Showing papers in "Current Opinion in Allergy and Clinical Immunology in 2005"
TL;DR: This review summarizes current knowledge on the incidence, prevalence, mortality and risk factors for hypersensitivity drug reactions in different populations.
Abstract: Purpose of review Hypersensitivity drug reactions are but one of the many different types of adverse drug reactions. They may be potentially life-threatening, prolong hospitalization, affect drug prescribing patterns of physicians and result in socioeconomic costs. This review summarizes current knowledge on the incidence, prevalence, mortality and risk factors for these reactions in different populations. Recent findings Hypersensitivity reactions represent about one third of all adverse drug reactions. Adverse drug reactions affect 10-20% of hospitalized patients and more than 7% of the general population. Severe reactions including anaphylaxis, drug hypersensitivity syndromes, Stevens Johnson syndrome and toxic epidermal necrolysis are also associated with significant morbidity and mortality. Although several risk factors have been identified, their clinical importance has not been fully understood. Future progress in immunogenetics and pharmacogenetics may help identify populations at risk for specific types of reactions. Summary Well designed epidemiological studies on hypersensitivity drug reactions are lacking as most studies have been on adverse drug reactions. Such studies will be helpful in identifying patients at risk of developing such reactions, in particular severe reactions, and implementing early preventive measures.
383 citations
TL;DR: Examination of other mechanisms (e.g. oxidative stress pathways, glucocorticoid resistance, nerve–mast cell interactions, intestinal dysbiosis) and a broader range of cytokines and neuropeptides produced by cells both within and outside the immune system may better delineate the true complexity of the underlying mechanisms linking stress to allergic sensitization and asthma.
Abstract: Summary Psychological stress may be conceptualized as a social pollutant that, when ‘breathed’ into the body, may disrupt biological systems related to inflammation through mechanisms potentially overlapping with those altered by physical pollutants and toxicants.
345 citations
TL;DR: An enhanced Th2 immune response and the elaboration of cytokines such as IL-4, IL-13, and IL-5 contribute to the induction of allergy and asthma.
Abstract: Purpose of reviewThis review examines recent articles on the relationship of cytokines to allergy and asthma with particular emphasis on immune mechanisms involved in disease development in early life.Recent findingsIt was previously proposed that reduced microbial exposure in early life is responsi
331 citations
TL;DR: Current evidence supports use of the supine/Trendelenburg position, epinephrine by intravenous infusion and aggressive volume resuscitation, and serial measurements of mast cell tryptase may be preferable to a single measurement for the diagnosis of anaphylaxis.
Abstract: Purpose of reviewAnaphylactic cardiovascular collapse can be resistant to treatment with epinephrine (adrenaline) and, in some cases, diagnostic uncertainty compromises follow-up care. The purpose of this review is to examine recent studies relevant to the management and diagnosis of this condition.
156 citations
TL;DR: The prevalence of asthma and allergic diseases is increasing progressively and those who are involved in the care of young children should be prepared to recognize risk factors for development of these diseases and to appreciate the role of gene–environment interactions.
Abstract: Purpose of reviewThe aim of this article is to provide information on risk factors associated with the development of atopy and asthma in childhood.Recent findingsSeveral gene polymorphisms have been associated with susceptibility to asthma and allergy; complex gene–environmental interactions, howev
149 citations
TL;DR: The experience of the last several years shows that allergic hypersensitivity symptoms in gastroallergic anisakiasis are clinical events accompanying a wide range of immunologic reactions as a host response against a ubiquitous parasite.
Abstract: Purpose of reviewWhereas gastric anisakiasis has been known for several decades, the implications of Anisakis simplex-related allergic disorders had not been thoroughly studied until the late 1990s. This article reviews recent knowledge of allergic disorders ascribed to A. simplex contact or parasit
128 citations
TL;DR: The knowledge about the highly prevalent phenomenon of oral allergy syndrome is still incomplete, in respect to both, epidemiology and foods inducing symptoms, and it is very important to reach consensus on several aspects of this food-induced allergic disease.
