Adrenaline Auto-Injectors for Preventing Fatal Anaphylaxis

Sim, M., Sharma, V., Li, K., Gowland, M., Garcez, T., Shilladay, C., Pumphrey, R., Patel, N., Turner, P. and Boyle, R. (2024), Clin Exp Allergy. https://doi.org/10.1111/cea.14565

ABSTRACT

Anaphylaxis affects up to 5% of people during their lifetime. Although anaphylaxis usually resolves without long-term physical consequences, it can result in anxiety and quality of life impairment. Rarely and unpredictably, community anaphylaxis can cause rapid physiological decompensation and death. Adrenaline (epinephrine) is the cornerstone of anaphylaxis treatment, and provision of adrenaline autoinjectors (AAI) has become a standard of care for people at risk of anaphylaxis in the community. In this article, we explore the effectiveness of AAIs for preventing fatal outcomes in anaphylaxis, using information drawn from animal and human in vivo studies and epidemiology. We find that data support the effectiveness of intravenous adrenaline infusions for reversing physiological features of anaphylaxis, typically at doses from 0.05 to 0.5 μg/kg/min for 1–2 h, or ~ 10 μg/kg total dose. Intramuscular injection of doses approximating 10 μg/kg in humans can result in similar peak plasma adrenaline levels to intravenous infusions, at 100–500 pg/mL.

CD169+ Macrophages Mediate the Immune Response of Allergic Rhinitis Through the Keap1/Nrf2/HO-1 Axis

W. Qi, C. Liu, L. Shi, H. Li, X. Hou, H. Du, L. Chen, X. Gao, X. Cao, N. Guo, Y. Dong, C. Li, F. Yuan, Z. Teng, H. Hu, F. Zhu, X. Zhou, L. Guo, M. Zhao, M. Xia. Adv. Sci. 2024, 2309331. https://doi.org/10.1002/advs.202309331

Abstract

Immunofluorescence and flow cytometry were used
to detect the expression of CD169+ macrophages
in the spleen, lymph nodes, and nasal lavage fluid
of mice.

CD169+ macrophages are a newly defined macrophage subpopulation that can recognize and bind with other cells through related ligands, playing an essential role in antigen presentation and immune tolerance. However, its role in Allergic Rhinitis (AR) is still unclear. To investigate the characteristics of CD169+ macrophages in AR, this work first detects their expression patterns in the nasal mucosa of clinical patients. These results show a significant increase in CD169+ macrophages in the nasal mucosa of patients with AR. Subsequently, this work establishes an animal AR model using CD169 transgenic mice and compared the advantages of the two models. Moreover, this work also demonstrates the effects of CD169 knockout on eosinophils, Th cells, Treg cells, and the migration of dendritic cells (DCs).

Reliability and validation of an electronic penicillin allergy risk-assessment tool in a pregnant population

Wang, J., Elwood, C., Paquette, V. et al. Allergy Asthma Clin Immunol 20, 55 (2024). https://doi.org/10.1186/s13223-024-00918-3

Abstract

Background

Penicillin allergy adversely impacts patient care, yet most cases do not have true allergies. Clinicians require efficient, reliable clinical tools to identify low risk patients who can be safely de-labeled. Our center implemented the FIRSTLINE electronic point-of-care decision support tool to help non-allergist practitioners risk stratify patients with penicillin allergy. We sought to explore the reliability and validity of this tool in relation to allergist assessment and actual patient outcomes. We additionally compared it with two other published stratification tools, JAMA and PENFAST, to assess ability to accurately identify low risk patients appropriate for direct oral challenge.

Methods

In this single-center, retrospective, observational study, 181 pregnant females with self-reported penicillin allergy between July 2019 to June 2021 at BC Women’s Hospital, Vancouver, Canada were used to assess the reliability and validity of all three tools.

Epithelial barrier dysfunction and associated diseases in companion animals: Differences and similarities between humans and animals and research needs

Ardicli S, Ardicli O, Yazici D, et al. Allergy. 2024; 00: 1-31. doi:10.1111/all.16343

Abstract

Since the 1960s, more than 350,000 new chemicals have been introduced into the lives of humans and domestic animals. Many of them have become part of modern life and some are affecting nature as pollutants. Yet, our comprehension of their potential health risks for both humans and animals remains partial. The “epithelial barrier theory” suggests that genetic predisposition and exposure to diverse factors damaging the epithelial barriers contribute to the emergence of allergic and autoimmune conditions.

Impaired epithelial barriers, microbial dysbiosis, and tissue inflammation have been observed in a high number of mucosal inflammatory, autoimmune and neuropsychiatric diseases, many of which showed increased prevalence in the last decades.

