Summary Expert Review of Clinical Immunology April 2013, Vol. 9, No. 4, Pages 297-299 , DOI 10.1586/eci.13.10 (doi:10.1586/eci.13.10) Meeting Report    Immune-mediated inflammatory diseases: progress in molecular pathogenesis and therapeutic strategies Jagadeesh Bayry*1 and Timothy R Radstake2 * Author for correspondence Seventh European Workshop on Immune-Mediated Inflammatory Diseases 2012 Noordwijk aan Zee, The Netherlands, 28–30 November 2012 The European Workshop on Immune-Mediated Inflammatory Diseases aims to exchange scientific knowledge and promote the collaboration between various disciplines (rheumatology, dermatology and gastroenterology) among physicians and scientists. This year ophthalmologists and neurologists were also present for the first time. The meeting revolved around the following topics: fibrosis, gene therapy in ophthalmology, functional genomics, challenges in human immunology, environmental factors, diabetes and metabolism, novelties in multiple sclerosis and innate lymphoid cells. The workshop was preceded by a masterclass that covered the last 15 years of IL-17/Th17 research and provided an overview on future therapeutics to battle immune-mediated inflammatory diseases. Full Text PDF (821 KB) PDF Plus (835 KB)

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Expert Review of Clinical Immunology

April 2013, Vol. 9, No. 4, Pages 285-287 , DOI 10.1586/eci.13.15

(doi:10.1586/eci.13.15)

Emerging concepts of dietary therapy for pediatric and adult eosinophilic esophagitis

Benjamin P Davis and Marc E Rothenberg^*

* Author for correspondence

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Eosinophilic esophagitis (EoE) is a disease of the esophagus distinguished by pronounced esophageal eosinophilia, and for which dietary antigen appears to be an important driving factor of the disease process. Multiple studies have demonstrated that food elimination diets are an effective therapy [1–4]. In addition, food reintroduction triggers relapse of the disease, suggesting an allergic mechanism to ingested foods [5–7].

Predictive values for both skin prick test (SPT) and atopy patch test (APT) have been reported [3,5,8]. However, APTs have not been standardized in an EoE population [9–11], and both SPT and APT may not be widely applicable [12]. Thus, SPTs, serum IgE tests and APTs may be adjunctive in identifying a causative food in EoE, but food triggers can only be identified by disease remission, after a specific food elimination, followed by EoE relapse upon reintroduction of that food [13]. Several studies published in the past year, of both adult and pediatric patients with EoE, have compared skin test-directed diet therapy with six-food elimination diet (SFED) therapy as well as attempted to identify causative foods [14–16]. Herein, we summarize the results of these studies and suggest a clinical approach based on collective data.

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A proposed model to study immunologic changes during chronic rhinosinusitis exacerbations

• Am J Rhinol Allergy >
• PMC3610944

American Journal of Rhinology & Allergy

Am J Rhinol Allergy. 2013 Mar-Apr; 27(2): 98–101.

Published online 2013 January 30. doi:  10.2500/ajra.2013.27.3850

PMCID: PMC3610944

A proposed model to study immunologic changes during chronic rhinosinusitis exacerbations: Data from a pilot study

Matthew A. Rank, M.D.,¹ John B. Hagan, M.D.,² Shefali A. Samant, M.D.,² and Hirohito Kita, M.D.²

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Abstract

Background:

One way to gain insight into the pathophysiology of chronic rhinosinusitis (CRS) is to study the immunologic changes that occur with exacerbation. This study describes the immunologic changes during CRS exacerbation

Methods:

We performed a prospective study to investigate the immunologic changes seen during exacerbation of CRS with nasal polyposis. We recruited adult subjects who met clinical criteria for CRS with sinus CT scan within the past 5 years with Lund-Mackay score of >5 and nasal polyps. Subjects underwent a baseline visit with collection of nasal secretion and nasal wash. With acute worsening of symptoms, subjects underwent 6 near-consecutive-day collections and one follow-up collection 2 weeks later. IL-6, IL-33, eosinophil major basic protein (MBP), eosinophil-derived neurotoxin (EDN), myeloperoxidase (MPO), and uric acid were measured on the nasal samples from each visit.

Results:

A total of 10 subjects were recruited and 9 had acute worsening of CRS during the study period. Eight of the nine subjects were women and ages ranged from 26 to 56 years. At baseline, most inflammatory parameters were low and eight of the nine subjects were on intranasal corticosteroids. Compared with baseline measurements, IL-6, MBP, MPO, EDN, and uric acid were significantly elevated during CRS exacerbation. Levels of IL-6 and MBP (r = 0.47) levels as well as IL-6 and MPO (r = 0.75) were both significantly correlated (p < 0.01).

