Allergen Immunotherapy Extract Shortages and Their Effects on Clinical Care: A Work Group Report of the AAAAI Immunotherapy, Allergen Standardization, and Allergy Diagnostics Committee

Impact of climate change on aerobiology, rhinitis, and allergen immunotherapy: Work Group Report from the Aerobiology, Rhinitis, Rhinosinusitis & Ocular Allergy, and Immunotherapy, Allergen Standardization & Allergy Diagnostics Committees of the American Academy of Allergy, Asthma & Immunology

Climate change is imposing a profound effect on health conditions triggered by environmental exposures. Climate change has affected aeroallergens in numerous ways, including: (1) changes in the vegetation microbiome distribution, (2) increases in C4 grasses globally, (3) increased occurrence of acute weather events, (4) increases in ambient temperature that amplify fungal spore concentration and pollen season duration, and (5) increased allergenicity of pollen and fungi due to exposure to higher levels of carbon dioxide, ozone, and diesel exhaust particles. In addition, greenhouse gases and air pollutants disrupt the epithelial barrier, trigger eosinophilic inflammation, and serve as adjuvants that stimulate IgE-mediated responses. All of these factors have influenced the prevalence and morbidity of allergic rhinitis, nonallergic rhinitis, and chronic rhinosinusitis. Data regarding changes in aeroallergen exposures due to climate change are lacking, and longitudinal sensitization data are rarely available. Allergists need to adapt diagnostic and treatment strategies to limit aeroallergen and air pollutant exposure and facilitate desensitization. Steps needed to address these challenges include: (1) expanding local measurement of pollen and fungal spores, (2) increasing the intensity of allergen avoidance measures, (3) addressing supply chain issues, and (4) promoting collaboration between allergists, insurance companies, aeroallergen manufacturers, and regulatory agencies.

An Overview of Adherence-What It Is and Why It Is Important

Asthma, allergic rhinitis, and food allergy are common allergic diseases, yet adherence to many management options remains poor, leading to worse health outcomes and financial implications for society and health systems. The underlying causes of nonadherence are numerous, ranging from patient-specific factors to broader socioeconomic and systems-based factors. In this review, we aim to discuss the definition of adherence, which can be divided into 3 components: initiation, implementation, and persistence, as well as to review various methods of measuring adherence. Subsequently, we will review the epidemiology of adherence to asthma and allergic rhinitis medications, allergen immunotherapy, and oral immunotherapy. Finally, we will discuss the multifaceted etiology of poor adherence and its subsequent impact on patients and society.

Paper-based microfluidics and tailored gold nanoparticles for visual colorimetric detection of multiplex allergens

The highly efficient and accurate recognition of targeted allergens is an essential element in the diagnosis of allergic diseases and follow-up desensitization treatment in clinic. The current clinical methods widely used to detect sIgE are high cost, time-consuming procedures, and bulky equipment. Herein, a multiplex microfluidic paper-based device (multi-μPAD) was developed that combined with tailored gold nanoparticles for simultaneously visual, colorimetric detection of different allergens in serum. This device could be used as quantitative detection of sIgE with LOD as low as 0.246 KUA/L in colorimetric method. In vitro results also showed that this device possessed good repeatability, high accuracy and incredible stability in different pH (6.0-7.4) and temperature (24-37 °C), as well as long-term storage within 90-day. Finally, this method was successfully utilized for assessing clinical multi-sample screening in 35 allergic patients. After the addition of the samples from allergic patients, the agreement rate of clinical results with commercial enzyme-linked immunosorbent assay (ELISA) kit reached more than 97%, which further indicated that this device had the advantages of efficient, accurate and sensitive to screen various allergens in real clinical serum samples. Therefore, by simply altering antigens and antibodies, this device can also be used for high-throughput detection of other allergens, making it considerable potential for clinical diagnosis of allergic diseases.

Updates and Recent Advances on Venom Immunotherapy

Purpose of Review

Venom immunotherapy has been utilized to treat Hymenoptera venom allergy since the 1920s. Over the last century, significant advances in the fields of immunology and genetics have led to improvements in the practice of venom immunotherapy. This review encompasses recent advances in the use of venom immunotherapy to provide precise, patient-centered care.

Recent Findings

Research about the mechanism of action of venom immunotherapy continues to highlight the modification of both the innate and adaptive immune systems. Molecular techniques have allowed for the identification of specific venom allergens to improve the diagnostic accuracy and safety of venom immunotherapy. Research continues to support the safety of accelerated schedules which can impact the cost, adherence, and quality of life for patients receiving this treatment modality. Finally, significant advances have led to the elucidation of risk factors that place patients at risk for reactions during and after venom immunotherapy. Creation of risk profiles for venom-allergic patients can thus inform the process of immunotherapy in order to provide personalized and precise care.

Summary

Significant progress in the use of venom immunotherapy makes the practice a dynamic and active field for continued research. Future research needs to build on these recent advances to continue to optimize and enhance this life-saving treatment.