Recombinant allergens for immunotherapy: state of the art
Purpose of review More than 30 years ago, the first molecular structures of allergens were elucidated and defined recombinant allergens became available. We review the state of the art regarding molecular AIT with the goal to understand why progress in this field has been slow, although there is huge potential for treatment and allergen-specific prevention. Recent findings On the basis of allergen structures, several AIT strategies have been developed and were advanced into clinical evaluation. In clinical AIT trials, promising results were obtained with recombinant and synthetic allergen derivatives inducing allergen...
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: SPECIAL COMMENTARY Source Type: research

Therapeutic approach of anaphylaxis
Purpose of review Anaphylaxis is a recognized cause of death in all ages, which requires prompt recognition and treatment. We here propose to review the current and new pharmacological treatment of anaphylaxis in the view of the new knowledge in the field that can support the quality practice and empower allergists and health professionals with new tools that can be used to treat symptoms and prevent anaphylaxis. Recent findings The recent description of phenotypes provides new insight and understanding into the mechanisms and causes of anaphylaxis through a better understanding of endotypes and application of precisi...
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: PHARMACOTHERAPY AND EVIDENCE BASED MEDICINE: Edited by Enrico Compalati and Ignacio J. Ansotegui Source Type: research

Treatment of urticaria: a clinical and mechanistic approach
Purpose of review This manuscript describes the recommended therapy of chronic spontaneous urticaria based on our understanding of the pathogenesis of hive formation. Thus, the mechanism of action of each medication is elaborated in addition to a discussion of clinical utility. Recent findings The main drugs are antihistamines, omalizumab, and cyclosporine with a success rate of 40–55, 65–80, and 70–80%, respectively. Used in sequence, over 90% of patients can be successfully treated. The addition of omalizumab represents a major advance because of its efficacy, easy utility, and favorable side-effec...
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: PHARMACOTHERAPY AND EVIDENCE BASED MEDICINE: Edited by Enrico Compalati and Ignacio J. Ansotegui Source Type: research

Biological treatments for severe asthma
Purpose of review Asthma is a heterogenous disease associated with different phenotypes and endotypes. The unmet needs with severe asthma have led to the emergence of potential therapeutic targets beyond the existing therapies. Recently, several biologics were examined and some have now been approved to target T2 airway inflammation in patients with severe disease. We provide an overview of recently approved biologic, those which are emerging and highlight unmet needs in this area. Recent findings Multiple biologics targeting T2 high asthma are now available for clinical use in the appropriate groups of severe asthma....
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: PHARMACOTHERAPY AND EVIDENCE BASED MEDICINE: Edited by Enrico Compalati and Ignacio J. Ansotegui Source Type: research

Treatable traits in chronic rhinosinusitis with nasal polyps
Purpose of review Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex inflammatory sinonasal disease that deserves a multidisciplinary precision medicine approach. In a precision medicine model, a more pragmatic approach taking in consideration disease features that are potentially treatable should be considered. Recent findings Several treatable traits in CRSwNP can be identified: from disease-related ones, to extra-ENT features, to behavioral and environmental factors. This review article summarizes primarily the recent findings of CRSwNP-related treatable traits and how they can be modified by given trea...
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: PHARMACOTHERAPY AND EVIDENCE BASED MEDICINE: Edited by Enrico Compalati and Ignacio J. Ansotegui Source Type: research

Use of biologics in chronic sinusitis with nasal polyps
Purpose of review Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory condition with different endotypes between patients from eastern or western countries. Targeted biologics are currently used to treat CRSwNP, but the outcomes widely vary. This review focuses on the present use of biologics for treating CRSwNP. Recent findings Monoclonal biologics have been used as an innovative therapy for multiple allergic diseases and comorbid allergic conditions. Over the past several decades, numerous biomarkers have been investigated and were found to be closely correlated with CRSwNP, improving t...
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: PHARMACOTHERAPY AND EVIDENCE BASED MEDICINE: Edited by Enrico Compalati and Ignacio J. Ansotegui Source Type: research

