Management Of Allergic Patients Research Articles

Aerobiological and clinical study in the semidesertic area of the Southeastern of Spain.

Aerobiological studies constitute a relevant tool to predict the most influential parameters over the pollen seasons with significant clinical relevance in the allergic populations. The aim of this study was to describe the aerobiological behaviour of the most relevant allergenic sources in the semi-arid area of southeast of Spain (Almería) and to investigate the correlation with meteorological factors and clinical symptoms of allergic patients. Daily pollen count and meteorological parameters of Almería, Spain, were compiled for ten years. The clinical symptoms of 248 allergic patients were also recorded. Descriptive statistics and correlations between variables were assessed. Multivariate analyses were performed to predict the influence of meteorological factors on pollen concentration and the risk of suffer respiratory symptoms. Eight pollen families were identified as the most relevant allergenic sources. Temperature correlated with main pollen season evolution of all taxa whereas rainfall and relative humidity only correlated in Oleaceae, Pinaceae, Amaranthaceae, Asteraceae and Urticaceae. Rainfall and relative humidity were the most influential predictors of pollen concentration, except in Amaranthaceaea and Poaceae families, while temperature only influenced on Cupressaceae and Urticaceae pollen concentrations. A significant positive influence was observed between maximum temperature and rainfall with the appearance of allergic symptoms in patients sensitized to grasses, Parietaria sp. and Olea sp. This study, highlight the main aerobiological features in the region and establish a suitable tool for clinical follow-up and management of allergic patients. Further studies are needed to establish an accurate measurement aimed to control and prevent pollinosis in sensitized patients.

Besoins en formations et informations en biologie de l’allergie : résultats de l’enquête SFA/ANAFORCAL

Biology is an essential tool in the diagnosis and management of allergic patients. To complete the survey of young allergists published in 2022, the Allergy Biology Working Group (GTBA) in partnership with ANAFORCAL has carried out a new survey of senior allergists to assess their training in allergy biology and to know their expectations in terms of information and continuing education. A total of 1095 allergists were contacted (with duplicates between the two lists) and 219 responded. Allergists consider themselves to be well trained. More than 70% believe they have a good knowledge of the subject and 94% receive regular training on the subject, first at congresses, by reading scientific articles and then at local training meetings. Of this sample, 69.4% have read the recommendations on the biology of allergy published in 2021. Of those who have read it, 90% are satisfied with it. However, of this sample, 89% had never done an internship in an immuno-allergology laboratory during their studies. This survey reports that 95% of respondents want more training and information, about new Activé par Editorial Manager® and ProduXion Manager® about Aries Systems Corporation molecular allergens, then the exploration of bradykine angioedema, allergen chips, about tryptase and finally for the follow-up of immunotherapy allergen (ITA). These themes are desired in online CPD training, at the French-speaking congress of allergology (CFA), or in the form of sheets on the site of the French Society of Allergology (SFA).

Integration of in vitro allergy test results and ratio analysis for the diagnosis and treatment of allergic patients (INTEGRA).

The introduction of molecular diagnosis into routine clinical practice has substantially improved the diagnosis and management of allergic patients by allowing clinicians to precisely identify the allergenic molecule responsible for immunoglobulin E (IgE)‐mediated allergies. However, it can be challenging to accurately interpret the results of molecular assays, partly due to the limited evidence base. In this context, a panel of experts with extensive experience in interpreting in vitro measures of total and serum specific IgE reviewed the available scientific evidence. After this review, the panel selected a series of representative case studies to demonstrate how determination of specific and total IgE values and the relationship between them (ratio analysis) can add value to the diagnostic process by more precisely defining the patient’s sensitization profile. Finally, the experts developed a series of recommendations on the clinical application of ratio analysis to optimize and complement the classical approach to allergy diagnosis.

Allergy and coronavirus disease (COVID-19) international survey: Real-life data from the allergy community during the pandemic

