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Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Rhinitis is a symptomatic inflammatory disorder of the nose with different causes such as allergic, nonallergic, infectious, hormonal, drug induced, and occupational and from conditions such as sarcoidosis and necrotizing antineutrophil cytoplasmic antibodies positive (Wegener's) granulomatosis. Allergic rhinitis affects up to 40% of the population and results in nasal (ocular, soft palate, and inner ear) itching, congestion, sneezing, and clear rhinorrhea. Allergic rhinitis causes extranasal untoward effects including decreased quality of life, decreased sleep quality, obstructive sleep apnea, absenteeism from work and school, and impaired performance at work and school termed 'presenteeism.' The nasal mucosa is extremely vascular and changes in blood supply can lead to obstruction. Parasympathetic stimulation promotes an increase in nasal cavity resistance and nasal gland secretion. Sympathetic stimulation leads to vasoconstriction and consequent decrease in nasal cavity resistance. The nasal mucosa also contains noradrenergic noncholinergic system, but the contribution to clinical symptoms of neuropeptides such as substance P remains unclear. Management of allergic rhinitis combines allergen avoidance measures with pharmacotherapy, allergen immunotherapy, and education. Medications used for the treatment of allergic rhinitis can be administered intranasally or orally and include oral and intranasal H1-receptor antagonists (antihistamines), intranasal and systemic corticosteroids, intranasal anticholinergic agents, and leukotriene receptor antagonists. For intermittent mild allergic rhinitis, an oral or intranasal antihistamine is recommended. In individuals with persistent moderate/severe allergic rhinitis, an intranasal corticosteroid is preferred. When used in combination, an intranasal H1-receptor antagonist and a nasal steroid provide greater symptomatic relief than monotherapy. Allergen immunotherapy is the only disease-modifying intervention available. [ABSTRACT FROM AUTHOR]

Indoor allergen exposure to sources such as house-dust mites, pets, fungi, and insects plays a significant role in patients with allergic rhinitis and asthma. The identification of the major allergens has led to methods that can quantitate exposure, e.g., immunoassays for Der p 1 in settled dust samples. Sensitization and the development of allergic respiratory disease result from complex genetic and environmental interactions. New paradigms that examine the role of other environmental factors, including exposure to proteases that can activate eosinophils and initiate Th2 responses, and epigenetics, are being explored. Recommendations for specific environmental allergen avoidance measures are discussed for house-dust mites, cockroaches, animal dander, and fungi. Specific measures to reduce indoor allergen exposure when vigorously applied may reduce the risk of sensitization and symptoms of allergic respiratory disease, although further research will be necessary to establish cost-effective approaches. [ABSTRACT FROM AUTHOR]

Background: It is unresolved whether circulating CD25hiCD4+ T cells in patients with atopic dermatitis who have elevated IgE (IgEhigh) are regulatory or effector in nature. Objective: To analyze the properties of CD25hi T-cell subtypes in IgEhigh atopic dermatitis. Methods: The phenotype of circulating CD25hi T cells was analyzed by flow cytometry using PBMCs from patients with atopic dermatitis (total IgE > 250 IU/mL). Cytokines induced in CD25hi subtypes were analyzed after activation with anti-CD3 mAb (±IL-2) and in the presence of activated autologous effector T cells (CD25negCD4+). Reactivity to bacterial superantigen derived from the skin-colonizing organism Staphylococcus aureus was also evaluated. Results: CD25hi T cells expressing regulatory T-cell markers (Foxp3, CCR4, cutaneous lymphocyte-associated antigen) were increased in atopic dermatitis compared with IgElow controls. This phenomenon was linked to disease severity. Two subtypes of CD25hi T cells were identified on the basis of differential expression of the chemokine receptor CCR6. Although the ratio of CCR6+ and CCR6neg subtypes within the CD25hi subset was unaltered in atopic dermatitis, each subtype proliferated spontaneously ex vivo, suggesting in vivo activation. Activated CCR6neg cells secreted TH2 cytokines, and coculture with effector T cells selectively enhanced IL-5 production. Moreover, induction of a TH2-dominated cytokine profile on activation with bacterial superantigen was restricted to the CCR6neg subtype. Conclusion: Despite a regulatory phenotype, activated CD25hi T cells that lack expression of CCR6 promote TH2 responses. [Copyright &y& Elsevier]