Second generation antihistamines: an update
This article presents an update on the clinical pharmacology, mechanisms of action, and safety of second generation antihistamines (SGAHs). Recent findings Recent research has shown the efficacy and good tolerance of SGAHs supporting its indication as first line medications for the treatment of allergic rhinoconjunctivitis and urticaria. Summary The information contained in this review is relevant for the correct utilization of SGAHs by practicing physicians who take care of these highly prevalent clinical disorders. (Source: Current Opinion in Allergy and Clinical Immunology)
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: PHARMACOTHERAPY AND EVIDENCE BASED MEDICINE: Edited by Enrico Compalati and Ignacio J. Ansotegui Source Type: research

Eosinophilic esophagitis during sublingual and oral allergen immunotherapy
Purpose of review The aim of this review is to discuss the current evidence regarding the development of eosinophilic esophagitis (EoE) in individuals undergoing oral and sublingual immunotherapy (SLIT) for both food and environmental allergens. Cumulative incidence of EoE in patients on allergen immunotherapy for peanut, milk, and egg is estimated. Recent findings De novo development of EoE in patients undergoing oral and SLIT has been demonstrated on the scale of case reports and prospective randomized trials. However, few individuals with EoE-like symptoms during immunotherapy undergo endoscopy, and the long-term o...
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: PHARMACOTHERAPY AND EVIDENCE BASED MEDICINE: Edited by Enrico Compalati and Ignacio J. Ansotegui Source Type: research

Dupilumab after the 2017 approval for the treatment of atopic dermatitis: what's new and what's next?
Purpose of review The IL-4/13 antagonist dupilumab was approved in 2017 as the first biologic for atopic dermatitis. Here, we comprehensively review compelling new data regarding dupilumab published following the approval. Recent findings Daily clinical practice reports of dupilumab in atopic dermatitis are favorable and in line with the registration trials. Dupilumab does not appear to negatively affect pharmacokinetics of CYP450-metabolized drugs nor vaccination responses. Type 2 inflammation biomarkers in skin and serum are reduced following dupilumab treatment. Dupilumab increases the risk for conjunctivitis, espe...
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: SKIN ALLERGY: Edited by Thomas Werfel and Torsten Zuberbier Source Type: research

Highlights in allergic contact dermatitis 2018/2019
Purpose of review The purpose was to highlight recent findings especially concerning new and old allergens, trends, diagnosis and causes of contact allergy. Recent findings Nickel is still the most frequent cause of contact allergy in women and piercings remain an important risk factor. Countries with a long history of regulation of contact allergens have the lowest level of contact allergy to nickel and chromium in Europe. Among the most frequent causes of fragrance contact allergy is terpenes, which are oxidized such as limonene, linalool and in some countries: geraniol. Methylisothiazolinone is still causing consid...
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: SKIN ALLERGY: Edited by Thomas Werfel and Torsten Zuberbier Source Type: research

Microbiome and skin biology
Purpose of review The skin is home to a diverse milieu of bacteria, fungi, viruses, bacteriophages, and archaeal communities. The application of culture-independent approaches has revolutionized the characterization of the skin microbiome and have revealed a previously underappreciated phylogenetic and functional granularity of skin-associated microbes in both health and disease states. Recent findings The physiology of a given skin-niche drives the site-specific differences in bacterial phyla composition of healthy skin. Changes in the skin microbiome have consistently been associated with atopic dermatitis. In parti...
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: SKIN ALLERGY: Edited by Thomas Werfel and Torsten Zuberbier Source Type: research

Common and different roles of IL-4 and IL-13 in skin allergy and clinical implications
Purpose of review This review summarizes the mode of action of IL-4 and IL-13 in skin allergy, upcoming therapeutics and depicts key outcomes of the latest clinical trials. Recent findings Atopic dermatitis is considered to be one of the most common inflammatory skin disease in industrialized countries. Accompanied by strong pruritus, atopic dermatitis has a significant impact on quality of life in severely affected individuals. Aside from unspecific immunosuppressant medications, therapeutics targeting the key cytokines IL-4 and IL-13 and their downstream mediators are under development or have been approved just rec...
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: SKIN ALLERGY: Edited by Thomas Werfel and Torsten Zuberbier Source Type: research

