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ABSTRACT: This narrative review explores the relationship between allergic diseases and sleep disorders in children, highlighting the significant impact allergies have on pediatric sleep quality. Allergic conditions such as allergic rhinitis, asthma, and atopic dermatitis are prevalent in children and are known to contribute to sleep disturbances. These disorders can lead to issues such as sleep fragmentation, obstructive sleep apnea, and excessive daytime sleepiness, which negatively affect cognitive function, behavior, and overall well-being. Studies from Saudi Arabia and other regions indicate a clear association between allergies and impaired sleep, with factors such as nasal congestion, wheezing, and itching playing key roles in disrupting sleep patterns. Treatment options, including pharmacological therapies, immunotherapy, and allergen avoidance strategies, aim to alleviate symptoms and improve sleep outcomes. Further research is needed to better understand the mechanisms behind this relationship and to develop more effective management strategies for children suffering from both allergic diseases and sleep disorders. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Limited decision‐support tools are available to help shared decision‐making (SDM) regarding food oral immunotherapy (OIT) initiation. No current tool covers all foods, forms, and pediatric ages for which OIT is offered.In compliance with International Patient Decision Aid Standards criteria, this pediatric decision‐aid comparing OIT versus avoidance was developed in three stages. Nested qualitative data assessing OIT decisional needs were supplemented with evidence‐synthesis from the OIT literature to create the prototype decision‐aid content. This underwent iterative development with food allergy experts and patient advocacy stakeholders until unanimous consensus was reached regarding content, bias, readability, and utility in making a choice. Lastly, the tool underwent validated assessment of decisional acceptability, decisional conflict, and decisional self‐efficacy.The decision‐aid underwent 5 iterations, resulting in a 4‐page written aid (Flesch–Kincaid reading level 6.1) explaining therapy choices, risks and benefits, providing self‐rating for attribute importance for the options and self‐assessment regarding how adequate the information was in decision‐making. A total of n = 135 caregivers of food‐allergic children assessed the decision‐aid, noting good acceptability, high decisional self‐efficacy (mean score 85.9/100) and low decisional conflict (mean score 20.9/100). Information content was rated adequate and sufficient, the therapy choices wording balanced, and presented without bias for a “best choice.” Lower decisional conflict was associated with caregiver‐reported anaphylaxis.This first pediatric OIT decision‐aid, agnostic to product, allergen, and age has good acceptability, limited bias, and is associated with low decisional conflict and high decisional self‐efficacy. It supports SDM in navigating the decision to start OIT or continue allergen avoidance. [ABSTRACT FROM AUTHOR]

Purpose of Review: Precautionary allergen labeling (PAL) suggests the risk of unintended allergen presence (UAP) in food but is unregulated in most countries and inconsistently applied by food manufacturers. This review evaluates the current use of PAL, its relevance to allergic consumers, and weighs possible advantages and disadvantages of avoiding products with PAL. Recent Findings: In most countries, manufacturers are free to decide whether, when, and how to apply PAL resulting in inconsistencies and consumer confusion. Patients with food allergy often interpret PAL incorrectly and without guidance from their health care providers. Health care providers are also prone to misinterpreting PAL, indicating a need for better education. Consumers desire guidance on whether to avoid products with PAL or not. Summary: Until further regulatory guidance is available, shared decision-making between patient and provider is required to offer individualized, rather than one–size-fits-all, approaches to PAL. [ABSTRACT FROM AUTHOR]

