria symptoms were shown, as well as between the severity of pruritus and the value of the disease activity index were shown. Conclusions: Elevated levels of D-imers are significantly correlated with the severity of urticaria. [ABSTRACT FROM AUTHOR]

Introduction: Nowadays, the number of people with drug hypersensitivity has been increasing and it has become a major problem for the healthcare system. Unfortunately, not everyone is aware of which medications they can safely use. Aim: To assess the suitability of a drug allergy passport in patients with drug hypersensitivity in order to increase knowledge about medicines that can be safely used. Material and methods: The study was conducted in 54 hospitalized patients with confimed hypersensitivity to drugs by issuing a drug passport at discharge. The study was carried out with the questionnaire method. The questionnaire was conducted by phone 3, 6 and 12 months after the patients received the drug passport. Results: Fifty-eight people were contacted by phone. The survey was conducted in 54 people (42 women (77%), mean age: 48, range: 19--71), which gives a response rate of 98%. The application of the drug allergy passport by patients increased with time and the number of patients who did not use their passport decreased. With time, patients showed the drug allergy passport to a larger number of doctors, most often to general practitioners and dentists. In the following months, the number of doctors who followed passport recommendations and patients who adhered to the passport recommendations increased. Conclusions: The analysis of drug allergy passport shows that patients are better informed about medicines they can use and have a greater sense of security. By showing the passport to specialists, they choose the safest and adequate treatment. [ABSTRACT FROM AUTHOR]

Keywords: allergy treatment; basophil; biomarkers; immunological tests; immunotherapy and tolerance induction; immunotherapy clinical EN allergy treatment basophil biomarkers immunological tests immunotherapy and tolerance induction immunotherapy clinical 1321 1324 4 05/17/21 20210501 NES 210501 For decades, the approach to clinical care has involved the assessment of a fairly small set of patients' signs and symptoms, sampled over a short period of time with limited attention given to individual variations in aetiology and pathophysiology. In some cases, BAT has proven useful as a diagnostic test for venom allergies, even more sensitive than intradermal skin testing.3 Moreover, increased basophil responsiveness has been associated with adverse effects arising from venom immunotherapy. Allergy treatment, basophil, biomarkers, immunological tests, immunotherapy and tolerance induction, immunotherapy clinical. [Extracted from the article]

We have demonstrated that intranasal immunotherapy with allergens formulated in a nanoemulsion (NE) mucosal adjuvant suppresses Th2/IgE-mediated allergic responses and protects from allergen challenge in murine food allergy models. Protection conferred by this therapy is associated with strong suppression of allergen specific Th2 cellular immunity and increased Th1 cytokines. Here we extend these studies to examine the effect of NE-allergen immunization in mice sensitized to multiple foods. Mice were sensitized to both egg and peanut and then received NE vaccine formulated with either one or both of these allergens. The animals were then subjected to oral challenges with either egg or peanut to assess reactivity. Immunization with NE formulations containing both egg and peanut markedly reduced reactivity after oral allergen challenge with either allergen. Interestingly, mice that received the vaccine containing only peanut also had reduced reactivity to challenge with egg. Protection from oral allergen challenge was achieved despite the persistence of allergen-specific IgE and was associated with strong suppression of both Th2-polarized immune responses, alarmins and type 2 innate lymphoid cells (ILC2). NE-induced bystander suppression of reactivity required IFN-γ and the presence of an allergen in the NE vaccine. These results demonstrate that anaphylactic reactions to food allergens can be suppressed using allergen-specific immunotherapy without having to eliminate allergen-specific IgE and suggests that modulation of Th2 immunity towards one allergen may induce bystander effects that suppress reactivity to other allergens through the induction of IFN-γ and suppression of alarmins in the intestine. In addition, these data suggest that a NE vaccine for a single food allergen may lead to a global suppression of allergic responses to multiple foods.