Cutaneous drug hypersensitivity: developments and controversies
Purpose of review Cutaneous drug hypersensitivity reactions (CDHRs) are a complicated area with multiple clinical manifestations and differential diagnoses, requiring differentiated diagnostic measurements and optimized therapeutic management. Recent findings Disseminated CDHRs to classical drugs can be classified by a simple algorithm, whereas chemotherapeuticals or biopharmaceuticals may show drug-specific and atypical clinical presentations. Controversies in drug hypersensitivity diagnosis exist about the benefit and accuracy of in-vitro tests. Although skin tests are the best means of detecting sensitization to dr...
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: SKIN ALLERGY: Edited by Thomas Werfel and Torsten Zuberbier Source Type: research

New phenotypes in hypersensitivity reactions to nonsteroidal anti-inflammatory drugs
Purpose of review Nonsteroidal anti-inflammatory drug (NSAID) is one of the most frequently prescribed medications in the medical field, and hypersensitivity to NSAID is a common adverse drug reaction encountered. However, NSAID hypersensitivity presents a variety of symptoms caused by diverse pharmacological and immunological mechanisms. Recent findings Owing to the heterogeneity of the disease, a new concept for the classification of NSAID hypersensitivity has recently been proposed to diagnose and manage NSAID hypersensitivity for personalized treatment. Acute and delayed reactions were distinguished in this classi...
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: DRUG ALLERGY: Edited by Miguel Blanca and Paul Whitaker Source Type: research

Role of T cells in non-immediate drug allergy reactions
Purpose of review Nonimmediate drug hypersensitivity reactions (NI-DHR) constitute the most complex group of drug allergy, with many drugs involved. Both parent drugs and their reactive metabolites can be implicated. Although with some drugs the number of metabolites is limited, with others it is quite extensive and many still remain to be identified. The diagnostic approaches are insufficient for the diagnosis and realistic approaches that reproduce the pathological response are lacking. Recent findings A wider view has now been considered, with the inclusion of several mechanisms that may contribute to drug hypersen...
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: DRUG ALLERGY: Edited by Miguel Blanca and Paul Whitaker Source Type: research

Making a diagnosis in severe cutaneous drug hypersensitivity reactions
Purpose of review Severe cutaneous adverse reactions (SCAR) are relatively uncommon but can be life-threatening. This review focuses on the nonanaphylactic (non-IgE-mediated) phenotypes of drug hypersensitivity, with specific reference to diagnosis and management of acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens–Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). Recent findings Here, we review recent guidelines on optimal supportive care as well as publications of interventional treatment for SJS/TEN, including various immunomo...
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: DRUG ALLERGY: Edited by Miguel Blanca and Paul Whitaker Source Type: research

Drug hypersensitivity in HIV infection
Purpose of review Immune-mediated adverse drug reactions (IM-ADRs) are many times more common in HIV-infected patients. Usual offending drugs include antiretroviral and antiinfectives, but the burden of specific drug IM-ADRs is population-specific; changing as new and fixed dose combinations enter the market, and drug-resistance patterns demand. This review considers recent literature on epidemiology, mechanisms, clinical management and prevention of IM-ADRs amongst persons living with HIV/AIDS. Recent findings Epidemiological studies continue to describe high rates of delayed hypersensitivity to known offenders, as w...
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: DRUG ALLERGY: Edited by Miguel Blanca and Paul Whitaker Source Type: research

Drug provocation testing: risk stratification is key
Purpose of review This review aims to describe current best practice and recent advances in the use of risk stratification as a tool for drug provocation testing (DPT). In particular, we focus on the testing of unsubstantiated penicillin allergy labels. Recent findings The inherent risks of DPT are mitigated through careful selection of patients. A detailed history will elicit features of a potentially severe index reaction, as well as significant patient comorbidities which may increase the risks associated with DPT. Such patients require skin testing and/or in vitro testing prior to consideration for a DPT. However,...
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: DRUG ALLERGY: Edited by Miguel Blanca and Paul Whitaker Source Type: research

