Showing papers in "Current Opinion in Allergy and Clinical Immunology in 2016"
TL;DR: Human eosinophils were first identified and named by Paul Ehrlich in 1879 on the basis of the cell's granular uptake of Eosin this paper.
Abstract: Purpose of reviewHuman eosinophils were first identified and named by Paul Ehrlich in 1879 on the basis of the cell's granular uptake of eosin. Although eosinophils represent approximately 1% of peripheral blood leukocytes, they have the propensity to leave the blood stream and migrate into inflamed
143 citations
Journal Article•
TL;DR: Overall, targeting interleukin-5/interleuk in-5R&agr; is associated with a marked decrease in blood and sputum eosinophilia, the number of exacerbations and improvement of some clinical parameters in adult patients with severe eOSinophilic asthma.
122 citations
TL;DR: Until global emissions continue to rise, adaptation to the impacts of future climate variability will also be required, and measures of mitigation need to be applied for reducing future impacts of climate change.
Abstract: Purpose of reviewThe rising trend in prevalence of allergic respiratory disease and bronchial asthma, observed over the last decades, can be explained by changes occurring in the environment, with increasing presence of biologic, such as allergens, and chemical atmospheric trigger factors able to st
78 citations
TL;DR: Atopy and asthma appear to have their roots in an insufficiency of early-life exposure to the diverse environmental microbiota necessary to ensure colonization of the gastrointestinal and/or respiratory tracts with the commensal microbes necessary for induction of balanced, toleragenic immune function.
Abstract: Purpose of reviewFirst, to review how the global rise in prevalence of asthma prompted studies of the relationships between microbial exposure in early infancy, the rate and pattern of development of immune function, and the development of allergic sensitization and of wheezing in childhood. And, se
75 citations
TL;DR: This article presents recent findings and perspectives on the relationship between early-life respiratory infections and asthma inception, and discusses emerging concepts on strategies that target these infectious agents for asthma prevention.
Abstract: Purpose of review This article presents recent findings and perspectives on the relationship between early-life respiratory infections and asthma inception, and discusses emerging concepts on strategies that target these infectious agents for asthma prevention. Recent findings Cumulative evidence supports the role of early-life viral infections, especially respiratory syncytial virus and human rhinovirus, as major antecedents of childhood asthma. These viruses may have different mechanistic roles in the pathogenesis of asthma. The airway microbiome and virus-bacteria interactions in early life have emerged as additional determinants of childhood asthma. Innovative strategies for the prevention of these early-life infections, or for attenuation of acute infection severity, are being investigated and may identify effective strategies for the primary and secondary prevention of childhood asthma. Summary Early-life infections are major determinants of asthma development. The pathway from early-life infections to asthma is the result of complex interactions between the specific type of the virus, genetic, and environmental factors. Novel intervention strategies that target these infectious agents have been investigated in proof-of-concepts trials, and further study is necessary to determine their capacity for asthma prevention.
70 citations
TL;DR: There is further evidence that a disturbed gut microbiota influences the propensity to develop allergic manifestations, and that changing the gut microbiota by dietary means (high fiber/acetate or prebiotics) in pregnancy may reduce the risk of allergic airways disease and food allergy in the offspring, respectively.
Abstract: Purpose of review The purpose is to review recent studies examining the role of gut microbiota in allergic diseases and asthmaRecent findings Work in experimental models gives further evidence tha
67 citations
TL;DR: In asthma patients with frequent exacerbations, the addition of a biologic agent targeting the interleukin-5 pathway, or immunoglobulin E, can significantly reduce exacerbations and improve asthma control.
Abstract: Purpose of reviewCurrent asthma management relies on inhaled corticosteroids, but some asthma is not well controlled with inhaled steroids alone or in combination with long-acting bronchodilators or leukotriene pathway inhibitors. The field of biologic therapy has grown dramatically in the past two
61 citations
TL;DR: Though food allergyQoL has emerged as a recognized outcome, more is needed to enhance life with disease, and the field lacks specific tools beyond potential therapies to target and help repair poor QoL in patients and their caregivers.
