Digitally-enabled, person-centred care (PCC) in allergen immunotherapy: An ARIA-EAACI Position Paper

Pfaar O, Sousa-Pinto B, Papadopoulos NG, et al.  Allergy. 2024; 00: 1-14. doi:10.1111/all.16135

Abstract

In rhinitis and asthma, several mHealth apps have been developed but only a few have been validated. However, these apps have a high potential for improving person-centred care (PCC), especially in allergen immunotherapy (AIT). They can provide support in AIT initiation by selecting the appropriate patient and allergen shared decision-making. They can also help in (i) the evaluation of (early) efficacy, (ii) early and late stopping rules and (iii) the evaluation of (carried-over) efficacy after cessation of the treatment course.

Daily improvement of allergy control by SLIT (regression coefficients)

Associations of Gut and Circulating Microbiota with Circulating Vitamin D3, Type I Interferon, and Systemic Inflammation in Chronic Spontaneous Urticaria Patients

Yang Z, Song Y, Chen B, Hao F. J Inflamm Res. 2024;17:2775-2785

Abstract:

Objective: To analyze the associations of the gut and circulating microbiota with circulating vitamin D3 (VD3), type I interferon (IFNI), systemic inflammation, and clinical profiles in chronic spontaneous urticaria (CSU) patients.

Methods: A total of 36 CSU patients with VD3 insufficiency (VDI; serum 25(OH)VD3 < 30 ng/mL) and 36 sex-, age-, and body mass index–matched CSU patients with non-VDI were enrolled. Fecal and serum bacteria were identified through 16S rRNA sequencing, and serum 25(OH)VD3 and inflammation biomarkers were assessed using ELISA kits. IFNI response was determined by measuring the stimulatory activity of serum on IFNI-stimulated response element in HEK293 cells in vitro with luciferase assays.

Comparisons of disease duration (A), UAS7 (B), serum CRP (C),
serum IL6 (D), serum claudin 3 (E), stool calprotectin (F), IFNI response
(G), and serum IgE (H) between the two groups.

Results: Higher urticarial activity score over 7 days (UAS7), higher frequency of levocetirizine resistance, and more severe proinflammation but weaker IFNI response were observed in VDI than non-VDI patients (all P< 0.05).

Intranasal antihistamines and corticosteroids in allergic rhinitis: A systematic review and meta-analysis

Sousa-Pinto B, Vieira RJ, Brozek J et al.  J Allergy Clin Immunol. 2024 Apr 27:S0091-6749(24)00419-6. doi: 10.1016/j.jaci.2024.04.016.

Abstract

Background

There is insufficient systematised evidence on the effectiveness of individual intranasal medications in allergic rhinitis (AR).

Objective

To perform a systematic review to compare the efficacy of individual intranasal corticosteroids and antihistamines against placebo in improving the nasal and ocular symptoms and the rhinoconjunctivitis-related quality-of-life of patients with perennial or seasonal AR.

A Comprehensive Review Exploring Allergic Rhinitis With Nasal Polyps: Mechanisms, Management, and Emerging Therapies

Narasimhan G, Deshmukh P T, Gaurkar S S, et al. (April 28, 2024) Cureus 16(4): e59191. doi:10.7759/cureus.59191

Abstract: 

Allergic rhinitis (AR) and nasal polyps (NP) are common inflammatory disorders of the upper airways that often coexist and significantly impact patients' quality of life. This comprehensive review explores the intricate relationship between AR and NP, elucidating the underlying mechanisms, clinical manifestations, and management strategies. Immunological mechanisms, genetic predispositions, and environmental factors contribute to the development and progression of both conditions. Pharmacological therapies, including intranasal corticosteroids and biologic agents, are cornerstone treatments for managing AR with NP. At the same time, surgical interventions such as functional endoscopic sinus surgery (FESS) may be necessary in refractory cases. Emerging therapies, including immunomodulatory agents and precision medicine approaches, hold promise in improving treatment outcomes. A multidisciplinary approach, personalized treatment plans, and patient education are essential for optimizing clinical practice.

Mast cell signaling and its role in urticaria.

