The cover image is based on the article Oral Immunotherapy Should Play a Key Role in Preschool Food Allergy Management by Lianne Soller et al., https://doi.org/10.1111/cea.70013.
The cover image is based on the article Oral Immunotherapy Should Play a Key Role in Preschool Food Allergy Management by Lianne Soller et al., https://doi.org/10.1111/cea.70013.
Background: Mucosal-associated invariant T cells (MAIT) are emerging as important regulators at mucosal surfaces. While these cells have been linked to a Th1-biased immune response and support for B cells, their roles in allergic diseases characterised by type 2 inflammation remain elusive. The study seeks to characterise MAIT cells in house dust mite (HDM)-induced allergic rhinitis (AR) and subsequent allergen immunotherapy (AIT), aiming to elucidate their clinical significance in AR and potential to enhance AIT effectiveness.
Methods: MAIT cells were assessed in patients with AR and individuals undergoing AIT. The ratio and cytokine-producing capacity of these cells were analysed to explore their correlations with AR progression and their responsiveness to HDM extracts and MAIT cell-specific agonists.
Results: In AR patients, there was an increase in the ratios of circulating MAIT cells and tonsil follicular T helper-like MAIT cells, alongside a decrease in the IFN-γ-producing MAIT cells. AIT restored their IFN-γ producing capacity, which was further boosted by T cell receptor (TCR) activation using MAIT cell-specific agonist-loaded artificial antigen-presenting cells (aAPCs). Synergistic effects of aAPCs and HDM enhance MAIT cell activation and IFN-γ production while reducing HDM-induced IgE levels in PBMC cocultures. Moreover, higher ratios of MAIT cells and IFN-γ-producing MAIT cells correlated with decreased IgE and increased IgG4 and improved clinical outcomes during AIT.
Conclusions: These findings underscore the compromised IFN-γ-producing MAIT cells in AR and their restoration following AIT and TCR stimulation, highlighting the cell's therapeutic potential and predictive value for clinical outcomes in AR and AIT.
Background: There is an unmet need for specialist allergy treatment in the United Kingdom. Allergen immunotherapy and treatment with omalizumab for chronic spontaneous urticaria (CSU) are key markers for these services. The British Society for Allergy and Clinical Immunology (BSACI) Registry for Immunotherapy (BRIT) is a national project to record the real-world effectiveness, safety and access to treatment for aero-allergen, venom and peanut immunotherapy as well as omalizumab for CSU.
Methods: We described participant demographics, the index of multiple deprivation (IMD) and access to treatment from the registry launch. Data for 1835 participants were available for analysis from 63 centres enrolled between 1st October 2018 and 24th August 2023.
Results: 96.5% (1771/1835) were living in England, with only 3.5% (64) being from the devolved nations. 14.4% (251/1748) were in the most affluent IMD decile compared to 4.5% (78/1748) in the most deprived IMD decile. White participants were 1.74 times more likely to be referred directly from primary care compared to people of Asian, black, mixed or other minority ethnic groups. Instead, these groups were referred more frequently from secondary or tertiary hospital services. The median distance travelled from home to the treatment centre was 15.2 miles, with evidence of clustering around specialist centres.
Conclusions: We have described disparities and unwarranted variation in the provision of treatment around the UK. The data suggest that there is limited access to immunotherapy in the devolved nations. Access is also reduced by socioeconomic deprivation. White participants were more likely to receive a direct referral from primary care than those from other ethnic groups whose referral pathways were more complex. Registry data are limited by participant enrolment and may have selection bias. Nevertheless, BRIT has highlighted inequity in access to specialist allergy services in the UK.
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