Inhalant Allergy Research Articles

Venom Immunotherapy: From Proteins to Product to Patient Protection.

In this review, we outline and reflect on the important differences between allergen-specific immunotherapy for inhalant allergies (i.e., aeroallergens) and venom-specific immunotherapy (VIT), with a special focus on Venomil® Bee and Wasp. Venomil® is provided as a freeze-dried extract and a diluent to prepare a solution for injection for the treatment of patients with IgE-mediated allergies to bee and/or wasp venom and for evaluating the degree of sensitivity in a skin test. While the materials that make up the product have not changed, the suppliers of raw materials have changed over the years. Here, we consolidate relevant historical safety and efficacy studies that used products from shared manufacture supply profiles, i.e., products from Bayer or Hollister–Stier. We also consider the characterization and standardization of venom marker allergens, providing insights into manufacturing controls that have produced stable and consistent quality profiles over many years. Quality differences between products and their impacts on treatment outcomes have been a current topic of discussion and further research. Finally, we review the considerations surrounding the choice of depot adjuvant most suitable to augmenting VIT.

COVID-19 pandemic and allergen immunotherapy-an EAACI survey.

BackgroundAs in many fields of medical care, the coronavirus disease 2019 (COVID‐19) resulted in an increased uncertainty regarding the safety of allergen immunotherapy (AIT). Therefore, the European Academy of Allergy and Clinical Immunology (EAACI) aimed to analyze the situation in different countries and to systematically collect all information available regarding tolerability and possible amendments in daily practice of sublingual AIT (SLIT), subcutaneous AIT (SCIT) for inhalant allergies and venom AIT.MethodsUnder the framework of the EAACI, a panel of experts in the field of AIT coordinated by the Immunotherapy Interest Group set‐up a web‐based retrospective survey (SurveyMonkey®) including 27 standardized questions on practical and safety aspects on AIT in worldwide clinical routine.Results417 respondents providing AIT to their patients in daily routine answered the survey. For patients (without any current symptoms to suspect COVID‐19), 60% of the respondents informed of not having initiated SCIT (40% venom AIT, 35% SLIT) whereas for the maintenance phase of AIT, SCIT was performed by 75% of the respondents (74% venom AIT, 89% SLIT). No tolerability concern arises from this preliminary analysis. 16 physicians reported having performed AIT despite (early) symptoms of COVID‐19 and/or a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2).ConclusionsThis first international retrospective survey in atopic diseases investigated practical aspects and tolerability of AIT during the COVID‐19 pandemic and gave no concerns regarding reduced tolerability under real‐life circumstances. However, the data indicate an undertreatment of AIT, which may be temporary, but could have a long‐lasting negative impact on the clinical care of allergic patients.

Component-Resolved Diagnosis of American Cockroach (Periplaneta americana) Allergy in Patients From Different Geographical Areas

Background: Manifestation of respiratory allergy to American cockroach (Periplaneta americana) is prominent in the subtropical and tropical areas. However, co-existing perennial indoor inhalant allergies frequently compromise clinical diagnosis of cockroach allergy, and the analysis of sensitization pattern is limited by the lack of Periplaneta allergens widely available for component-resolved diagnostics (CRD).Objective: To evaluate a collection of previously described recombinant Periplaneta allergens for CRD in cockroach allergy.Methods: A panel of nine recombinant Periplaneta allergens (Per a 1–5, 7–10) was generated, purified, and subjected to physicochemical characterization by applying circular dichroism (CD) spectroscopy, dynamic light scattering (DLS), amino acid (AA) analysis, and mass spectrometry (MS). Patients (n = 117) from India, Korea, Venezuela, and Iran, reporting perennial respiratory indoor allergies with IgE sensitization to cockroach (P. americana and/or Blattella germanica), were included. The sensitization profile was monitored by the experimental ImmunoCAP testing.Results: ImmunoCAP testing confirmed IgE sensitization to Periplaneta and/or Blattella extract in 98 of 117 patients (r = 0.95). Five out of 117 patients were sensitized to only one of the two cockroach species. Within the whole study group, the prevalence of sensitization to individual allergens varied from 4% (Per a 2) to 50% (Per a 9), with the highest IgE values to Per a 9. Patients from four countries displayed different sensitization profiles at which Per a 3 and Per a 9 were identified as major allergens in India and Korea. Periplaneta-derived lipocalin and myosin light chain were characterized as new minor allergens, designated as Per a 4 and Per a 8. Periplaneta extract showed higher diagnostic sensitivity than all individual components combined, suggesting the existence of allergens yet to be discovered.Conclusion: Utilization of a panel of purified Periplaneta allergens revealed highly heterogeneous sensitization patterns and allowed the classification of lipocalin and myosin light chain from Periplaneta as new minor allergens.