Abstract: PURPOSE OF REVIEW The aim of this article is to review recent clinical and molecular findings related to the oral allergy syndrome in order to define its relevance in the field of food allergy, describe current diagnostic approaches and discuss attempts to use specific immunotherapy for treatment. RECENT FINDINGS New allergenic sources causing the oral allergy syndrome have been reported. Their allergenic molecules have been identified. In most of those studies oral allergy syndrome is reported as a clinical manifestation among more severe ones. Some of the molecules generally considered not to be at risk for severe reactions have been demonstrated to pose a threat for inducing generalized reactions. Some studies tried to assess the usefulness of immunotherapy with birch pollen extract by either subcutaneous or sublingual routes for the treatment of associated food allergies. In most of the cases, a well defined study design and a molecular approach at different study levels are lacking and thus the value of the obtained results is limited. To date, no final conclusion can be drawn on the basis of reported results. SUMMARY The knowledge about the highly prevalent phenomenon of oral allergy syndrome is still incomplete, in respect to both, epidemiology and foods inducing symptoms. It is very important to reach consensus on several aspects of this food-induced allergic disease. Further studies are required to highlight whether immunotherapy using co-recognized inhalant allergens is an effective way of curative treatment, or if co-treatment with purified pollen-related food allergens will be required to obtain a long-lasting effect.
123 citations
TL;DR: The role of the upper airways in the atopic march is examined, finding that many patients with allergic rhinitis have lower airway hyperreactivity or bronchial hyperresponsiveness and the link between upper and lower airways is confirmed.
Abstract: Purpose of reviewThis review examines the role of the upper airways in the atopic march. Evidence examining the theory that allergic rhinitis precedes asthma will be discussed. In addition, the role of allergic rhinitis as an end point in the atopic march will be reviewed.Recent findingsCiprandi and
113 citations
TL;DR: Beekeepers and their family members are at an increased risk of severe sting anaphylaxis and therefore need especially careful instruction with regard to avoidance of re-exposure, emergency treatment and specific immunotherapy with bee venom.
Abstract: Purpose of reviewTo analyze prevalence of allergic sting reactions, including the clinical and diagnostic features as well as management options in a population heavily exposed to honeybee stings such as beekeepers and their family members.Recent findingsThe higher sting frequency is associated with
112 citations
TL;DR: The clinical evidence for corticosteroid resistance in smokers with asthma is summarized, the mechanisms which could be responsible and potential management of this resistance are considered, and alternative or additional therapies are needed for individuals with asthma who are unable to quit smoking.
Abstract: Purpose of reviewCigarette smoking and asthma are associated with poor symptom control and impaired therapeutic responses to corticosteroids. We summarize the clinical evidence for corticosteroid resistance, the mechanisms which could be responsible and potential management of this resistance. We al
105 citations
TL;DR: There is evidence that obesity and overweight are associated with the development of asthma, yet the mechanisms underlying this relation are unclear and several hypotheses have been proposed to explain the epidemiological associations.
Abstract: Purpose of reviewObesity is a major cause of morbidity accounting for approximately 300 000 deaths each year and about 7% of the health care budget with an economic impact greater than US$100 billion annually in the United States. Obesity and its sequelae such as cardiovascular disease, diabetes, ar
TL;DR: An overview of the current status of genetic studies of asthma and atopy using genome screens and association studies that have occurred in the literature since January 2003 is presented.
Abstract: Purpose of reviewThe mapping of complex traits such as asthma and atopy is one of the most important and central areas of human genetics. This article will present an overview of the current status of genetic studies of asthma and atopy using genome screens and association studies that have occurred
TL;DR: Data indicate that R2 is not present in the final conjugate and that recognition by IgE antibodies is mainly directed to the R1 acyl side chain and to the β-lactam fragment that remains linked to the carrier protein in the cephalosporin conjugation process.
Abstract: Purpose of review The aim of this article is to analyze the chemical reactivity of cephalosporins resulting in the epitope responsible for recognition by IgE antibodies and to establish the basis of the allergenicity. Recent findings Increasing evidence supports the role of cephalosporins in IgE hypersensitivity reactions. Third and fourth generation cephalosporins appear to be more involved in specific IgE reactions and often no cross-reactivity with traditional benzyl penicillin determinants exists. In some instances selective responses to unique cephalosporins occur and in others common side-chain similarities exist. Summary Lack of knowledge of the exact chemical structure of cephalosporin antigenic determinants has hindered clinical interpretation of allergic reactions to these drugs and hampered understanding of the specific recognition by IgE molecules of these determinants. Data indicate that R2 is not present in thefinal conjugate and that recognition by IgE antibodies is mainly directed to the R1acyl side chain and to the b-lactam fragment that remains linked to the carrier protein in the cephalosporin conjugation process.
