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Precision medicine in atopic diseases
Purpose of review To analyze the status of precision medicine in atopic diseases. Recent findings Atopic diseases are increasingly recognized as heterogeneous in nature and they can be quite different in severity, response to therapy, triggers, genetic back ground, ancestral risk and type of inflammation. This significant variability in the landscape of atopic diseases is not reflected in the common treatment guidelines that follow ‘one fits all’ approach for their management. Such an approach is largely based on minimal ‘phenotype’ elements, such as severity of disease and response to therapy and does not ref...
Source: Current Opinion in Allergy and Clinical Immunology - November 5, 2019 Category: Allergy & Immunology Tags: PRECISION MEDICINE Source Type: research

Is immunotherapy with fungal vaccines effective?
Purpose of review Although allergen immunotherapy (AIT) for fungi has been performed for many years, evidence clearly demonstrating its clinical benefit are still lacking. Here, we reviewed the available studies assessing efficacy and safety of AIT for molds. Recent findings Studies on AIT for fungi were performed only for the two predominating mold species in the external environment, namely Cladosporium and Alternaria. There is no evidence for other mold species. Recent finding in the literature are lacking; the 2 most recent studies on AIT for molds were published in 2011. Overall, 13 studies were identified (the f...
Source: Current Opinion in Allergy and Clinical Immunology - November 5, 2019 Category: Allergy & Immunology Tags: IMMUNOTHERAPY AND NEW TREATMENTS: Edited by Giovanni Passalacqua and Robert Bush Source Type: research

Manufacturing and quality assessment of allergenic extracts for immunotherapy: state of the art
Purpose of review The recent developments in the manufacturing and quality assessment of allergenic extracts in Europe are summarized. Recent findings Quality assessment has always been a fundamental part of allergen product evaluation. New analytical methods have been reported that fill currently existing gaps in the characterization of commonly used allergen products. New types of products require innovative considerations and concepts for their assessment. Advanced standardization efforts aim at increasing reliability and comparability of analytical tools applied for allergen product characterization. In consequenc...
Source: Current Opinion in Allergy and Clinical Immunology - November 5, 2019 Category: Allergy & Immunology Tags: IMMUNOTHERAPY AND NEW TREATMENTS: Edited by Giovanni Passalacqua and Robert Bush Source Type: research

B-cell responses in allergen immunotherapy
Purpose of review The establishment of long-term clinical tolerance in AIT requires the involvement of basophils, mast cells, allergen-specific regulatory T and B cells, downregulation of effector type 2 responses, and increase in production of specific IgG, particularly immunglobulin G4 (IgG4) antibodies. This review aims to provide an overview of the role of B cells in AIT, their mechanism of action, and their potential for improving AIT. Recent findings In-depth research of B cells has paved the way for improved diagnosis and research on allergic diseases. B cells play a central role in allergy and allergen toleran...
Source: Current Opinion in Allergy and Clinical Immunology - November 5, 2019 Category: Allergy & Immunology Tags: IMMUNOTHERAPY AND NEW TREATMENTS: Edited by Giovanni Passalacqua and Robert Bush Source Type: research

The multiple roles of mite allergens in allergic diseases
Purpose of review Mites are the most worldwide spread allergens and relevant causative of respiratory allergies. Life cycle, component allergens, biological activity and immunogenicity are discussed in depth. Recent findings It is now known that mite allergens are able to stimulate the innate immune system through different receptors, for example, TLRs and PARs. The activation of the cells in the airway mucosa is followed by type 2 polarizing cytokine production in predisposed individuals. This complex network plays a pivotal role into the promotion of Th2 differentiation. Summary This is a comprehensive review reg...
Source: Current Opinion in Allergy and Clinical Immunology - November 5, 2019 Category: Allergy & Immunology Tags: IMMUNOTHERAPY AND NEW TREATMENTS: Edited by Giovanni Passalacqua and Robert Bush Source Type: research