Abstract: Purpose of reviewFood allergy quality of life (QoL) has emerged as a key outcome to understand how food-allergic individuals and their families live with disease. Food allergy QoL has been measured since the early 2000's, but in the past 10–12 years, the advent of disease-specific indices has better
60 citations
TL;DR: Steroid resistant severe asthma with predominant bronchial neutrophilic inflammation could benefit from IL-17 targeted therapies and the definition of clinical phenotypes and inflammatory endotypes of asthma in each patient will be necessary for personalizing the therapeutic approach.
Abstract: Purpose of reviewTh17 lymphocytes are now widely believed to be critical for the regulation of various chronic immune diseases, including asthma and chronic obstructive pulmonary disease. In this review, we discuss the current understanding of the role of Th17 cells in the pathogenesis of different
58 citations
TL;DR: It is revealed that neutrophil recruitment is important in the development of allergic sensitization and inflammation, and inhibition of neutrophils recruitment may be a strategy to control allergic inflammation.
Abstract: Purpose of review
To discuss the presence and role of neutrophils in asthma and allergic diseases, and outline importance of pollen and cat dander-induced innate neutrophil recruitment in induction of allergic sensitization and allergic inflammation.
57 citations
TL;DR: It is proposed that maternal milk composition has not adapted to the needs of allergy prevention because of the recent and rapid increase of allergy.
Abstract: Purpose of reviewAllergy is a modern disease which does not seem to benefit from breast milk preventive effects. We propose that maternal milk composition has not adapted to the needs of allergy prevention because of the recent and rapid increase of allergy. Modulation of breast milk composition may
TL;DR: An improved ability to accurately gather and analyse population-level anaphylaxis data in a harmonized fashion is required, so as to ultimately minimize risk and improve management.
Abstract: PURPOSE OF REVIEW The observed increase in incidence of allergic disease in many regions over the past 3 decades has intensified interest in understanding the epidemiology of severe allergic reactions. We discuss the issues in collecting and interpreting these data and highlight current deficiencies in the current methods of data gathering. RECENT FINDINGS Anaphylaxis, as measured by hospital admission rates, is not uncommon and has increased in the United Kingdom, the United States, Canada, and Australia over the last 10-20 years. All large datasets are hampered by a large proportion of uncoded, 'unspecified' causes of anaphylaxis. Fatal anaphylaxis remains a rare event, but appears to be increasing for medication in Australia, Canada, and the United States. The rate of fatal food anaphylaxis is stable in the United Kingdom and the United States, but has increased in Australia. The age distribution for fatal food anaphylaxis is different to other causes, with data suggesting an age-related predisposition to fatal outcomes in teenagers and adults to the fourth decade of life. SUMMARY The increasing rates of food and medication allergy (the latter exacerbated by an ageing population) has significant implications for future fatality trends. An improved ability to accurately gather and analyse population-level anaphylaxis data in a harmonized fashion is required, so as to ultimately minimize risk and improve management.
TL;DR: Given the relative rarity of life-threatening biphasic anaphylaxis and the new context of the NIAID/FAAN standardized definition, further research is needed to better elucidate the care model for anaphlyaxis patients with a focus on prevention of bipwasic reactions.
Abstract: Purpose of reviewBiphasic anaphylaxis is a well documented complication of anaphylaxis, but it has been inconsistently defined in the literature. Analysis of contemporary studies of biphasic anaphylaxis based on modern definitions is needed.Recent findingsThe rate of biphasic reactions in contempora
TL;DR: Evidence of a causal effect of chronic workplace irritant exposure in new-onset asthma remains limited, mainly because of a lack of longitudinal studies and the difficulty to evaluate irritant exposures, but recent epidemiological studies strengthen the evidence of an effect of Chronic exposure to irritants in work-related asthma.
