Increasing the dose of inhaled corticosteroids (ICS) may bring asthma under control during an exacerbation. Zhang et al have undertaken a systematic review and meta‐analysis to compare increased with stable doses of ICS.1 They used a standard approach searching three databases to 02 August 2018 and included only parallel group randomized clinical trials. They found a total of 8 trials (N = 3866). Quality was mixed with only four judged to be at low risk of bias. Increasing the dose of ICS was associated with a significantly re‐ duced risk of needing systematic corticosteroids compared with a stable dose (odds ratio 0.82, 95% confidence interval 0.70‐0.97). But when looking at subgroups, it was only effective for adults and when ICS was quadrupled. Extra‐fine particle formulations of ICS have better lung deliv‐ ery characteristics than fine particle formulations. Kuo et al have looked to see whether or not they improve clinical asthma out‐ comes.2 A total of 24 adult patients were changed to extra‐fine par‐ ticle hydrofluoroalkane beclomethasone dipropionate (mean dose 355μg). Compared with previously, asthma control questionnaire and asthma quality of life questionnaire scores improved at 8 weeks (−0.53, 95% confidence interval −0.83, −0.23 and 0.69, 0.35, 1.04, respectively) (Figure 1). There were also significant reductions in symptoms and reliever use. None of the lung function, FeNO nor blood eosinophils changed. With this clinically significant improve‐ ment in patient outcomes, a randomized controlled trial should be undertaken to evaluate the effectiveness of extra‐fine particle ICS in clinical practice. Peanut oral immunotherapy (OIT) has been demonstrated to be effective but it is associated with severe adverse reactions. Brandström et al have assessed whether combining omalizumab therapy with peanut OIT can improve the safety of this approach.3,4 A total of 23 adolescents with peanut allergy were included. Omalizumab was commenced, and then, the OIT dose was increased from 280 to 2800 mg peanut protein over 8 weeks. Finally, omali‐ zumab was withdrawn on the basis of clinical symptoms and baso‐ phil activation test results. All the participants reached the 2800 mg maintenance peanut dose. There were hardly any adverse reactions on full‐dose omalizumab (Figure 2). These were though seen off omalizumab and only half of the participants continued with OIT after omalizumab was stopped, so not quite the panacea we were hoping for.
{"title":"Improving asthma control and oral immunotherapy protocols","authors":"G. Roberts","doi":"10.1111/cea.13499","DOIUrl":"https://doi.org/10.1111/cea.13499","url":null,"abstract":"Increasing the dose of inhaled corticosteroids (ICS) may bring asthma under control during an exacerbation. Zhang et al have undertaken a systematic review and meta‐analysis to compare increased with stable doses of ICS.1 They used a standard approach searching three databases to 02 August 2018 and included only parallel group randomized clinical trials. They found a total of 8 trials (N = 3866). Quality was mixed with only four judged to be at low risk of bias. Increasing the dose of ICS was associated with a significantly re‐ duced risk of needing systematic corticosteroids compared with a stable dose (odds ratio 0.82, 95% confidence interval 0.70‐0.97). But when looking at subgroups, it was only effective for adults and when ICS was quadrupled. Extra‐fine particle formulations of ICS have better lung deliv‐ ery characteristics than fine particle formulations. Kuo et al have looked to see whether or not they improve clinical asthma out‐ comes.2 A total of 24 adult patients were changed to extra‐fine par‐ ticle hydrofluoroalkane beclomethasone dipropionate (mean dose 355μg). Compared with previously, asthma control questionnaire and asthma quality of life questionnaire scores improved at 8 weeks (−0.53, 95% confidence interval −0.83, −0.23 and 0.69, 0.35, 1.04, respectively) (Figure 1). There were also significant reductions in symptoms and reliever use. None of the lung function, FeNO nor blood eosinophils changed. With this clinically significant improve‐ ment in patient outcomes, a randomized controlled trial should be undertaken to evaluate the effectiveness of extra‐fine particle ICS in clinical practice. Peanut oral immunotherapy (OIT) has been demonstrated to be effective but it is associated with severe adverse reactions. Brandström et al have assessed whether combining omalizumab therapy with peanut OIT can improve the safety of this approach.3,4 A total of 23 adolescents with peanut allergy were included. Omalizumab was commenced, and then, the OIT dose was increased from 280 to 2800 mg peanut protein over 8 weeks. Finally, omali‐ zumab was withdrawn on the basis of clinical symptoms and baso‐ phil activation test results. All the participants reached the 2800 mg maintenance peanut dose. There were hardly any adverse reactions on full‐dose omalizumab (Figure 2). These were though seen off omalizumab and only half of the participants continued with OIT after omalizumab was stopped, so not quite the panacea we were hoping for.","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"53 1","pages":"1272 - 1273"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89270667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angioedema is a common reason for referral to immunology and allergy specialists. Not all cases are in fact angioedema. There are many conditions that may mimic its appearance, resulting in misdiagnosis. This may happen when a clinician is unfamiliar with conditions resembling angioedema or when there is a low index of clinical suspicion. In this article, we explore a list of differential diagnoses based on body parts, including the lips, the limbs, periorbital tissues, the face, epiglottis and uvula, as well as the genitalia, that may pose as a masquerader even to an experienced eye.