Editorial: Advances in drug hypersensitivity reactions
No abstract available (Source: Current Opinion in Allergy and Clinical Immunology)
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: DRUG ALLERGY: Edited by Miguel Blanca and Paul Whitaker Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Allergy and Clinical Immunology)
Source: Current Opinion in Allergy and Clinical Immunology - June 28, 2019 Category: Allergy & Immunology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Allergy to food additives
Purpose of review To provide an update of the studies concerning the diagnosis and management of food additives allergy. Recent findings Additives improve specific characteristics of food products, but they may induce allergic even life-threatening reactions. Physical examination and medical history are basic to assess specific in-vivo and in-vitro tests. The only treatment for allergic patients consists in avoiding the food containing culprit additives. High-risk patients should be able to recognize severe reactions and self-manage them. Summary The prevalence of adverse reactions to food additives is low, and it ...
Source: Current Opinion in Allergy and Clinical Immunology - April 30, 2019 Category: Allergy & Immunology Tags: FOOD ALLERGY: Edited by Alessandro Fiocchi and Motohiro Ebisawa Source Type: research

Gender aspects in food allergy
Purpose of review The difference of food allergy prevalence between male and female individuals is well documented and should have more impact for personalized diagnosis and management. Although in younger age male sex dominates, in adults more women are affected by food allergies. This sex disparity diminishes again around menopause, underlining the influence of sex hormones, but in addition, also metabolic gender-specific factors and differences in microbiome composition might contribute to the different expression of food allergy in the two genders. The sex-dependent and gender-dependent influence on development of fo...
Source: Current Opinion in Allergy and Clinical Immunology - April 30, 2019 Category: Allergy & Immunology Tags: FOOD ALLERGY: Edited by Alessandro Fiocchi and Motohiro Ebisawa Source Type: research

Occupational food allergy
Purpose of review Occupation is an important contributing factor in the presentation of allergic disease in adults. This review article focuses on the contribution of occupation to the development and presentation of food allergies. Recent findings A variety of occupations involve repeated transdermal and respiratory exposures to food-related allergens, which can result in sensitization. A sensitized individual can then manifest symptoms of food allergy after ingestion of the relevant food, even in a nonoccupational setting. Cooks and other food-processing workers bear increased risk for being sensitized to foods. Alt...
Source: Current Opinion in Allergy and Clinical Immunology - April 30, 2019 Category: Allergy & Immunology Tags: FOOD ALLERGY: Edited by Alessandro Fiocchi and Motohiro Ebisawa Source Type: research

An update on shellfish allergy
Purpose of review Shellfish is an important cause of food allergy worldwide, and a major cause of food-triggered anaphylaxis. Despite the wide variety of shellfish, there is considerable serological and clinical cross-reactivity of major shellfish allergens, and accurate diagnosis remains a challenge in the management of shellfish allergy. Recent findings Novel minor allergens have been discovered and characterized, and advances in component resolved diagnostics have provided insights into the prevalence of sensitization and their clinical importance in shellfish allergy. The extensive cross-reactivity between tropomy...
Source: Current Opinion in Allergy and Clinical Immunology - April 30, 2019 Category: Allergy & Immunology Tags: FOOD ALLERGY: Edited by Alessandro Fiocchi and Motohiro Ebisawa Source Type: research

Red meat allergy in children and adults
Purpose of review To highlight recent advances in our understanding of the clinical features, prevalence, and pathophysiology of red meat allergy. Recent findings Allergic reactions to red (i.e. mammalian) meat have historically been considered rare and described primarily in young atopic children. It is now clear that red meat allergy is not uncommon in some parts of the world in other age groups. Strikingly, the majority of these cases relate to specific IgE to galactose-α-1,3-galactose, an oligosaccharide of nonprimate mammals. The mechanism of sensitization in this syndrome relates to bites of certain hard t...
Source: Current Opinion in Allergy and Clinical Immunology - April 30, 2019 Category: Allergy & Immunology Tags: FOOD ALLERGY: Edited by Alessandro Fiocchi and Motohiro Ebisawa Source Type: research

