Biomarkers of immediate drug hypersensitivity

REVIEW - Open Access

Mayorga, C, Ariza, A, Muñoz-Cano, R, Sabato, V, Doña, I, Torres, MJ.  Allergy. 2023; 00: 1-12. doi:10.1111/all.15933

Abstract

Immediate drug hypersensitivity reactions (IDHRs) are a burden for patients and the health systems. This problem increases when taking into account that only a small proportion of patients initially labelled as allergic are finally confirmed after an allergological workup. The diverse nature of drugs involved will imply different interactions with the immunological system. Therefore, IDHRs can be produced by a wide array of mechanisms mediated by the drug interaction with specific antibodies or directly on effector target cells. These heterogeneous mechanisms imply an enhanced complexity for an accurate diagnosis and the identification of the phenotype and endotype at early stages of the reaction is of vital importance.

Sensitization to avian and fungal proteins in different work environments

Sánchez-Díez, S., Muñoz, X., Montalvo, T. et al. Allergy Asthma Clin Immunol 19, 96 (2023). https://doi.org/10.1186/s13223-023-00852-w

Abstract

Introduction

Hypersensitivity pneumonitis (HP) is usually caused by the inhalation of avian and fungal proteins. The present study assesses a cohort of Urban Pest Surveillance and Control Service (UPSCS) workers with high exposure to avian and fungal antigens, in order to identify their degree of sensitization and the potential risk of developing HP.

Methods

Workers were divided according to their work activity into Nest pruners (Group 1) and Others (Group 2). All individuals underwent a medical interview, pulmonary function tests and the determination of specific IgG antibodies. Antigenic proteins of pigeon sera were analysed using two-dimensional immunoblotting. Proteins of interest were sequenced by liquid-chromatography–mass spectrometry (LC–MS).

Results

101 workers were recruited (76 men, average age: 42 yrs); (Group 1 = 41, Group 2 = 60). Up to 30% of the study population exhibited increased levels of IgGs to pigeon, small parrot and parrot, and up to 60% showed high levels of Aspergillus and Penicillium IgGs.

Back to the roots of medicine: It's severe asthma patient-reported symptoms that matter!

Louis G, Schleich F, Guillaume M, Sousa-Pinto B, Bousquet J, Ganse ÉV, Louis R, Pétré B.  Pulmonology. 2023 Nov 10:S2531-0437(23)00194-0. doi: 10.1016/j.pulmoe.2023.10.005.

To the Editor,

Severe asthma can be defined as an “asthma which requires treatment with high-dose inhaled corticosteroids (ICS) + LABA to prevent it from becoming ‘uncontrolled’ or which remains ‘uncontrolled’ despite this therapy”.1 It is an important public health problem strongly associated with a significant health-related quality of life (HRQL) burden 2 and with considerable healthcare costs, almost twice those of non-severe asthmatics.3

Several studies have assessed the factors associated with HRQL in severe asthmatics, demonstrating the key role played by asthma control and comorbidities.2 However, very few studies have assessed the impact of detailed respiratory symptoms on HRQL. A recent study conducted by Louis et al.4 has demonstrated that dyspnoea was the most impactful symptom on the lives of mild asthmatics. However, to the best of our knowledge, no study has ever assessed the impact of specific respiratory symptoms on HRQL in a population of severe asthmatics. Knowing which symptoms are the most impactful on the lives of severe asthmatics is useful for adopting personalised care strategies.

Pseudo-Allergies in the Emergency Department: A Common Misdiagnosis of Hypersensitivity Type 1 Allergic Reaction.

Eraky AM, Wright A, McDonald D.  Cureus. 2023 Oct 5;15(10):e46536. doi: 10.7759/cureus.46536. 

Abstract

Type-1 hypersensitivity reaction represents an acute IgE-mediated reaction that can cause life-threatening conditions, such as anaphylactic shock, angioedema, and airway obstruction. Other reactions that can mimic type-1 hypersensitivity reactions include IgE-independent mast cell degranulation, bradykinin-mediated reactions, leukotrienes-mediated reactions, and pseudo-allergies. We use the term pseudo-allergy in this article for histamine-mediated reactions that are mast cell-independent.

Hypersensitivity type I-like reactions that can be life threatening

We did not discuss pseudo-allergic reactions that are not acute or life-threatening, such as celiac disease, Heiner's syndrome, eosinophilic esophagitis, and food protein-induced enterocolitis in our article because the emergency department is not the primary location to diagnose or treat these reactions. Herein, we present some allergic-like reactions that can be life-threatening, such as scombroid food poisoning (SFP), bradykinin-induced angioedema, IgE-independent angioedema, opioid-induced angioedema, and non-steroidal anti-inflammatory drug (NSAID)-induced hypersensitivity and angioedema.

From MASK-air® and SILAM to CATALYSE (Climate Action to Advance HeaLthY Societies in Europe)

Sousa-Pinto B, Palamarchuk Y, Leemann L et al. J Investig Allergol Clin Immunol. 2023 Jul 26:0. doi: 10.18176/jiaci.0923.