The compliance of dust-mite (DM) allergic patients receiving immunotherapy (IT) with environmental avoidance measures has not been reported. To investigate patient practices, a questionnaire was distributed to patients receiving IT for indoor allergens. Ninety-three of 200 patients (46%) with indoor allergies completed the questionnaire. Of the 93 patients, 69% were allergic to DMs, 45% were allergic to pets, 17% were allergic to mold, and 3% were allergic to cockroaches. Of 64 patients allergic to DMs, 53% reported use of mattress covers, 61% reported use of pillow covers, 81% reduced moisture in their homes, 83% washed their bed linens in water that was >130°F, 77% vacuumed or dusted weekly, and 21% replaced carpets with polished flooring. Fifty-two percent of patients who did not use covers and 49% who did not replace their carpets cited cost as the most common reason. Education about the use of DM covers was reported by 97% of patients allergic to DMs, predominantly by physicians. In conclusion, many patients on IT for DM allergy do not use avoidance measures for decreasing allergen exposure. Cost appears to influence compliance with several measures including protective mattress and pillow covers. It may be unreasonable to require most patients to use such avoidance measures before being candidates for IT. [ABSTRACT FROM AUTHOR]

The article discusses the implication of allergens to asthma pathogenesis. Allergic sensitization is an important factor for asthma and allergen exposure in sensitized patients has been associated with increase asthma symptoms, greater medication requirements and poorer lung function. In addition, allergen avoidance measures are essential to the management of asthma in sensitized patients and can improve asthma control.

Background: Profilin is a small actin-binding protein that contributes to the allergenic potency of many fruits and vegetables, including tomato. Two highly similar genes encoding tomato profilin have been isolated and designated as allergen Lyc e 1.01 and Lyc e 1.02. Objective: The aim of the study was to generate profilin-reduced hypoallergenic tomato fruits by silencing of both genes in transgenic tomato plants by means of RNA interference (RNAi). Methods: The efficiency of gene silencing was documented by means of Northern blotting, immunoblotting, and skin prick testing. Results: Quantification of the remaining protein revealed that profilin accumulation in transgenic fruits was decreased 10-fold compared with that seen in untransformed controls. This decrease was sufficient to cause a reduced allergenic reactivity in patients with tomato allergy, as determined with skin prick tests. Because most patients with tomato allergy are not monosensitized to profilin, the IgE reactivity to the profilin-silenced tomato fruits in vivo varied widely between individuals tested. Conclusion: We could demonstrate the efficient silencing of both profilin genes in transgenic tomato plants using RNAi. This resulted in Lyc e 1–diminished tomato fruits, providing proof of concept and demonstrating that RNAi can be used to design allergen-reduced food. However, simultaneous silencing of multiple allergens will be required to design hypoallergenic tomatoes. Clinical implications: Our findings demonstrate the feasibility of creating low-allergenic food by using RNAi. This concept constitutes a novel approach to allergen avoidance. [Copyright &y& Elsevier]

Background: Early life exposures may be important in the development of asthma and allergic disease. Objective: To test house dust mite (HDM) avoidance and dietary fatty acid modification, implemented throughout the first 5 years of life, as interventions to prevent asthma and allergic disease. Methods: We recruited newborns with a family history of asthma antenatally and randomized them, separately, to HDM avoidance or control and to dietary modification or control. At age 5 years, they were assessed for asthma and eczema and had skin prick tests for atopy. Results: Of 616 children randomized, 516 (84%) were evaluated at age 5 years. The HDM avoidance intervention resulted in a 61% reduction in HDM allergen concentrations (μg/g dust) in the child''s bed but no difference in the prevalence of asthma, wheeze, or atopy (P > .1). The prevalence of eczema was higher in the active HDM avoidance group (26% vs 19%; P = .06). The ratio of ω-6 to ω-3 fatty acids in plasma was lower in the active diet group (5.8 vs 7.4; P < .0001). However, the prevalence of asthma, wheezing, eczema, or atopy did not differ between the diet groups (P > .1). Conclusion: Further research is required to establish whether other interventions can be recommended for the prevention of asthma and allergic disease. Clinical implications: House dust mite avoidance measures and dietary fatty acid modification, as implemented in this trial during infancy and early childhood, did not prevent the onset of asthma, eczema, or atopy in high-risk children. [Copyright &y& Elsevier]