The role of component-resolved diagnosis in Hymenoptera venom allergy
Purpose of review Component-resolved diagnostics (CRD) is a new tool aiming at detecting IgE-mediated sensitizations against individual, relevant allergens. Here, we discuss recent literature on molecular diagnosis in the field of Hymenoptera venom allergy (HVA) as well as CRD strengths and weaknesses. Recent findings CRD, using single molecules or panels of allergens, may discriminate between primary sensitization and cross-reactivity in patients with double/multiple positivity in diagnostic tests with whole extracts, allowing the specialist to choose the most suitable venom for specific immunotherapy (VIT), avoiding...
Source: Current Opinion in Allergy and Clinical Immunology - November 5, 2019 Category: Allergy & Immunology Tags: IMMUNOTHERAPY AND NEW TREATMENTS: Edited by Giovanni Passalacqua and Robert Bush Source Type: research

Oral and sublingual immunotherapy for food allergy
Purpose of review To critically appraise the recent most relevant studies in the rapidly advancing field of food oral and sublingual immunotherapy. Recent findings Food allergen-specific immunotherapy via oral (OIT) and sublingual route (SLIT) increases the threshold of reactivity to peanut, cow's milk, egg, wheat, and many other foods in the majority of the treated individuals. This desensitized state is contingent upon the continued ingestion of the maintenance doses of the food. Permanent oral tolerance is achievable in a smaller subset of the treated individuals. The optimal duration of therapy has not been firmly...
Source: Current Opinion in Allergy and Clinical Immunology - November 5, 2019 Category: Allergy & Immunology Tags: IMMUNOTHERAPY AND NEW TREATMENTS: Edited by Giovanni Passalacqua and Robert Bush Source Type: research

Duration of allergen immunotherapy for inhalant allergy
Purpose of review We evaluated the time-course of clinical and immunologic changes that occur during and after cessation of sublingual and subcutaneous allergen immunotherapy for inhalant allergies. Recent findings Increases in production of inhibitory cytokines, such as IL-10 and allergen-specific IgE and IgG4 antibodies are induced within weeks of starting immunotherapy for both seasonal and perennial allergens. In general, 2–4 months’ immunotherapy is needed for onset of efficacy whereas maximal clinical effect is achieved within 1–2 years of treatment. Therefore, assuming optimal patient selection, good comp...
Source: Current Opinion in Allergy and Clinical Immunology - November 5, 2019 Category: Allergy & Immunology Tags: IMMUNOTHERAPY AND NEW TREATMENTS: Edited by Giovanni Passalacqua and Robert Bush Source Type: research

Nonsevere combined immunodeficiency T-cell lymphopenia identified through newborn screening
Purpose of review Although severe combined immunodeficiency (SCID) is the primary target condition for newborn screening (NBS), over 25 secondary targets, conditions other than SCID, have been identified. There is no standard method for evaluating neonates with non-SCID T-cell lymphopenia (TCL) and no standard approaches to treatment. We will describe these conditions and discuss recommendations for evaluating and follow-up of non-SCID TCL detected by NBS. Recent findings The birth prevalence of non-SCID TCL detected through SCID NBS is higher than SCID and can be a burden on NBS programs. We will present some publica...
Source: Current Opinion in Allergy and Clinical Immunology - November 5, 2019 Category: Allergy & Immunology Tags: PRIMARY IMMUNE DEFICIENCY DISEASE: Edited by Stephen Jolles and M. Teresa (Maite) de la Morena Source Type: research

Disorders of CTLA-4 expression, how they lead to CVID and dysregulated immune responses
Purpose of review The landscape of common variable immunodeficiency disorder (CVID) is rapidly evolving as the availability of next-generation sequencing leads to the discovery of new monogenic causes with the clinical phenotype of CVID. Herein, the biology of cytotoxic T lymphocyte-associated protein four (CTLA-4), differentially expressed in FDCP6 homolog (DEF6), and lipopolysaccharide responsive beige-like anchor protein (LRBA), and their impact on the development of a dysregulated, rather than an isolated, infectious phenotype of CVID are explored. Recent findings The broad clinical phenotype associated with these...
Source: Current Opinion in Allergy and Clinical Immunology - November 5, 2019 Category: Allergy & Immunology Tags: PRIMARY IMMUNE DEFICIENCY DISEASE: Edited by Stephen Jolles and M. Teresa (Maite) de la Morena Source Type: research