A mathematical model for the prediction of the prevalence of allergies in Zimbabwe

BackgroundThe prevalence of allergies has been observed to be increasing in the past years in Zimbabwe. It is thus important to consider the long term prevalence of allergies. Our interest is in investigating the trends of allergies in the next 2 decades. MethodWe formulate a deterministic model with 6 compartments to predict the prevalence of allergies in Zimbabwe. The human population is divided into 4 distinct epidemiological, classes based on their exposure to 2 allergen groups (food and inhalants), represented by 2 compartments. The model is used to predict the prevalence of allergen sensitization. The number of human allergen groups in each compartment are tracked through a system of differential equations. Model parameters were obtained by fitting observed data to the model. Graphical solutions of the model were developed using Matlab and Excel. ResultsThe rate of sensitisation to food allergen sources is found to be lower than the rate of sensitisation to inhalant allergens. The rate at which individuals develop tolerance to food allergen sources is found to be almost twice the rate of developing tolerance to inhalant allergies. The equilibrium solutions (the long-term states of the populations) of the model are found to be non-zero implying that there will never be an allergy-free population. Our results also show that the prevalence of food allergy is likely to increase in the next 2 decades while inhalant allergy prevalence is expected to decrease. ConclusionOur long-term solutions show endemicity in allergies in Zimbabwe. So, allergy will be endemic in the Zimbabwean population; hence there is a need for allergy care and management facilities to be increased. These results are critical in policy development and planning around allergies in the near future.

A Component-Resolved Therapeutic Vaccine for Cockroach Allergy Made of Per a 9 and Transforming Growth Factor-β Homologue, an Immunosuppressive Protein of Brugia malayi.

Allergen-specific-immunotherapy (ASIT) can cause long-term resolution of allergic diseases, reduces drug use and chances of new allergen sensitization. Nevertheless, therapeutic vaccine and data on ASIT efficacy for cockroach (CR) allergy are relatively scarce. In this study, efficacy and mechanism of a novel intranasal vaccine consisting of liposome (L)-entrapped mixture of American CR (Periplaneta americana) major allergen (Per a 9) and immunosuppressive protein of Brugia malayi nematode named transforming growth factor-beta homologue (TGH) in treatment of CR allergy were investigated along with two other vaccines (L-Per a 9 alone and L-TGH alone). All three vaccines could reduce pathogenic type 2 response and lung immunopathology in the vaccines-treated CR-allergic mice, but by different mechanisms. L-Per a 9 caused a deviation of the pathogenic type 2 to type 1 response (IFN-γ-upregulation), whereas the L-(TGH + Per a 9) and L-TGH generated regulatory immune responses including up-expression of immunosuppressive cytokine genes and increment of serum adenosine and lung indoleamine-2,3-dioxygenase-1 which are signatures of regulatory T cells (Tregs) and tolerogenic dendritic cells, respectively. The L-(TGH + Per a 9) should be further evaluated towards clinical application, as this vaccine has a propensity to induce broadly effective therapeutic effects for inhalant allergies.

Neonatal airway immune profiles and asthma and allergy endpoints in childhood.