Summary: It is widely acknowledged that avoidance of allergens such as those derived from foods, drugs, latex and stinging insects results in a complete disappearance of symptoms. By contrast, although it has been clearly shown that allergens are an important risk factor for the development of respiratory symptoms and that several avoidance measures reduce allergen levels, whether this gives clinical improvement in symptoms is debatable. Many reasons could be invoked to justify this evident discrepancy. Apart from the intrinsic methodological aspects (e.g. single or combined interventions measure, population studied, severity of respiratory symptoms, outcomes, evaluated parameters, etc.), it is important to outline that a successful approach requires that the avoided allergen is the only and real factor responsible for symptoms, the patient''s education and the use of a comprehensive protocol to reduce allergen exposure. Other important factors include the involvement of the patient, the relevance of other allergens/non-specific agents, and exposure to sensitizing agents also outside patient''s home. It is likely that the clinical phase of allergic airway disease and the degree of bronchial (and also nasal) remodelling, in each individual, represent relevant factors for the clinical outcome of allergen avoidance procedures. Since the management of respiratory allergy is a complex strategy (including drugs, allergen avoidance, immunological and educational interventions), it is difficult in real life to distinguish the efficacy of a single intervention in comparison to the others. A combined strategy is likely to produce better clinical results. [Copyright &y& Elsevier]

The relentless increase in the prevalence of asthma and allergic diseases highlights the need for devising effective preventive strategies. Although the genetics of these disorders are being investigated, manipulation of known environmental risk factors remains the best available approach to this problem. However, the large number of potential environmental risk factors and our inability to accurately predict the development of asthma and allergy has led to conflicting data from recent prevention studies. Nonetheless, some useful recommendations can be made. Exclusive breast-feeding and avoidance of exposure to environmental tobacco smoke exposure can be safely recommended for the whole population, not only for prevention of allergy but also for other known benefits. Additionally, for children at high risk of allergy, maternal exclusion diet during lactation and protein hydrolysate as a supplement or alternative for children who could not be breast-fed seems to provide further protection. The preventive effect of avoidance of house dust mite allergen alone during pregnancy or after birth is disappointing. However, prospective randomized studies evaluating a combined food and house dust mite allergen avoidance regimen show some protection against atopic dermatitis in infancy and asthma in later childhood. Urgent research is needed to accurately identify children at high risk and to test novel preventative measures with the potential for immunomodulation. Further randomized controlled trials are also needed with long-term follow up to evaluate combined approaches that might provide maximum benefit. [Copyright &y& Elsevier]

Although allergen exposure can clearly aggravate the condition of sensitized patients with asthma, there is uncertainty and controversy about exactly which allergen avoidance interventions should be recommended to patients with asthma. Interventions that appear logical may fail to be clinically efficacious for several reasons. Although narrow interventions, such as allergen-impermeable mattress covers to reduce exposure to dust mite allergens, may offer little benefit if used alone, recent evidence suggests that a multifaceted, home-based environmental intervention focusing on multiple exposures may provide clinical benefits to patients with asthma. The role of allergen avoidance in infancy in the primary prevention of asthma is a subject of active investigation, but data remain too preliminary to make public health recommendations in this regard. [Copyright &y& Elsevier]

Copyright of EMC-Medecine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A 10-year national program to improve prevention and management of allergic diseases and asthma was implemented in Finland (population 5.5. million) in 2008-2018. The main aim was to reduce the long-term burden of these conditions. The strategy was changed from traditional avoidance to tolerance and resilience of the population. Health was endorsed instead of medicalization of mild symptoms. Disease severity was reevaluated, and disabling clinical manifestations were given high priority. For health care, 5 quantitative goals and 1 qualitative goal were set. For each of the goals, specific tasks, tools, and outcome evaluation were stipulated. During the program, 376 educational sessions gathered 24,000 health care participants. An information campaign targeted the lay public, and social media was used to contact people. In the 10 years of the program, the prevalence of allergic diseases and asthma leveled off. Asthma caused fewer symptoms and less disability, and 50% fewer hospital days. Food allergy diets in day care and schools decreased by half. Occupational allergies were reduced by 45%. In 2018, the direct and indirect costs of allergic diseases and asthma ranged from €1.5 billion to €1.8 billion, with the 2018 figures being 30% less than in the respective figures in 2007. The Finnish proactive and real-world intervention markedly reduced the public health burden of allergic disorders. The allergy paradigm was revisited to improve management with systematic education. [ABSTRACT FROM AUTHOR]