Aims: Only limited Indian data is available regarding the food allergy pattern among allergic rhinitis patients in Indian population. This study aims to assess the pattern of food allergen sensitivity amongst allergic rhinitis patients in central India. Material and Methods: A total of 218 subjects with allergic rhinitis were enrolled in the study (from May 2018 to August 2022). Skin prick test was done in all subjects with proper technique and precautions by using 125 common food allergens and 75 aero allergens. The test readings were noted after 20 minutes by comparing the wheals so formed with the negative control of Saline and positive control of Histamine. Any reaction with a wheal diameter of 3mm or greater was considered as positive. Results: While test results of both food and inhalant allergens were issued to individual patients, this study was restricted to detection and analysis of pattern of food allergens. Our study observed male preponderance with predominantly a third decade affliction. The most common food allergen in the study population was beetle nut (29.3%) followed by chilli powder and spinach (28.8% each). Conclusion: Along with aeroallergens, food allergens are also important provocateurs of allergic rhinitis. Diagnosing the offending food allergens and its avoidance reduces patient morbidity, need for pharmaceutical agents and subsequently drug dependence and its side effects. Offering subjects a replacement diet with food items of similar taste and nutritive character helps in sustainable avoidance therapy. [ABSTRACT FROM AUTHOR]

Allergen exposure is associated with the development of allergen‐specific sensitization, but their relationship is influenced by other contemporaneous exposures (such as microbial exposure) and the genetic predisposition of the host. Clinical outcomes of the primary prevention studies that tested the effectiveness of allergen avoidance in pregnancy and early life on the subsequent development of sensitization and asthma published to date are inconsistent. Therefore, we cannot provide any evidence‐based advice on the use of allergen avoidance for the primary prevention of these conditions. The evidence about the impact of allergen exposure among and among sensitized children with asthma is more consistent, and the combination of sensitization and high exposure to sensitizing allergen increases airway inflammation, triggers symptoms, adversely impacts upon disease control, and is associated with poorer lung function in preschool age. However, there are differing opinions about the role of inhalant allergen avoidance in asthma management, and recommendations differ in different guidelines. Evidence from more recent high‐quality trials suggests that mite allergen‐impermeable bed encasings reduce hospital attendance with asthma attacks and that multifaceted targeted environmental control improves asthma control in children. We therefore suggest a pragmatic approach to allergen avoidance in the management of childhood asthma for clinical practice, including the recommendations to: (1) tailor the intervention to the patient's sensitization and exposure status by using titer of allergen‐specific IgE antibodies and/or the size of the skin test as indicators of potential response; (2) use a multifaceted allergen control regime to reduce exposure as much as possible; and (3) start intervention as early as possible upon diagnosis. [ABSTRACT FROM AUTHOR]

Environmental allergen control is recommended as an essential part of allergic rhinitis (AR) management guidelines. In this scoping review, our objective is to identify measures of allergen avoidance and to evaluate their effectiveness in the management of AR. We conducted systematic searches for randomized controlled trials and observational studies in PubMed, the Cochrane Central Register of Controlled Trials, and the Web of Science databases. We included all types of control measures based on allergen eviction or reduction in exposure. Overall, 18 studies satisfied our criteria and were thus included for further analysis. The majority of the studies (15 out of 18) reported decreases in overall AR symptom scores, improvements in quality of life, or reductions in medication usage. However, due to the low number of participants and the limitations in study designs, it is not possible to make a definitive recommendation on the use of these interventions in the management of AR. A multifaceted approach, including treatment, prevention, and eradication of allergens from the environment, may be necessary to effectively reduce symptoms. [ABSTRACT FROM AUTHOR]

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.)

Environmental allergen control is recommended as an essential part of allergic rhinitis (AR) management guidelines. In this scoping review, our objective is to identify measures of allergen avoidance and to evaluate their effectiveness in the management of AR. We conducted systematic searches for randomized controlled trials and observational studies in PubMed, the Cochrane Central Register of Controlled Trials, and the Web of Science databases. We included all types of control measures based on allergen eviction or reduction in exposure. Overall, 18 studies satisfied our criteria and were thus included for further analysis. The majority of the studies (15 out of 18) reported decreases in overall AR symptom scores, improvements in quality of life, or reductions in medication usage. However, due to the low number of participants and the limitations in study designs, it is not possible to make a definitive recommendation on the use of these interventions in the management of AR. A multifaceted approach, including treatment, prevention, and eradication of allergens from the environment, may be necessary to effectively reduce symptoms.