BackgroundThe COVID-19 outbreak brought an unprecedented challenge to the world. Knowledge in the field has been increasing exponentially and the main allergy societies have produced guidance documents for better management of allergic patients during this period. However, few publications so far have provided real-life data from the allergy community concerning allergy practice during the COVID-19 outbreak. Therefore, we proposed an international survey on the management of allergic patients during the current pandemic. MethodsWe performed an online survey undertaken to reach out the worldwide allergy community by e-mail and social media. The web-based questionnaire contained 24 questions covering demographic data from the participants, clinical practice during this period, and questions related to the new international classification and coding tools addressed for COVID-19. It was circulated for 8 weeks and had anonymous and volunteer context. ResultsData are presented for 635 participants from 78 countries of all continents. Allergists with long-term professional experience were the main audience. As expected, we received many responses as “I have no data” or “I don't know” to the questions of the survey. However, most with more experience on managing allergic patients during the pandemic agreed that patients suffering from allergic or hypersensitivity conditions have no increased risk of contracting COVID-19 or developing SARS CoV-2. Also, participants mentioned that none of the allergy treatments (inhaled corticosteroids, allergen immunotherapy, biological agents) increased the risk of contracting COVID-19 infection including severe presentations. ConclusionThe data presented are a starting point in the process of getting feedback on all the recommendations provided by the allergy societies; it could also be the basis of new strategies to support health professionals while new COVID-19 specific treatments and vaccines are being explored. The information here presented intends to be helpful to the community but represents a course of action in a highly specific situation due to the state of emergency, and it should be helpful to health systems.

Management of allergic patients during severe acute respiratory syndrome coronavirus-2 pandemic

A novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 in China. The mutated coronavirus spread worldwide, and some patients infected with SARS-CoV-2 developed coronavirus disease 2019 (CO VID-19) manifested with upper respiratory infection, pneumonia, or respiratory distress. Since the SARS-CoV-2 pandemic was de clared with surging confirmed cases and mortality of COVID-19 worldwide, it has reshaped our way of living and how to manage patients with allergic diseases. The medical staff, including allergy specialists, has been at the forefront of fighting against the SARS-CoV-2 pandemic and is struggling to guarantee safety to themselves and their patients. Thanks to vigorous research into the rela tionship between SARS-CoV-2 and allergic diseases, we have become able to treat allergic patients with the best of evidence to date. The clinician should make a careful decision on each clinical situation with regard to patient characteristics, local and national circumstances as well as the knowledge we have, since it is still limited. We hope further efforts to identify the nature of SARS-CoV-2 and COVID-19 clearer and effective SARS-CoV-2 vaccination will soon remove the grim picture of the worldwide pandemic and bring us back to normal. (Allergy Asthma Respir Dis 2021;9:115-123)

Digital health in the management of allergic diseases.

In recent years there has been an important implementation in the medical field of both Mobile Health, such as the use of mobile communication devices, and of other telemedicine tools in general, with the aim of supporting the supervision of diseases from the moment of the first diagnosis to the therapeutic follow-up. In fact, Digital Health can also have a very positive impact on the management of allergic patients, who are known to have the greatest need for regular monitoring, simplifying contact between doctor and patient, but there is still a need to improve implementation regulations, define certification programs and adequate reimbursement systems, as well as to guarantee a high level of attention to the protection of sensitive data. The hope is that one positive outcome of the Covid-19 pandemic will be an acceleration, by all stakeholders involved, of the process of the modernization of health care. (www.actabiomedica.it)

Management of Allergic Patients During the COVID-19 Pandemic in Asia.

Although a viral infection is a major triggering factor of asthma and allergic diseases, asthma is suggested to be not a predisposing condition for coronavirus disease 2019 (COVID-19) infection. However, patients with severe asthma/allergic disease requiring systemic corticosteroids or immunosuppressive agents may be at higher risk of more severe clinical course of this infectious disease. For allergic patients who have been followed up at an allergy clinic in our region, it is recommended that they (patients with asthma, rhinitis, atopic dermatitis or chronic urticaria) continue to receive maintenance therapy and be in a well-controlled status. Patients who have used biologics (currently available for targeting type 2 inflammation) and allergen immunotherapy should continue the treatment while minimizing hospital and face-to-face visits. It is essential to wear protective equipment for the protection of health care workers as well as patients. We report this consensus to support allergists and clinical immunologists to make optimal decisions under the urgent situation in Asia.

Prevalence of allergic disorders of respiratory system in children in Shebin Elkom

Introduction Allergic rhinitis is a global health problem that causes significant illness and disability worldwide. Interactions between the lower and the upper airways are well known and have been studied since 1990. More than 80% of asthmatics have rhinitis, and 10–40% of patients with rhinitis have asthma. Indoor and outdoor allergens, as well as occupational agents, cause rhinitis and other allergic diseases. Aim A trial was done to determine or distinguish the causative agents, either one or multiple agents, in allergic patients. We hope this will help us in the management of allergic patients by avoiding this causative agent(s) if possible. Patients and methods A total of 97 individuals were recruited from the outpatient clinics of Shebin Elkom teaching hospital. Results Pigeon and pollens showed the highest prevalence at 56.7%, whereas wheat showed the least incidence at 5.15%. As for ingestant, the cacao showed the highest incidence at 16.49%, and the least one was strawberry at 5.15%. Conclusion The importance of our research that If we recognize the causative allergen that triggers the allergic disorder, we can try to avoid it and protect the patient from the hazards of an allergic disorder.