Food-dependent exercise-induced anaphylaxis
Purpose of review The following article provides an overview of food-dependent exercise-induced anaphylaxis (FD-EIAn). The review focuses on the epidemiology, pathophysiology, and clinical findings of FD-EIAn and details current practice in terms of the investigation, management, and treatment options available. Recent findings The management of FD-EIAn has not changed significantly over the last few years and still requires careful investigation by an experienced clinician to ensure that the correct diagnosis is made and appropriate treatment is given. Although new therapies such as synthetic prostaglandin E1 analogs...
Source: Current Opinion in Allergy and Clinical Immunology - April 30, 2019 Category: Allergy & Immunology Tags: FOOD ALLERGY: Edited by Alessandro Fiocchi and Motohiro Ebisawa Source Type: research

New findings, pathophysiology, and antigen analysis in pollen-food allergy syndrome
We describe recent findings for PR-10 family, profilin and LTP, as known major antigens for PFAS. Microarrays of allergen components have significantly improved the ability to describe IgE profiles. In addition, we describe a new antigen, GRP, in the fruit pulp of recently identified fruit. Summary PFAS is a food allergy based on the cross-reactivity of pollen antigens and food antigens. Symptoms induced by sensitization differ depending on the specific antigen. The functions of each antigen are diverse, and even the same antigen can cause different symptoms. As analytical techniques progress, the findings will help to ...
Source: Current Opinion in Allergy and Clinical Immunology - April 30, 2019 Category: Allergy & Immunology Tags: FOOD ALLERGY: Edited by Alessandro Fiocchi and Motohiro Ebisawa Source Type: research

Editorial: Adults are not big children
No abstract available (Source: Current Opinion in Allergy and Clinical Immunology)
Source: Current Opinion in Allergy and Clinical Immunology - April 30, 2019 Category: Allergy & Immunology Tags: FOOD ALLERGY: Edited by Alessandro Fiocchi and Motohiro Ebisawa Source Type: research

Outcome measures to be considered on asthma in elderly
Purpose of review Asthma is a chronic heterogeneous respiratory disease which is characterized by airflow limitation and variable respiratory symptoms. Asthma in patients more than 65 years of age has an important negative impact on quality of life. The pathophysiology and treatment of asthma in older patients are not as well identified as in younger groups of ages. In this review we intend to outline characteristics found in elderly adults which distinguish them from other age groups of patients with asthma. Recent findings With increasing age, there are alterations in the innate and adaptive immune responses, known ...
Source: Current Opinion in Allergy and Clinical Immunology - April 30, 2019 Category: Allergy & Immunology Tags: OUTCOME MEASURES: Edited by Henry Milgrom and René Maximiliano Gómez Source Type: research

Clinical outcomes related to molecular allergy diagnosis
Purpose of review Aim of this review is the description of the medical conditions in which the support of molecular allergy diagnostics (MAD) has an impact on the clinical outcomes, such as laboratory diagnostics, prognosis, and therapy of allergic diseases. Recent findings The review of the literature of the last 2 years generated a wide number of results on this topic. As expected, not all were obtained by the use of MAD, but, in general, a clear trend is evident. Summary Within the large number of works available, laboratory allergy diagnostics seems to be the most frequently discussed topic, in particular consi...
Source: Current Opinion in Allergy and Clinical Immunology - April 30, 2019 Category: Allergy & Immunology Tags: OUTCOME MEASURES: Edited by Henry Milgrom and René Maximiliano Gómez Source Type: research

Are outcome measures in allergic diseases relevant for the WHO's International Classification of Diseases in allergology?
Purpose of review To review and understand the impact of the outcome measures of allergic and hypersensitivity conditions for the WHO's International Classification of Diseases (ICD) and its impact in the management of anaphylaxis and identify potential strategies to improve patients’ care and prevention. Recent findings The pioneer chapter addressed to allergic and hypersensitivity conditions in the 11th version of the WHO's ICD is the result of the evidence-based academic technical actions consistently following of collaborations of the allergy community and integrated international initiatives in order to rea...
Source: Current Opinion in Allergy and Clinical Immunology - April 30, 2019 Category: Allergy & Immunology Tags: OUTCOME MEASURES: Edited by Henry Milgrom and René Maximiliano Gómez Source Type: research