Allergic contact dermatitis (ACD) is a common skin condition caused by contact with an exogenous agent that elicits an inflammatory response. Patch testing (PT) is considered the gold standard for diagnosing ACD. Unfortunately, PT may not be available to some patients due to insurance and financial limitations, contributing to health care disparity and leaving patients with undiagnosed, incompletely managed dermatitis that can have further detrimental health and occupational effects. For other patients, PT is precluded by lack of availability of specialist/expert care, comorbid medications, or diffuse disease. This article will present a patient with ACD and will work through the differential diagnosis and share strategies for empiric avoidance of suspected/common triggers. The epidemiology of ACD with respect to race and ethnicity, considerations for affordability of hypoallergenic products, access to testing, and the need for future research are addressed in this article., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Abstract Background Eating outside the home is challenging for consumers with food allergy (FA) and intolerance (FI) and lack of allergen information provision in eating out venues can lead to unnecessary restrictions. Following European legislation (2014) designed to improve allergen information provision, little is known about differences in information provision experienced by consumers seeking to avoid particular allergens, or how this impacts on their eating out experiences. This study compared the information provision that consumers with FA/FI to different allergens experience when eating out. Methods Using mixed methods, participants were recruited from across the UK and took part in self-report surveys or in-depth interviews. Surveys were completed by 232 participants avoiding either gluten (n = 66), nuts (peanuts/tree nuts) (n = 94), or milk (n = 74), and responses were subject to quantitative analyses. Interviews were carried out with 49 participants avoiding either gluten (n = 13), nuts (n = 14), milk (n = 13) or a combination of these allergens (n = 9), and analysed using the framework approach. Results Although general improvements in information provision following the legislation were reported, variations in provision between allergen groups led participants seeking to avoid milk to conclude that their dietary needs were less well-understood and seen as less important. These perceptions were reflected in a reluctance to involve eating out venue staff in deliberations about the potential for milk-free meal options. Conclusions The provision of visual indicators of the presence of milk and of staff trained in allergen-awareness would improve the eating out experiences of consumers seeking to avoid milk. Medical professions can play a key role in encouraging these patients to pursue their right to make enquiries about allergens in order to avoid accidental milk ingestion when eating out.

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.)

Abstract Background For parents and caregivers of food hypersensitive (FH) children, accommodating their child’s dietary needs when eating out can be a challenging experience. This study explored caregivers’ experiences and behaviours when eating out with their FH child in order to gain insights into how they support and prepare their child in negotiating safe eating out experiences. Methods A cross-sectional, qualitative design was used. In depth, semi-structured interviews were carried out with 15 caregivers of children with FH. Interviews were analysed using framework analysis. Results Caregivers reported a number of issues relating to eating out with their FH child, or allowing their child to eat out without their supervision. Through themes of ‘family context’, ‘child-focused concerns’, and ‘venue issues’, caregivers described how they managed these and explained the limitations and sacrifices that FH imposed on their child, themselves, and family members. Conclusions Through deeper understanding of the anxieties, negotiations and compromises experienced by caregivers of children with FH when they are eating out, clinicians and support charities can tailor their support to meet the needs of caregivers and children. Support and education provision should focus on providing caregivers of children with FH the tools and strategies to help enable safe eating out experiences.