Conclusion:

Prospective study of CRS exacerbations is feasible and provides insights into the immunologic mechanisms of CRS.

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Management of Childhood Urticaria: Current Knowledge and Practical Recommendations

Management of Childhood Urticaria: Current Knowledge and Practical Recommendations

doi: 10.2340/00015555-1573

Abstract:

Urticaria, defined by the presence of wheals and/or angio-edema, is a common condition in children, prompting parents to consult physicians. For its successful management, paediatric-specific features must be taken into account, regarding the identification of eliciting triggers and pharmacological therapy. This review systematically discusses the current best-available evidence on spontaneous acute and chronic urticaria as well as physical and other urticaria types in children. Potential underlying causes, namely infections, food and drug hypersensitivity, autoreactivity and autoimmune or other conditions, and eliciting stimuli are considered, with practical recommendations for specific diagnostic approaches. Second-generation antihistamines are the mainstay of pharmacological treatment aimed at relief of symptoms, which require dose adjustment for pae-diatric use. Other therapeutic interventions are also discussed. In addition, unmet needs are highlighted, aiming to promote research into the paediatric population, ultimately aiming at the effective management of childhood urticaria.

Authors:

Helene Pite, Bettina Wedi, Luís Miguel Borrego, Alexander Kapp, Ulrike Raap
Department of Immunoallergy, Hospital Dona Estefania, Centro Hospitalar Lisboa Central Rua Jacinta Marto, 1169-045 Lisbon, Portugal. E-mail: helenampite@gmail.com

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Potential of Immunoglobulin A to Prevent Allergic Asthma

Clinical and Developmental Immunology
Volume 2013 (2013), Article ID 542091, 12 pages
http://dx.doi.org/10.1155/2013/542091

Review Article

Potential of Immunoglobulin A to Prevent Allergic Asthma

Anouk K. Gloudemans,^1,2 Bart N. Lambrecht,^1,3 and Hermelijn H. Smits²

¹Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands
²Leiden Immunoparasitology Group, Department of Parasitology, Leiden University Medical Center, Albinusdreef 2, P4-37A, 2333 ZA Leiden, The Netherlands
³Laboratory of Immunoregulation and Mucosal Immunology, Department of Molecular Biomedical Research, VIB, Technologiepark 927, 9052 Ghent, Belgium

Received 31 January 2013; Revised 15 March 2013; Accepted 16 March 2013

Academic Editor: Mohamad Mohty

Copyright © 2013 Anouk K. Gloudemans et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Allergic asthma is characterized by bronchial hyperresponsiveness, a defective barrier function, and eosinophilic lower airway inflammation in response to allergens. The inflammation is dominated by Th2 cells and IgE molecules and supplemented with Th17 cells in severe asthma. In contrast, in healthy individuals, allergen-specific IgA and IgG4 molecules are found but no IgE, and their T cells fail to proliferate in response to allergens, probably because of the development of regulatory processes that actively suppress responses to allergens. The presence of allergen-specific secretory IgA has drawn little attention so far, although a few epidemiological studies point at a reverse association between IgA levels and the incidence of allergic airway disease. This review highlights the latest literature on the role of mucosal IgA in protection against allergic airway disease, the mechanisms described to induce secretory IgA, and the role of (mucosal) dendritic cells in this process. Finally, we discuss how this information can be used to translate into the development of new therapies for allergic diseases based on, or supplemented with, IgA boosting strategies.

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Study protocol

The acute and long-term management of anaphylaxis: protocol for a systematic review

Sangeeta Dhami, Sukhmeet S Panesar, Tamara Rader, Antonella Muraro, Graham Roberts, Margitta Worm and Aziz Sheikh

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Clinical and Translational Allergy 2013, 3:14 doi:10.1186/2045-7022-3-14

Published: 10 April 2013

Abstract (provisional)

Background

The European Academy of Allergy and Clinical Immunology is in the process of developing its Guideline for Food Allergy and Anaphylaxis, and this systematic review is one of seven inter-linked evidence syntheses that are being undertaken in order to provide a state-of-the-art synopsis of the current evidence base in relation to epidemiology, prevention, diagnosis and clinical management and impact on quality of life, which will be used to inform clinical recommendations.

The aims of this systematic review will be to assess the effectiveness of interventions for the acute management of anaphylaxis, and pharmacological and non-pharmacological approaches for the long-term management of anaphylaxis.