Abstract: The present review summarizes the recent literature on the relation between chronic workplace irritant exposures and asthma, focusing on exposures of low to moderate levels. We discuss results from epidemiological surveys, potential biological mechanisms, and needs for further research. These aspects are largely illustrated by studies on exposure to cleaning products. Recent results from nine population-based and workplace-based epidemiological studies, mostly cross-sectional, found an increased risk of both new-onset and work-exacerbated asthma among participants exposed to moderate level of irritants and/or cleaning products. Evidence of a causal effect of chronic workplace irritant exposure in new-onset asthma remains limited, mainly because of a lack of longitudinal studies and the difficulty to evaluate irritant exposures. However, recent epidemiological studies strengthen the evidence of an effect of chronic exposure to irritants in work-related asthma. The underlying mechanism remains unknown but may be related to oxidative stress, neurogenic inflammation and dual irritant and adjuvant effects. However, disentangling chronic irritant effects from either acute irritant-induced asthma or immunological low molecular weight agent-induced asthma is difficult for some agents. Further research is needed to improve assessment of irritant exposures and identify biomarkers.
TL;DR: Supplementing studies of allergic skin diseases with ‘-omics’ approaches are transforming the pathogenic understanding, diagnosis and, perhaps, also the treatment of these diseases.
Abstract: Purpose of review To evaluate how the genomic, transcriptomic, and proteomic profiles of allergic skin diseases, like atopic dermatitis and allergic contact dermatitis, contribute to their understanding and promote their therapeutic development. Recent findings The '-omics' revolution has facilitated the quantification of inflammatory skin diseases at the molecular level, expanding our understanding of disease pathogenesis. It has also greatly expanded once-limited treatment options and improved the ability to define posttreatment improvements, beyond clinical scores. The findings on the genomic/transcriptomic level are also complemented by proteomic data, contributing to the understanding of the later changes taking place in the final stages of protein formation. Atopic dermatitis is defined as a Th2/Th22 polarized disease with some contributions of Th17 and Th1 pathways. In atopic dermatitis, studies of biologics and small molecules, targeting specific pathways upregulated in atopic dermatitis, seem to provide well tolerated alternatives to conventional immunosuppressive therapies (i.e. corticosteroids and cyclosporine A), particularly for severe patients. Allergic contact dermatitis is defined as having Th1/Th17-centered inflammation, especially with nickel-induced disease, but additional pathways, including Th2 and Th22, are upregulated with other allergens (i.e. fragrance). Summary Supplementing studies of allergic skin diseases with '-omics' approaches are transforming the pathogenic understanding, diagnosis and, perhaps, also the treatment of these diseases.
TL;DR: Ocular allergy involving specific modifiable and treatable environmental sensitizations is common and often underrecognized and can impair quality of life to varying degrees.
Abstract: Purpose of reviewThe update reviews prevalence, classification, cause, and treatment options for allergic eye disease.Recent findingsThe incidence of allergic eye disease is underreported but may affect almost all patients with allergic rhinitis. Increased rates of oculonasal symptoms have been repo
TL;DR: A more detailed understanding of the interaction between natural, environmental biodiversity, and health is still lacking, which calls for new innovative and more long-term investigations.
Abstract: Purpose of review It has been proposed that biodiversity loss leads to reduced interaction between environmental and human microbiotas. This, in turn, may lead to immune dysfunction and impaired tolerance mechanisms in humans. That is, contact with environmental biodiversity is expected to protect from allergies. However, direct evidence linking contact with biodiversity and risk of allergy has been lacking. In this review, we consider the latest research on the biodiversity hypothesis of allergy. Recent findings It is becoming clear that what you eat, drink, inhale, and touch all contribute to the grand scheme of host-microbial crosstalk that is needed for a balanced, healthy immune system to develop and maintain a healthy recognition between harmful and harmless invasions. Microbes can either communicate directly with host immune cells or affect the host via metabolism that can even lead to epigenetic modifications. Our living environment plays a key role in this process. Although especially, early exposure to diverse, beneficial microbiota from the environment is repeatedly found crucial, studies on immigrants demonstrate that condition in later life can also be decisive. Conclusion We are still lacking a more detailed understanding of the interaction between natural, environmental biodiversity, and health, which calls for new innovative and more long-term investigations. The outcomes should be utilized in policy and urban planning efforts, promoting human interaction with natural biodiversity, and supporting a healthy lifestyle.
TL;DR: Scombroid syndrome is a Histamine-induced reaction because of the ingestion of histamine-contaminated fish, whereas fish allergy is an IgE-mediated reaction.