Aim: To investigate teachers' knowledge and preparedness of schools about food allergy and anaphylaxis in elementary schools in Edirne city. Material and Methods: The study was performed as a cross sectional survey study. Questionnaires were answered by 560 teachers, all of them were working in 35 public elementary schools in Edirne. In addition to questions concerning food allergies, teachers were asked about their attitudes in the case of a life-threatening food-induced allergic reaction. The presence of a nurse or other trained personnel, an action plan for management of anaphylaxis, and/or epinephrine availability and use in these schools in the case of such a reaction were also evaluated. Results: The vast majority of teachers (97.3%) reported they had not been informed about food allergies, and only 19.1% stated that "shock" may be related to a food allergy situation. Only 4 schools (11.4%) employed a nurse. Examination of school drugs cabinets revealed no epinephrine in any school, and none of the students were found to carry epinephrine autoinjectors. Furthermore, none of the schools had an emergency action plan related to food-induced allergic reactions. Conclusion: The current study revealed an urgent need to inform elementary school teachers of Edirne about food allergies and their treatment and to improve access to emergency treatments and action plans. [ABSTRACT FROM AUTHOR]

Latest forecasts predict that half of the European population will be allergic within the coming 15 years, with food allergies contributing substantially to the total burden; preventive measures are urgently needed. Unfortunately, all attempted alimentary strategies for primary prevention of allergic diseases through allergen avoidance so far have failed. This also holds true for the prevention of food allergies in breastfed infants by the common practice of excluding certain foods with allergenic potential from the maternal diet. As a preventive measure, therefore, exclusion diets should be discouraged. They can exhaust nursing mothers and negatively impact both their nutritional status as well as their motivation to breastfeed. A prolonged exclusion diet may be indicated solely in cases of doctor-diagnosed food allergy following rigid medical tests (e.g. double-blind placebo-controlled food challenges). Indicated cases usually involve exclusion of only a few food items. Continued breastfeeding is generally important for many aspects of the infant's health, including the training of the infant's immune responses to foreign compounds and avoidance of overshooting inflammatory responses. Recent studies suggest that the presence of maternal dietary proteins in amniotic fluid, cord blood, and human milk might support the induction of tolerance towards solid foods in infants. These are exactly the same species of proteins or remnants thereof that, in comparatively few cases, trigger allergic responses. However, the insight that the proteins of maternal dietary origin in human milk are more likely to be cure (or, more precise, directing prevention) than curse has still largely evaded the attention of health care professionals consulted by worried breastfeeding mothers. In this paper, we summarize recent literature on the importance of exposure to dietary proteins in the establishment of immunological tolerance and hence prevention of allergic disease. Multiple organizations have used the scientific knowledge to build (local) guidelines (e.g. AAAAI, EAACI, BSACI) that can support health care professionals to provide the best strategy to prevent the onset of allergic diseases. We thus hope to clarify existing confusion about the allergenic propensities of dietary proteins during early life, which has contributed to exaggerated fears around the diet of pregnant and breastfeeding mothers. [ABSTRACT FROM AUTHOR]

Background and Objective: Airway macrophages perform the crucial functions of presenting antigens, clearing pathogens, and apoptotic cells. Macrophage phagocytosis is increased in adults with mild asthma and allergen exposure is known to activate macrophages. However, it is not clear whether the mechanism behind this is due to a primary defect or environmental factors such as allergen or lipopolysaccaride (LPS) exposure. Our aim was to assess the phagocytic function of airway macrophages in children with mild to moderate asthma after residence in a low allergen\LPS environment at high altitude.Methods: Sputum induction was performed in children with asthma at baseline and after residence for a 3 weeks' period at a high-altitude asthma center that has very low ambient allergen levels. The markers of eosinophilic inflammation (including percentage of macrophage cytoplasm with red hue) and phagocytosis of fluorescein isothiocyanate-labeled, heat-killed Staphylococcus aureus by airway macrophages was analyzed. Internalized bacteria were quantified using confocal microscopy.Results: The median bacterial count [mean (standard deviation)] per macrophage was significantly lower [39.55 (4.51) vs. 73.26 (39.42) (p = 0.006)] after residence at high altitude. No association was observed between markers of eosinophilic inflammation and bacterial phagocytosis.Conclusions: The results suggest that the mechanism behind the enhanced phagocytosis of bacteria in childhood asthma may be secondary to allergen or possibly LPS exposure.