Methods

A highly sensitive search strategy has been developed, and validated study design filters will be applied to retrieve all articles pertaining to the management of anaphylaxis from electronic bibliographic databases. We will systematically review the literature on the acute management of anaphylaxis by assessing the effectiveness of epinephrine, H1-antihistamines (versus placebo), systemic glucocorticosteroids, methylxanthines or any other treatments for the emergency management of people experiencing anaphylaxis. The main interventions that have been studied in the context of long-term management are anaphylaxis management plans and allergen-specific immunotherapy.

Discussion

There is at present little in the way of robust evidence to guide decisions on the acute and/or long-term management of anaphylaxis. Given the risk of death and the considerable morbidity associated with anaphylaxis these evidence gaps need to be filled wherever possible; this systematic review will make a start in this area.

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Pay Attention to Valvular Disease in the Presence of Atopic Dermatitis

Circulation Journal
Article ID: CJ-12-1371

http://dx.doi.org/10.1253/circj.CJ-12-1371

 

DN/JST.JSTAGE/circj/CJ-12-137

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  Advance Publication  

Pay Attention to Valvular Disease in the Presence of Atopic Dermatitis

Naoto Fukunaga¹⁾, Yukikatsu Okada¹⁾, Yasunobu Konishi¹⁾, Takashi Murashita¹⁾, Tadaaki Koyama¹⁾

1) Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital

 [Advance Publication] Released: 2013/03/27

Keywords: Atopic dermatitis, Infective endocarditis, Staphylococcus aureus, Valvular disease

Background: Atopic dermatitis (AD) is a common skin condition in which Staphylococcus(S.) aureus can cause native valve destruction in patients with infective endocarditis (IE). The aim of this study was to determine the early and late outcomes of IE and AD. Methods and Results: The medical records of patients with IE and AD who presented between January 1997 and September 2010 were analyzed retrospectively. IE and AD patients were compared with those with IE without AD. The mean follow-up period was 5.5±3.4 years. The incidence of AD among IE patients was 6.7% and they were significantly younger than those without AD (28.4 years vs. 53.7 years; P<0 .0001="" methicillin-sensitive="" span=""> S. aureus andStreptococcus species were more prevalent in IE with AD (P<0 .0001="" ad="" and="" by="" caused="" developed="" mediastinitis="" methicillin-resistant="" one="" postoperative="" respectively.="" span="" without=""> S. aureus despite preoperative skin care. None of the patients died in hospital or had IE recurrence. Freedom from recurrent IE or prosthetic valve endocarditis at 5 years was 100±0.0%. Conclusions: Patients with IE must be checked for AD and history of AD because AD patients have a high incidence of staphylococcal colonization in their skin lesion.

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Copyright © 2013 THE JAPANESE CIRCULATION SOCIETY

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Pediatric Drugs

April 2013,

Open Access

Topical Calcineurin Inhibitors for Atopic Dermatitis: Review and Treatment Recommendations

• Warner W. Carr

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Abstract

Atopic dermatitis (AD) is an inflammatory skin disease commonly affecting children and managed by pediatricians, primary care physicians, allergists, and dermatologists alike. For many years, the only available topical pharmacological treatment was topical corticosteroids. This changed in 2000–2001, when topical formulations of two calcineurin inhibitors (tacrolimus and pimecrolimus) were approved for short-term or chronic intermittent treatment of AD in patients ≥2 years of age, in whom other treatments have been ineffective or contraindicated. These topical calcineurin inhibitors (TCIs) quickly became a popular treatment option due at least in part to concerns over adverse events associated with prolonged topical corticosteroid use, especially in children. However, based on theoretical concerns about a possible risk of lymphoma associated with TCI use, a Boxed Warning was placed on both products in 2006. Since then, despite an extensive body of evidence, no causal relationship has been demonstrated between TCI use and an increased risk of lymphoma; however, the US FDA has concluded that a link cannot be ruled out. In fact, based on post-marketing surveillance of spontaneous, literature, and solicited reports, we report here that the lymphoma incidence in the topical pimecrolimus-exposed population is up to approximately 54-fold less than that seen in the general US population. This review summarizes the mechanism of action of TCIs, the factors that prompted the Boxed Warning, and recent TCI safety and efficacy data. Based on these data, both topical corticosteroids and TCIs should have defined roles in AD management, with TCIs favored for sensitive skin areas (e.g., face) and instances where topical corticosteroids have proven ineffective, thereby minimizing the risk of adverse effects with both drug classes.