Abstract: Purpose of reviewScombroid poisoning is a frequent cause of admission in emergency department. In everyday clinical practice, it can be difficult to discriminate between scombroid syndrome and fish allergy. The aim of this review is to provide the clinician some instruments to make a correct differe
TL;DR: A diverse range of exposures were associated with allergic disease risk, highlighting the susceptibility of children during the perinatal period and Clinicians should reinforce public health messages concerning maternal obesity, smoking, and breastfeeding.
Abstract: Purpose of reviewExposures during the perinatal period, a phase of rapid development, may have a profound and sustained effect on disease risk. In particular, perinatal exposures may influence the development and maturation of the infant immune system and the risk of allergic disease. We aimed to su
TL;DR: There are multiple risk factors for allopurinol-induced SCARs, including genetic and nongenetic factors, and a structurally different new generation xanthine oxidase inhibitor can provide a safer alternative for patients intolerant to allopURinol.
Abstract: Purpose of reviewThe article reviews the immunopathogenesis and risk factors related to allopurinol-induced severe cutaneous adverse reactions (SCARs).Recent findingsFor years, allopurinol remains one of the leading cause for SCARs worldwide. The pathogenesis of allopurinol-induced SCARs have been d
TL;DR: Latex is an excellent model for component-resolved diagnosis and demonstrates well how to improve the diagnosis by using single allergens, but single wheat allergens might help to discriminate between wheat-induced food allergy, grass-pollen allergy, and baker's asthma.
Abstract: Purpose of reviewRapid developments have been seen in molecular allergy diagnosis, based on the detection and quantification of specific IgE to single allergens. This review summarizes and discusses studies on allergen component analysis as a tool in the diagnosis of occupational allergy.Recent find
TL;DR: Multifactorial assessments, including comorbidities, treatment adherence, and polypharmacy, are important for better asthma control in elderly asthmatic patients.
Abstract: Purpose of reviewWe are in the era of rapid aging of the global population. Elderly asthmatic patients have an increased frequency of hospitalization and a high mortality rate. In this review, we focus on comorbidities and treatment issues in terms of the predictors of asthma control in the elderly.
TL;DR: Ligands for Siglec-8 and SigleC-9 may regulate the function of eosinophils, mast cells, neutrophils, and other cells in sinus mucosa and dampen inflammation and disease in CRS patients.
Abstract: Purpose of review Inflammatory cells involved in the allergic response, including eosinophils, mast cells, basophils, and neutrophils, express sialoglycan-binding proteins such as Siglec-8 and Siglec-9, which inhibit cell function and survival. The purpose of this review is to briefly discuss the biology of these siglecs and their ligands and consider their potential impact in pathology and treatment of chronic rhinosinusitis (CRS). Recent findings Recent studies demonstrate the presence of ligands for Siglec-8 and Siglec-9 in sinonasal tissue from patients with CRS as well as healthy patients, suggesting that the immunoregulatory functions of siglecs may be triggered in sinus tissue in health and disease. Summary Ligands for Siglec-8 and Siglec-9 may regulate the function of eosinophils, mast cells, neutrophils, and other cells in sinus mucosa. Therapeutic strategies that activate the anti-inflammatory effects of siglecs may dampen inflammation and disease in CRS patients.
TL;DR: Using the right device with appropriate needle length based on BMI, obesity, and employing the proper technique can improve the outcome in an anaphylactic event.
Abstract: Purpose of reviewThe purpose of this manuscript is to review the literature on the clinical effects of the needle length of epinephrine (adrenaline) auto-injectors.Recent findingsEpinephrine has maximal pharmacodynamic effect within 10 min of intramuscular administration into the thigh. Prefilled ep
TL;DR: The effects of air pollutants on upper airway disease has hitherto received little attention, but increasing evidence suggests that particulate matter, photochemical pollutants, and ozone are associated with such conditions.
Abstract: Purpose of reviewWe discuss the effects of air pollutants on upper airway disease; the topic has hitherto received little attention.Recent findingsSeveral epidemiological studies have shown that air pollutants aggravate airway diseases including asthma, bronchitis, and chronic obstructive pulmonary
TL;DR: Programs that simplify guidelines, provide decision support tools and use electronic technologies and an expanded medical team may improve the quality of asthma care provided by the primary care community to children and their families with asthma.