{"title":"Angioedema Masqueraders","authors":"Jie Shen Fok, Constance H Katelaris","doi":"10.1111/cea.13463","DOIUrl":"https://doi.org/10.1111/cea.13463","url":null,"abstract":"Angioedema is a common reason for referral to immunology and allergy specialists. Not all cases are in fact angioedema. There are many conditions that may mimic its appearance, resulting in misdiagnosis. This may happen when a clinician is unfamiliar with conditions resembling angioedema or when there is a low index of clinical suspicion. In this article, we explore a list of differential diagnoses based on body parts, including the lips, the limbs, periorbital tissues, the face, epiglottis and uvula, as well as the genitalia, that may pose as a masquerader even to an experienced eye.","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"1 1","pages":"1274 - 1282"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75801272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Johanna M. Smeekens, R. Immormino, Peter A Balogh, S. Randell, M. Kulis, T. Moran
There is growing evidence that environmental peanut exposure through non‐oral routes, including the skin and respiratory tract, can result in peanut sensitization. Environmental adjuvants in indoor dust can promote sensitization to inhaled antigens, but whether they contribute to peanut allergy development is unclear.
{"title":"Indoor dust acts as an adjuvant to promote sensitization to peanut through the airway","authors":"Johanna M. Smeekens, R. Immormino, Peter A Balogh, S. Randell, M. Kulis, T. Moran","doi":"10.1111/cea.13486","DOIUrl":"https://doi.org/10.1111/cea.13486","url":null,"abstract":"There is growing evidence that environmental peanut exposure through non‐oral routes, including the skin and respiratory tract, can result in peanut sensitization. Environmental adjuvants in indoor dust can promote sensitization to inhaled antigens, but whether they contribute to peanut allergy development is unclear.","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"47 1","pages":"1500 - 1511"},"PeriodicalIF":0.0,"publicationDate":"2019-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82364635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. DunnGalvin, G. Roberts, S. Schnadt, S. Astley, M. Austin, W. Blom, J. Baumert, C. Chan, R. Crevel, K. Grimshaw, A. Kruizinga, L. Regent, Stephen Taylor, M. Walker, E. Mills
Food allergy is a major public health concern with avoidance of the trigger food(s) being central to management by the patient. Food information legislation mandates the declaration of allergenic ingredients; however, the labelling of the unintentional presence of allergens is less defined. Precautionary allergen labelling (PAL) was introduced by the food industry to help manage and communicate the risk of reaction from the unintended presence of allergens in foods. In its current form, PAL is counterproductive for consumers with food allergies as there is no standardized approach to applying PAL. Foods with a PAL often do not contain the identified food allergen while some products without a PAL contain quantities of common food allergens that are capable of inducing an allergic reaction. Integrated Approaches to Food Allergen and Allergy Risk Management (iFAAM) was an EU‐funded project that aimed to improve the management of food allergens by the food industry for the benefit of people with food allergies. Within iFAAM, a clinically validated tiered risk assessment approach for food allergens was developed. Two cross‐stakeholder iFAAM workshops were held on 13‐14 December 2016 and 19‐20 April 2018. One of the objectives of these workshops was to develop a proposal to make PAL effective for consumers. This paper describes the outcomes from these workshops. This provides the basis for the development of more informative and transparent labelling that will ultimately improve management and well‐being in consumers with food allergy.