Background: Pollen forecasts are highly valuable for allergen avoidance and thus raising the quality of life of persons concerned by pollen allergies. They are considered as valuable free services for the public. Careful scientific evaluation of pollen forecasts in terms of accurateness and reliability has not been available till date.Objective: The aim of this study was to analyze 9 mobile apps, which deliver pollen information and pollen forecasts, with a focus on their accurateness regarding the prediction of the pollen load in the grass pollen season 2016 to assess their usefulness for pollen allergy sufferers.Methods: The following number of apps was evaluated for each location: 3 apps for Vienna (Austria), 4 apps for Berlin (Germany), and 1 app each for Basel (Switzerland) and London (United Kingdom). All mobile apps were freely available. Today's grass pollen forecast was compared throughout the defined grass pollen season at each respective location with measured grass pollen concentrations. Hit rates were calculated for the exact performance and for a tolerance in a range of ±2 and ±4 pollen per cubic meter.Results: In general, for most apps, hit rates score around 50% (6 apps). It was found that 1 app showed better results, whereas 3 apps performed less well. Hit rates increased when calculated with tolerances for most apps. In contrast, the forecast for the "readiness to flower" for grasses was performed at a sufficiently accurate level, although only two apps provided such a forecast. The last of those forecasts coincided with the first moderate grass pollen load on the predicted day or 3 days after and performed even from about a month before well within the range of 3 days. Advertisement was present in 3 of the 9 analyzed apps, whereas an imprint mentioning institutions with experience in pollen forecasting was present in only three other apps.Conclusions: The quality of pollen forecasts is in need of improvement, and quality control for pollen forecasts is recommended to avoid potential harm to pollen allergy sufferers due to inadequate forecasts. The inclusion of information on reliability of provided forecasts and a similar handling regarding probabilistic weather forecasts should be considered. [ABSTRACT FROM AUTHOR]

Background A recently reported small, out-of-season environmental exposure unit study found nasal filters to be efficacious in preventing seasonal allergic rhinitis (AR). However, nasal filters still need to show efficacy in a natural setting in a regular pollen season. Objective We sought to evaluate the efficacy of nasal filters (Rhinix; Rhinix ApS, Aarhus, Denmark) for the prevention of symptoms related to seasonal AR. Methods The trial was a single-center, randomized (1:1), double-blind, placebo-controlled crossover clinical trial ( NCT02108574 ) conducted over 2 days in the main grass pollen season in June 2014 in Aarhus, Denmark, on 65 adults with proven grass allergy. A total nasal symptom score (TNSS) consisting of blocked nose, runny nose, nasal itching, and sneezing was used to evaluate symptoms. The difference in daily ∑ TNSS (the sum of 13 ratings) was the primary outcome measure. The difference in maximum TNSS (highest score, 13 ratings) was also evaluated. Results The nasal filters significantly reduced daily ∑ TNSSs ( P = .03) and maximum TNSSs ( P = .03) compared with placebo. Median relative reductions were 40% for daily ∑ TNSSs ( P = .02), 43% for maximum TNSSs ( P = .004), 83% for daily ∑ sneezing ( P = .001), 75% for daily ∑ watery eyes ( P = .02), and 53% for daily ∑ runny nose ( P = .005) when compared with placebo. The nasal filters were well tolerated, and no serious adverse events were recorded. Conclusion Statistically significant and clinically relevant reductions were achieved for the primary outcome measure of daily ∑ TNSS, for maximum TNSS and for a subset of individual symptoms. The results support the preventive role of nasal filters for managing seasonal AR. [ABSTRACT FROM AUTHOR]

The role of allergen exposure in the etiology of allergic sensitization and asthma is complex. Advice on strategies to avoid domestic allergens remains contentious because trials of interventions aimed to prevent asthma or reduce symptoms have often failed to demonstrate benefits. Asthma management guidelines differ widely in their recommendations, while Web-based information often claims benefits associated with products. In this rostrum we argue that although many factors have a role in both the etiology and the exacerbation of asthma, allergen exposure probably remains an important contributor to the manifestations of the disease. Currently, there is no evidence-based framework for effective domestic allergen avoidance interventions to reduce chronic aeroallergen exposure. The development of an effective approach to allergen avoidance requires a better understanding of (a) the physical nature of chronic aeroallergen exposure and methods for measuring and reducing this, (b) the interaction between allergen exposure and innate immune modulators at different disease stages, and (c) markers enabling the identification of individuals who would benefit from this. The strategic risk of overemphasizing other novel mechanisms and approaches to asthma management is that we will prematurely abandon and fail to improve an existing approach that could have a significant impact on the development, progression, and symptoms of the disease. [ABSTRACT FROM AUTHOR]