We have demonstrated that intranasal immunotherapy with allergens formulated in a nanoemulsion (NE) mucosal adjuvant suppresses Th2/IgE-mediated allergic responses and protects from allergen challenge in murine food allergy models. Protection conferred by this therapy is associated with strong suppression of allergen specific Th2 cellular immunity and increased Th1 cytokines. Here we extend these studies to examine the effect of NE-allergen immunization in mice sensitized to multiple foods. Mice were sensitized to both egg and peanut and then received NE vaccine formulated with either one or both of these allergens. The animals were then subjected to oral challenges with either egg or peanut to assess reactivity. Immunization with NE formulations containing both egg and peanut markedly reduced reactivity after oral allergen challenge with either allergen. Interestingly, mice that received the vaccine containing only peanut also had reduced reactivity to challenge with egg. Protection from oral allergen challenge was achieved despite the persistence of allergen-specific IgE and was associated with strong suppression of both Th2-polarized immune responses, alarmins and type 2 innate lymphoid cells (ILC2). NE-induced bystander suppression of reactivity required IFN-γ and the presence of an allergen in the NE vaccine. These results demonstrate that anaphylactic reactions to food allergens can be suppressed using allergen-specific immunotherapy without having to eliminate allergen-specific IgE and suggests that modulation of Th2 immunity towards one allergen may induce bystander effects that suppress reactivity to other allergens through the induction of IFN-γ and suppression of alarmins in the intestine. In addition, these data suggest that a NE vaccine for a single food allergen may lead to a global suppression of allergic responses to multiple foods. [ABSTRACT FROM AUTHOR]

Introduction: Sublingual immunotherapy (SLIT) has been shown to be efficacious in patients with airway allergic diseases. However, less data have been demonstrated to show the efficacy of SLIT in patients with atopic dermatitis (AD). Aim: This study is to evaluate, in a randomized controlled study, the effect of SLIT with house dust mite (HDM) in patients with mild--moderate AD. Material and methods: AD patients aged 4 to 60 years with a Scoring Atopic Dermatitis (SCORAD) score of 7--40 and sensitization to HDM were enrolled in the study. SLIT or control treatment was given for 24 months. SCORAD, visual analog scale (VAS) score were recorded at 6, 12, 24 month, and rescue medications were required to be recorded in the diary card. A serum level of specific IgE was tested at 24-month treatment. Results: Ninety-six patients were enrolled, and forty-eight were allocated to SLIT. Thirty-nine patients in the SLIT group and thirty-eight patients in the control group completed the study. The patients in the SLIT group had significantly decreased ΔSCORAD, VAS and rescue medication score from 12 months' treatment compared with the control group (p < 0.05). At 24 months of treatment, no significant change of specific IgE (p < 0.05) was observed in both groups. No severe adverse events were reported during the treatment. Conclusions: Two years' SLIT to HDM significantly improved the clinical symptoms and reduced drug use in patients with mild--moderate AD. SLIT may represent an additional therapeutic tool for the treatment of AD in properly selected patients. [ABSTRACT FROM AUTHOR]

Nickel is ubiquitous in our daily environment and remains the most common cause of contact allergy worldwide. Regulation of nickel release exists in Europe but unfortunately continues to be absent in the United States. Nickel contact allergy most often is associated with earrings and other jewelry; however, novel exposures to nickel through diet and electronic devices and other materials also occur. Once diagnosed, allergen avoidance is key for improvement of symptoms. [ABSTRACT FROM AUTHOR]