{"title":"Evidence‐based approaches to the application of precautionary allergen labelling: Report from two iFAAM workshops","authors":"A. DunnGalvin, G. Roberts, S. Schnadt, S. Astley, M. Austin, W. Blom, J. Baumert, C. Chan, R. Crevel, K. Grimshaw, A. Kruizinga, L. Regent, Stephen Taylor, M. Walker, E. Mills","doi":"10.1111/cea.13464","DOIUrl":"https://doi.org/10.1111/cea.13464","url":null,"abstract":"Food allergy is a major public health concern with avoidance of the trigger food(s) being central to management by the patient. Food information legislation mandates the declaration of allergenic ingredients; however, the labelling of the unintentional presence of allergens is less defined. Precautionary allergen labelling (PAL) was introduced by the food industry to help manage and communicate the risk of reaction from the unintended presence of allergens in foods. In its current form, PAL is counterproductive for consumers with food allergies as there is no standardized approach to applying PAL. Foods with a PAL often do not contain the identified food allergen while some products without a PAL contain quantities of common food allergens that are capable of inducing an allergic reaction. Integrated Approaches to Food Allergen and Allergy Risk Management (iFAAM) was an EU‐funded project that aimed to improve the management of food allergens by the food industry for the benefit of people with food allergies. Within iFAAM, a clinically validated tiered risk assessment approach for food allergens was developed. Two cross‐stakeholder iFAAM workshops were held on 13‐14 December 2016 and 19‐20 April 2018. One of the objectives of these workshops was to develop a proposal to make PAL effective for consumers. This paper describes the outcomes from these workshops. This provides the basis for the development of more informative and transparent labelling that will ultimately improve management and well‐being in consumers with food allergy.","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"22 1","pages":"1191 - 1200"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84798144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Call for papers for special issue in 2020","authors":"G. Roberts","doi":"10.1111/cea.13483","DOIUrl":"https://doi.org/10.1111/cea.13483","url":null,"abstract":"","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"33 1","pages":"1176 - 1177"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77337489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yang TB et al. J Allergy Clin Immunol. 2019;144:353‐360 https ://doi.org/10.1016/j.jaci.2019.06.016 This is an exciting article addressing a common symptom of allergic disease(s)—itch. The authors discuss the currently understood im‐ muno‐pathogenesis and management of itch, highlighting how in‐ effective antihistamines are in combating itch, suggesting that the pathogenesis of itch encompasses both histaminergic (IgE‐mast cell‐ histamine axis) and non‐histaminergic pathways. Recent advances in the biology and neuroimmunology of itch have provided key new insight into the development of various new targeted therapies such as dupilumab, tralokinumab, lebrikizumab, neurokinin receptor an‐ tagonists, Mrgpr antagonists and JAK inhibitors, which are likely to transform the management of itch‐associated disorders in allergy and immunology.
{"title":"Best of the other journals","authors":"E. Harnik, V. Harper, N. Patel","doi":"10.1111/cea.13482","DOIUrl":"https://doi.org/10.1111/cea.13482","url":null,"abstract":"Yang TB et al. J Allergy Clin Immunol. 2019;144:353‐360 https ://doi.org/10.1016/j.jaci.2019.06.016 This is an exciting article addressing a common symptom of allergic disease(s)—itch. The authors discuss the currently understood im‐ muno‐pathogenesis and management of itch, highlighting how in‐ effective antihistamines are in combating itch, suggesting that the pathogenesis of itch encompasses both histaminergic (IgE‐mast cell‐ histamine axis) and non‐histaminergic pathways. Recent advances in the biology and neuroimmunology of itch have provided key new insight into the development of various new targeted therapies such as dupilumab, tralokinumab, lebrikizumab, neurokinin receptor an‐ tagonists, Mrgpr antagonists and JAK inhibitors, which are likely to transform the management of itch‐associated disorders in allergy and immunology.","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81057273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Caubet, A. Cianferoni, M. Groetch, A. Nowak‐Wegrzyn
Food protein‐induced enterocolitis syndrome (FPIES) is a non‐IgE‐mediated gastrointestinal food allergic disorder that has gained a major interest the past decade. FPIES prevalence, which still needs to be accurately determine in different populations, appears to be higher than previously thought (ie up to 0.7% in infants in the 1st year of life). FPIES to seafood in adults is also increasingly reported; limited data suggest that adult FPIES is most commonly triggered by shellfish, tends to affect females more than men, is characterized by a significant delay in diagnosis and a prolonged course. The first international consensus guidelines on diagnosis and management of FPIES have been published in 2017, proposing new diagnostic criteria as well as new criteria for a positive oral food challenge. However, there is a need to develop new biomarkers to improve the diagnosis and management of FPIES patients, and this requires a better understanding of the pathophysiology. Recently, the role of T cells has been questioned and a major role of innate immune cells has been suggested in acute FPIES. Regarding the treatment of acute FPIES reaction, ondansetron has emerged as an adjunct to intravenous rehydration in moderate‐severe reactions and as a first‐line treatment in mild reactions. Important information regarding the nutritional management of FPIES patients that might be complex has also been provided in the international guidelines. In this review, we discuss recent advances regarding all those different aspects.