Advances in the pathogenesis representing definite outcomes in chronic urticaria
Purpose of review We reviewed in this article, the recent advances in CSU physiopathology and potential clinical and laboratory biomarkers in CSU. Recent findings In addition to the central role of mast cells in urticaria physiopathology, increased interest in basophils has arisen. Recent data corroborate the autoimmunity pathway as one of the main pathways in mast cell activation. The association of inflammatory cytokines, heat shock proteins and staphylococcal infection with CSU are also reviewed. C-reactive protein, D-dimers, autologous serum skin test, IgE levels and FcεRI expression in basophils have show...
Source: Current Opinion in Allergy and Clinical Immunology - April 30, 2019 Category: Allergy & Immunology Tags: OUTCOME MEASURES: Edited by Henry Milgrom and René Maximiliano Gómez Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Allergy and Clinical Immunology)
Source: Current Opinion in Allergy and Clinical Immunology - April 30, 2019 Category: Allergy & Immunology Tags: EDITORIAL INTRODUCTIONS Source Type: research

How guideline can shape clinical practice globally: the diagnosis and rationale for action against cow's milk allergy experience
We report here the main international allergy guidelines with a more focused look on the Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines and their effect on clinical practice. Recent findings DRACMA guidelines have clearly modified the approach to cow's milk allergy (CMA) from its diagnosis to treatment tailoring the choices for each patient. Although they strongly recommend oral food challenge for diagnosing CMA, they also indicate that it may not be necessary in many cases with the introduction of the pretest probability of CMA. Studies on the implementation of DRACMA guidelines show ...
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: GENETICS AND EPIDEMIOLOGY: Edited by Isabella Annesi-Maesano and Antonella Cianferoni Source Type: research

Contributions of innate lymphocytes to allergic responses
Purpose of review Allergic diseases represent a growing global health concern, especially among pediatric populations. Current strategies for the treatment of allergies and asthma focus on limiting the severity of the symptoms; however, additional research investigating the mechanisms promoting inflammation in the context of allergic reactions may lead to the development of more effective therapeutic strategies. Recent findings Novel studies have highlighted the contributions of innate lymphocytes to the induction of inflammatory responses to allergens. Remarkably, neuron-derived signals, hormones, and even vitamins h...
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: GENETICS AND EPIDEMIOLOGY: Edited by Isabella Annesi-Maesano and Antonella Cianferoni Source Type: research

Symptom-based patient-reported outcomes in adults with eosinophilic esophagitis: value for treatment monitoring and randomized controlled trial design
Purpose of review In adults with eosinophilic esophagitis (EoE), a chronic, inflammatory immune-mediated condition of the esophagus, both inflammation and fibrosis are likely associated with symptom generation. Therefore, assessing symptom-based patient-reported outcomes (PROs), defined by US Food and Drug Administration as ‘any report of the status of a patient's health condition that comes directly from the patients, without interpretation of the patient's response by a clinician or anyone else’, is important in the context of trials and observational studies of emerging therapies. Recent findings For pu...
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: GENETICS AND EPIDEMIOLOGY: Edited by Isabella Annesi-Maesano and Antonella Cianferoni Source Type: research

Preventing the development of asthma: stopping the allergic march
Purpose of review To describe important precipitants of asthma and allergic disease, to highlight the links between these triggers and modifications within the immune system, and to examine innovative research regarding asthma prevention with focus on attenuating the atopic march. Recent findings Allergen avoidance, allergen immunotherapy, IgE antagonists, prevention and treatment of respiratory infections, as well as management of gastrointestinal and respiratory dysbiosis have been considered as strategies in asthma prevention. Antenatal vitamin D supplementation in expectant mothers and aggressive control of atopic...
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: PEDIATRIC ASTHMA AND DEVELOPMENT OF ATOPY: Edited by Leonard B. Bacharier and John Oppenheimer Source Type: research