The immune system plays a key role in the pathogenesis of asthma and allergy, but the role of the airway cytokine and chemokine composition in vivo in early life prior to symptom development has not been described previously. Here, we aimed to examine whether the neonatal airway immune composition associates with development of allergy and asthma in childhood. We measured unstimulated levels of 20 immune mediators related to the Type 1, Type 2, Type 17, or regulatory immune pathways in the airway mucosal lining fluid of 620 one-month-old healthy neonates from the COPSAC2010 birth cohort. Allergy and asthma were diagnosed at our research clinic by predefined algorithms and objective assessments at age 6years. Principal component analyses were used to describe the airway cytokine and chemokine composition. A neonatal airway immune profile particularly characterized by enhanced IL-1β and reduced CCL26 was significantly associated with later development of elevated specific IgE to inhaled allergens, a positive skin prick test, and allergic rhinitis, but not with food sensitization. Conversely, reduced Type 17 immune-associated markers, including IL-1β and CXCL8, showed trend of association with development of early asthma endpoints. Development of early asthma endpoints and inhalant allergy during the first 6years of life seems associated with distinctly perturbed airway immune profiles in neonatal life, which is suggestive of an early origin and different pathogenesis of childhood asthma and allergy. These exploratory findings suggest pre- and perinatal life as an important window of opportunity for prevention of asthma and inhalant allergy.

Assessing patients\u2019 characteristics and treatment patterns among children with atopic dermatitis

BackgroundAtopic dermatitis (AD) is the most common immune-mediated skin disease in childhood. Several treatment options for pediatric AD, both topical and systemic, are currently available. We carried out a single-center observational study with the aim of describing characteristics and treatment patterns in pediatric AD patients.MethodsThe study included 867 patients aged ≤16 years (females 50.5%, mean patient’s age 5.9 years, standard deviation ±3.6 years) with a previous doctor-confirmed diagnosis of AD who underwent balneotherapy at the Comano Thermal Spring Water Center (Comano, Trentino, Italy) from April to October 2014.ResultsAmong the patients included in the study, 41.2% had mild (SCORing Atopic Dermatitis, SCORAD 0-15), 43.6% moderate (SCORAD 16–40) and 15.2% severe AD (SCORAD > 40). A higher occurrence of reported food allergy was observed among children with more severe AD (p < 0.0001), while no association was found between AD severity and reported inhalant allergy or passive smoking (p = 0.15 and 0.92, respectively). Emollients (55.1%) and topical corticosteroids (TCS; 45.7%) were the main treatment options used in the previous month. The use of oral steroids and topical calcineurin inhibitors (TCI) was considerably less common (6.3 and 4.5%, respectively), while no patients were on systemic agents other than steroids. Among patients with severe AD, 9.8% had not used TCS, TCI or any systemic treatments. Moreover, 20.0% of the patients in the study population had followed elimination diets, although only 27.2% of them had a reported food allergy.ConclusionsA significant difference in the prevalence of reported food allergy emerged across the different AD severity categories. Furthermore, although further data are necessary to confirm our findings, undertreatment in children with AD appeared to be very common, at least among those attending the Comano Thermal Spring Water Center. Moreover, many patients followed elimination diets in the absence of reported food allergy.

A population-based study on associations of stool microbiota with atopic diseases in school-age children