TL;DR: All reports or studies describing allergic, inflammatory or toxic effects related to eyedrops since 2004 are reviewed, with strong evidence that preservative is a major source of toxicity for the ocular surface.
Abstract: Purpose of review To examine recently published papers dealing with drug-induced allergic reactions. As allergy is only one possible mechanism, this review was extended to all reports or studies describing allergic, inflammatory or toxic effects related to eyedrops since 2004. Recent findings These studies were first classified into clinical reports or surveys, experimental works and biological studies showing drug-induced effects on the ocular surface or eyelids. Studies aimed at determining the role of preservatives or comparing preservative-free and preserved eyedrops were further analysed separately. Summary Reports on allergic or toxic reactions of eyedrops are published repeatedly. The reports raising the most important issues are those concerning antiglaucoma drugs. They consistently describe inflammatory reactions at the conjunctival level, with strong evidence that preservative is a major source of toxicity for the ocular surface.
TL;DR: To combine the known aspects of the pathogenesis of common variable immunodeficiency to a conclusive picture, the clinical and immunologic phenotyping of patients needs to be standardized.
Abstract: Purpose of review Common variable immunodeficiency is clinically the most relevant primary immunodeficiency of the adult. Its heterogeneity has hindered progress in the pathogenetic understanding of the majority of common variable immunodeficiency patients. This abstract summarizes recent aspects of the field and emphasizes the need for a commonly accepted approach to classify common variable immunodeficiency. Recent findings In the last 2 years, the first genetic defects underlying common variable immunodeficiency, including ICOS, TACI, BAFF-R and CD19, have been identified. The analysis of dendritic cells demonstrated alterations in a majority of patients in addition to the disturbed T and B-cell function. Several changes of the adaptive immune system might be secondary to an underlying chronic inflammatory setting possibly due to a HHV8 infection in a subgroup of patients with granulomatous disease, autoimmune phenomena and T-cell dysfunction. The occurrence of granulomatous inflammation is associated with a worse prognosis compared with common variable immunodeficiency patients without granuloma. Summary The pathogenesis of common variable immunodeficiency includes disturbances of the adaptive as well as innate immune system. Identified monogenic defects account for about 10% of cases, leaving the majority of defects undefined and certainly in part epigenetic. To combine the known aspects of the pathogenesis of common variable immunodeficiency to a conclusive picture, the clinical and immunologic phenotyping of patients needs to be standardized.
TL;DR: The causes of food allergy are still unknown and no particular genes associated particularly with food allergy have been identified, although there is a strong association in general between genetic susceptibility to food allergy and that to IgE-mediated allergy.
Abstract: Purpose of reviewTo review recent clinical and experimental studies of genetic and environmental risk factors for the development of food allergy.Recent findingsIt may be true, although it is yet to be shown, that food allergies in early childhood are becoming more common and that the causes are the
TL;DR: This review includes a variety of reactions, particularly involving neurological, renal and cardiovascular symptoms, related to insect stings, and it is important to be aware of this relationship when assessing people with these reactions and address future prophylaxis.
Abstract: Purpose of reviewA variety of unusual or unexpected reactions have occurred in a temporal relationship to insect stings. This review will summarize these case history reports in recent years. As these reactions are very infrequent, the review will also include prior reported unusual reactions attrib
TL;DR: In most patients, controlled oral food challenges remain the gold standard in the diagnostic work-up of suspected food allergy and the skin prick test and measurement of specific IgE antibodies to food extracts, individual allergens or allergenic peptides are helpful in the diagnosis.
Abstract: Purpose of reviewThe accurate diagnosis of food allergy is crucial not only for the right treatment but also for the avoidance of unnecessary diets. The diagnostic work-up of suspected food allergy includes the measurement of food-specific IgE antibodies using serologic assays, the skin prick test,
TL;DR: The future is likely to see a concerted effort to further define the role that environmental exposures play in allergic sensitization and the expression of atopic diseases, in order to provide a rational platform on which to develop new methods of allergy prevention that can be targeted at high-risk children.
Abstract: Purpose of reviewAsthma and other atopic disorders are the result of complex interactions between genetic predisposition and multiple environmental influences. However, the marked increase in asthma prevalence over recent decades is unlikely to be due to genetic changes, highlighting the contributio
TL;DR: There are no compelling arguments to decide whether or not thyroid autoimmunity plays a significant role in the pathogenesis of chronic urticaria, and new developments concerning a role for complement activation in the route of pathogenesis may lead to better understanding of this phenomenon in the future.