{"title":"Food protein‐induced enterocolitis syndrome","authors":"J. Caubet, A. Cianferoni, M. Groetch, A. Nowak‐Wegrzyn","doi":"10.1111/cea.13415","DOIUrl":"https://doi.org/10.1111/cea.13415","url":null,"abstract":"Food protein‐induced enterocolitis syndrome (FPIES) is a non‐IgE‐mediated gastrointestinal food allergic disorder that has gained a major interest the past decade. FPIES prevalence, which still needs to be accurately determine in different populations, appears to be higher than previously thought (ie up to 0.7% in infants in the 1st year of life). FPIES to seafood in adults is also increasingly reported; limited data suggest that adult FPIES is most commonly triggered by shellfish, tends to affect females more than men, is characterized by a significant delay in diagnosis and a prolonged course. The first international consensus guidelines on diagnosis and management of FPIES have been published in 2017, proposing new diagnostic criteria as well as new criteria for a positive oral food challenge. However, there is a need to develop new biomarkers to improve the diagnosis and management of FPIES patients, and this requires a better understanding of the pathophysiology. Recently, the role of T cells has been questioned and a major role of innate immune cells has been suggested in acute FPIES. Regarding the treatment of acute FPIES reaction, ondansetron has emerged as an adjunct to intravenous rehydration in moderate‐severe reactions and as a first‐line treatment in mild reactions. Important information regarding the nutritional management of FPIES patients that might be complex has also been provided in the international guidelines. In this review, we discuss recent advances regarding all those different aspects.","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"35 1","pages":"1178 - 1190"},"PeriodicalIF":0.0,"publicationDate":"2019-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81554374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eun Ji Kwak, Jung Yeon Hong, M. N. Kim, Soo-Yeon Kim, S. H. Kim, C. Park, K. Kim, C. Lee, J. Elias, H. Jee, M. Sohn
Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by defective skin barrier and Th2 immune responses. Chitinase 3‐like 1 (CHI3L1), also known as breast regression protein 39 (BRP‐39) in mice and human homologue YKL‐40, plays important roles in Th2 inflammation and allergen sensitization. CHI3L1 has been implicated in a variety of diseases including asthma characterized by inflammation, apoptosis and tissue remodelling, but its role in AD remains elusive.
{"title":"Chitinase 3‐like 1 drives allergic skin inflammation via Th2 immunity and M2 macrophage activation","authors":"Eun Ji Kwak, Jung Yeon Hong, M. N. Kim, Soo-Yeon Kim, S. H. Kim, C. Park, K. Kim, C. Lee, J. Elias, H. Jee, M. Sohn","doi":"10.1111/cea.13478","DOIUrl":"https://doi.org/10.1111/cea.13478","url":null,"abstract":"Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by defective skin barrier and Th2 immune responses. Chitinase 3‐like 1 (CHI3L1), also known as breast regression protein 39 (BRP‐39) in mice and human homologue YKL‐40, plays important roles in Th2 inflammation and allergen sensitization. CHI3L1 has been implicated in a variety of diseases including asthma characterized by inflammation, apoptosis and tissue remodelling, but its role in AD remains elusive.","PeriodicalId":10148,"journal":{"name":"Clinical & Experimental Allergy","volume":"17 1","pages":"1464 - 1474"},"PeriodicalIF":0.0,"publicationDate":"2019-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87638825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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