Background: The quality of life of chronically ill individuals, such as hay fever sufferers, is significantly dependent on their health behavior. This survey aimed to explain the health-related behavior of allergic individuals using the protection motivation theory (PMT) and the transtheoretical model (TTM).Methods: The influencing variables stated by PMT were operationalized based on data from semistructured pilot interviews and a pretest with 12 individuals from the target population. The final questionnaire inquired perceived seriousness and severity of hay fever, response efficacy, response costs, self-efficacy, and the use of various hay fever management measures in relation to the TTM stages. Multivariate logistic regression was performed to investigate the relationships between the PMT constructs and the examined health behavior.Results: A total of 569 allergic individuals completed the online questionnaire. Only 33.26% of allergic individuals were in the maintenance stage for treatment under medical supervision, and almost 60% preferred hay fever self-management. A total of 67.56% had a well-established habit of taking anti-allergic medication, but only 25.31% had undergone specific immunotherapy. The likelihood of seeking medical supervision was positively influenced by perceived severity (OR = 1.35, 95% CI: 1.02-1.81), perceived seriousness (OR = 2.12, 95% CI: 1.56-2.89), and self-efficacy (OR = 4.52, 95% CI: 3.11-6.65). The perceived severity of symptoms predicted the practice of hay fever self-management (OR = 1.60, 95% CI: 1.21-2.11), as well as anti-allergic medication intake (OR = 1.65, 95% CI: 1.16-2.35). The latter measure was also positively influenced by self-efficacy (OR = 1.52, 95% CI: 1.01-2.28) and hay fever self-management (OR = 4.76, 95% CI: 2.67-7.49). Undergoing specific immunotherapy was significantly predicted only by medical supervision (OR = 9.80, 95% CI: 8.16-13.80). Allergen avoidance was a strategy used by allergic individuals who preferred hay fever self-management (OR = 2.56, 95% CI: 1.87-3.52) and experienced notable symptom severity (OR = 2.12, 95% CI: 1.60-2.81).Conclusion: Educational interventions that increase the awareness of health risks associated with inadequate hay fever management and measures to increase self-efficacy might be beneficial for the promotion of appropriate hay fever management among allergic individuals. [ABSTRACT FROM AUTHOR]

In the last decade single domain antibodies (nanobodies, VHH) qualified through their unique characteristics have emerged as accepted and even advantageous alternative to conventional antibodies and have shown great potential as diagnostic and therapeutic tools. Currently nanobodies find their main medical application area in the fields of oncology and neurodegenerative diseases. According to late-breaking information, nanobodies specific for coronavirus spikes have been generated these days to test their suitability as useful therapeutics for future outbreaks. Their superior properties such as chemical stability, high affinity to a broad spectrum of epitopes, low immunogenicity, ease of their generation, selection and production proved nanobodies also to be remarkable to investigate their efficacy for passive treatment of type I allergy, an exaggerated immune reaction to foreign antigens with increasing global prevalence.

In 2018, at the end of the Programme, the total costs of allergic diseases and asthma were estimated €1.5-1.8 billion (Table S1). Allergy treatment, asthma, asthma treatment, prevention Keywords: allergy treatment; asthma; asthma treatment; prevention EN allergy treatment asthma asthma treatment prevention 3817 3819 3 12/01/21 20211201 NES 211201 ACKNOWLEDGEMENTS We thank all the government officials and persons who helped with the statistics, Juha Tuominen for his help in calculating the costs of private healthcare, and all those who responded to our questionnaire surveys. [Extracted from the article]

In the last decade single domain antibodies (nanobodies, VHH) qualified through their unique characteristics have emerged as accepted and even advantageous alternative to conventional antibodies and have shown great potential as diagnostic and therapeutic tools. Currently nanobodies find their main medical application area in the fields of oncology and neurodegenerative diseases. According to late-breaking information, nanobodies specific for coronavirus spikes have been generated these days to test their suitability as useful therapeutics for future outbreaks. Their superior properties such as chemical stability, high affinity to a broad spectrum of epitopes, low immunogenicity, ease of their generation, selection and production proved nanobodies also to be remarkable to investigate their efficacy for passive treatment of type I allergy, an exaggerated immune reaction to foreign antigens with increasing global prevalence. [ABSTRACT FROM AUTHOR]

The article discusses the Allergic contact dermatitis (ACD), which occurs due to the hypersensitivity reaction in people to tattoo ink. It is mentioned that many tattoo reactions are a response to red pigment but also have occurred with other tattoo ink, but red ink was the most common color reported to cause tattoo hypersensitivity reactions. It is also noted that hypersensitivity reactions to temporary tattoos can be managed with topical steroids.