Abstract: Purpose of reviewThis article reviews new approaches, facilitators, barriers, and opportunities to increasing guideline-adherent care for children with asthma by primary care clinicians.Recent findingsPrimary care clinicians are challenged by the volume of guidelines and want transparent guidelines
TL;DR: This review describes the literature over the past 18 months that evaluated childhood asthma phenotypes, highlighting the key aspects of these studies, and comparing these studies to previous ones in this area.
Abstract: Purpose of reviewThis review describes the literature over the past 18 months that evaluated childhood asthma phenotypes, highlighting the key aspects of these studies, and comparing these studies to previous ones in this area.Recent findingsRecent studies on asthma phenotypes have identified new ph
TL;DR: Oxidative DNA damage repair-mediated cell activation signaling result in gene expression that ‘primes’ the mucosal epithelium and submucosal tissues to generate mediators of airway smooth muscle contractions.
Abstract: Purpose of reviewTo provide an overview on the present understanding of roles of oxidative DNA damage repair in cell signaling underlying bronchoconstriction common to, but not restricted to various forms of asthma and chronic obstructive pulmonary disease.Recent findingsBronchoconstriction is a tig
TL;DR: Widespread uptake of dendritic cell/monocyte screening in clinical practice will facilitate the discovery of novel d endritic cell and monocyte disorders as well as advancing the understanding of human dendrite cell biology in health and disease.
Abstract: Purpose of review Dendritic cells are specialized antigen-presenting cells which link innate and adaptive immunity, through recognition and presentation of antigen to T cells. Although the importance of dendritic cells has been demonstrated in many animal models, their contribution to human immunity remains relatively unexplored in vivo.Given their central role in infection, autoimmunity, and malignancy, dendritic cell deficiency or dysfunction would be expected to have clinical consequences. Recent findings Human dendritic cell deficiency disorders, related to GATA binding protein 2 (GATA2) and interferon regulatory factor 8 (IRF8) mutations, have highlighted the importance of dendritic cells and monocytes in primary immunodeficiency diseases and begun to shed light on their nonredundant roles in host defense and immune regulation in vivo. The contribution of dendritic cell and monocyte dysfunction to the pathogenesis of primary immunodeficiency disease phenotypes is becoming increasingly apparent. However, dendritic cell analysis is not yet a routine part of primary immunodeficiency disease workup. Summary Widespread uptake of dendritic cell/monocyte screening in clinical practice will facilitate the discovery of novel dendritic cell and monocyte disorders as well as advancing our understanding of human dendritic cell biology in health and disease.
TL;DR: The underlying mechanisms of accelerated allergic reactions to drugs, defined here as reactions occurring between 1 and 24 h after drug intake, are understood to be T cell-mediated, although an IgE mechanism cannot be ruled out in some cases.
Abstract: Purpose of review The purpose is to understand the underlying mechanisms of accelerated allergic reactions to drugs, defined here as reactions occurring between 1 and 24 h after drug intake. Recent findings Recent publications have shown that accelerated reactions are T cell-mediated, although an IgE mechanism cannot be ruled out in some cases. Summary Classification of allergic reactions to drugs is complex. Based on the time interval between drug administration and appearance of the clinical reaction, as well as the type of clinical symptoms, they can be classified as: immediate, typically appearing from less than 1 to 6 h after the last drug administration and nonimmediate, occurring at any time from 1 h after drug administration. Therefore, overlap exists in what the Levine classification defined as accelerated reactions, where clinical symptoms are mainly urticaria and less often exanthema and serum sickness-like reactions. The immunological mechanisms involved suggest that they are T cell-mediated reactions with a Th1 pattern, comprising increased production of IFNγ, TNFα, the chemokine CXCL9 and its corresponding receptor CXCR3. In most cases an IgE-mediated response is ruled out because of negative immediate skin test results, no detection of serum-specific IgE antibodies or tryptase, and no skin-secreted tryptase. However, an IgE-mediated response can be demonstrated in exceptional situations. Finally, serum sickness-like reactions have been reported as an immune complex-mediated accelerated reaction. However, the exact mechanism has not been confirmed.