Prize‐winning abstracts from BSACI/WAO 2022 meeting

Abstract

The British Society of Allergy and Clinical Immunology (BSACI) annual conference was held at the Edinburgh International Conference, Edinburgh, UK, from 25th to 27th April 2022, and was a great success, with nearly 900 members attending the event in person. This year, the Barry Kay Award was awarded for the best abstracts in the Basic Science, Adult Allergy, Paediatric Allergy, Primary Care, Allied Health and Allergy Education categories. The award recognizes Professor Kay's national and international research contributions to the field of allergy and asthma and his inspiration for so many young Allergists and Chest Physicians. Here, we have asked the award recipients (Figure 1) to summarize their research findings. Adult Clinical category winner: Veronica Varney, Immunology and respiratory, Surry, UK. IgE-mediated systemic anaphylaxis and its association with gene polymorphisms of ACE, Angiotensinogen, renin, chymase and angiotensin-1 receptor. IgE-mediated anaphylaxis can result in clinical symptoms from rash to profound hypotension with circulatory collapse. The severity of these reactions cannot be predicted from the IgE levels alone or the allergen involved. Animal studies show histamine drives many different mediators that ultimately activate endothelial nitric oxide (eNO) as the final common pathway, with the blockade of eNO preventing shock and death in anaphylaxis. In man, angiotensin II competes with eNO on the vascular endothelium reducing its activity linked to cardiovascular disease. Our study examined six gene polymorphisms (ACE, renin, angiotensinogen, chymase, Angiotensin II-receptor-1 and bradykinin B2 receptor) in healthy controls, atopics and patients with anaphylaxis. Our findings showed that atopics, healthy controls and patients with non-life-threatening allergic reactions had gene polymorphisms consistent with increased activity of angiotensin II. Patients with life-threatening anaphylaxis involving airway angioedema and cardiovascular collapse had gene polymorphisms for low AII activity that could encourage higher eNO activity and shock in anaphylaxis. Single gene analysis, bi-allelic and tri-allelic ensembles of these genes confirmed highly significant differences in gene frequency between these groups. This may offer further understanding of AII and eNO effects on microcirculation in anaphylaxis. Paediatric Clinical category winners: Dhanis Lad, Infant research centre, Cork, Ireland. Evaluating the role of early short-term moisturization from birth on the rate of Atopic Dermatitis at 12 months in a high-risk cohort. Recently, the spotlight has been on the potential role of emollients in infancy for atopic dermatitis (AD) prevention. We have shown previously that trans-epidermal water loss increases from birth to 2 months and stabilizes thereafter, suggesting a feasible intervention window while targeting a critical period of skin maturation. The Short-term Topical Application to Prevent Atopic Dermatitis study aimed to investigate if daily emollient use in this window would reduce the incidence of AD in high-risk infants. We found that daily emollient use initiated in the first week of life until 2 months was associated with a 50% and 29% reduction in the risk of the cumulative incidence of AD at 6 and 12 months, respectively. Our findings are at variance with two large RCTs, where no evidence of a protective effect of emollient use in the first year against AD was found. Among the most notable differences was our infants beginning treatment within days of birth during a dynamic period of skin maturation. The mechanisms behind this are unclear, but ongoing analysis of biomarkers and microbiome diversity may provide further information. Future studies should examine the use of complex emollients while identifying an effective treatment window acceptable to parents. Jack Pepys, National Heart and Lung Institute, Imperial College London, London, UK. Exposure to endotoxin modifies the risk of asthma in children with risk variants in the 17q21 locus. Analysing data from the Manchester Asthma and Allergy birth cohort study (MAAS), we found that endotoxin exposure differently affects the risk of childhood asthma depending on the 17q21 genotype. rs721638 is an SNP located in an intron of the GSDMB gene, which is consistently associated with childhood-onset asthma. However, recent data suggest that the risk allele (T) in rs7216389 is associated with asthma only among individuals with a low immune response after innate endotoxin stimulation. In the MAAS, children were genotyped, and endotoxin content was measured in their house dust samples. We used the genotype of 894 children, 130 of whom were diagnosed with asthma. We found that endotoxin exposure significantly modified the association between rs7216389 and asthma, in that among risk (T) allele carriers, the risk decreased with increasing exposure, with the opposite effect of endotoxin exposure among C-allele homozygotes (p int = 0.05). This indicates that, contrary to the hygiene hypothesis, high endotoxin exposure reduces the risk of preschool asthma only in risk (T) allele carriers of rs7216389 in GSDMB but may be detrimental in C-allele homozygotes. Basic Science category winner: Robert Ryan, Aimmune Therapeutics, London, UK. Mechanisms of Immune Responses and Relationship to Clinical Reactivity During Oral Immunotherapy with Peanut (Arachis hypogaea) Allergen Powder-dnfp: Findings from the Phase 3 PALISADE Trial. Current evidence shows that oral immunotherapy (OIT) with peanut (Arachis hypogaea) allergen powder-dnfp (PTAH; Palforzia®) leads to successful desensitization in children and adolescents with