IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper

DNA-Programmed Reaction to Evaluate Specific IgE for Allergy Point-of-Care Testing

A DNA-programmed reaction to evaluate non-nucleic acids inputs with computation speed (≈30 min) and sensitivity (sub-picomolar) suitable for analyzing physiologically relevant biomarkers in a one-pot format and point-of-care testing setting is reported. Specifically, a DNA programme based on the proximity-activation exponential amplification reaction (PEAR) is designed to evaluate specific IgE (sIgE) against Der p 2 implicated in dust mite allergy which affects millions worldwide. In this work, we tailored the molecular components of the input-to-oligo barcode conversion module as an AND gate to detect inputs with binding specificity to Der p 2 antigen and is of an IgE isotype. In addition, an in situ biotinylation method is developed to generate amplified oligo barcodes amendable for direct visualization on a lateral flow format. As a proof-of-concept demonstration of its potential clinical utility, 21 clinical samples are evaluated by the as-developed sIgE PEAR programme using the dual readout modality of real-time fluorescence measurement for precise input quantification and simple lateral flow yes/no answer.

Performance of a point of care allergy test compared to an established laboratory test for specific IgE in Japanese patients with allergic rhinitis

BACKGROUND

Pollinosis is highly prevalent. Reliable specific IgE tests are needed to identify the causative aeroallergens. This study aims to evaluate the performance of DropScreenTM (DS), a point of care test, by comparing it with that of ViewAllergy39TM, a laboratory test (VA).

METHODS

Sera from 70 Japanese outpatients with pollinosis (median age: 29.5 years; 35% were men) were used. Qualitative analysis and concordance rate assessment were performed. For allergens with discrepant results between DS and VA, inhibition tests were carried out on relevant samples and allergen component analysis for specific allergens was conducted.

RESULTS

The average positivity rates for the 17 allergens included in the study were 20.8% and 26.6% for DS and VA, respectively. DS positive rate for Japanese cypress was 10-fold lower than that of VA. Clear discrepancies in detection rates between VA and DS were also shown for Japanese cedar, Moth, and A. fumigatus. Inhibition tests on discrepant sera confirmed that VA could accurately measure specific IgE toward these allergens.

CONCLUSION

DS and VA were not equally effective in reliably detecting specific IgE toward Japanese cypress. This study highlights the importance of understanding the impact of testing performance differences between assays on diagnostic workup and subsequent therapy selection.

Food Hypersensitivity: Distinguishing Allergy from Intolerance, Main Characteristics, and Symptoms-A Narrative Review

Background/Objectives: Food hypersensitivity remains an understudied and overlooked subject globally. It is characterized by adverse reactions to dietary substances, potentially triggered by various mechanisms. Food allergy, a subset of food hypersensitivity, denotes an immune response to food proteins categorized into immunoglobulin IgE-mediated or non-IgE-mediated reactions. Conversely, food intolerance, another facet of food hypersensitivity, refers to non-immunological reactions, in which the human body cannot properly digest certain foods or components, leading to gastrointestinal discomfort and other non-immune-related symptoms. The main objective of this study was to determine and differentiate the differences, characteristics, and types of food hypersensitivity. Methods: This study involved a comprehensive review of key research from 1990 onward, including review articles, prospective studies, nested case-control studies, and meta-analyses. Results: Recognizing these differences is essential for healthcare professionals to ensure accurate diagnosis, effective management, and improved patient outcomes, while also aiding dietitians in providing optimal nutritional and dietary guidance. Conclusions: there are big differences between the main characteristics, such as symptoms, complications, and treatments between allergies, and food intolerances. Commonly reported trigger foods include cow milk, gluten, eggs, nuts, and seafood.

Application and research progress of artificial intelligence in allergic diseases

Artificial intelligence (AI), as a new technology that can assist or even replace some human functions, can collect and analyse large amounts of textual, visual and auditory data through techniques such as Reinforcement Learning, Machine Learning, Deep Learning and Natural Language Processing to establish complex, non-linear relationships and construct models. These can support doctors in disease prediction, diagnosis, treatment and management, and play a significant role in clinical risk prediction, improving the accuracy of disease diagnosis, assisting in the development of new drugs, and enabling precision treatment and personalised management. In recent years, AI has been used in the prediction, diagnosis, treatment and management of allergic diseases. Allergic diseases are a type of chronic non-communicable disease that have the potential to affect a number of different systems and organs, seriously impacting people's mental health and quality of life. In this paper, we focus on asthma and summarise the application and research progress of AI in asthma, atopic dermatitis, food allergies, allergic rhinitis and urticaria, from the perspectives of disease prediction, diagnosis, treatment and management. We also briefly analyse the advantages and limitations of various intelligent assistance methods, in order to provide a reference for research teams and medical staff.

Clinical study on the utility of allergy tests to detect IgE-mediated anaphylaxis after diclofenac etalhyaluronate administration

OBJECTIVES

This study was conducted to investigate factors involved in anaphylaxis related to diclofenac etalhyaluronate (DEH) [product name: Joyclu® (JCL)] (containing DEH and macrogol 400), which is used to treat patients with osteoarthritis.

METHODS

Patients with osteoarthritis were divided into two groups that had (experienced patients) or had not experienced anaphylactic symptoms after JCL administration (nonexperienced patients). Five tests performed to assess factors related to anaphylaxis consisted of a skin prick test as the primary endpoint and the other tests including basophil activation test, allergen-specific IgE tests using enzyme-linked immunosorbent assay or immunochromatographic kits, and genetic study were secondary endpoints.

RESULTS

The skin prick test showed 4 (wheal)/7 (erythema) of 15 experienced patients and 0/3 of 19 nonexperienced patients were positive for any of the test reagents containing DEH. The basophil activation test showed two experienced patients were positive for test reagents containing DEH. DEH- and diclofenac-allergen-specific IgE were detected in 3 and 1 of 12 experienced patients, respectively. No clear results were shown in the other tests.

CONCLUSIONS

DEH may be the main factor involved in the development of anaphylaxis. The skin prick test was more sensitive than the basophil activation and allergen-specific IgE tests for identifying factors associated with anaphylaxis.

A Single Multiplex CytoBas Assay Incorporating Eight Major Components for Accurate Detection of Allergen Sensitization in Asthma and Allergic Rhinitis

BACKGROUND

Allergic rhinitis and asthma can be triggered by a variety of aeroallergens, including house dust mites (HDM), tree and grass pollen, and household pets. Identification of the relevant allergen is critical for lifestyle changes and treatments, including allergen immunotherapy. We here assessed the diagnostic performance and clinical utility of a single flow cytometry staining of basophils with major aeroallergen components (AeroDiff CytoBas).

METHODS

In 156 atopic patients with allergic rhinitis/asthma and 21 non-atopic individuals, allergen-specific IgE levels were determined by ImmunoCAP, and component-specific IgE by ELISA. PBMCs were analyzed by flow cytometry with basophil markers and eight fluorochrome-conjugated allergen component tetramers.

RESULTS

Patients were stratified for sensitization to each of the four allergens. Allergen-component staining in a single multiplex CytoBas assay and component-specific IgE serology performed similarly for Der p 2, Lol p 1, Fel d 1, and Can f 1 (ROC AUC: 0.76-0.97 vs. 0.73-0.93). CytoBas had greater diagnostic accuracy than component-specific IgE serology (p < 0.001) for HDM sensitization using Der f 1 or Der p 1, and grass pollen using Lol p 5 or Phl p 1. Furthermore, the combined evaluation of Der p 1 and Der p 2 with CytoBas was 96.3% sensitive and 90.7% specific for HDM sensitization. The combined evaluation of Lol p 1 and Lol p 5 achieved 95.4% sensitivity and 96.4% specificity for ryegrass pollen sensitization.

CONCLUSION

AeroDiff CytoBas has similar to superior diagnostic accuracy compared to singleplex IgE serology, with the additional advantage of a single assay to evaluate multiple allergens. This enables precise and efficient component-resolved diagnosis of aeroallergen sensitization to guide personalized treatment for patients with allergic rhinitis and/or asthma.

