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Current Opinion in Allergy and Clinical Immunology

Mark W Tenn, Matthew Rawls, Anne K Ellis
PURPOSE OF REVIEW: The nasal allergen challenge (NAC) model can be a valuable diagnostic tool for allergic rhinitis. Alongside its clinical use, NACs can be used as primary and secondary endpoints in studies evaluating allergen immunotherapy (AIT) products for allergic rhinitis treatment. This review will discuss the technical aspects of the NAC model and provide a summary of recent studies using NACs to assess existing and new AIT treatments. RECENT FINDINGS: Over the last 2 years, both titrated and single-dose nasal challenge protocols have been used to evaluate immunotherapies targeting grass, birch, house dust mite, and cat allergens...
September 7, 2018: Current Opinion in Allergy and Clinical Immunology
Mark J Ponsford, William Rae, Adam Klocperk
PURPOSE OF REVIEW: Understanding the pathophysiology of monogenic primary immunodeficiency (PID) with atopic presentation has pivotal implications for intervention strategies and potentially wider polygenic atopic-related traits. This review will discuss advances in gene discovery arising from monogenic defects at the interface between PID and atopy, notably the hyper-IgE syndromes. RECENT FINDINGS: Key molecular pathways underlying development of primary atopic diseases have recently been proposed...
September 3, 2018: Current Opinion in Allergy and Clinical Immunology
Carlo Lombardi, Giorgio W Canonica, Giovanni Passalacqua
PURPOSE OF REVIEW: In this review, we sought to outline many of the recent evidences about the available clinical trials in which biologic agents [i.e. omalizumab (OMA)] were associated as add-on to allergen-specific immunotherapy (AIT). RECENT FINDINGS: The available literature shows that OMA may be a valuable option as add-on to AIT for respiratory allergy, or food desensitization, especially in the escalation or build-up phases, in which adverse events are more commonly expected...
August 24, 2018: Current Opinion in Allergy and Clinical Immunology
Yin Yao, Zhi-Chao Wang, Di Yu, Zheng Liu
PURPOSE OF REVIEW: The discovery of novel T-cell subsets including follicular helper T (Tfh) cells has broadened our knowledge on the complex immune networks in allergic diseases. This review summarizes the evidence for Tfh cells in controlling immune responses to allergens with a particular focus on immunoglobulin E (IgE) production and discusses the implication of such regulation in allergen-specific immunotherapy. RECENT FINDINGS: Tfh cells support the production of IgE in animal models for allergic diseases...
August 18, 2018: Current Opinion in Allergy and Clinical Immunology
Joachim W Fluhr, Torsten Zuberbier, Razvigor Darlenski
PURPOSE OF REVIEW: To summarize the current knowledge on the morphology, functionality and biochemical composition of the skin in allergic reactions. We address novel noninvasive techniques that promise to disclose intimate mechanisms of skin allergy in vivo. Epidermal barrier is not just a static wrap of the organism but rather a dynamic field for immunological, biophysical and biochemical processes and serves as a bio-sensor for exogenous danger signals. RECENT FINDINGS: Classical biophysical methods are amended by novel in-vivo techniques, such as Raman spectroscopy, analysing the skin microcomposition and develop epidermal profiles...
October 2018: Current Opinion in Allergy and Clinical Immunology
Thomas Werfel
PURPOSE OF REVIEW: The present review will give an update of recently published clinical studies on novel systemic treatment approaches in atopic dermatitis. RECENT FINDINGS: Until 2017 immunosuppressive drugs such as cyclosporine had to be used in atopic dermatitis when the disease could not sufficiently be treated with topical drugs. Several new substances specifically targeting inflammation in atopic dermatitis are currently studied. In 2017, dupilumab was approved in the United States and in Europe for first-line biologic treatment of moderate to severe atopic dermatitis in adults...
October 2018: Current Opinion in Allergy and Clinical Immunology
Anna Sala-Cunill, Mar Guilarte, Victoria Cardona
PURPOSE OF REVIEW: The aim of the review is to describe the different clinical pictures of anaphylaxis (phenotypes), in relation to the underlying mechanisms and potential biomarkers, to describe anaphylaxis endotypes. This may aid in achieving a better understanding, management and outcomes of such severe reactions. RECENT FINDINGS: Different anaphylaxis phenotypes have been outlined, ranging from the classical type-I-like to those suggestive of cytokine-storm-like or complement-mediated reactions...