Infants with less diverse gut microbiota seem to have higher risks of atopic diseases in early life, but any associations at school age are unclear. This study sought to examine the associations of diversity, relative abundance, and functional pathways of stool microbiota with atopic diseases in school-age children. We performed a cross-sectional study within an existing population-based prospective cohort among 1440 children 10 years of age. On stool samples, 16S ribosomal RNA gene sequencing was performed, and taxonomic and functional tables were produced. Physician-diagnosed eczema, allergy, and asthma were measured by questionnaires, allergic sensitization by skin prick tests, and lung function by spirometry. The α-diversity of stool microbiota was associated with a decreased risk of eczema (odds ratio [OR], 0.98; 95% CI, 0.97, 1.00), and β-diversity was associated with physician-diagnosed inhalant allergy (R2= 0.001; P= .047). Lachnospiraceae, Ruminococcaceae_UCG-005, and Christensenellaceae_R-7_group species were associated with decreased risks of eczema, inhalant allergic sensitization, and physician-diagnosed inhalant allergy (OR range, 0.88-0.94; 95% CI range, 0.79-0.96 to 0.88-0.98), while Agathobacter species were associated with an increased risk of physician-diagnosed inhalant allergy (OR, 1.23; 95% CI, 1.08-1.42). Functional pathways related to heme and terpenoid biosynthesis were associated with decreased risks of physician-diagnosed inhalant allergy and asthma (OR range, 0.89-0.86; 95% CI range, 0.80-0.99 to 0.73-1.02). No associations of stool microbiota with lung function were observed. The diversity, relative abundance and functional pathways of stool microbiota were most consistently associated with physician-diagnosed inhalant allergy in school-age children and less consistently with other atopic diseases.

Changes in qualitative and quantitative traits of birch (Betula pendula) pollen allergenic proteins in relation to the pollution contamination

Birch (Betula pendula) pollen causes inhalant allergy in about 20% of human population in Europe, most of which is sensitive to the main birch allergen, Bet v1. The aim of the study was to find out (i) whether and how the analysed birch individuals differ in regard to composition of individual subunits of pollen proteins and to protein content in these subunits; (ii) whether the level of particulate matter relates to concentration of Bet v1 allergen. Study was performed in Southern Poland, in 2017–2019. Pollen material was collected at 20 sites, of highly or less polluted areas. Protein composition was analysed by SDS-PAGE, while the concentration of Bet v1 was evaluated by ELISA. The obtained results were estimated at the background of the particulate matter (PM10) level and the birch pollen seasons in Kraków. The electrophoregrams of pollen samples collected at different sites showed huge differences in staining intensities of individual protein subunits, also among important birch allergens: Bet v1, Bet v2, Bet v6 and Bet v7. The level of Bet v1 was significantly higher in the pollen samples collected at the more polluted sites. While the birch pollen allergenic potential is determined, the both pollen exposure and the content of the main allergenic components should be considered, as factors causing immunological response and clinical symptoms manifestation in sensitive individuals.

Studying and Evaluating the Immune System in Urticaria, Asthma and Rhinitis

Background: Diseases related with allergy such as urticaria, asthma, and rhinitis have an effect onautoimmune system.Objectives: This study was planned and carried out to assess how the immunity affected in patients withallergy and urticaria, asthma, and rhinitis through measuring the total IgE and IL-33.Materials and Method: A collection of females and males (74 patients) with urticaria, asthma, and rhinitiswere chosen in this research, 24 with urticaria, 26 with asthma, and 24 with rhinitis their ages were rangedfrom 30 to 45 years while their weight ranged from 69 to 92 kg, using immuno sorbent assay (ELISA),the IL-33 and IgE were calculated and evaluated respectively in the patients and the collected data werecompared with healthy individuals (control).Results: The data that was gathered from the blood serum of urticaria, asthma, and rhinitis patients indicatesconsiderable differences in levels of IL-33 which were tolerated from172 to 185 Ng/l, while the IgE rangedfrom 321 to 397 Ng/l comparing with healthy individuals (control). Also results of specific IgE signify aexistence for one or more inhalant allergens in urticaria, asthma, and rhinitis, especially in rhinitis patients,precisely in Weeds allergens (w6, w9), Tree allergens (t2, t3, t4, t7), and Grasse’s allergens (g6, g12) and itwas lower in females than males.Conclusion: The considerable changes in the IL-33, and IgE in the patients affect the immunity system inthe patients due to the chronic inflammatory diseases (urticaria, asthma, and rhinitis) and it will increased inpatients with inhalant allergy.