Tralokinumab Treatment in Adult Atopic Dermatitis Patients: 28-Week Evaluation of Clinical Effectiveness, Safety, Serum Proteins and Total IgE Levels

INTRODUCTION AND OBJECTIVES

Tralokinumab-a biological that specifically targets interleukin-13-is one of the newer advanced systemic treatments for patients with moderate-to-severe atopic dermatitis (AD). Although safety and efficacy have been shown in phase-III clinical trials, daily practice data are needed. Therefore, the aim of this study was to evaluate 28-week safety and effectiveness, serum proteins and total IgE levels in adult AD patients treated with tralokinumab in daily practice.

MATERIALS AND METHODS

Data of all adult AD patients who started treatment with tralokinumab and participated in the BioDay registry were collected at baseline, and after 4,16 and 28 weeks of treatment. Clinical efficacy was evaluated by clinical outcome measures, such as the Eczema Area and Severity Index (EASI) as well as patient-reported outcome measures, such as the numerical rating scale (NRS) for pruritus. Adverse events were evaluated. In a subgroup of patients, 18 proteins as well as total IgE levels were measured in serum.

RESULTS

A total of 84 patients were included, of whom 39 were dupilumab-naïve (D-naïve) and 45 were dupilumab non-naïve (D-non-naïve) patients. All primary outcomes significantly improved during 28 weeks of tralokinumab treatment and the probability of achieving EASI ≤ 7 and NRS-pruritis ≤ 4 was 75.8% (56.9-88.2) and 51.4% (28.0-74.2), respectively. The disease severity-associated proteins TARC/CCL17 and PARC/CCL18 decreased during treatment, and total IgE levels significantly decreased in the D-naïve patients. The most reported adverse events were eye disorders (n = 24, 28.6%). A total of 23 patients (27.4%) discontinued treatment due to adverse events and/or ineffectiveness, with hair loss being the most common adverse event leading to treatment discontinuation (n = 6).

CONCLUSION

Tralokinumab is an effective treatment for moderate-to-severe AD in adult patients, in both dupilumab-naïve patients and patients who previously failed on dupilumab treatment. The clinical effect is supported by the biological data.

Detection of anti-MGL_1304 IgE using the ImmunoCAP system for diagnosis of type I allergy to sweat

BACKGROUND

Type I allergy to sweat is involved in the pathogenesis of atopic dermatitis (AD) and cholinergic urticaria (CholU), with MGL_1304 from Malassezia globosa being the major causative antigen. Currently, no standard diagnostic test exists for sweat allergy that uses serum.

METHODS

The ImmunoCAP (iCAP) system to measure antigen-specific IgE was developed using recombinant MGL_1304 (rMGL_1304). Using a positive histamine release test (HRT) against the semi-purified sweat antigen (QR) as a criterion for diagnosing sweat allergy, the diagnostic usefulness of anti-MGL_1304 IgE detected through iCAP was analyzed in comparison with conventional anti-Malassezia antigen m227 IgE (anti-m227 IgE).

RESULTS

The iCAP system with rMGL_1304 detected anti-MGL_1304 IgE in serum samples without detection of non-specific reactions. In 93 patients with AD or CholU, of which 58 were HRT-positive, anti-MGL_1304 IgE titers correlated with histamine release levels in HRT against QR better than anti-m227 IgE titers. The cutoff value for sweat allergy diagnosis was 1.55 UA/mL for anti-m227 IgE (sensitivity: 79.3 %; specificity: 65.7 %) and 0.671 UA/mL for anti-MGL_1304 IgE (sensitivity: 84.5 %; specificity: 80.0 %). Clinical features of AD and CholU were partially associated with anti-m227 IgE and anti-MGL_1304 IgE titers but not with histamine release in HRT using QR.

CONCLUSIONS

Anti-MGL_1304 IgE detection using iCAP is simple and can help diagnosis of sweat allergy with better accuracy than conventional anti-Malassezia antigen IgE.

Immunological In Vitro Assay for Quantification of Adjuvanted Allergoids

BACKGROUND

Many IgE-mediated allergic disorders can be treated with allergen immunotherapy (AIT). In order to improve safety and efficacy, some AIT products contain allergen extracts which are chemically cross-linked to generate allergoids and are adsorbed to aluminum hydroxide adjuvant. The modification and adsorption impair accessibility of the protein and quantification of the allergoid content.

METHODS

An ELISA-like assay to quantify the allergoid content in adjuvanted grass pollen allergoid AIT products (from here on called: AIT drug products; AIT-DPs) was developed using a fluorescence detection system. The high density of the aluminum hydroxide particles enabled pelleting the antigen complexes by centrifugation. Rabbit anti-grass pollen allergoid sera or a mouse anti-Phl p 5 monoclonal antibody (mAb) was used as the primary antibody. Protein content of the samples was quantified by nitrogen analysis.

RESULTS

High specificity of the primary antibodies was confirmed by isoelectric focusing, gel-electrophoresis, and immunoblotting. Performance of the allergoid content assay was demonstrated in grass pollen AIT-DPs with high specificity and low/absent cross-reactivity with tree pollen or mite AIT-DPs. It was used to confirm batch-to-batch consistency and allergoid content of distinct grass pollen AIT-DPs. Overall, in relation to their total protein content, the allergoid content ranged between 0.8 and 2.1 relative to an in-house reference for all grass pollen AIT-DPs, whereas use of mAb revealed product-specific differences in the Phl p 5 amount. Additionally, the assay detects product alteration by heat stress.

CONCLUSION

The described assay is suitable to quantify the allergoid content and quality of allergoids in complex with aluminum hydroxide. It is suitable for animal-free final product testing in vitro, for example, for batch release to ensure the quality of AIT-DPs.

Immunoelectrochemical assessment of human IgE in non-invasive samples of allergic individuals using PdNCs-labelled antibodies

The escalating global prevalence of allergies presents a substantial public health challenge. Immunoglobulin E (IgE) serves as a key biomarker for allergic diseases, often measured in blood serum by ELISA immunoassays. Despite recent interest in minimally invasive sampling of biological fluids, the low sample volumes and IgE concentrations demand highly sensitive methodologies, typically confined to centralized laboratories. In this article, a decentralizable approach based on competitive immunoassays using Pd nanocluster (PdNCs)-labelled antibodies for electrochemical detection is proposed. With this aim, PdNCs were successfully bioconjugated with an anti-hIgE antibody to perform competitive immunoassays. To improve the analytical capabilities of the methodology, disposable screen-printed carbon electrodes with dual working electrodes were used for enhancing precision. Prior electrodeposition of PdNCs at - 0.6 V for 90 s significantly improved sensitivity (7.1 µA g ng⁻1) and lowered the limit of detection (LoD) to 0.3 ng g⁻1 for PdNCs determination. The use of PdNCs as labels resulted in an improvement in the LoD for IgE determination. Calibration curves performed using competitive immunoassays for IgE determination, ranging from 10-5 to 102 ng g-1, demonstrated sensitivity comparable to high-tech methods, with a LoD of 0.008 ng g-1 for electrochemical measurements. Bimodal detection of Pd (linear sweep voltammetry and inductively coupled plasma-mass spectrometry) in various biological fluids (saliva, tears, nasal exudate, capillary blood, and blood serum) revealed significant differences in IgE levels between allergic and non-allergic individuals. Notably, capillary blood correlated strongly with serum blood, and a certain correlation has also been found with nasal exudate. The electrochemical approach, combining sensitivity and precision with non-invasive sampling, offers a simplified alternative for IgE determination in allergic disease.

Sensitization profiles to olive pollen allergens and allergic respiratory disease severity in patients from Jaén, Spain: A cross-sectional study

Objective

To determine the molecular sensitization profile of patients allergic to olive pollen and evaluate its correlation with the type and severity of the allergic respiratory disease (ARD).

Patients and methods

Observational, cross-sectional study including patients aged 5-55 years with seasonal ARD (rhinitis and/or asthma) due to olive pollen sensitization from the Jaén University Hospital (Jaén, Spain), an area with prolonged high olive pollen exposure. Specific IgE (sIgE) levels to Ole e 1, Ole e 7, and Ole e 9 and clinical variables were considered. ARD severity was categorized according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines (rhinitis) and the Guía Española para el Manejo del Asma (GEMAv4.2).