UK NEQAS survey of allergen component testing across the United Kingdom and other European countries.

The clinical utility of molecular diagnostic approaches in allergy investigation is being recognized increasingly to play a significant role in the management of allergic patients. Determining the sensitization pattern, which is best achieved through the use of component resolved diagnostics (CRD), allows effective risk stratification, appropriate treatment and patient selection for immunotherapy. In order to assess the diagnostic service provisions for in-vitro allergy testing across Europe, a survey was carried out via the total immunoglobulin (Ig)E and specific IgE external quality assurance schemes run by UK National External Quality Assessment Service (NEQAS) Immunology, Immunochemistry and Allergy. This survey assessed allergy testing, and in particular allergen components offered by the laboratories, and found a wide variability in service provision, particularly between the United Kingdom and other European Union (EU) countries. Furthermore, there was lack of standardization for acquisition of clinical information to aid allergen (and component) selection, gating strategy, testing algorithms and clinical interpretation. Interestingly, a significant proportion of laboratories (the majority from EU) stated that they 'used' the results for peanut components for risk stratification. However, the vast majority of participants were unaware of guidelines relating to the use of allergen component testing, and agreed that further education would assist in reaching a common platform. Hence, this survey has highlighted that although CRD has been adopted into routine diagnostics across Europe, it is potentially compromised by lack of standardized protocols and guidance sources. Consequently, there is a need for local or national standards and education through External Quality Assurance services on the performance and application of CRD into allergy investigation.

Development of an allergy management support system in primary care.

BackgroundManagement of allergic patients in the population is becoming more difficult because of increases in both complexity and prevalence. Although general practitioners (GPs) are expected to play an important role in the care of allergic patients, they often feel ill-equipped for this task. Therefore, the aim of this study was to develop an allergy management support system (AMSS) for primary care.MethodsThrough literature review, interviewing and testing in secondary and primary care patients, an allergy history questionnaire was constructed by allergists, dermatologists, GPs and researchers based on primary care and specialists’ allergy guidelines and their clinical knowledge. Patterns of AMSS questionnaire responses and specific immunoglobulin E (sIgE)-test outcomes were used to identify diagnostic categories and develop corresponding management recommendations. Validity of the AMSS was investigated by comparing specialist (gold standard) and AMSS diagnostic categories.ResultsThe two-page patient-completed AMSS questionnaire consists of 12 (mainly) multiple choice questions on symptoms, triggers, severity and medication. Based on the AMSS questionnaires and sIgE-test outcome of 118 patients, approximately 150 diagnostic categories of allergic rhinitis, asthma, atopic dermatitis, anaphylaxis, food allergy, hymenoptera allergy and other allergies were identified, and the corresponding management recommendations were formulated. The agreement between the allergy specialists’ assessments and the AMSS was 69.2% (CI 67.2–71.2).ConclusionUsing a systematic approach, it was possible to develop an AMSS that allows for the formulation of diagnostic and management recommendations for GPs managing allergic patients. The AMSS thus holds promise for the improvement of the quality of primary care for this increasing group of patients.

EAACI Molecular Allergology User's Guide

The availability of allergen molecules ('components') from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled 'component-resolved diagnosis' (CRD). The European Academy of Allergy and Clinical Immunology (EAACI) Molecular Allergology User's Guide (MAUG) provides comprehensive information on important allergens and describes the diagnostic options using CRD. Part A of the EAACI MAUG introduces allergen molecules, families, composition of extracts, databases, and diagnostic IgE, skin, and basophil tests. Singleplex and multiplex IgE assays with components improve both sensitivity for low-abundance allergens and analytical specificity; IgE to individual allergens can yield information on clinical risks and distinguish cross-reactivity from true primary sensitization. Part B discusses the clinical and molecular aspects of IgE-mediated allergies to foods (including nuts, seeds, legumes, fruits, vegetables, cereal grains, milk, egg, meat, fish, and shellfish), inhalants (pollen, mold spores, mites, and animal dander), and Hymenoptera venom. Diagnostic algorithms and short case histories provide useful information for the clinical workup of allergic individuals targeted for CRD. Part C covers protein families containing ubiquitous, highly cross-reactive panallergens from plant (lipid transfer proteins, polcalcins, PR-10, profilins) and animal sources (lipocalins, parvalbumins, serum albumins, tropomyosins) and explains their diagnostic and clinical utility. Part D lists 100 important allergen molecules. In conclusion, IgE-mediated reactions and allergic diseases, including allergic rhinoconjunctivitis, asthma, food reactions, and insect sting reactions, are discussed from a novel molecular perspective. The EAACI MAUG documents the rapid progression of molecular allergology from basic research to its integration into clinical practice, a quantum leap in the management of allergic patients.