Maternal iron status during early pregnancy and school‐age, lung function, asthma, and allergy: The Generation R Study

BackgroundIron deficiency during early life could affect the developing lung and immune system, and influence child's respiratory or allergy outcomes in later life.ObjectiveTo examine the associations of maternal iron status during early pregnancy with child's lung function, asthma, inhalant allergic sensitization, and physician‐diagnosed inhalant allergy at school‐age.MethodsIn a population‐based cohort study, among 3825 mother–child pairs, ferritin, transferrin concentrations, and transferrin saturation were measured from maternal venous blood samples during early pregnancy. In children at the age of 10 years, spirometry was used to determine child's lung function, current asthma and physician‐diagnosed inhalant allergy were assessed by questionnaires, and inhalant allergic sensitization was measured by skin prick tests. We used multivariable regression models to examine the associations.ResultsAfter adjustment for gestational age at maternal iron status measurement and sociodemographic or lifestyle‐related confounders, a higher maternal transferrin concentration was associated with a higher risk of physician‐diagnosed inhalant allergy (odds ratio [95% confidence interval]: 1.13 [1.01 to1.26]), but not with lung function, asthma, or inhalant allergic sensitization. This association did not attenuate after further adjustment for maternal hemoglobin levels or early growth factors. We observed no consistent association of maternal ferritin concentrations or transferrin saturation with child's respiratory or allergy outcomes.ConclusionHigher maternal transferrin concentrations during pregnancy, reflecting lower serum iron levels, were associated with an increased risk of child's physician‐diagnosed inhalant allergy but not lung outcomes. Underlying mechanisms and clinical implications need to be explored.

Optimal human pathogenic TH2 cell effector function requires local epithelial cytokine signaling

IL-33 is an emerging key factor in development of allergic diseases. The IL-33 receptor (suppressor of tumorigenicity [ST2]) is a differentially expressed gene in pathogenic TH2 cells, but its role in T-cell effector function has not been elucidated. We investigated the role of IL-33 in modulating circulating allergen-specific T-cell responses. We hypothesized that selective ST2 expression on allergen-specific CD4+ T cells would confer susceptibility to the effects of IL-33. PBMCs from subjects with food allergy, inhalant allergy, and no allergy were obtained on the basis of clinical history and serum IgE level. AT-cell receptor-dependent CD154 upregulation assay and direct peptide major histocompatibility complex class II tetramer staining were used to profile allergen-specific CD4+ T cells by flow cytometry. Allergen-specific CD4+ T cell cytokine production was evaluated during IL-33 exposure. ST2 expression was also tracked by using a 2-color flow-based assay. ST2 expression on peripheral allergen-specific CD4+ T cells was confined to subjects with allergy and restricted to TH2A cells. Comparison between direct peptide major histocompatibility complex class II tetramer staining and the CD154 functional assay identified ST2 as a marker of TH2A cell activation. IL-33 exposure enhanced IL-4 and IL-5 secretion in allergen-reactive TH2A cells. Allergen-induced ST2 expression on peripheral CD4+ T cells can be used to track allergen-reactive TH2A cells from donors with allergy. ST2 expression on circulating CD4+ T cells represents a transient phenotype associated with TH2A cell activation, allowing these cells to sense locally elicited tissue cytokines. IL-33 selectively amplifies pathogenic TH2 cell effector functions, suggesting a tissue checkpoint that may regulate adaptive allergic immunity.