October 2018: Current Opinion in Allergy and Clinical Immunology
Giulia De Feo, Roberta Parente, Massimo Triggiani
PURPOSE OF REVIEW: Anaphylaxis is an acute medical emergency characterized by sudden presentation of life-threatening respiratory and cardiovascular symptoms. Rapid diagnosis of anaphylaxis is crucial to implement an appropriate treatment and management plan. However, mistakes in the diagnosis of anaphylaxis may occur because of the limited time during which the diagnosis must be made, the stressful environment of the emergency room, the often aspecific or incomplete clinical features of early anaphylaxis and the lack of useful laboratory markers...
October 2018: Current Opinion in Allergy and Clinical Immunology
Luciana Kase Tanno, Ignacio Ansotegui, Pascal Demoly
PURPOSE OF REVIEW: To understand the impact of globalization in the management of anaphylaxis and identify potential strategies to improve patients' care and prevention. RECENT FINDINGS: Developments in the field of anaphylaxis have been consistently following these globalization trends offering possibilities of collaborations of the allergy community and integrated international initiatives to reach quality care of allergic patients worldwide. SUMMARY: Globalization is the process of interaction and integration between people, companies, and governments worldwide...
October 2018: Current Opinion in Allergy and Clinical Immunology
Marcelo V Aun, Jorge Kalil, Pedro Giavina-Bianchi
PURPOSE OF REVIEW: Despite many international guidelines have been published in the last 10 years, anaphylaxis continues to be underdiagnosed, undernotified, and undertreated. Anaphylactic reactions in adults and children in emergency departments are frequently not recognized, leading to underutilization of epinephrine, and a higher risk of death. RECENT FINDINGS: A few studies have been recently published showing that educational intervention for both physicians and other healthcare professionals improve diagnosis and treatment of anaphylaxis...
October 2018: Current Opinion in Allergy and Clinical Immunology
Hadas Ben-Eli, Abraham Solomon
PURPOSE OF REVIEW: To address the current trends of therapeutic mechanisms for treatment of allergic conjunctivitis (AC), based on topical antihistamines and mast cell stabilizers (MCS). RECENT FINDINGS: The antihistamine drug alcaftadine has H4 receptor inverse agonism, anti-inflammatory and MCS activities. The antihistamines levocabastine and azelastine are more effective than placebo in treatment of AC symptoms in randomized controlled trials (RCTs). The topical dual-action antihistamines/MCS olopatadine, azelastine, ketotifen, and epinastine are commonly used in Europe and in the United States for mild subtypes of AC...
October 2018: Current Opinion in Allergy and Clinical Immunology
Arianna Prince, Matthew R Norris, Leonard Bielory
PURPOSE OF REVIEW: The purpose of the article is to provide a historical overview of literature regarding pollen sensitization and ocular allergy with an emphasis on developments that have occurred over the past 5 years. RECENT FINDINGS: Currently, pollen studies have examined the molecular and cellular pathways involved in initiating allergic conjunctivitis to find targets for therapeutics. Studies have also documented the threshold, linear increase and plateau point in the relationship between pollen levels and allergic conjunctivitis symptoms...
October 2018: Current Opinion in Allergy and Clinical Immunology
Julian Schröder, Ralph Mösges
PURPOSE OF REVIEW: The conjunctival provocation test (CPT) is often used to clearly identify the specific allergen causing the symptoms of allergic rhinoconjunctivitis but also to assess the clinical efficacy of an allergen immunotherapy (AIT). As there is no consensus about its predictive value, the aim of this publication is to evaluate under which conditions the CPT can predict the symptom severity during the allergy season after previous AIT. RECENT FINDINGS: Three out of four randomized controlled trials (RCTs) showed a correlation between CPT reactivity and symptoms occurring under natural allergen exposure after previous AIT...