Late Breaking Poster Session Group III – Green LB TPS 2

Background: Diagnosis and management of allergic patients are often performed exclusively by general practitioners (GPs). Because of the increasing prevalence of allergic diseases and because of the limited knowledge of GPs on allergy, an allergy management support system (AMSS) was developed. The aim of this study was to test the feasibility of an AMSS for primary care in a pilot study. Method: Using a randomized controlled design, GPs in the intervention group received AMSS advice in addition to sIgE test results and GPs in the control group performed usual care based on sIgE test results only. The AMSS advice was based on the AMSS history questionnaire completed by patients and sIgE test results. The AMSS advice included probable diagnoses and recommendations for management. AMSS advice was also formulated for patients in the control group for evaluative purposes only. Patients were included by GPs when ordering an sIgE test. GPs in both groups completed a short questionnaire on diagnosis and management at the time of inclusion (T1) and after sIgE test outcomes were known (T2). A total agreement score between GP and AMSS was calculated as the number of concordant diagnoses minus the number of false negative and false positive diagnoses. The AMSS was considered feasible when >70% of the AMSS advice was sent to the GP within 10 workdays of sIgE testing. Results: Of the 75 GPs that agreed to participate, 27 GPs (37%) included one or more patients in the study. Together they included 101 patients of which 66 (67%) completed the AMSS history questionnaire. The majority of the AMSS advice (93%) was sent back to the GP within 10 workdays after sIgE test results were known (mean (SD) 4.7 (4.0) workdays). GPs in the intervention group reported that the AMSS advice was complete and to-the-point in 80% of cases, agreed for the most part with the AMSS advice in 80% of cases and followed the AMSS advice for the most part in 71% of cases. The difference in total agreement scores on diagnosis (T2 minus T1), was significantly higher in the intervention group than in the control group (mean (SD) 0.9 (1.8); -0.8 (1.0); P <0.001). Conclusion: Because 93% of the AMSS advice was sent to the GP within 10 workdays the AMSS may be considered feasible. In addition, a majority of the GPs reported that they completely followed the AMSS advice. This was confirmed by the greater agreement on diagnoses between GPs and AMSS in the intervention group than in GPs using usual care.

Multiple action agents and the eye: do they really stabilize mast cells?

Multiple action drugs, such as azelastine, epinastine, ketotifen and olopatadine, have recently been suggested to combine antihistaminic effect, mast cell stabilization and anti-inflammatory action. This pharmaceutical class is, therefore, rapidly becoming the first choice for prevention and treatment for allergic conjunctivitis. Increasing in-vitro studies have been performed to investigate the mast-cell-stabilizing effect of multiple action drugs. Most of the study results agree that these drugs are able to inhibit histamine and several neoformed mediators, including cytokines and arachidonic acid-derived products, from mast cells. However, the mechanisms of action have not yet fully been elucidated. Most of the results from clinical trials as well as the in-vivo experimental studies, including the conjunctival provocation model, support the evidence of a stabilizing effect of these drugs. Evidence of a different inhibitory effect of multiple action compounds on the pro-inflammatory mediators released from the mast cells suggests the possibility to target different phases of the allergic reaction, leading to a potential improvement in the management of allergic patients.