Results

We included 1111 patients (mean [SD] age: 23.4 [12.7] years, 47.7% female) with asthma (87.8%) and rhinitis (96.9%). Ole e 1 sensitization was the most prevalent (79.6%), followed by Ole e 7 (62.0%) and Ole e 9 (50.8%); 60.3% of patients were sensitized to more than 1 olive pollen allergen and 19.2% had negative sIgE results. Ole e 1, Ole e 7, and Ole e 9 sensitizations were associated with asthma diagnosis and severity (p < 0.001 for all), Ole e 7 sensitization with rhinitis diagnosis (p = 0.006), and Ole e 1 and Ole e 9 with rhinitis severity (p = 0.007 and p = 0.006, respectively). The Ole e 1, Ole e 7, and Ole e 9 triple sensitization profile was associated with asthma diagnosis (p < 0.001) and severity (p = 0.029), and with rhinitis severity (p = 0.009).

Conclusion

Sensitizations to the olive pollen allergens Ole e 7 and Ole e 9 are prevalent in areas with prolonged high pollen exposure and become major allergens together with Ole e 1. In these areas, a considerable proportion of patients allergic to olive pollen have negative sIgE results. Triple sensitization to Ole e 1, Ole e 7, and Ole e 9 is associated with ARD severity and asthma diagnosis. The sensitization profiles based on molecular diagnosis (MD) may affect decisions regarding allergen immunotherapy treatment.

From diagnosis to desensitization in immediate hypersensitivity reactions to both oral and parenteral iron salts

Background: Hypersensitivity reactions (HRs) to iron agents are increasing in parallel with increased use of iron preparations. Objective: We aimed to evaluate the clinical features and our previous desensitization protocol in patients with immediate hypersensitivity reactions (IHR) to iron agents. Methods: We screened the medical records of 96 patients with a history of IHRs to oral or intravenous (IV) iron agents. We evaluated clinical features and diagnostic test results. Furthermore, we assessed the safety and success rate of the desensitization protocol. Results: Forty-seven patients had a history of IHRs to oral iron preparations, whereas 49 patients had a history of IHRs to IV iron agents. Skin-prick tests (SPT) with suspected and alternative oral iron salts were performed in 52.1% of the patients, and five were positive. SPTs and intradermal tests with IV iron products were applied to 67.7% and 65.6% of the patients, respectively, and four yielded positivity. Anaphylaxis was more common in patients hypersensitive to IV iron agents (n = 33) (p < 0.001). In 15 patients for whom iron agents were mandatory, 52 successful desensitizations with ferric carboxymaltose were performed. Conclusion: Our study demonstrated that skin tests were not helpful in the diagnosis of IHRs to iron agents and the parenteral route of administration was related to more severe IHRs. Furthermore, in case of necessity, our IV desensitization protocol generated for ferric carboxymaltose is a safe, effective, and practical treatment of choice.

DNA methylation at birth and IgE trajectories from birth to adolescence, different patterns between White and Asian

AIM

We aim to assess association of DNA methylation (DNAm) at birth with total immunoglobulin E (IgE) trajectories from birth to late adolescence and whether such association is ethnicity-specific.

METHODS

We examined the association of total IgE trajectories from birth to late adolescence with DNAm at birth in two independent birth cohorts, the Isle of wight birth cohort (IOWBC) in UK (n = 796; White) and the maternal and infant cohort study (MICS) in Taiwan (n = 60; Asian). Biological pathways and methylation quantitative trait loci (methQTL) for associated Cytosine-phosphate-Guanine sites were studied.

RESULTS

Two total IgE trajectories, high vs. low, were inferred from each of the two cohorts. Associations of DNAm at 103 CpGs with IgE trajectories in IOWBC and at 476 CpGs in MICS were identified. Between the two cohorts, of the identified CpGs, one was in common, methQTL site cg16711274 (mapped to gene MINAR1), and 17 pathways were common with at least four linked to airway diseases.

CONCLUSION

The findings suggest at-birth epigenetics may explain ethnicity differences in total IgE trajectories later in life.

Successful desensitization to horse antithymocyte globulin for aplastic anemia: two case reports and literature review

BACKGROUND

Horse antithymocyte globulin (hATG) is an important therapeutic option for aplastic anemia (AA). However, hATG carries the risk of fatal anaphylaxis, and skin tests are performed to identify high-risk patients. We report on the successful desensitization of two AA patients with positive skin tests to hATG.

CASE PRESENTATION

Case 1: A 72-year-old man with a history of successful treatment with rabbit ATG was referred for pancytopenia. Neutrophil, reticulocyte, and platelet counts were 546 /µL, 32,000 /µL, and 19,000 /µL, despite the oral administration of eltrombopag and cyclosporine. Bone marrow biopsy showed hypocellularity, and he was diagnosed with relapsed severe AA. Case 2: A 69-year-old man was referred for anemia and thrombocytopenia, and diagnosed with non-severe AA. Neutrophil, reticulocyte, and platelet counts were 2,044 /µL, 23,000 /µL, and 37,000 /µL. Bone marrow biopsy revealed hypocellularity. Neither patient had a history of allergy, and the skin prick test (SPT) of hATG was negative, but the intradermal test (IDT) was positive. The result of the IDT in case 2 was reproducible. They received hATG desensitization under close monitoring of vital signs in our high-care unit. The protocol consisted of gradually increasing doses of hATG (four intradermal, two subcutaneous, and four intravenous (IV) push) and some premedications prior to administration of the full dose IV drip. They completed the course without developing any systemic allergic reactions.

CONCLUSIONS

Despite the risk of anaphylaxis, hATG desensitization can be beneficial in AA patients with a positive skin test, especially when no alternative is available or hATG is preferred.

A Comparison of asIgE Levels Measured with ALEX and ImmunoCAP ISAC in Polish Children with Food Allergies

In order to establish the reliability of new multiplex tests for determining allergen-specific immunoglobulin E (asIgE) levels in serum, the results of asIgE determinations obtained via ALEX tests were compared to those obtained via ImmunoCAP ISAC in a group of 40 Polish children hospitalized due to food allergy and/or anaphylaxis. The analysis was based on 6320 determinations of asIgEs relative to 79 common allergen molecules included in both tests (80 tests conducted-40 ALEX and 40 ISAC). The study showed a high correlation of results between the compared diagnostic tests, with the concordance of asIgE determinations at the level of 92.5% (n = 2922). The results of this study showed the sensitivity of the ALEX test to be comparable with that of the ImmunoCAP ISAC test. One indisputable advantage of the ALEX test is its high number of determinations per procedure, which provides more information about the patient's molecular profile; moreover, the use of an inhibitor of the asIgEs that bind to cross-reactive carbohydrate determinants (CCDs) reduces their impact on the results for allergens naturally containing carbohydrate determinants. Comparative analyses of asIgE test results obtained with ALEX and ImmunoCAP ISAC tests demonstrate that the ALEX test is a reliable diagnostic tool for asIgE assessments. However, significant differences in the absolute values of asIgEs relative to individual molecules suggest the need for caution when directly comparing asIgE levels from both tests.

Exploring the Role of Allergenic Components in Children with House Dust Mite-Induced Allergic Diseases

Purpose

To investigate the main characteristics of HDM-induced allergic diseases in children and to explore allergen component-specific sensitization patterns, features, and correlations with clinical symptoms.

Methods

Serum samples were collected from children with HDM-induced allergic diseases. Information on age, sex, and clinical symptoms was recorded. A protein chip method was used to detect specific IgE (sIgE) against HDM components, including Der p 1, Der f 1, Der p 2, Der f 2, Der p 5, Der p 7, Der p 10, Der p 21, and Der p 23.

Results

116/120 (96.67%) exhibited positive reactions to HDM components. The highest positive rates were for Der p 1 (95.83%) and Der f 1 (95.83%), followed by Der p 2 (86.67%), Der f 2 (85.83%), and Der p 23 (62.50%). Der p 5, 7, and 23 positivity increased with age. Notably, Der p 23 positivity was higher in the allergic asthma (AA) group than in the non-AA, atopic dermatitis (AD), and allergic rhinitis (AR) groups and higher in AR with AA than AR-only. Der p 2 and Der f 2 had higher positive rates in respiratory allergies than in AD alone. The impact of other HDM components on different allergic diseases was minimal. Pearson correlation analysis demonstrated strong positive correlations between sIgE concentrations for various HDM components, especially between Der p 2 and Der f 2 (r = 0.96, p < 0.01).