Puxeddu I, Pistone F, Pisani F, Levi-Schaffer F.  Ann Allergy Asthma Immunol. 2024 Apr 23:S1081-1206(24)00242-4. doi: 10.1016/j.anai.2024.04.023.

Abstract

Skin MC receptors and ligands involved in CSU

Chronic urticaria (CU) is a mast cells (MC)-driven disease characterized by the development of itching wheals and/or angioedema. In the last decades, outstanding progress has been made in defining the mechanisms involved in MC activation, and novel activating and inhibitory receptors expressed in MC surface were identified and characterized. Besides an IgE-mediated activation via FcεRI-cross-linking, other activating receptors, including Mas-related G protein–coupled receptor-X2 (MRGPRX2), C5a receptor and protease-activated receptors (PAR1 and PAR2) are responsible for MC activation.

Ambient pollen exposure and pollen allergy symptom severity in the EPOCHAL study

Luyten A, Bürgler A, Glick S et al.  Allergy. 2024 Apr 24. doi: 10.1111/all.16130. 

Abstract

Background

Ambient pollen exposure causes nasal, ocular, and pulmonary symptoms in allergic individuals, but the shape of the exposure–response association is not well characterized. We evaluated this association and determined (1) whether symptom severity differs between subpopulations; (2) how the association changes over the course of the pollen season; and (3) which pollen exposure time lags affect symptoms.

Methods

Adult study participants (n = 396) repeatedly scored severity of nasal, ocular, and pulmonary allergic symptoms, resulting in three composite symptom scores. We calculated hourly individually relevant pollen exposure to seven allergenic plants (alder, ash, birch, hazel, grasses, mugwort, and ragweed) considering personal sensitization and exposure time lags of up to 96 h. We fitted generalized additive mixed models, with a random personal intercept, adjusting for weather and air pollution as potential time-varying confounders.

Interstitial Lung Disease: A Review

Maher TM.  JAMA. Published online April 22, 2024. doi:10.1001/jama.2024.3669

Abstract

Importance  Interstitial lung disease (ILD) consists of a group of pulmonary disorders characterized by inflammation and/or fibrosis of the lung parenchyma associated with progressive dyspnea that frequently results in end-stage respiratory failure. In the US, ILD affects approximately 650 000 people and causes approximately 25 000 to 30 000 deaths per year.

Observations  The most common forms of ILD are idiopathic pulmonary fibrosis (IPF), which accounts for approximately one-third of all cases of ILD, hypersensitivity pneumonitis, accounting for 15% of ILD cases, and connective tissue disease (CTD), accounting for 25% of ILD cases. ILD typically presents with dyspnea on exertion. Approximately 30% of patients with ILD report cough. Thoracic computed tomography is approximately 91% sensitive and 71% specific for diagnosing subtypes of ILDs such as IPF. Physiologic assessment provides important prognostic information. A 5% decline in forced vital capacity (FVC) over 12 months is associated with an approximately 2-fold increase in mortality compared with no change in FVC.

Precision Dermatology: A Review of Molecular Biomarkers and Personalized Therapies

Tan, Isabella J., Alicia Podwojniak, Aarushi Parikh, and Bernard A. Cohen. 2024.  Current Issues in Molecular Biology 46, no. 4: 2975-2990. https://doi.org/10.3390/cimb46040186

Abstract

The evolution of personalized medicine in dermatology signifies a transformative shift towards individualized treatments, driven by the integration of biomarkers. These molecular indicators serve beyond diagnostics, offering insights into disease staging, prognosis, and therapeutic monitoring. Specific criteria guide biomarker selection, ensuring attributes like specificity, sensitivity, cost feasibility, stability, rapid detection, and reproducibility. This literature review, based on data from PubMed, SCOPUS, and Web of Science, explores biomarkers in Hidradenitis Suppurativa (HS), Psoriasis, Atopic Dermatitis (AD), Alopecia Areata (AA), Vitiligo, and Chronic Spontaneous Urticaria (CSU). In HS, TNF-α, IL-1β, and MMPs serve as biomarkers, influencing targeted therapies like adalimumab and anakinra.