New insights into seafood allergy

Seafood plays an important role in human nutrition worldwide, sustained by international trade of a variety of new seafood products. Increased production and consumption have resulted in more frequent reports of adverse reactions, highlighting the need for more specific diagnosis and treatment of seafood allergy. This review discusses recent literature in this field. The most recent prevalence data from Asia highlight seafood as a significant sensitizer in up to 40% of children and 33% of adults. Furthermore, the demonstration of species-specific sensitization to salt-water and fresh-water prawns and processed prawn extract should improve diagnosis. Studies on humans demonstrated for the first time that biologically active fish allergens can be detected in serum samples as early as 10 min after ingestion. These studies highlight that minute amounts of ingested seafood allergens can quickly trigger allergic symptoms; also, inhaled airborne allergens seem to induce sensitization and reactions. In the past 2 years, over 10 additional seafood allergens have been characterized. Allergen-specific detection assays in food products are available for crustacean tropomyosin; however, many specific mollusk and some fish allergens are not readily identified. Although cross-reactivity between crustacean and mollusks as well as mites is demonstrated, the often poor correlation of IgE reactivity and clinical symptoms calls for more detailed investigations. The recent development of hypoallergenic parvalbumin from carp could form the basis for safer vaccination products for treatment of fish allergy. Molecular characterization of more universal marker allergens for the three major seafood groups will improve current component-resolved clinical diagnosis and have a significant impact on the management of allergic patients, on food labeling and on future immunotherapy for seafood allergy.

An update on the safety of specific immunotherapy

As allergen sublingual immunotherapy becomes more widely used in Europe and draws the attention of physicians of the USA, it is important to compare and contrast the safety aspects of this therapy versus allergen subcutaneous immunotherapy. There are reports of severe systemic reactions associated with sublingual immunotherapy, but no fatalities. There are various studies of systemic reactions, including those that result in death, associated with subcutaneous immunotherapy over its nearly 100-year worldwide experience. Local reactions are common to both forms of the treatment. If both forms of therapy are equally effective, a cost (including safety aspects) -benefit analysis of sublingual immunotherapy versus subcutaneous immunotherapy is necessary to determine how best to incorporate both forms of specific immunotherapy into the management of allergic patients. Adherence to published guidelines will reduce the likelihood of adverse reactions.

Soluble interleukin-4 receptor (sIL-4R) in allergic diseases.

The mediator interleukin-4 (IL-4) plays an important role in the development of allergic inflammatory responses. IL-4 controls the production of IgE, expands IL-4 producing T cell subsets and stabilises effector cells functions. Based on this concept, it was aimed to neutralize secreted IL-4 molecules using recombinant soluble IL-4 receptors. The molecular characterization of soluble IL-4 receptors allowed the design of a recombinant drug initially evaluated in cell culture, then in animal models, followed by investigations of T cell functions from allergic patients in vitro. Based on these data, phase I/II studies have been initiated to take this approach from bench to bedside. Initial data reveal that this approach is safe and without drug-related toxicity. Stabilization of lung functions in moderate asthma patients has been reported. These results have proven the concept for a central role of IL-4 in the immunopathogenesis of allergic diseases. The immediate future will reveal whether neutralization of IL-4 with suitable drugs will provide an additional tool in the management of allergic patients.

The modified RAST in the diagnosis and management of allergic patients

The modified RAST in the diagnosis and management of allergic patients

Environmental Control as a Modality of Management for the Pulmonary and Allergic Patient

Environmental control has been a subject frequently addressed in chapters or review articles in the medical literature on the management of allergic patients. The author's title often is "House Dust Eliminations." However, producing the optimal air for inhalation requries an understanding of not only the particulate components of allergens but also the particulate components of specific and nonspecific inhalant irritants, as well as the gaseous components allergens and irritants. This review addresses the health consequences to the pulmonary patient with mucocillary impairement and also the results of both allergen and irritant exposure in the allergic patient.

PRIST, RAST, and Beyond: Diagnosis and Therapy

The measurement of total and specific IgE antibody by in vitro methods offers a significant advance in the diagnosis and management of allergic patients. These tests allow the physician to combine a precise diagnosis with an evaluation of patient sensitivity to provide care in a cost-effective manner.

Clinical Immunology and Allergy.

This volume is a well-organized text encompassing almost all biological conditions considered to be mediated by a hypersensitivity phenomenon. In addition, nonimmunological disciplines related to the clinical management of allergic patients, such as pulmonary physiology and adrenal steroid metabolism, are discussed in depth. The organization of the chapters within the framework of a combined immunological and pathological classification of hypersensitive states provides a logical transition from the basic immunology section into and through the section on clinical allergic states. All conditions are first separated into the delayed or the immediate types of response and later in accordance with the characteristics of the antibodies in the serum or tissues. It is interesting to note that over 80% of the text fitted into the classification before the inevitable miscellaneous section was required for the unclassifiable and alleged-allergic conditions. Dr. Criep should be commended for his faithful adherence to this traditional classification throughout.