Conclusion

Der p 1, Der f 1, Der p 2, Der f 2, and Der f 23 are the major allergens, with Der p 5, 7, and 23 showing age-specific sensitization patterns. Der p 2 and Der f 2 are closely associated with respiratory allergies, whereas Der p 23 is particularly linked to the development of asthma. There is a general positive correlation among the sIgE concentrations of various HDM components.

Allergens in Atopic Dermatitis

Atopic dermatitis (AD) is a chronic inflammatory skin disease with a complex relationship to allergens. While AD itself is not an allergic reaction and does not necessarily involve allergen sensitization, AD patients show higher rates of sensitization to food and inhalant allergens compared to the general population. Recent evidence refining the "dual allergen exposure hypothesis" demonstrates that early oral exposure to allergens through an intact gastrointestinal barrier typically promotes tolerance, while exposure through compromised skin or respiratory barriers often leads to sensitization. Therefore, the impaired skin barrier function in AD patients increases the risk of transcutaneous sensitization and may interfere with oral tolerance development. Interestingly, AD patients' sensitivity to contact allergens (such as metals and fragrances) is not necessarily higher than that of the general population, which may be related to the inherent properties of these allergens. Personalized allergen testing can help guide appropriate allergen avoidance and reintroduction strategies in AD management. The insights into optimal allergen exposure conditions have also expanded the potential applications of allergen-specific immunotherapy in preventing AD onset in high-risk populations and halting the atopic march.

A systematic review of total IgE reference intervals - A 2024 update

BACKGROUND

Total IgE (tIgE) is a frequently requested analyte in patients presenting with symptoms of atopy. Although tIgE has limited clinical utility in the diagnosis of atopic diseases, it is still important that appropriate reference intervals are provided to the intepreting clinician. Concerns have recently been raised whether laboratories may be using outdated tIgE reference intervals. The aim of this study was therefore to perform the first systematic literature review of tIgE reference intervals to aid laboratories in choosing appropriate sources.

METHODS

A search was performed in MEDLINE, Embase and the Cochrane Library from time of inception to July 2024. Eligible studies had to provide an estimate of paediatric and/or adult tIgE reference intervals using current generation immunoassays. The methodology followed PRISMA guidelines, and the study protocol was registered in the PROSPERO database (CRD42023396441).

RESULTS

A total of 1667 records were screened of which 20 studies remained after full text review. The studies included 23 910 individuals and covered 18 countries. Upper reference limits varied significantly, with participant selection (inclusion or exclusion of in vitro confirmed specific IgE sensitised individuals) and statistical methods identified as the most important factors influencing the upper reference limit.

CONCLUSION

This review emphasises the need for laboratories to carefully evaluate the participant selection criteria and employed statistical methods whilst determining which tIgE reference intervals are the most appropriate to report to clinicians. Further efforts must also be made to harmonise and improve the reporting of tIgE reference interval studies.

Environmental exposures associated with atopy in a rural community in Gwanda district, Zimbabwe: a cross-sectional study

Introduction

The increasing prevalence of allergic diseases in Zimbabwe may be attributed to changing environmental exposure patterns. In this study, we sought to identify the most influential environmental and lifestyle factors that may explain the observed atopy in a rural community in Zimbabwe.

Methods

Using a cross-sectional study, information on a wide array of environmental and lifestyle exposures was self-reported by a sample of participants (children aged <18 years and adults aged ≥18 years) in the Gwanda district, Zimbabwe. To consenting participants, we performed skin prick testing (SPT) at a local clinic in Gwanda district to identify atopic individuals. Variables with a p value <0.25 from univariate analysis were included in backward-elimination multiple logistic regression analysis. Separate regression analyses were conducted for children (n = 108), adults (n = 388), and a subgroup of adults who reported ever being employed in any potentially harmful occupation (n = 153).

Results

Compared with boys, girls were more likely to be sensitised to at least one allergen (OR = 4.87, 95% CI = 1.22-19.51). Among adults, the likelihood of sensitisation increased with increasing age (OR = 1.02, 95% CI = 1.01-1.03) and with a history of bloody urine and/or schistosomiasis (OR = 2.20, 95% CI = 0.98-4.95). In the subgroup of adults who reported ever being employed in any potentially harmful occupation, atopic sensitisation was associated with a history of tuberculosis (TB; OR = 3.37, 95% CI = 1.08-10.52) and a history of bloody urine and/or schistosomiasis (OR = 4.36, 95% CI = 1.40-13.65). Other notable, though not significant, factors were passive or parental smoking, alcohol consumption, indoor dampness and visible mould on walls.

Conclusion

Girls were more likely to be sensitised to at least one allergen when compared to boys. Among adults, atopic sensitisation was positively associated with age, parental smoking, alcohol consumption and history of bloody urine or schistosomiasis but negatively associated with indoor cooking. A history of TB or helminth infection increased the likelihood of atopy among adults with history of employment. Longitudinal studies to explore the temporal and causal relationships between these factors and allergic outcomes are essential. There is a need for early public health interventions to address environmental and lifestyle factors for the prevention and control of allergic diseases in African rural communities.

Comparison of the new RIDA qLine Allergy multiparameter immunoblot and the ImmunoCAP Specific IgE test for the identification of clinically relevant food and aeroallergen allergies

Background

Multiparameter immunoblot testing is increasingly used as an alternative to multiple individual IgE analyses for type 1 allergies. This study investigated the performance of an inexpensive immunoblot method, the RIDA qLine allergy test system (R-Biopharm AG), vs. the current gold standard.

Methods

Three study-specific panels with 57 individual allergens (food and aeroallergens) were analyzed in serum samples from 200 patients with signs and symptoms of IgE-mediated allergies, using both the RIDA qLine Allergy and the reference method, the ImmunoCAP Specific IgE test (Thermo Fisher Scientific). In case of divergent results, corresponding allergens were remeasured using the secondary reference method, the 3gAllergy Specific IgE Universal Kit (Siemens). The clinical diagnoses of the 200 patients were included. In addition, a cross-reactive carbohydrate determinant (CCD)-inhibitor was used in the testing to decrease the incidence of positive CCD bands.

Results

The mean overall agreement of all food and aeroallergens with the reference methods was 94.9%. Qualitative evaluation showed an average negative percent agreement of 98.9% and an average positive percent agreement of 75.1% for all individual allergens after testing with both reference methods. The additional treatment of samples with the CCD inhibitor successfully reduced the occurrence of positive CCD reactivity after retesting.

Conclusion

The comparative analysis of RIDA qLine Allergy with the reference methods for specific IgE detection revealed a strong correlation between serum IgE levels measured across these platforms and clinical presentations, while also highlighting the necessity for careful contextual interpretation of results. Standardized allergen extracts would improve independent comparisons of different allergy testing methods.

Challenges in diagnosing polyethylene glycol and polysorbate 80 allergies: implications for allergic reactions in COVID-19 mRNA vaccination program: experience from Qatar

Introduction

COVID-19 vaccination has been a key intervention in reducing the severity of symptoms; however, concerns about vaccine safety, particularly regarding allergic reactions, arose early on. Healthcare workers faced the challenge of addressing these concerns to ensure safe vaccine administration. This study aimed to review the practical aspects of using allergy skin testing for COVID-19 vaccine excipients in patients with a history of allergic reactions developed following mRNA COVID-19 vaccination.

Methods

A retrospective chart review was conducted for patients who reported allergic reactions after the COVID-19 vaccine and underwent allergy skin testing for COVID-19 vaccine excipients in the Adult Allergy and Immunology Service at Hamad Medical Corporation, Doha, Qatar. The testing protocol, developed based on published data during the pandemic, included skin prick (SPT) and intradermal (ID) testing using medications containing polysorbate 80 and polyethylene glycol (PEG), the primary excipients in the COVID-19 vaccines suspected of triggering allergic responses.