Purpose: Evaluation of a new individual wearable air purifier (Respiray Wear A+) for birch pollen, house dust mite (HDM), and cat-allergic rhinoconjunctivitis (ARC) patients in a standardized allergen exposure chamber (AEC)., Materials and Methods: Eligible allergic patients were exposed to birch pollen, HDM raw material, and cat allergen in an AEC for 60 minutes without (V1) and with (V3) the use of the Respiray device. Nasal, ocular, bronchial, and other symptoms were rated by the patients every 10 minutes, and their wellbeing, peak nasal inspiratory flow (PNIF), and lung function parameters were assessed every 30 minutes. The primary endpoint was the change in the median of the total symptom score (TSS) at V3 compared to V1 at 60 minutes of exposure. The secondary endpoints consisted of the total nasal symptom score (TNSS) and total eye symptom score (TESS)., Results: 23 patients with birch pollen allergy, 37 patients with HDM allergy, and 41 patients with cat allergy were included in the analysis. Significant reduced symptom scores of ~ 49% were observed when using Respiray Wea A+ under birch pollen exposure (p < 0.05) in the primary endpoint TSS (V3 2.43 compared to V1 4.78). An 48% reduction of symptoms was seen in TSS in case of HDM exposure (V3 3.59; V1 6.92, (t-test: p < 0.01)) and the highest reduction of TSS (60%) under Respiray A+ using cat allergens (V3 2.95, V1 7.44, (t-test p < 0.01) after 60 minutes of exposure. The personal wellbeing revealed clinically meaningful improvements over time in all three studies which manifested in a lower symptom increase during the final allergen exposures., Conclusion: The individual wearable air purifier Respiray Wear A+ protects significantly against airborne pollen, HDM, and cat allergens and may be a very useful device for avoiding indoor allergens in a new way., Competing Interests: The authors declare no conflict of interest. Table 1.Characteristics of probands at the studies with birch pollen, house dust mite, and cat allergens. Subject dataBirch pollen (n = 23)Dust mites (n = 37)Cat allergens (n = 41)Age (years), mean (SD)39.4 (12.5)40.4 (13.6)35.4 (11.8)Female, n (%)17 (73.9)31 (83.8)32 (78)Male, n (%)6 (26.1)6 (16.2)9 (22)Weight (kg), mean (SD)74.7 (27.8)76.4 (20.4)71,7 (13.6)Prick test (mm), mean (SD)9.3 (3.5)7.5 (2.7)6.4 (1.8) Table 2.Flow chart of the entire study. At least 7 days prior to V1Day 1Day 2Day 7Day 8Screening V0Baseline exposure without Respiray V1Safety call V2Exposure with Respiray V3Safety call V4 Figure 1.Components of Respiray Wear A+. 1 = Air is drawn into the device through the intake grille. 2 = Large particles are filtered using the pre-filter. 3 = The body of the device houses fans, battery, and electronics. 4 = The HEPA filter blocks allergens and allows only clean air to pass through. 5 = Clean air is blown out from the output grilles. 6 = The device is worn on the user’s chest using straps.Figure 2.Capture from a CFD simulation depicting the streamlines exiting the device. Table 3.Total symptom score values V1 and V3 at the 60-minute time point are used as base of operation to determine the improvement rate in percentage. The p-value was calculated applying a t-test. „Improvement“ in the table means fewer symptoms using Respiray Wear A+ in comparison to symptom severity without a filter. AllergenMean value baseline (V1)Mean value – with filter (V3)Improvement rate (%)p-valueBirch4.782.43490.01149House dust mite6.923.59480.00236Cat7.442.95600.00308 Figure 3.Mean values of the sums of total symptom score (TSS) for V1 (without Respiray) and V3 (with Respiray) during exposure to birch, house dust mite, and cat allergens.Figure 4.Mean values of the sums of total eye symptom score (TESS) for V1 (without Respiray) and V3 (with Respiray) during exposure to birch, house dust mite, and cat allergens.Figure 5.Mean values of the sums of total nose symptom score (TNSS) for V1 (without Respiray) and V3 (with Respiray) during exposure to birch, house dust mite, and cat allergens. Table 4.Total eye symptom scores for V1 and V3 at the 60-minute time point are used as base of operation to determine the improvement rate in percent. The p-value was calculated applying a t-test. „Improvement“ in the table means fewer symptoms using Respiray Wear A+ in comparison to symptom severity without a filter. AllergenMean value – baseline (V1)Mean value – with filter (V3)Improvement rate (%)p-valueBirch2.481.35460.03390House dust mite3.732.00460.00519Cat4.001.66590.00308 Table 5.Total nasal symptom scores for V1 and V3 at the 60-minute time point are used as base of operation to determine the improvement rate in percent. The p-value was calculated applying a t-test. „Improvement“ in the table means fewer symptoms using Respiray in comparison to symptom severity without a filter. AllergenMean value – baseline (V1)Mean value – with filter (V3)Improvement rate (%)p-valueBirch2.301.09530.00307HDM3.191.59500.00098Cat3.441.29620.00311 Table 6.Visual analog scale well-being values for V1 and V3 at the 60-minute time point are used as base of operation to determine the improvement rate in percent. The p-value was calculated applying a t-test. „Improvement“ in the table means fewer symptoms using Respiray Wear A+ in comparison to symptom severity without a filter. AllergenMean value – baseline (V1)Mean value – with filter (V3)Improvement rate (%)p-valueBirch2114310.5192House dust mite3118400.2556Cat3116460.2565 Figure 6.Mean values of the visual analog scale scores at minutes 0, 30, and 60 at baseline and final exposure to all different allergens without Respiray (V1) and with Respiray (V3). Table 7.Total symptom score values for V1 and V3 over the measured time frame. The mean value of all investigated subjects as well as the standard deviation are depicted. AllergenMoment0 minutes10 minutes20 minutes30 minutes40 minutes50 minutes60 minutesMeanSDMeanSDMeanSDMeanSDMeanSDMeanSDMeanSDBirchBaseline (V1)1.742.801.351.072.701.493.522.003.962.314.302.844.783.22BirchWith filter (V3)1.041.021.571.242.091.472.131.222.221.382.351.612.431.56House dust miteBaseline (V1)1.651.773.382.304.782.656.243.156.703.136.733.176.923.23House dust miteWith filter (V3)1.411.382.051.842.971.643.382.143.272.293.572.573.592.67CatBaseline (V1)1.241.483.201.854.932.606.202.856.712.877.393.537.443.65CatWith filter (V3)1.001.181.801.472.561.663.001.973.122.143.222.662.952.48, (© Dustri-Verlag Dr. K. Feistle.)