Trends and research foci in immunoregulatory mechanisms of allergic rhinitis: a bibliometric analysis (2014-2024)

Front. Immunol., 23 September 2024, Sec. Immunological Tolerance and Regulation Volume 15 - 2024 | https://doi.org/10.3389/fimmu.2024.1443954

Abstract:

Background: This study aims to provide a comprehensive bibliometric analysis of research trends, hotspots, and future directions in the immunoregulatory mechanisms of allergic rhinitis (AR) from 2014 to 2024.

Methods: Data were sourced from the Web of Science Core Collection (WoSCC), covering articles and reviews published between April 1, 2014, and March 31, 2024. The search terms included “Allergic Rhinitis,” “AR,” and related terms along with specific keywords related to immune cells and inflammatory mediators. Bibliometric tools such as CiteSpace, VOSviewer, and SCImago Graphica were used to analyze institutional cooperation networks, keyword co-occurrence, citation bursts, and research topic evolution. Microsoft Excel 2019 was employed to display annual publication trends.

Global research output and collaboration in immunoregulatory
mechanisms of allergic rhinitis.

Results: A total of 2200 papers met the inclusion and exclusion criteria. The number of publications showed an upward trend over the past decade, with a significant peak in 2021. China (583 papers) and the United States (454 papers) were the major contributing countries. Imperial College London emerged as the leading institution.

Cord Blood Serum Levels of IL-31 and CCL17, Cutaneous Markers, and Development of Atopic Dermatitis

D’Erme AM, Fidanzi C, Bevilacqua M, et al. JAMA Dermatol. 2024;160(10):1112–1115. doi:10.1001/jamadermatol.2024.3178

Key Points

Question  Which are the possible cutaneous and serological markers that can be used to predict the development of atopic dermatitis (AD) in infants?

Findings  In this observational study, serum biomarkers, transepidermal water loss, and hydration rate of 40 infants were evaluated. There were statistically significant higher CCL17 and IL-31 cord blood serum levels in the infants who developed AD, and anterior cubital fossa transepidermal water loss values at 1, 6, and 12 months of age were also considerably higher in infants who developed AD.

Meaning  AD is a chronic skin disease for which some identifiable cutaneous or serological markers may be capable of predicting its development.

Abstract

Importance  Atopic dermatitis (AD) is the most prevalent chronic skin condition characterized by inflammation and itching. Currently, there is no reliable method for identifying which newborns might have an increased risk of developing AD.

FDA Perspective on the Regulation of Artificial Intelligence in Health Care and Biomedicine.

Warraich HJ, Tazbaz T, Califf RM. JAMA. 2024 Oct 15. doi: 10.1001/jama.2024.21451

Abstract

Importance  Advances in artificial intelligence (AI) must be matched by efforts to better understand and evaluate how AI performs across health care and biomedicine as well as develop appropriate regulatory frameworks. This Special Communication reviews the history of the US Food and Drug Administration’s (FDA) regulation of AI; presents potential uses of AI in medical product development, clinical research, and clinical care; and presents concepts that merit consideration as the regulatory system adapts to AI’s unique challenges.

Artificial Intelligence–Enabled Medical Devices Authorized for
Marketing by the US Food and Drug Administration, by Year

Observations  The FDA has authorized almost 1000 AI-enabled medical devices and has received hundreds of regulatory submissions for drugs that used AI in their discovery and development. Health AI regulation needs to be coordinated across all regulated industries, the US government, and with international organizations. Regulators will need to advance flexible mechanisms to keep up with the pace of change in AI across biomedicine and health care. Sponsors need to be transparent about and regulators need proficiency in evaluating the use of AI in premarket development.

The role of OX40 ligand/OX40 axis signalling in atopic dermatitis

Emma Guttman-Yassky, Michael Croft, Bob Geng et al. British Journal of Dermatology, Volume 191, Issue 4, October 2024, Pages 488–496, https://doi.org/10.1093/bjd/ljae230

Abstract

Atopic dermatitis (AD) is a heterogeneous inflammatory condition involving multiple immune pathways mediated by pathogenic T cells. OX40 ligand (OX40L) and OX40 are costimulatory immune checkpoint molecules that regulate effector and memory T-cell activity and promote sustained immune responses in multiple immunological pathways, including T helper (Th)2, Th1, Th17 and Th22. As such, OX40L/OX40 signalling between antigen-presenting cells (APCs) and activated T cells postantigen recognition promotes pathogenic T-cell proliferation and survival.