Results

Of the 88 patients reviewed, 38 reported different types of allergic reactions following mRNA COVID-19 vaccination, with the majority being female. Anaphylaxis was reported in 21.1% of the patients, while the remaining experienced less severe allergic reactions. All patients underwent SPT and ID testing with PEG and polysorbate 80. By SPT, two patients tested positive for PEG and none for polysorbate 80. By ID, seven tested positive for polysorbate 80 and one for PEG. Among patients who experienced anaphylaxis, 50% had positive allergy test results. Twenty-three percent of patients with negative test results could receive additional vaccine doses without adverse reactions.

Conclusion

Managing patients with a history of allergic reactions to the COVID-19 vaccine is challenging, as the exact mechanisms and accurate and valid allergy testing are yet to be determined. In our cohort, most patients had mild allergic reactions following vaccination. Excipients' allergy skin testing has helped to reduce vaccine hesitancy despite its questionable utility in clinical practice.

V Brazilian Consensus on Rhinitis - 2024

Since we published the "IV Brazilian Consensus on Rhinitis", in2017, several advances have been achieved and have enabled a further understanding of the different aspects of "Rhinitis". This new guideline, developed jointly by ASBAI, SBP and SBORL, represents a relevant milestone in the updated and integrated management of the different forms of the disease, and it aims to unify evidence-based approaches to improve the diagnosis and treatment of this common and often underestimated condition. The document covers a wide range of topics, including clear definitions of the different phenotypes and endotypes of rhinitis, risk factors, updated diagnostic criteria, and recommended methods for clinical and laboratory investigation. We stress the importance of detailed clinical history and objective assessment, as well as tools for control and assessing severity tools an accurate diagnostic approach to the disease. Regarding treatment, it emphasizes the treatment customization, considering the severity of symptoms, the presence of comorbidities and the impact on the patient's quality of life. We discuss different drug treatment, in addition to non-pharmacological measures, such as environmental control and specific immunotherapy; and the possible role of immunobiological agents. Furthermore, the consensus addresses issues related to patient education, prevention and management of special situations, such as rhinitis in children, in pregnant women and in the elderly. In short, the "V Brazilian Consensus on Rhinitis" represents a comprehensive and updated guide for healthcare professionals involved in the diagnosis and management of rhinitis, aiming to improve patients' quality of life through an integrated and evidence-based approach.

Use and limitations of clinical data in the identification and classification of low molecular weight chemicals (LMWCs) as respiratory sensitizers: recommendations for improvement

While progress has been made in recent years, there are still no suitable and accepted in silico, in vitro, or in vivo models that can be used to accurately predict whether a chemical substance has the intrinsic property to cause immune-mediated chemical respiratory allergy, typically manifested as allergic asthma or allergic rhinitis which represents a severe health hazard. Regulatory authorities have relied primarily on clinical evidence (case reports, clinical databases, worker exposure studies) to classify substances as respiratory sensitizers, but this evidence can lack a proven immunological mechanism which is necessary to identify substances which can cause life-long sensitization and clinically relevant allergic symptoms in the respiratory tract in an exposed population (such respiratory allergens may be considered as "true" sensitizers, in analogy to the definition of skin sensitization, and in contrast to respiratory irritants). In light of this, the European Center for Ecotoxicology and Toxicology of Chemicals convened a Task Force to evaluate the types of clinical methods and data sources and the implications of relying on such data for regulatory decision making from a scientific perspective. Recognizing that there are benefits and important insights from using such data, significant shortcomings were identified. With clinical work being focused on treatment and diagnosis of individual patients, the approaches and methods used for clinical guidance, diagnostics and reporting have serious limitations in proving the respiratory sensitization potential of a specific chemical, definitely restricting their suitability in deriving legally binding hazard classifications for human health protection. Even within the current broader regulatory definition of respiratory sensitization, a robust assessment and sound evidence of causation by a specific chemical seems mandatory in order to avoid misclassifications. Application of a systematic weight-of-evidence approach is considered suitable to determine the level of confidence, including a thorough assessment of the specificity or non-specificity of observed bronchial hyperreactivity. Recommendations proposed in this publication may not only aid industry and regulators in their decision making but also facilitate a further exchange between stakeholders to improve the data used to (a) more precisely identify true respiratory sensitizers to effectively protect human health, (b) aid evaluation of potential predictive models, and (c) encourage regulators to clarify guidance and to consider a re-evaluation of the current regulatory definition of respiratory sensitizers.

Omalizumab with allergen immunotherapy in respiratory & food allergy

Allergen Immunotherapy (AIT) is the only disease modifying treatment option for patient with IgE mediated allergic disorder. Conventional subcutaneous immunotherapy is associated with adverse events during build-up and maintenance phase but cluster allergen immunotherapy with monoclonal anti-IgE antibody (omalizumab) has complementary and synergistic effect. Omalizumab plus AIT can significantly enhance the efficacy, safety, and steroid-sparing effect of AIT by increasing target maintenance dose (TMD) and sustained unresponsiveness (SU) to allergen while decreasing the adverse events and severe systemic reactions. This review aims to highlight that combination of omalizumab plus AIT is superior than AIT alone.

Immunoglobulin E (IgE)-mediated food allergy

Food allergy is defined as an adverse immunologic response to a food. Immunoglobulin E (IgE)-mediated reactions to foods are associated with a broad range of signs and symptoms that may involve any of the following body systems: the skin, gastrointestinal tract, respiratory tract, and cardiovascular system. IgE-mediated food allergy is a leading cause of anaphylaxis. Therefore, timely and appropriate diagnosis and treatment are imperative. A diagnosis of food allergy entails a careful history and diagnostic tests, which may include skin prick tests, serum-specific IgE, and oral food challenge. The goal of food allergy care is to empower patients and caregivers to manage the risk of food-allergic reactions, reduce food allergy-related anxiety, and achieve a sense of control over their condition. This can be achieved in different ways for different patients and across different life stages. This article provides an overview of the epidemiology, pathophysiology, diagnosis, and management of IgE-mediated food allergy.

[Consensus for the treatment of atopic dermatitis in primary care: resolving myths and legends based on evidence]

Atopic dermatitis (AD) is a disease that significantly impacts the quality of life of patients. Although there are multiple evidence-based guidelines, they are usually aimed at providing recommendations to AD specialists rather than primary care physicians (PCPs). The aim of this study was to construct a consensus document for PCPs, with the aim of presenting evidence-based recommendations that allow general practitioners, family physicians, pediatricians, internists and emergency physicians to provide appropriate care to AD patients, facilitating their diagnosis, management, and avoiding delays that can deteriorate patients' f quality of life. As a central source of information, we used the recommendations of different international AD guidelines. Delegates from distinct medical societies identify barriers to care and possible solutions for the application of recommendations in primary care. Subsequently, a second evaluation for physicians from different Latin American countries was carried out. The main doubts and barriers that PCPs face in applying the recommendations proposed by the guidelines were identified across different areas, diagnostic criteria, non-pharmacological therapies, pharmacological therapies, management in special conditions and guidelines for referral to a specialist. Consensus solutions were proposed for each identified issue. In conclusion, this consensus contains recommendations regarding the management and treatment of AD in children and adults, which clarify doubts and provide tools to primary care physicians to offer effective treatment for patients and their families.

Molecular Profiles of Sensitization to Non-Specific Lipid Transfer Proteins in Lithuania: Single Center Experience

Non-specific Lipid Transfer proteins (nsLTPs) are relevant allergens of several pollens and plant foods. Sensitization to nsLTPs is not typical in our region. Still, it has become an increasingly common cause of IgE-mediated food allergies and food-induced anaphylaxis in Northern Europe in recent decades. No in-depth studies describe the prevalence of sensitization of molecular components to nsLTPs in Lithuania. This study aimed to determine the sensitization profile of atopic patients at the Immunology and Allergy Department of Kauno Klinikos to the components of nsLTPs, using molecular allergen component analysis. Sixty Lithuanian adults with symptoms of allergic rhinitis and/or allergic asthma and/or food allergies were included into the study. Specific immunoglobulin E (IgE) levels were measured using two in vitro techniques: allergen extract and molecular component analysis. Results showed that 25% of subjects were sensitized to nsLTP-containing allergen sources, mostly to Zea m 14, Mal d 3, Vit v 1, and Art v 3. The median amount of total IgE was higher in nsLTP-sensitized patients than in nsLTP-nonsensitized patients. Based on Cohen's Kappa and McNemar tests, the results of allergen extract and component analysis tests do not always agree, especially when we determine the sensitization to allergen sources containing nsLTPs. Molecular allergen component analysis could be the first choice in determining detailed sensitization to nsLTPs in patients who experienced anaphylaxis of unknown origin.