peanut allergy. The exact immune mechanism that underpins PTAH OIT remains unknown. This work by Bajzik et al., led by Dr Wambre, demonstrates the mechanisms underlying immune responses in participants undergoing OIT with PTAH or matched placebo during the Phase 3 PALISADE Study. Assessing the blood samples of participants at entry screening and at multiple time-points of the trial found: (a) a direct correlation between the participants' absence of clinical reactivity at entry food challenge with a significantly lower basophil sensitivity and T cell reactivity compared with the participants who had reactions; (b) peanut-reactive TH2A cells were found in many participants, their levels correlating with T cell reactivity to peanut, and serum psIgE and IgG4 levels; (c) no difference observed in peanut-reactive Treg cell frequency; (d) changes in basophil and T cell responses closely paralleled clinical benefits of PTAH, resembling those with lower clinical sensitivity to peanut. The complete results from the study were recently accepted from publication. These data offer insight into the PTAH-induced mechanism of immune response that leads to desensitization in participants with peanut allergy. Allied Health category winner: Holly Tallentire, University of Surrey, Guildford, UK. Preliminary findings for the effect of group cognitive behavioural therapy in parents, adults and children with food allergy. The impairment of food allergy (FA) on psychological well-being is well documented. Despite this, psychological interventions for people affected by FA are relatively sparse. Holly Tallentire and her colleagues Gina Sherlock and Rebecca Edgecumbe conducted three randomized controlled trials that assessed the feasibility and efficacy of brief group CBT for parents, adults and children (aged 11–17 years) with FA. All participants were recruited through third-sector organizations and social media and were randomized to receive an online group CBT workshop or treatment. All trials measured FA quality of life (relevant FAQLQ for specific population) and worry (Penn State Worry Questionnaire) at baseline, 1- and 3-month post-intervention. A total of 129 participants (n = 33 parents, n = 44 adults and n = 52 children) were recruited and randomized to the intervention or control groups, and 100 (n = 26 parents, n = 40 adults and n = 34 children) were retained at the 1-month follow-up. Group CBT reduced impairment in FAQLQ in all populations and reduced levels of worry in the parent group. This study provides encouraging findings regarding the feasibility of brief, online, group CBT in terms of recruitment and retention and a preliminary short-term signal of efficacy on FA quality of life. Primary Care category winner: Lisa Waddell, Nottingham CityCare Partnership, Nottingham, UK. Impact of community dietetic leadership in paediatric food allergy on the burden of care for both primary care and families: A service evaluation comparison. Food allergy is common in young children, and symptoms overlap with other gastrointestinal conditions and atopic eczema, impacting GP workload. There is concern about overdiagnosis of cow's milk allergy (CMA), and GPs generally receive little training in allergy, nutrition and paediatrics. Over the last 15 years, the community dietetic-led service has been training children's public health nurses (0–19 team) on the management of colic, reflux, constipation and taking an allergy focussed history when a food allergy is suspected. The 0–19 team instigated 4-week cow's milk exclusion trials, reintroduction and subsequent referral to a dietitian, supported by local CMA guidelines. A service evaluation comparison with a more traditional model of GP referral highlighted that 78% of children referred to the dietetic-led service were under 6 months of age, compared to 40% in the community service, where 34% were over 1 year. Patient contacts with GPs prior to referral was three vs six visits, and input from secondary care was also lower (8 vs. 25 patients) in dietetic-led vs. community services, respectively. Dietetic-led joint working with the 0–19 team can relieve the burden of care of food allergies on primary care and free up secondary care to focus on more severe allergic conditions. Allergy Education category winner: Dr Minal Gandhi, Royal Free Hospital, London, UK. Food Matters: Raising food allergy awareness. Anxiety and confusion about food allergy awareness exist among staff working in healthcare settings, as increasing numbers of children and young people (CYP) with co-existing food allergies present in the hospital. Raising food allergy awareness to improve the safety of these CYP is an educational priority, and no local or national universal training programmes exist. To facilitate face-to-face microteach sessions in busy clinical areas, quality improvement methodology was used to develop a quick, simple and effective universal structured training toolkit, incorporating material from the Natasha Allergy Research Foundation. Housekeepers, ward administrators, nurses, school team, play therapists, physician assistants and doctors participated (n = 72). Confidence and knowledge of the targeted learning objectives improved pre- and post-teaching, respectively; food allergens and labelling laws (61.1%–96.7%), knowledge about when and how food allergies present (40.8%–83.8%), appropriate use of Adrenaline autoinjectors (52.8%–95.1%). Staff confidence in providing appropriate food to a child improved (40.8%–78.9%), and more CYP felt safe eating the food provided (60%–100%). This toolkit can be adopted and cascaded for delivery within healthcare teams with support from any professional familiar with food allergy awareness.