Abstract: Purpose of reviewAlthough it is generally accepted that thyroid autoimmunity is more prevalent in patients with chronic urticaria than in the general population, the importance of this finding is unclear. In addition, there are reports that chronic urticaria remits in some but not all patients who h
TL;DR: The structural stability and physicochemical properties of plant nonspecific lipid-transfer proteins (nsLTPs) are focused on as keys to their allergenicity and how primary sensitization occurs.
Abstract: Purpose of reviewHere we focus our attention on the structural stability and physicochemical properties of plant nonspecific lipid-transfer proteins (nsLTPs) as keys to their allergenicity. We further present the current opinions on the route of sensitization and include the latest additions to the
TL;DR: Evidence is presented that the increased generation of nitric oxide during rhinovirus infections is associated with fewer symptoms and more rapid viral clearance, and further studies are warranted to evaluate the role ofNitric oxide in colds and to determine whether the administration of Nitric oxide donor compounds could be a viable therapeutic approach for viral exacerbations of airway diseases.
Abstract: Purpose of reviewThe common cold is a clinical syndrome triggered by a variety of viral pathogens, but rhinoviruses are the most frequent cause. Complications of such infections include sinusitis, otitis media, and exacerbations of asthma and chronic obstructive lung disease. There is growing intere
TL;DR: Nonspecific inflammatory responses to bioaerosols, modified by psychosocial factors such as stress, may be a promising area for continued research.
Abstract: Purpose of reviewSick building syndrome is a poorly understood condition that can be vexing to clinicians and public health investigators alike. Concerns about possible causes have recently shifted to bioaerosols, especially indoor mold contamination. Recently, controversy over the health effects of
TL;DR: In this paper, the authors discuss the potential role of shared antigens between parasites and environmental allergens in modulating allergic immune responses, specifically tropomyosin, in the development of asthma.
Abstract: Purpose of review It is estimated that over 1 billion individuals are infected with helminth parasites worldwide. Epidemiologic studies have pointed to a protective role of helminthic infections in the development of allergy and asthma; however, evidence for this inverse association has not been consistently established. The focus of this review is to discuss the potential role of shared antigens between parasites and environmental allergens in modulating allergic immune responses, specifically tropomyosin. Recent findings Tropomyosin has been identified as a highly conserved molecule in invertebrates. In populations exposed concomitantly to mites, cockroach, Ascaris, and shrimp and other crustaceans and mollusks, IgE antibody responses to tropomyosin are found in over 50% of individuals. Evidence suggests that IgE cross-reactivity to tropomyosin has clinical relevance. Summary Mechanisms underlying the immunomodulatory effects of parasites in allergy and asthma remain poorly understood. Identification of molecules in intestinal parasites, particularly Schistosoma mansoni and Ascaris lumbricoides, associated with protection from or promotion of allergy and asthma, could provide the basis for novel forms of treatment or prevention of these diseases. Prospective studies will be necessary to clarify the role of tropomyosin and other parasite antigens shared with inhalant or food allergens in the development of allergic diseases.
TL;DR: The measurement of FENO is evolving to provide a complementary role alongside existing pulmonary function tests, and its role in determining optimum steroid requirements in chronic asthma and to identify steroid responsiveness in chronic obstructive pulmonary disease are two important areas for future research.
Abstract: Purpose of reviewExhaled nitric oxide measurements (FENO) are easy to perform and are repeatable. Given the strong correlations between FENO and bronchial biopsy and induced sputum eosinophilia, as well as airway hyper-responsiveness, FENO may now be advocated as a surrogate for these tests in certa
TL;DR: The effect of histamine on conjunctival H1 receptors appears to be the primary target for ocular allergy treatment as it is primarily involved in ocular pruritus.
Abstract: Purpose of reviewThe purpose of this review is to evaluate the effect of histamine on various receptors in the conjunctiva. A Medline search from 1980 was performed on the histamine receptor subtypes H1, H2 and H3 in the human conjunctiva.Recent findingsIn the conjunctiva, histamine has been shown t
TL;DR: Further longitudinal interventional studies are required, with multiple airway sampling times, to fully elucidate the full potential for corticosteroids to benefit remodelling of the airways in chronic inflammatory diseases.