Abstract:

Allergy risk prediction by the SILAM model:
single forecast example for 25 Oct 2022.

Plant species vary under different climate conditions and the distribution of pollen in the air and their trends can be used to assess the impact of climate change on public health. In 2015, MASK-air® (Mobile Airways Sentinel networK for rhinitis and asthma) was launched as a project of the European Innovation Partnership on Active and Healthy Ageing (EIP-on-AHA, DG Santé and DG CONNECT). This project aimed to develop a warning system to inform patients about the pollen season onset. SILAM (System for Integrated modeLling of Atmospheric composition), a global-to-meso-scale dispersion model was developed by the Finnish Meteorological Institute (FMI). It provides quantitative information on atmospheric pollution of anthropogenic and natural origins, particularly on allergenic pollens. POLLAR (Impact of Air Pollution on Asthma and Rhinitis, EIT Health) has combined MASK-air clinical data with SILAM forecasts. A new Horizon Europe grant, CATALYSE (Climate Action to Advance HeaLthY Societies in Europe; grant agreement number 101057131), which started in September 2022, aims at better understanding climate change and finding ways to counteract it.

Limited beneficial effects of systemic steroids when added to standard of care treatment of seasonal allergic rhinitis

Article - Open access

Carl Skröder, Laila Hellkvist, Åslög Dahl, Ulla Westin, Leif Bjermer, Agneta Karlsson & Lars Olaf Cardell 

Scientific Reports volume 13, Article number: 19649 (2023)

Abstract

Intramuscular injections with methylprednisolone treating allergic rhinitis (AR) have a long history. Modern guidelines are designed to dissuade this treatment, but it´s frequently used, especially in primary care. This despite of concern for side effects and lack of modern placebo-controlled studies. This study was designed to evaluate if methylprednisolone, could significantly improve symptoms of birch pollen induced AR and reduce the concomitant use of standard of care medication. Forty-two patients with birch pollen induced AR were randomized to treatment with methylprednisolone (80 mg) or placebo (NaCl 0.9%). Daily symptom- and medication scores was registered for 3 weeks.

(A,B) Individual changes in SNOT-22 in each group.
(C,D) Individual changes in Juniper RQLQ in each group.

Quality of life questionnaires Sino-nasal Outcome Test-22 (SNOT-22) and Juniper Rhinoconjunctivitis Quality of Life Questionaire (Juniper RQLQ) were registered at trial start and at the end of the 3 weeks period.

Trends and Hospital Outcomes in HOSPITAL Admissions for Anaphylaxis in Children with and without Asthma in Spain (2016–2021)

De Miguel-Díez J, Lopez-de-Andres A, Caballero-Segura FJ et al.  J Clin Med. 2023 Oct 6;12(19):6387. doi: 10.3390/jcm12196387. 

Abstract

Background: To assess and compare the temporal trends in the incidence, characteristics and hospital outcomes among children with and without asthma who were hospitalized with anaphylaxis in Spain from 2016 to 2021, and identify the variables associated with severe anaphylaxis among children with asthma. 

Methods: An observational, retrospective study was conducted using a population-based database. The study population included pediatric patients with anaphylaxis. This population was stratified based on whether they had asthma. 

Results: The number of hospital admissions was stable from 2016 to 2019, dropping in 2020 and raising to the highest number in 2021. A total of 60.63% of hospitalizations occurred in boys and the most common anaphylactic reactions were due to food consumption (67.28%), increasing over time. The in-hospital mortality (IHM) remained stable and under 1% in all the years studied. The incidence of anaphylaxis was 2.14 times higher in children with asthma than in those without asthma (IRR 2.14; 95% CI 1.87–2.44).

Oral immunotherapy as a curative treatment for food-allergic preschool children: Current evidence and potential underlying mechanisms

Barten, LJC, Zuurveld, M, Faber, J, Garssen, J, Klok, T. Pediatr Allergy Immunol. 2023; 34:e14043. doi:10.1111/pai.14043

Abstract

The worldwide rising prevalence of food allergy is a major public health concern. Standard care consists of allergen avoidance and rescue medication upon accidental exposure. Oral immunotherapy (OIT) is increasingly being studied as a treatment option. Although desensitization (an increased reaction threshold) is often achieved during OIT, sustained unresponsiveness (SU; clinical nonreactivity after finishing OIT) is not achieved in most patients.

Immune mechanisms of tolerance induction by OIT

A few studies have investigated the effectiveness of OIT in children younger than 4 years of age (early = e-OIT) and have shown a much more favorable outcome in terms of SU development. Together with food allergy prevention studies, which have demonstrated high efficacy of early oral allergen exposure, the outcomes of e-OIT studies indicate an early-life window of opportunity to achieve SU, allowing unrestricted dietary intake. However, the underlying mechanism of the high effectiveness of e-OIT is not understood yet.