Management of acute loss of asthma control: yellow zone strategies
This article reviews the evidence behind various recommended yellow zone intervention strategies. Recent findings There are many potential methods of delivering yellow zone therapy, and recent studies have assessed preventive efficacy of a scheduled increase in controller medication(s), reliever medication(s), or a symptom-driven combination of both. The literature suggests that, in certain asthma subpopulations, some methods may be more efficacious than others. Summary Multiple yellow zone approaches may be beneficial, and the yellow zone is not a ‘one size fits all’ narrative. (Source: Current Opinion i...
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: PEDIATRIC ASTHMA AND DEVELOPMENT OF ATOPY: Edited by Leonard B. Bacharier and John Oppenheimer Source Type: research

Phenotypes of wheezing and asthma in preschool children
Purpose of review The purpose of this review is to provide an overview of the identified phenotypes of preschool wheezing. Recent findings Early life wheezing patterns have been described in multiple populations, with several commonalities found between cohorts. Early life environmental exposures have been found to be differentially associated with preschool wheezing phenotypes and their future trajectories. These include allergen and microbe exposure, environmental tobacco smoke exposure, and maternal stress and depression. Elevated IgE in early life may also influence future asthma risk. Summary Preschool wheezin...
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: PEDIATRIC ASTHMA AND DEVELOPMENT OF ATOPY: Edited by Leonard B. Bacharier and John Oppenheimer Source Type: research

Precision medicine in childhood asthma
Purpose of review Childhood asthma is a heterogeneous disease and many children have uncontrolled disease. Therefore an individualized approach is needed to improve asthma outcomes in children. Precision medicine using clinical characteristics, biomarkers, and the rapidly involving field of genomics and pharmacogenomics aims to achieve asthma control and reduce future risks with less side-effects in individual children with asthma. Recent findings It is not yet possible to select treatment options on clinical characteristics. Novel monoclonal antibodies are efficacious in patients with severe, eosinophilic asthma. Red...
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: PEDIATRIC ASTHMA AND DEVELOPMENT OF ATOPY: Edited by Leonard B. Bacharier and John Oppenheimer Source Type: research

Severe asthma in children: therapeutic considerations
Purpose of review Children with poor asthma control despite maximal maintenance therapy have problematic severe asthma (PSA). A step-wise approach including objective adherence monitoring and a detailed multidisciplinary team assessment to identify modifiable factors contributing to poor control is needed prior to considering therapy escalation. Pathophysiological phenotyping in those with true severe therapy-resistant asthma (STRA) and the current array of add-on therapies will be discussed. Recent findings Adherence monitoring using electronic devices has shown that only 20–30% of children with PSA have STRA a...
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: PEDIATRIC ASTHMA AND DEVELOPMENT OF ATOPY: Edited by Leonard B. Bacharier and John Oppenheimer Source Type: research

Vitamin D and childhood asthma: causation and contribution to disease activity
Purpose of review To review the literature of the past 18 months (April 2017 through September, 2018) relating to vitamin D and childhood asthma. Recent findings A combined analysis of two clinical trials of maternal vitamin D supplementation trials showed a significant protective effect of vitamin D supplementation trials in the primary prevention of asthma and recurrent wheeze up to age 3 years. Secondary analyses from these trials have also suggested that initial maternal vitamin D status could affect the response to supplementation during pregnancy, with the biggest protective effect in children born to mothers wi...
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: PEDIATRIC ASTHMA AND DEVELOPMENT OF ATOPY: Edited by Leonard B. Bacharier and John Oppenheimer Source Type: research

The impact of exercise on asthma
Purpose of review Asthma is one of the most common chronic diseases in children and adults in developed countries around the world. Despite international treatment guidelines, poor asthma control remains a frequent problem leading to missed school and work, and emergency room visits and hospitalizations. Many patients with asthma report exercise as a trigger for their asthma, which likely leads to exercise avoidance as a means to control symptoms. Evolving research has suggested that routine exercise may actually help improve some aspects of asthma control. This review discusses the recent research addressing how routine...
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: PEDIATRIC ASTHMA AND DEVELOPMENT OF ATOPY: Edited by Leonard B. Bacharier and John Oppenheimer Source Type: research