Protein Biochips with Three-Dimensional Hydrogel or Polymer Brush Elements for the Detection of Human Serum Immunoglobulin E Specific to Inhalation Allergens

The development of rapid analysis of human serum for the presence of allergen-specific Immunoglobulin E (IgE) is currently important. Consequently, we developed two types of three-dimensional (3D) protein biochips. The first one is a 3D hydrogel biochip containing hydrogel droplets with protein molecules (allergens, immunoglobulins and others). These droplets are disposed on elements consisting of short polymer brushes grafting from a surface of polybutylene terephthalate polymer. The immobilization of proteins was induced by short-wave ultraviolet (UV) radiation. On such a biochip, the kinetics of allergen-sIgE complex formation reached 60% of saturation for 6 h. Also, we developed a 3D brush microchip containing on the surface of a polyethylene terephthalate polymer the brush elements with protein molecules covalently immobilized by opening oxirane cycles by amino and thiol nucleophilic groups contained in proteins. In the case of the 3D brush microchip, the kinetics of allergen-sIgE complex formation reached 100% of saturation for 3 h, and fluorescent signals were 2-3 times higher than those of the 3D hydrogel biochip for some allergens. Thus, the comparative analysis revealed that 3D brush biochips are more useful for further studies of protein-protein interaction than 3D hydrogel ones.

Improved quality control of allergen products: Assessing the molecular allergen composition by mass spectrometry

BACKGROUND

Natural allergen sources contain a variety of allergens, against which allergic subjects have developed individual sensitization profiles. Ideal allergen products for skin prick testing (SPT) and allergen immunotherapy (AIT) should contain the complete set of allergens of the respective allergen sources to cover all sensitization profiles. However, commercially available allergen products were shown to vary regarding their allergen composition.

METHODS

The qualitative allergen composition of different SPT and AIT products produced from pollen of grasses, birch, mugwort and from house dust mites was assessed by a consistent high-resolution liquid chromatography-coupled tandem mass spectrometry method (LC-MS/MS).

RESULTS

All major, mid-tier and most minor allergens were detected in each of the investigated three batches of SPT and AIT products, demonstrating the completeness of the allergen composition and a high degree of batch-to-batch consistency.

CONCLUSION

This is the first study using a single consistent high-resolution LC-MS/MS method to provide solid data on the qualitative allergen composition of SPT and AIT products manufactured from various common allergen sources. The applied method showed high reliability in qualitative batch-to-batch consistency testing and can be performed fast and with high throughput. High-resolution LC-MS/MS is applicable for process development and quality control to ensure market availability of allergen products corresponding to the composition of the respective natural allergen sources.

Allergen Testing: A Review of the Indications, Procedures, and Limitations in Ocular Allergy

Allergen-based diagnostics are essential in the management algorithm of allergic diseases. Unlike systemic allergy, where the indications and interpretation of these diagnostic modalities are well established, their utility in ocular allergy is not well-defined. With the rising prevalence of ocular allergies and the need for personalized treatment strategies, there is a growing demand for precision allergen diagnostics. This review describes the commonly used tests with their indications, procedures, and limitations. A review of the literature was carried out on articles on allergen diagnostics in ocular allergy, and after excluding articles that were not relevant, 82 papers were included in the current review. IgE-mediated pathways contribute significantly to seasonal and perennial ocular allergy and partly to vernal keratoconjunctivitis. Most diagnostic techniques aim to detect IgE sensitization. In vivo tests include skin prick (SPT), intradermal, and patch tests. SPT is considered the gold standard and directly evaluates the presence of allergen-specific IgE in the skin. In vitro tests measure total and specific IgE from either tears or sera. Tear IgE measurement is relatively specific for allergic conjunctivitis and can provide insight into the potential allergens responsible for local sensitization. The conjunctival provocation test can help establish true allergy, especially in patients with polysensitization. This review also provides an overview of evidence in literature segregated based on the test employed. This includes 17 studies on only SPT; 42 studies on IgE measured in serum, tears, or both; and 20 studies which have evaluated both SPT and IgE. The pattern of allergen sensitization can guide recommendations for avoidance measures and immunotherapy. Thus, this could create a corticosteroid-sparing therapy avenue in these patients, reducing disease severity and resulting visual morbidity.

The Cough Response to Inhaled Mannitol in Healthy Subjects

PURPOSE

Inhaled mannitol induces bronchoconstriction and cough. This study aimed to describe the cough response to mannitol among healthy adult subjects.

METHODS

125 healthy subjects (aged 18-82 years, 52% females, 50% skin prick test positive) underwent a mannitol test. The coughs were recorded both simultaneously and afterwards from video recordings by two researchers. Three indices were evaluated: The cumulative number of coughs per cumulative dose of mannitol (CDR), cumulative provocative dose of mannitol to cause at least 5 coughs, and the maximal number of coughs provoked by any single mannitol dose. The test was repeated in 26 subjects after 3-7 days.

RESULTS

CDR showed the best repeatability with an intraclass correlation coefficient of 0.829. Gender was the only characteristics that associated with the cough response: The median CDR was 2.53 (interquartile range 0.45-7.01) coughs/100 mg among females and 0.787 (0.0-3.29) coughs/100 mg among males (p = 0.002). The interquartile range upper limits were defined as the cut-off limits for a normal response. The threshold for a statistically significant change in CDR was 6.26 coughs/100 mg. There was a close correlation between simultaneous- and video-assessed CDR (intraclass correlation coefficient 0.985).

CONCLUSION

Females cough more than males in response to mannitol. CDR is the most suitable index to describe the cough responsiveness. The repeatability of the response is good. Video recording of the coughs is not mandatory. The cut-off limits for a normal cough response to mannitol were provided.

Dendritic cell-specific deletion of PKCδ in offspring of allergic mothers prevents the predisposition for development of allergic lung inflammation in offspring

In humans and in mice, maternal allergy predisposes offspring to development of allergy. In murine models, increased levels of maternal β-glucosylceramides are both necessary and sufficient for the development of allergic predisposition in offspring. Furthermore, increased numbers of CD11b+ dendritic cell subsets in the offspring of allergic mothers are associated with allergic predisposition. In vitro, β-glucosylceramides increase CD11b+ dendritic cell subset numbers through increased PKCδ signaling, but it is not known if enhanced PKCδ signaling in dendritic cells is required in vivo. We demonstrate that dendritic cell-specific deletion of PKCδ prevents the β-glucosylceramide-induced increase in CD11b+ dendritic cell subset numbers both in vitro as well as in vivo in the fetal liver of offspring of mothers injected with β-glucosylceramides. Furthermore, dendritic cell-specific deletion of PKCδ in offspring prevents the maternal allergy-induced increase in CD11b+ dendritic cell subsets and decreases allergen-induced interleukin-5 and eosinophilia in lungs of offspring. However, loss of PKCδ in dendritic cells did not prevent development of allergen-specific IgE. Our study provides mechanistic insight into the function of PKCδ in the origins of allergic disease beginning in utero as well as in the development of postnatal allergic lung inflammation.

Molecular allergology: a clinical laboratory tool for precision diagnosis, stratification and follow-up of allergic patients

Identification of the molecular culprits of allergic reactions leveraged molecular allergology applications in clinical laboratory medicine. Molecular allergology shifted the focus from complex, heterogeneous allergenic extracts, e.g. pollen, food, or insect venom, towards genetically and immunologically defined proteins available for in vitro diagnosis. Molecular allergology is a precision medicine approach for the diagnosis, stratification, therapeutic management, follow-up and prognostic evaluation of patients within a large range of allergic diseases. Exclusively available for in vitro diagnosis, molecular allergology is nonredundant with any of the current clinical tools for allergy investigation. As an example of a major application, discrimination of genuine sensitization from allergen cross-reactivity at the molecular level allows the proper targeting of the culprit allergen and thus dramatically improves patient management. This review aims at introducing clinical laboratory specialists to molecular allergology, from the biochemical and genetic bases, through immunological concepts, to daily use in the diagnosis and management of allergic diseases.