October 2018: Current Opinion in Allergy and Clinical Immunology
Matthew R Norris, Leonard Bielory
PURPOSE OF REVIEW: The purpose of this review was to explore recent developments in the study of ocular cosmetics, as they pertain to adverse reactions that can be attributed to them. RECENT FINDINGS: Immunologically mediated adverse reactions to cosmetics are most commonly the result of sensitization to preservatives, fragrances and dyes used in these products. Metals such as nickel, cobalt, chromium and lead are used in products such as eye shadows and eye liners as well as toy makeup sets in amounts greater than the recommended amount of 1 ppm...
October 2018: Current Opinion in Allergy and Clinical Immunology
Stefania Arasi, Maurizio Mennini, Rocco Valluzzi, Carla Riccardi, Alessandro Fiocchi
PURPOSE OF REVIEW: To familiarize the reader with the concept of precision medicine in food allergy through the most recent insights in the diagnosis, prognosis, and management of the disease. RECENT FINDINGS: With the advent of omics sciences, a new era is commencing. Food protein allergens characterization and quantification together with the immunoglobulin E epitope mapping will contribute to the diagnosis/prognosis of food allergy and will lead to a better safety assessment of foods...
October 2018: Current Opinion in Allergy and Clinical Immunology
Edoardo Villani, Giovanni Rabbiolo, Paolo Nucci
PURPOSE OF REVIEW: To provide an overview of the pathogenic mechanisms underlying the correlation between ocular allergy and dry eye disease (DED), highlighting how the first condition may be a risk factor for the second one. RECENT FINDINGS: Recent advances in our comprehension of the pathogenesis of ocular allergy and DED allow identifying several pathways of interaction between these two conditions. A growing body of evidence supports the role of ocular allergy as a risk factor for DED...
October 2018: Current Opinion in Allergy and Clinical Immunology
Emek Kocatürk, Torsten Zuberbier
PURPOSE OF REVIEW: Symptomatic management of chronic spontaneous urticaria (CSU) basically depends on second-generation H1 antihistamines and omalizumab. Omalizumab is a game changer in the management, but still there is a need for new targets and new biologics targeting new pathways in the treatment which will provide long-lasting remission, which will be given orally and which will be cheaper. This review will focus on new biologics that are underway of production or are already under use for different disorders but could be beneficial for the treatment of Chronic urticaria...
October 2018: Current Opinion in Allergy and Clinical Immunology
Xiaoli Meng, Daniel Yerly, Dean J Naisbitt
PURPOSE OF REVIEW: Delayed-type or nonimmediate drug hypersensitivity reactions often involve the activation of drug-specific T cells. As such, the molecular initiating event is an interaction between HLA proteins, HLA-binding peptides and the drug. For many years, the formation of covalently modified drug protein adducts was assumed to be a prerequisite for T-cell activation. The purpose of this article is to review recent studies using human PBMC, T-cell lines and clones, which show that drugs are in fact loaded onto HLA molecules in different forms to activate T cells...
August 2018: Current Opinion in Allergy and Clinical Immunology
Sowmya Nagarajan, Paul Whitaker
PURPOSE OF REVIEW: Tuberculosis (TB) is the commonest infectious cause of death globally. Adverse reactions to first-line tuberculosis antibiotics are common and have a major impact on the outcomes of patients as second-line antibiotics are less effective and more toxic. The present review addresses the most recent literature regarding epidemiology, investigating reactions, and reintroducing treatment in patients who have had their treatment interrupted. RECENT FINDINGS: Studies have demonstrated that up to 60% of patients experience adverse reactions to TB treatment; around a third of these are idiosyncratic and may relate to immune sensitization...
August 2018: Current Opinion in Allergy and Clinical Immunology
Joan Bartra, Giovanna Araujo, Rosa Muñoz-Cano
PURPOSE OF REVIEW: To assess the studies that focus on the study of food-dependent exercise-induced anaphylaxis (FDEIA) and food-dependent NSAID-induced anaphylaxis (FDNIA). RECENT FINDINGS: Cofactors, as exercise and nonsteroidal anti-inflammatory drugs (NSAIDs), are relevant in up to 30% of episodes of anaphylaxis. Gliadin and lipid transfer proteins are the main allergens involved. The attempts to reproduce FDEIA and FDNIA in a controlled setting have an important failure rate...
August 2018: Current Opinion in Allergy and Clinical Immunology
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