Abstract: Purpose of the reviewWe have attempted to bring together recent findings, mainly from airway endobronchial biopsies, on the structural changes that constitute ’remodelling’ in airway disease, with a particular focus on asthma. We have tried to put this into the context of classic studies on the asth
TL;DR: Predicting which chemical allergens may selectively induce respiratory sensitization is an important objective, but remains a significant challenge because the understanding of the relevant physicochemical characteristics and biological properties that confer on chemicals respiratory allergenic potential is incomplete.
Abstract: PURPOSE OF REVIEW: In this article we consider the characteristics that are associated with chemical respiratory allergens, and that may be essential for effective sensitization of the respiratory tract. RECENT FINDINGS: Chemical respiratory allergens share some characteristics with other chemical allergens, specifically chemical allergens that cause skin sensitization and allergic contact dermatitis. The unique and defining characteristic of chemical respiratory allergens, which in most instances distinguishes them from contact allergens, is the ability to provoke the preferential development of T helper 2-type immune responses. There are, in addition, other characteristics, such as the ability to increase matrix metalloproteinase expression or to cause perturbation of redox homeostasis, that may in some instances facilitate the induction or expression of respiratory allergy, but it is not yet clear if these attributes are common or essential properties of all chemical respiratory sensitizers. SUMMARY: Predicting which chemical allergens may selectively induce respiratory sensitization is an important objective, but remains a significant challenge because our understanding of the relevant physicochemical characteristics and biological properties that confer on chemicals respiratory allergenic potential is incomplete.
TL;DR: An in-depth understanding of the relevant protective mechanisms against allergic disorders will open the possibility of developing novel therapeutics to prevent the allergic march worldwide.
Abstract: PURPOSE OF REVIEW The observation that allergies are less prevalent in developing countries, especially in rural areas, has stimulated considerable research to identify environmental factors associated with protection against allergic disorders. Here, we review recent studies conducted in developing countries. RECENT FINDINGS Epidemiological studies conducted in South America, Asia and Africa have attempted to identify factors associated with differences in prevalence of atopy, asthma and atopic dermatitis. Particular attention is given to the complex relationship between helminth infections and allergies. In answer to the question of whether helminth infections are associated with protection against allergic disorders, conflicting data have been generated. In addition to epidemiological studies, animal models have been utilized to gain insight into the immunological mechanisms involved in the interaction between helminth infections and allergies. These animal studies are discussed. The possible explanations for discrepancies found within both human and murine studies have been considered, highlighting the need for further research. SUMMARY An in-depth understanding of the relevant protective mechanisms against allergic disorders will open the possibility of developing novel therapeutics to prevent the allergic march worldwide.
TL;DR: T helper subsets Th1 and Th2 in ocular inflammation, activation of T cells in the lymph node, and the role of IFN-γ as the endothelium gatekeeper in the pathology of Th2-mediated allergic conjunctivitis are discussed.
Abstract: Purpose of review The paradigm that diseases are either Th1 mediated or Th2 mediated has recently been challenged in a number of classical ocular diseases. The objective of this article is to highlight the importance of understanding the exact mechanisms of Th1 and Th2 cells in the pathology of ocular allergy. Recent findings Current research of Th1 and Th2 cytokines in an animal model of ocular allergy demonstrates the intricate complex regulation by both subsets of cytokines of the disease process. Th2 prone BALB/c wild type mice sensitized and topically challenged with short ragweed for seven consecutive days (multi-hit) developed a sustained, chronic conjunctival inflammation. Significantly, IFN-gamma knockout mice in the multi-hit antigen challenge model had a reduced conjunctival cellular infiltrate. Evaluation of adhesion molecules that actively regulate cellular infiltration into the conjunctiva revealed a lack of vascular cell adhesion molecule-1 in multi-hit antigen challenged IFN-gamma knockout mice. Summary Recent ocular allergy studies question the Th1/Th2 paradigm. These studies encourage further understanding of the intricate interactions of Th1 and Th2 cytokines in ocular inflammatory disease. The following components of Th1 and Th2 cells in the development of chronic inflammation associated with allergic conjunctivitis will be discussed: T helper subsets Th1 and Th2 in ocular inflammation, activation of T cells in the lymph node, and the role of IFN-gamma as the endothelium gatekeeper in the pathology of Th2-mediated allergic conjunctivitis.