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Medical Journal Review

August 2020

WAO Reviews – Editors' Choice

The Editors’ Choice comes to you from Juan Carlos Ivancevich, MD, and John J. Oppenheimer, MD, FACAAI, FAAAAI. They select articles for their importance to clinicians who care for patients with asthma and allergic/immunologic diseases, and whenever possible, for their accessibility to everyone.

Presence of positive skin prick tests to inhalant allergens and markers of T2 inflammation in subjects with chronic spontaneous urticaria (CSU): A systematic literature review
Wong MM, Keith PK
Allergy, Asthma & Clinical Immunology 2020;(16):72 (4 August)

Presently, guidelines recommend not performing aeroallergen skin prick testing (SPT) in chronic spontaneous urticaria (CSU). The goal of this review was to investigate the presence of aeroallergen sensitization and markers of T2 inflammation in subjects with CSU via a systematic literature review of all studies that evaluated the presence of T2 markers of allergic inflammation in CSU subjects. The authors identified 16 studies that assessed the prevalence of positive SPT to multiple aeroallergens in CSU, finding 38.5% of CSU subjects had positive SPT, including three controlled studies which demonstrated 34.2% of CSU subjects had positive SPT to multiple aeroallergens, compared to 13.6% of controls (p=0.047). In the three controlled studies, 27.5% of CSU subjects had positive SPT to HDM, compared to 2.1% of controls (p=0.047). Overall, they demonstrated that CSU subjects were 3.1 times more likely to be aeroallergen-sensitized (95% CI 1.7–5.8, p=0.0002) and 6.1 times more likely to be HDM-sensitized (95% CI 3.7–9.9,  p<0.00001) than controls. Mean total serum IgE (tIgE) levels were 238 kU/L and median tIgE levels were 164 kU/L, in those with CSU, which was greater than the upper 90th percentile of normal (<137 kU/L). Compared to healthy controls, CSU subjects were 6.5 times more likely to have IgG autoantibody against FcεR1α (p=0.001), 2.4 times more likely to have IgG anti-IgE antibody (p=0.03) and 5 times more likely to have anti-thyroid peroxidase antibody (p=0.02). The authors conclude that the increased aeroallergen sensitization, and tIgE, indicates the possible importance of T2 inflammation in the pathogenesis of CSU.

The effects of climate change on respiratory allergy and asthma induced by pollen and mold
D’Amato G, Chong-Neto HJ, Monge Ortega OP, Vitale C, Ansotegui IJ et al.
Allergy 2020; Published online ahead of print 26 June

In this review, the authors explore the impact of climate change on the environment, biosphere, and biodiversity. Human activities have increased atmospheric concentrations of carbon dioxide (CO2) and other greenhouse gases. Change in climate and the correlated global warming affects the quantity, intensity, and frequency of precipitation, as well as the frequency of extreme events including heat waves, droughts, thunderstorms, floods, and hurricanes. Respiratory health can be particularly affected by climate change, which contributes to the development of allergic respiratory disease and asthma.  Allergy to pollen (duration and intensity) is also altered by climate change. Research has demonstrated that plants exhibit enhanced photosynthesis and reproductive effects and produce more pollen as a response to high atmospheric levels of carbon dioxide (CO2). Molds whose proliferation is increased by floods and rainy storms are responsible for severe asthma. Furthermore, thunderstorms during pollen and mold seasons can cause exacerbation of respiratory allergy and asthma in patients with hay fever. Measures to reduce greenhouse gas emissions can have positive health benefits.

Molecular approach to a patient’s tailored diagnosis of the oral allergy syndrome
Alessandri C, Ferrara R, Bernardi ML, Zennaro D, Tuppo L et al.
Clinical and Translational Allergy 2020;10:22 (17 June)

This is a review of oral allergy syndrome (OAS), which is one of the most common IgE-mediated allergic reactions. It is characterized by a number of symptoms induced by exposure of the oral and pharyngeal mucosa to allergenic proteins belonging to class 1 or class 2 food allergens. OAS occurring when patients sensitized to pollens are exposed to some fresh plant foods has been called pollen food allergy syndrome (PFAS). In the case of PFAS, several different associations of allergenic sources have been progressively proposed and called syndromes. Molecular allergology has shown that these associations are based on IgE co-recognition taking place between homologous allergens present in different allergenic sources. In addition, through the molecular approach, it has been found that some allergens involved in OAS are also responsible for systemic reactions, as in the case of some food Bet v 1-related proteins, lipid transfer proteins, and gibberellin regulated proteins. As a result, the authors suggest that in the presence of a convincing history of OAS, it becomes crucial to perform a patient’s tailored molecule-based diagnosis in order to identify the individual IgE sensitization profile. This information allows the prediction of possible cross-reactions with homologous molecules contained in other sources. In addition, it allows the assessment of the risk of developing more severe symptoms on the based upon the specific allergenic proteins to which the patient is sensitized.

Impaired type I interferon activity and inflammatory responses in severe COVID-19 patients
Hadjadj J, Yatim N, Bernabei L, Corneau A, Boussier J et al.
Science 2020;369(6504):718-724

COVID-19 has been associated with distinct patterns of disease progression. This suggests a diverse host immune response. In this article, the authors performed an integrated immune analysis on a cohort of 15 COVID-19 patients with various levels of disease severity. They found a unique phenotype in severe and critical patients, including a highly impaired IFN type I response, which was characterized by no IFN-B and low IFN-α, associated with a persistent blood viral load and inflammatory response. Furthermore, inflammation was partially driven by transcriptional NF-KB and increased TNF- α and IL6 production and signaling. Overall, this suggests that type I IFN deficiency could be the hallmark of severe disease and provides a rationale for combined therapeutic approaches.

A demonstration project of Global Alliance against Chronic Respiratory Diseases: Prediction of interactions between air pollution and allergen exposure – the Mobile Airways Sentinel NetworK-Impact of air POLLution on Asthma and Rhinitis approach
Sofiev M, Palamarchuk Y, Bédard A, Basagana X, Anto JM et al.
Chinese Medical Journal 2020;133(13):1561-1567

In this review, the authors examine the state and recent progress in the field of information support for pollen allergy sufferers. For decades, information available for the patients and allergists largely consisted of pollen counts, which are vital but sadly insufficient. The authors note that new technology paves the way to increase substantially in amount and diversity of data. This paper explores new methods to predict pollen and air pollutant concentrations in the air and proposes an allergy risk concept, which combines the pollen and pollution information and transforms it into a qualitative risk index. This new index is available in an app (Mobile Airways Sentinel NetworK-air) that was developed by the European Union grant Impact of Air POLLution on sleep, Asthma and Rhinitis (a project of European Institute of Innovation and Technology-Health).


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