Prevalence of common inhaled allergies in Erbil province, Kurdistan Region of Iraq

Nowadays, inhaled allergens are the main causes of allergic diseases, which are derived from different sources such as animal dander, grasses, tree, insects and fungi/molds. Identification and detection of allergens play a critical role in the diagnosis and treatment of many allergic diseases. Aims were to determine the prevalence of most common inhaled allergens in Erbil province and determination the intensity of allergic response among allergic patients against 35 identified inhaled allergens items. A total number of 170 patients suffering from suspected inhalant allergy were checked in the present study. The study was carried out for patients who visited the private clinical sectors between 2018-2020 in Erbil province, Kurdistan Region of Iraq. Determination of specific IgE (sIgE) antibodies was examined for suspected patients. The country-specific inhaled allergy profile “Euroline inhaled Iraq 1” (Catalog no: DP 313816011 E, IVD approved, and CE certified EUROLINE immunoblot), containing strip for 35 different inhalant allergens, has been used in this study. Positive specific IgE to inhaled allergens was detected in 22.35% of our suspected patients. Orchard grass (21.05%) was the most inhaled allergen in our 38 allergic patients, followed by the Meadow foxtail (15.78%), Cockroach German and Sweet vernal grass (13.15%). Based on the present study results, we conclude that the prevalence of inhaled allergy differed between men and women in different age groups. Our study reached that there were no associations between inhaled allergens and sex or age. DOI: http://dx.doi.org/10.5281/zenodo.4395149

The Role of Allergen Sensitivity on Pityriasis Alba

Objective: Pityriasis alba is mostly seen in individuals with a history of atopy, although it may occur in non-atopic individuals. Despite many hypothesis, no certain etiologic factor for pitryriasis alba has been determined. We aimed to investigate the roles of environmental factors, inhalant and food allergy sensitization in its etiopathogenesis. Methods: We noted patients’ and controls’ age, gender, education level of parents, xerosis, hand soap type, bathing frequency, bath water temperature, wind condition in the location, using sun screen cream, sun exposure time, results of inhalant allergen and food allergen testing. Inhalant allergy test was carried out through a skin prick test for children older than two years, and a food allergy test was carried out through prick to prick test for children of all ages. Results: The findings showed that there were significant relationships between pityriasis alba and xerosis, inhalant allergen sensitization (p&lt;0.0001, p=0.009, respectively). Conclusion: We conclude that xerosis and inhalant allergen sensitization are associated with pityriasis alba. Therefore, we think that clinicians should suggest moisturizers to patients with pityriasis alba and make their inhalant allergy tests in clinical follow-up of patients.

The sensitization characteristics of adult Chinese patients diagnosed with chronic respiratory diseases.

The prevalence of allergen-induced chronic respiratory disease (CRD) is increasing annually. This study aimed to analyze the sensitization characteristics of adult Chinese CRD patients. The serum specific immunoglobulin E (sIgE) was detected via an inhalation allergy screening test. Total immunoglobulin E (tIgE) levels were measured in 85 asthma patients, 98 chronic obstructive pulmonary disease (COPD) patients, and 69 patients with other CRDs. The total positive rate of allergy screening among CRD patients was 36.1%. Asthma showed the highest rate (45.9%), followed by COPD (32.7%) and other CRDs (29.0%). The positive rate of inhalation allergy screening was significantly higher among office staff (68.9%) than among outdoor workers (42.8%) and farmers (25.0%, P < 0.05). In patients with COPD, atopy was a risk factor for dyspnea (Odds ratio = 1.22; P < 0.05). Optimal scaling analysis revealed a correlation between tIgE levels and smoking index (Cronbach's alpha = 91.1%). Up to 35.0% of GOLD III or IV patients showed low sIgE and high tIgE. Patients with CRD had high sensitization. Asthma patients who work indoors were more susceptible to allergies. Atopy was associated with COPD pulmonary function. It is necessary to initially screen the sensitization situation of CRD patients.

Atopic dermatitis, inhalant allergy and food allergy: A paediatric approach.