Handling of allergen immunotherapy in the COVID-19 pandemic: An ARIA-EAACI statement Keywords: allergy treatment; immunotherapy clinical; immunotherapy vaccines and mechanisms EN allergy treatment immunotherapy clinical immunotherapy vaccines and mechanisms 1546 1554 9 07/14/20 20200701 NES 200701 INTRODUCTION The current COVID-19 pandemic influences many areas of social life, medical treatments and the way allergy diagnosis and treatment is performed. This manuscript outlines the EAACI recommendations regarding AIT during the COVID-19 pandemic and aims at supporting allergists and all physicians performing AIT in their current daily practice with clear recommendations how to perform treatment during the pandemic and in SARS-CoV-2 infected patients. AIT can also be continued as usual in patients without clinical symptoms and signs of COVID-19 or other infections and without a history of exposure to SARS-CoV-2 or contact to COVID-19 confirmed individuals within the past 14 days. [Extracted from the article]

Background: Regulatory T lymphocytes (Treg) play an important role in preventing allergic diseases. We characterized Treg expansion kinetics, marker profiles, and recirculation behavior in allergen‐challenged mice, which had been pretreated with IL‐2/αIL‐2 complexes in the presence or absence of allergen. Moreover, the ability of induced Treg to control airway hyperreactivity and effector functions of lung T cells was determined. Methods: Humanized TCR/HLA‐transgenic allergy mice were treated in vivo with recombinant IL‐2 complexed to the anti‐IL‐2 mAb JES6‐1 in the presence or absence of mugwort pollen extract (MPE) on days 0‐2. Afterward, they were intranasally challenged with MPE (days 13‐15) followed by determination of airway hyperreactivity and lung T cell effector functions. Multiparametric flow cytometry on peripheral blood T cells was performed on a daily basis. Results: IL‐2/αIL‐2 complexes highly efficiently expanded peripheral Treg cells, while concomitant allergen exposure altered the phenotype of expanded Treg cells. Notably, application of allergen together with IL‐2/αIL‐2 complexes induced expression of Treg marker molecules CTLA4, NRP1, Helios, and GITR on conventional T cells. Apart from CD25, GARP was identified as the most reliable surface‐expressed lineage discrimination marker of Treg expanded in the presence of IL‐2/αIL‐2 complexes and allergen. Finally, IL‐2/αIL‐2 complex‐expanded Treg cells could be recalled upon allergen challenge, which was associated with suppression of lung‐specific Th2 responses long after initial treatment. Conclusion: The characterization of reliable surface and transcription markers of IL‐2/αIL‐2 complex‐expanded Treg along with their expansion kinetics and function will help to identify protocols for their long‐term expansion in vivo. [ABSTRACT FROM AUTHOR]

Keywords: allergy treatment; basic immunology; IgE; immunotherapy and tolerance induction; personalized medicine; venom and insect allergy EN allergy treatment basic immunology IgE immunotherapy and tolerance induction personalized medicine venom and insect allergy 1756 1759 4 07/14/20 20200701 NES 200701 Yellow jacket and honey bee stings are among the most common elicitors of severe anaphylactic reactions in Europe. Interestingly, one peptide, P54 (Api m 10 SB 160-174 sb ; amino acid sequence: ADSDVTTLPTLIGKN), was recognized by 100% of the Api m 10-positive sera and hence represents the dominant linear IgE epitope of Api m 10 (Figure 1A). In summary, we identified a major IgE epitope of the HBV allergen Api m 10 that is recognized by all sera from HBV-allergic patients sensitized to Api m 10. [Extracted from the article]