An update on X-Linked agammaglobulinaemia: clinical manifestations and management
Purpose of review X-linked agammaglobulinaemia (XLA) is a congenital defect of development of B lymphocytes leading to agammaglobulinaemia. It was one of the first primary immunodeficiencies described, but treatment has remained relatively unchanged over the last 60 years. This summary aims to outline the current outcomes, treatments and future research areas for XLA. Recent findings Immunoglobulin therapy lacks IgA and IgM, placing patients at theoretical risk of experiencing recurrent respiratory tract infections and developing bronchiectasis despite best current therapy. Recent cohort studies from Italy and the USA...
Source: Current Opinion in Allergy and Clinical Immunology - November 5, 2019 Category: Allergy & Immunology Tags: PRIMARY IMMUNE DEFICIENCY DISEASE: Edited by Stephen Jolles and M. Teresa (Maite) de la Morena Source Type: research

Immunoglobulin A and microbiota in primary immunodeficiency diseases
Purpose of review With the emergence of the microbiota as a potential driver of host inflammation, the role of iIgA is becoming increasingly important. This review discusses the current evidence regarding the effects of clinical IgA deficiency on the microbiota, and the possible role of microbial dysbiosis in driving inflammation in PID patients. Recent findings The gut microbiota has been investigated in selective IgA deficiency and common variable immunodeficiency, revealing an important role for IgA in maintaining gut microbiota homeostasis, with disparate effects of IgA on symbionts and pathobionts. Although IgA d...
Source: Current Opinion in Allergy and Clinical Immunology - November 5, 2019 Category: Allergy & Immunology Tags: PRIMARY IMMUNE DEFICIENCY DISEASE: Edited by Stephen Jolles and M. Teresa (Maite) de la Morena Source Type: research

Clozapine-associated secondary antibody deficiency
Purpose of review Clozapine has recently been described as a novel cause of secondary antibody deficiency (SAD), associated with long-term therapy. Here we critically review the evidence linking clozapine use to an increased infection risk, describe immunological alterations, and discuss potential mechanisms. Recent findings Individuals with schizophrenia are at two to five times more likely to develop pneumonia than the general population, in particular, when receiving clozapine. Delayed-onset distinguishes clozapine-associated hypogammaglobulinaemia from agranulocytosis or neutropenia that occur at lesser frequency....
Source: Current Opinion in Allergy and Clinical Immunology - November 5, 2019 Category: Allergy & Immunology Tags: PRIMARY IMMUNE DEFICIENCY DISEASE: Edited by Stephen Jolles and M. Teresa (Maite) de la Morena Source Type: research

Rheumatologic and autoimmune manifestations in primary immune deficiency
Purpose of review Here we review the rheumatologic and autoimmune features of primary immune deficiencies with a focus on recently recognized genetic diseases, the spectrum of autoimmunity in PID, and targeted therapies. Recent findings Primary immune deficiencies (PIDs) were initially described as genetic diseases of the immune system leading to susceptibility to infection. It is now well recognized that immune dysfunction and dysregulation also cause noninfectious complications including autoimmunity. The increased application of molecular testing for PID has revealed the diversity of clinical disease. Recent discov...
Source: Current Opinion in Allergy and Clinical Immunology - November 5, 2019 Category: Allergy & Immunology Tags: PRIMARY IMMUNE DEFICIENCY DISEASE: Edited by Stephen Jolles and M. Teresa (Maite) de la Morena Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Allergy and Clinical Immunology)
Source: Current Opinion in Allergy and Clinical Immunology - November 5, 2019 Category: Allergy & Immunology Tags: EDITORIAL INTRODUCTIONS Source Type: research