Food and inhalant allergens have also been identified as potential trigger factors of atopic dermatitis symptoms. Here we aimed to investigate relationships between atopic dermatitis and inhalant-food allergen sensitization in Turkish children with atopic dermatitis. We included 70 patients (42 male, 28 female) with atopic dermatitis and 45 controls (30 male, 15 female) with no atopy, no atopy familial history, no atopy clinical findings no atopic dermatitis. We noted patients' and controls' age, gender, passive smoking exposure, atopy, xerosis, bath water temperature, shower gel type, clothes detergent type, blood hemoglobin, blood eosinophil count, blood eosinophil percent, values of serum immunoglobulin E, serum immunoglobulin A, serum immunoglobulin G, serum immunoglobulin M, results of inhalant allergen, and food allergen testing. We found that nine cases had inhalant allergen sensitization and 21 cases had food allergen sensitization. There were significant relationships between cases and controls in terms of count of eosinophil and percent of eosinophil (P = .008, P = .009, respectively). Humoral and cellular allergen-specific immune responses to food and inhalant allergens can be detected in patients with atopic dermatitis. Accordingly, we believe that blood eosinophil count and percent are more valuable laboratory parameters than serum total IgE for following patients with atopic dermatitis.

Associations of Plasma Fatty Acid Patterns during Pregnancy with Respiratory and Allergy Outcomes at School Age.

Fatty acids might play a role in asthma and allergy development as they can modulate immune responses. We examined among 4260 mother-child pairs participating in a population-based cohort the associations of maternal plasma fatty acid patterns during pregnancy with a child’s respiratory and allergy outcomes at school-age. In mid-pregnancy, 22 individual fatty acids were measured from maternal blood. Three patterns were previously identified by principal component analysis: A ‘high n-6 polyunsaturated fatty acid (PUFA)’, a ‘monounsaturated and saturated fatty acid’, and a ‘high n-3 PUFA’ pattern. At the age of 10 years, a child’s lung function was assessed by spirometry, current asthma and physician-diagnosed inhalant allergy by questionnaire, and inhalant allergic sensitization by skin prick tests. A higher ‘high n-6 PUFA’ pattern was associated with a higher forced expiratory volume in 1 s/forced vital capacity and forced expiratory flow after exhaling 75% of forced vital capacity (Z-score difference (95% CI) 0.04 (0, 0.07) and 0.04 (0.01, 0.07), respectively, per SD increase in the fatty acid pattern). We observed no associations of maternal fatty acid patterns with a child’s asthma or allergy outcomes. Our results showed limited associations of maternal patterns of high n-6 PUFA concentrations in pregnancy with a better lung function in school-aged children.

Equine Hypersensitivity: the Dark Horse of Allergy.

A significant amount of medical literature has been published on the prevalence and treatment modalities of allergies to common household pets like dogs and cats. Although sensitization rates to horses are high in many urban areas, allergies to horses are rarely discussed. In order for allergists to treat effectively horse-allergic patients, they must be aware of various clinical presentations and treatment modalities that exist. A literature search was conducted in PubMED using the terms horse, immunotherapy, inhalant allergies, and food allergy limited to human studies from any period. What follows is a review of the prevalence, clinical presentations, and treatment modalities of horse aeroallergens and food allergies.

Basophil Activation as Marker of Clinically Relevant Allergy and Therapy Outcome

For some years now the basophil activation test (BAT) using flow cytometry has emerged as a powerful tool and sensitive marker that can be used to detect clinically relevant allergies, provide information on the severity of an allergic reaction, and monitor therapies. Compared to other in vitro diagnostic tests, BAT seems to have a better informative value in terms of clinical relevance. In general, the BAT can be used for the diagnosis of the most common forms of IgE-mediated allergy such as hymenoptera venom allergy, inhalant allergy, food allergy, and drug allergy. Various basophil markers and parameters have been established which, depending on the trigger of the respective allergy, can provide information on the clinical relevance of sensitization, on the development of natural tolerance, on trigger thresholds, and on the severity of the allergic reaction. The BAT also serves as a suitable follow-up instrument for various therapeutic approaches such as specific immunotherapy, desensitization protocols, or use of anti-IgE-antibodies for the various diseases. Quality controls for routine use, standardization, and automatization are expected to expand the range of applications for the above-mentioned indications.

Editorial introductions

Editorial introductions