Background: Eating outside the home is challenging for consumers with food allergy (FA) and intolerance (FI) and lack of allergen information provision in eating out venues can lead to unnecessary restrictions. Following European legislation (2014) designed to improve allergen information provision, little is known about differences in information provision experienced by consumers seeking to avoid particular allergens, or how this impacts on their eating out experiences. This study compared the information provision that consumers with FA/FI to different allergens experience when eating out.Methods: Using mixed methods, participants were recruited from across the UK and took part in self-report surveys or in-depth interviews. Surveys were completed by 232 participants avoiding either gluten (n = 66), nuts (peanuts/tree nuts) (n = 94), or milk (n = 74), and responses were subject to quantitative analyses. Interviews were carried out with 49 participants avoiding either gluten (n = 13), nuts (n = 14), milk (n = 13) or a combination of these allergens (n = 9), and analysed using the framework approach.Results: Although general improvements in information provision following the legislation were reported, variations in provision between allergen groups led participants seeking to avoid milk to conclude that their dietary needs were less well-understood and seen as less important. These perceptions were reflected in a reluctance to involve eating out venue staff in deliberations about the potential for milk-free meal options.Conclusions: The provision of visual indicators of the presence of milk and of staff trained in allergen-awareness would improve the eating out experiences of consumers seeking to avoid milk. Medical professions can play a key role in encouraging these patients to pursue their right to make enquiries about allergens in order to avoid accidental milk ingestion when eating out. [ABSTRACT FROM AUTHOR]