Single inhaler maintenance and reliever therapy in pediatric asthma
Purpose of review Asthma affects more than 25 million people worldwide and continues to grow in prevalence. According to a center for disease control and prevention (CDC) report, the total annual cost of asthma in the United States between 2008 and 2013, including medical care, absenteeism, and mortality, was $81.9 billion. Although the National Institute of Health guidelines recommend fixed inhaled corticosteroid (ICS) dosing, the 2008–2010 Medical Expenditure Panel Survey showed that asthma is still poorly controlled. Single inhaler maintenance and reliever therapy (SMART) offers a possible alternative management...
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: PEDIATRIC ASTHMA AND DEVELOPMENT OF ATOPY: Edited by Leonard B. Bacharier and John Oppenheimer Source Type: research

Diagnosis of occupational hypersensitivity pneumonitis
Purpose of review To discuss the diagnostic methods currently used in the study of patients with hypersensitivity pneumonitis, with special emphasis on the most recent contributions published in the medical literature regarding the diagnosis of occupational hypersensitivity pneumonitis (OHP). This review presents an update of the use of these diagnostic tests, a controversial issue among experts. Recent findings In spite of the multiple attempts at systematization and the publication of expert consensus statements, standardizing and diagnostic methods and criteria remain particularly difficult. As a result, centers te...
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: OCCUPATIONAL DISEASE: Edited by Susan M. Tarlo and Piero Maestrelli Source Type: research

Use of population data for assessing trends in work-related asthma mortality
Purpose of review Work-related asthma has been associated with poorer asthma control and frequent unscheduled healthcare visits, and can be fatal. Case reports of work-related asthma deaths are rare, but can initiate efforts to prevent additional cases. We reviewed relevant literature and data sources to evaluate whether analyzing mortality data at the population level can help identify potential sources of exposures that contribute to work-related asthma. Recent findings A limited number of population-based studies have addressed work-related asthma mortality. Data on asthma mortality are derived from death certifica...
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: OCCUPATIONAL DISEASE: Edited by Susan M. Tarlo and Piero Maestrelli Source Type: research

Basophil activation testing in occupational respiratory allergy to low molecular weight compounds
Purpose of review There is an unmet need for better immunological tests in cases of suspected occupational asthma to many workplace chemicals; here we consider the basophil activation test (BAT), a potential alternative to the detection of specific IgE antibodies. Recent findings BAT is fairly widely used in general allergy services; and there is increasing experience of its use in the diagnosis of occupational allergy to low molecular weight agents and chemicals including wood dusts, persulphates, antibiotics and latex. Summary There is potential for BAT to become a useful tool in the clinical consideration of occ...
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: OCCUPATIONAL DISEASE: Edited by Susan M. Tarlo and Piero Maestrelli Source Type: research

Impact of occupational exposure on human microbiota
Purpose of review Recent evidence suggests that environmental exposures change the adult human microbiome. Here, we review recent evidence on the impact of the work microbiome and work-related chemical, metal and particulate exposures on the human microbiome. Recent findings Prior literature on occupational microbial exposures has focused mainly on the respiratory effects of endotoxin, but a recent study suggests that not all endotoxin is the same; endotoxin from some species is proinflammatory, whereas endotoxin from other species is anti-inflammatory. Work with animals can change the adult human microbiome, likely t...
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: OCCUPATIONAL DISEASE: Edited by Susan M. Tarlo and Piero Maestrelli Source Type: research

Neutrophil activation in occupational asthma
Purpose of review The aim of this review is to emphasize the role of neutrophils in patients with occupational asthma. This review facilitates a better understanding, accurate diagnosis, and proper management of asthmatic reactions provoked at the workplace. Recent findings Increased recruitment and infiltration of neutrophils are found in patients with occupational asthma. Activated neutrophils release several mediators including pro-inflammatory cytokines and extracellular traps, leading to stimulation of airway epithelium and other inflammatory cells. Summary New insights into neutrophils in the pathogenesis of ...
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: OCCUPATIONAL DISEASE: Edited by Susan M. Tarlo and Piero Maestrelli Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Allergy and Clinical Immunology)
Source: Current Opinion in Allergy and Clinical Immunology - February 28, 2019 Category: Allergy & Immunology Tags: EDITORIAL INTRODUCTIONS Source Type: research