Bioorthogonal Chemistry: Enzyme Immune and Protein Capture for Enhanced LC-MS Bioanalysis

Immunocapture liquid chromatography-mass spectrometry (IC-LC-MS) bioanalysis has become an indispensable technique across various scientific disciplines, ranging from drug discovery to clinical diagnostics. While traditional immunocapture techniques have proven to be effective, they often encounter limitations in sensitivity, specificity, and compatibility with MS analysis. Chemoenzymatic immunocapture and protein capture (IPC) offers a promising solution, combining the high specificity of antibodies or proteins with the versatility of enzymatic and chemical modifications. This Review explores the foundational principles of chemoenzymatic IPC and examines various modification strategies including bioorthogonal click-chemistry, enzymatic-tagging, and HaloTag/CLIP-tag. Recent advancements in chemoenzymatic IPC techniques have significantly expanded their applicability to a diverse range of biomolecules including small molecules, peptides, RNAs, and proteins. This Review focuses on improvements in analytical performance achieved through these innovative approaches. Moreover, we discuss the broad applications of chemoenzymatic immunocapture in drug discovery, clinical diagnostics, and environmental analysis and explore its potential for future advancements in bioanalysis. We propose a novel solid-phase chemoenzymatic IPC assay (SCEIA) that effectively utilizes bioorthogonal click chemistry and chemoenzymatic approaches for efficient IPC and target analyte release. In summary, chemoenzymatic IPC represents a transformative paradigm shift in IC-LC-MS bioanalysis. By overcoming the limitations of traditional IPC techniques, this approach paves the way for more robust, sensitive, and versatile analytical workflows.

Impact of the COVID-19 pandemic and lockdown measures on clinical visits and subjective symptoms in childhood allergic rhinitis induced by house dust mites in Shanghai

BACKGROUND

Establishing the interaction between aeroallergens and air pollution in children with house dust mite induced allergic rhinitis (HDM-AR) remains challenging, especially in urban areas. The coronavirus disease 2019 (COVID-19) pandemic and the subsequent lockdown measures provided a valuable opportunity.

METHODS

We analyzed the clinical data of HDM-AR children between March and August in 2018-2020, and classified the children according to the type and the degree of HDM sensitization. The records of patients' hospital visits, allergic rhinitis symptoms assessments, and air pollution measurements in Shanghai were used to assess the differences before (2018-2019) and during the pandemic (2020), as well as during lockdown (March-June) and unlockdown (July-August) period in 2020.

RESULTS

The study included 1570 HDM-AR children aged 2 to 8 years old, 815 (51.9%) were monosensitized to HDM (mono-HDM-AR), and 755 (48.1%) were polysensitized to HDM (poly-HDM-AR). There was a significant increase in the rate of clinical visits among children with HDM-AR during the COVID-19 pandemic compared to pre-pandemic (P < 0.001), particularly among older children aged 7-8 years (P = 0.01). During the unlockdown period, there was a notable decrease in clinical visits for children with poly-HDM-AR (P < 0.001). Children with high levels of HDM sensitization exhibited significant symptom improvement in unlockdown period (P < 0.001). Although the air pollutants concentration had improved during the study, there was no effect on the improvement of HDM-AR children as expected.

CONCLUSIONS

The COVID-19 pandemic and its associated lockdown measures provided a unique context to observe the dynamics of management in children with HDM-AR. The findings underscore the complexity of managing allergic conditions in pediatric populations, highlighting the influence of environmental and lifestyle changes on disease presentation and the need for tailored approaches to treatment during periods of societal disruption.

Chronic Hand Eczema

Chronic hand eczema (CHE) is a complex, challenging, and frequently multifactorial skin disease of the hands. It is very common in the general population, especially in certain professions. When hand eczema (HE) persists for longer than 3 months or has a minimum of two relapses per year after initial manifestation with complete clearance, it is considered chronic. In this case, health-related quality of life and the patient's working life are often impaired. CHE can be considered as an umbrella term because it covers different clinical pictures and etiologies. To date, there is no definite and unique HE classification. Treatment starts with identifying the individual HE etiology paralleled by symptomatic therapy (local and/or systemic and/or ultraviolet phototherapy). Sustainable management of HE requires the identification and avoidance of its triggering factors, from the professional and private environment. This includes ruling out allergic contact dermatitis if any HE persists for more than 3 months despite adequate therapy. Randomized controlled trials investigating the efficacy in HE are lacking for several treatment modalities. Patient education measures of skin protection and prevention complete the multimodal treatment.

The Association of Nasal and Blood Eosinophils with Serum IgE Level in Allergic Rhinitis and Asthma: A Case-Control Study

Background and Aims

Allergic rhinitis and asthma are two common respiratory diseases with allergic etiology in the world's population. Eosinophils and serum IgE levels have been known as inflammatory allergy markers for many years. This study aimed to evaluate the correlation of nasal and blood eosinophils with serum IgE levels in allergic rhinitis and asthma patients.

Methods

This prospective study was done on patients (n = 78) diagnosed with asthma (n = 20), allergic rhinitis (n = 49), and chronic rhinosinusitis with nasal polyposis (CRSwNP) (n = 9) at our hospital in Ahvaz City, Iran. The age of participants in our study ranged from 3 to 73 years, and all of them were subjected to a complete blood count (CBC) test, nasal smear, and determination of serum IgE levels after their consent.

Results

There was no correlation between serum IgE level and nasal eosinophil count (p = 0.728) or between serum IgE level and blood eosinophil count (p = 0.657); however, a positive correlation was detected between blood and nasal eosinophil levels (p = 0.003).

Conclusion

There is no significant relationship between serum IgE level and eosinophil count in the blood and nasal secretions. Serum IgE level and blood or nasal eosinophil count are both useful biomarkers for monitoring allergic rhinitis and asthma individually, but no diagnostic conclusion can be drawn from their correlation.

Exploration of Allergic Rhinitis: Epidemiology, Predisposing Factors, Clinical Manifestations, Laboratory Characteristics, and Emerging Pathogenic Mechanisms

Allergic rhinitis (AR) is a widespread allergic condition, with its prevalence continuing to rise globally. This disease has a significant impact on patients' quality of life. Understanding the underlying pathophysiology is important to develop better-targeted therapies. For decades, the primary assumption has been that an allergy is caused by unbalanced and overactive immunological responses against allergens, driven mainly by activated T helper 2 (Th2) cells and due to aberrant T-regulatory cells. The more recent hypothesis that is gaining attention relies on the dysregulation of the epithelial barrier, which might result in allergen uptake as a primary defect in the pathogenesis of allergic reactions. The nasal epithelial barrier is considered a crucial first line of defense in the upper airway, as it protects the host's immune system from exposure to allergens. Thus, this review will discuss AR's epidemiology, predisposing factors, clinical manifestations, laboratory characteristics, and pathogenic mechanisms.

Peanut Allergy in Children-Is Prevention Better than Cure?

Peanut allergy, one of the most frequently occurring allergies, usually starts in childhood and rarely subsides-often persisting throughout adult life. Accidental exposure to peanuts can often result in adverse reactions ranging from mild to life-threatening, such as anaphylactic shock. Historically, food avoidance and the use of rescue drugs have remained a fundamental management mechanism for dealing with food allergy. However, prevention of adverse reactions to food allergy is playing an increasing role. This is possible through the early introduction of peanuts into the diet, especially in infants at risk of this allergy. In recent years, specific immunotherapy has been used to develop desensitisation and, in some patients, tolerance-defined as a persistent state of clinical non-reactivity to the allergen after therapy is finished. The aim of this article is to summarise the current state of knowledge on the prevention and treatment of peanut allergy, with a focus on clinical trials, current guidelines, and recent experimental studies. This review may be particularly useful for paediatricians and general practitioners.

Baked Egg Oral Immunotherapy: Current State in Pediatric Age

Hen's egg allergy is one of the most common food allergies in the Western world, with an increase in recent years. It affects about 9.5% of the pediatric population, and the onset most often occurs before the first year of life. The occurrence of spontaneous oral tolerance acquisition varies among studies, but it is generally high by school age. Nowadays, allergen immunotherapy may represent the only therapeutic strategy able to modify the natural history of hen's egg allergy. Specifically, many children with hen's egg allergy may tolerate baked eggs. Food processing, specifically high temperatures, alters the allergenicity of hen's egg proteins by causing conformational changes in allergen epitopes, which makes them less allergenic. This review aims to discuss the scientific evidence in the field of baked egg oral immunotherapy in hen's egg-allergic children, with a meticulous examination of the pertinent literature surrounding the subject matter.

Next-generation reference interval for total IgE in the United States: A retrospective real-world analysis

OBJECTIVE

To establish a next-generation reference interval (RI) for total IgE (tIgE) and evaluate its usefulness.

METHODS

A new allergen-specific IgE (sIgE)-based tIgE RI, including a continuous RI in children, was established using the NHANES 2005-2006 project. The usefulness of the RI was evaluated by sensitivity (Sen), specificity (Spec), positive predictive value (PPV), negative predictive value (NPV), κ coefficient and consistency.

RESULTS

The new tIgE RI showed better performance in identifying allergic sensitization (Sen 0.53, Spec 0.90, PPV 0.83, NPV 0.68, κ 0.44, consistency 0.72) than allergic diseases (Sen 0.37, Spec 0.75, PPV 0.55, NPV 0.60, κ 0.13, consistency 0.59). The 2014 U.S. tIgE RI was more effective in identifying allergic diseases (consistency 0.63 vs. 0.54, P<0.001) but less accurate in identifying allergic sensitization (consistency 0.59 vs. 0.67, P<0.001) in children than in adults. The new RI improved the accuracy of identifying allergic sensitization in children to a level similar to that in adults (consistency 0.72 vs 0.73, P=0.37) and maintained its advantage in identifying allergic diseases in children (consistency 0.64 vs 0.55, P<0.001).

CONCLUSIONS

The established next-generation tIgE RI is useful for identifying allergic sensitization, especially in children.

Diagnostic Workup in IgE-Mediated Allergy to Asteraceae Weed Pollen and Herbal Medicine Products in Europe

Anemophilous weeds from the Asteraceae family are highly allergenic and represent a significant source of aeroallergens in late summer and autumn. Ragweed and mugwort pollen allergies have become a significant health burden in Europe. Some people with respiratory allergies to weed pollen may also suffer hypersensitivity reactions to herbal medicines obtained from certain cross-reactive plants in the Compositae family, such as chamomile, marigold, and purple coneflower. General physicians, ear, nose, and throat (ENT) specialists, and pulmonologists need to be familiar with the diagnostic tests used by allergists in clinical practice to support accurate diagnosis in such patients. Allergists must also be aware of the suggestions of the European Medicines Agency (EMA)'s Herbal Medicinal Products Committee and the broad spectrum of herbal therapies to educate their patients about potential risks.

Skin Prick Tests and Enzyme-Linked Immunosorbent Assays among Allergic Patients Using Allergenic Local Pollen Extracts

Background

Allergic respiratory diseases are prevalent in the Philippines, with allergic rhinitis and asthma occurring at 20% and 8.7% of the population, respectively. The diagnosis of respiratory allergies is achieved by a combination of patient history and different screening tools, especially for the identification of the allergic triggers such as allergy skin prick test (SPT) and serum-specific IgE enzyme-linked immunosorbent assays (sIgE ELISA). The Philippines, being a tropical country, have a wide variety of plant species with potential to produce allergenic pollen grains. Knowledge of the sensitization profiles of Filipino allergic patients to our local pollen allergens is currently limited.

Objectives

The aim of this study is to determine the sensitization profile of patients with respiratory allergies (allergic rhinitis and/or asthma) through the allergy skin prick test (SPT) using allergenic local pollen extracts. It also aimed to determine if there is a positive agreement between the SPT and sIgE ELISA positivity rate and whether the results have relationship with the pollen purity and the protein content of the extracts.

Methods

Pollen allergens were extracted from Amaranthus spinosus (pigweed), Mimosa pudica (makahiya), Tridax procumbens (wild daisy), Imperata cylindrica (cogon), Oryza sativa (rice), Pennisetum polystachion (foxtail grass), Sorghum halepense (Johnson grass), Albizia saman (acacia), Cocos nucifera (coconut), Leucaena leucocephala (ipil-ipil), and Mangifera indica (mango). SPT was performed at the Allergy Clinic of the University of the Philippines-Philippine General Hospital on patients with allergic rhinitis and/or bronchial asthma. Blood samples were collected from patients who developed wheal diameters of 3 mm or more than the negative control. Sera were tested against the same pollen extracts using ELISA.

Results

Of the one hundred sixty-five (165) patients who submitted for skin prick test, 129 showed positive SPT results to the pollen extracts. Weeds were the most sensitizing (51.9%-58.1%). Blood samples were collected from these patients and tested for sIgE ELISA and among them, 71 were positive in the sIgE ELISA. Highest sensitization rates in sIgE ELISA were found in coconut, pigweed, Johnson grass, and rice. The highest positive agreements or the proportion of patients with positive sIgE ELISA among those with positive SPT were in coconut, followed by Johnson grass, pigweed, and rice. Most of the pollen sensitized patients on SPT are polysensitized.

Conclusion

SPT is a safe, simple, and rapid method for the diagnosis of IgE-mediated allergy. The lower number of positive patients in sIgE ELISA may be attributed to the low serum IgE levels and low quantities of effectual allergen components in extracts. Results of both SPT and ELISA must be correlated with a patient's clinical history, particularly the patient's exposures, and physical examination.

Food allergies in older people: An emerging health problem

The prevalence of food allergy (FA) is steadily increasing worldwide. Literature about FA in older people is very scarce since this is predominantly considered as a pediatric condition. However, FA can persist and/or develop across the life course. Given the growing increase in prevalence as well as their persistence, it can be expected that FA will soon represent an important issue in older people. Several age-related factors may potentially mask FA symptoms and/or mediate them in older people. These include mechanisms related to immune senescence, inflammation, and changes in gastrointestinal function as well as micronutrient deficiencies and the use of multiple medications. A multidimensional approach, taking into account the complexity in older people, it is thus important in the evaluation and management of FA during aging. The main and safest strategy in the management of FA is the allergen avoidance since their ingestion may lead to reactions ranging from mild to life-threatening. However, food restrictions should be carefully evaluated, especially in older people, for the risk of nutritional deficiencies and undernutrition.

Prevalence of aeroallergen sensitization in children in Northern China

OBJECTIVE

This study aimed to analyze the sensitization rate of different aeroallergens in children of different age, sex, and disease groups, describe the changing trend of different aeroallergens in different ages, and analyze the sensitization risk factors for asthma.

METHODS

Children (<18 years old) with suspected atopic diseases who visited the Department of Allergy of Children's Hospital Affiliated to Capital Institute of Pediatrics and underwent a skin prick test (SPT) were retrospectively enrolled from January 2019 to November 2021.

RESULTS

A total of 5465 patients (3514 boys, 1951 girls; mean age, 7 ± 3 years) were enrolled. Of them, 3703 patients (67.8%) were sensitized to at least one aeroallergen. Before 4 years of age, mold was the most prevalent aeroallergen (103/380 [27.1%]), whereas after 4 years of age, weed pollen was the most prevalent aeroallergen. After 6 years of age, tree pollen became the second most prevalent aeroallergen. After 12 years of age, the sensitization rate of indoor aeroallergens was lower than that of outdoor aeroallergens. Logistic regression showed that sensitization to mold (odds ratio [OR]:1.4, 95% confidence interval (CI): 1.2-1.7, p < 0.001), animal dander (OR: 1.6, 95% CI: 1.4-1.9, p < 0.001), and polysensitization (OR: 1.4, 95% CI: 1.0-1.8, p = 0.038) were potential sensitization risk factors for asthma.

CONCLUSIONS

Mold is an important allergen in early life. Different kinds of allergens affect different age groups. Patients who are sensitized to mold or animal dander or experience polysensitization should be carefully monitored for asthma risk.