Introduction: The first therapeutic choice for food allergy is avoidance of the responsible food, but when this approach is not possible, specific oral desensitization could be considered as a good alternative. It is not clear yet whether the acquired tolerance is transient or persistent. Aim: We report on a subset of 13 patients of a larger study, treated successfully with specific oral tolerance induction who experienced secondary loss of tolerance after a period of allergen avoidance. Material and methods: Thirteen patients affected by IgE-mediated food allergy: to cow milk (3 patients), to hen egg (3 patients), to cod fish (2 patients), to peanuts (1 patient) and to corn (1 patient) confirmed by a complete allergological workup and a double-blind placebo-controlled food challenge (DBPCFC), were treated with sublingualoral desensitization. After the interruption of the maintenance phase, the laboratory tests were performed and 12 of 13 patients underwent DBPCFC. Results: Oral specific desensitization was completed successfully in all the 13 reported patients. At different times after the end of treatment, they decided, on their own initiative, to stop the ingestion of incriminated food. A new food allergen re-exposure caused adverse reactions in 12 of 13 patients. The detection of specific IgE and IgG4 during the period of allergen avoidance showed an increase in or a stable level of specific IgE and a decrease in specific IgG4 in 8 patients. Conclusions: According to our experience, the tolerance obtained through the desensitizing treatment is transient and so the regular allergen intake is necessary for its maintenance. [ABSTRACT FROM AUTHOR]

Summary: Background: Children with severe, persistent atopic eczema (AE) have limited treatment options, often requiring systemic immunosuppression. Objective: To evaluate the effect of the temperature‐controlled laminar airflow (TLA) treatment in children/adolescents with severe AE. Methods: We recruited 15 children aged 2‐16 years with long‐standing, severe AE and sensitization to ≥1 perennial inhalant allergen. Run‐in period of 6‐10 weeks (3 visits) was followed by 12‐month treatment with overnight TLA (Airsonett®, Sweden). The primary outcome was eczema severity (SCORAD‐Index and Investigator Global Assessment‐IGA). Secondary outcomes included child/family dermatology quality of life and family impact questionnaires (CDQLI, FDQLI, DFI), patient‐oriented eczema measure (POEM), medication requirements and healthcare contacts. The study is registered as ISRCTN65865773. Results: There was a significant reduction in AE severity ascertained by SCORAD and IGA during the 12‐month intervention period (P < .001). SCORAD was reduced from a median of 34.9 [interquartile range 28.75‐45.15] at Baseline to 17.2 [12.95‐32.3] at the final visit, and IGA improved significantly from 4 [3‐4] to 2 [1‐3]. We observed a significant improvement in FDQLI (16.0 [12.25‐19.0] to 12 [8‐18], P = .023) and DFI (P = .011), but not CDQLI or POEM. Compared to 6‐month period prior to enrolment, there was a significant reduction at six months after the start of the intervention in potent topical corticosteroids (P = .033). The exploratory cluster analysis revealed two strongly divergent patterns of response, with 9 patients classified as responders, and 6 as non‐responders. Conclusion and Clinical Relevance: Addition of TLA device to standard pharmacological treatment may be an effective add‐on to the management of difficult‐to‐control AE. [ABSTRACT FROM AUTHOR]

Background: For parents and caregivers of food hypersensitive (FH) children, accommodating their child's dietary needs when eating out can be a challenging experience. This study explored caregivers' experiences and behaviours when eating out with their FH child in order to gain insights into how they support and prepare their child in negotiating safe eating out experiences.Methods: A cross-sectional, qualitative design was used. In depth, semi-structured interviews were carried out with 15 caregivers of children with FH. Interviews were analysed using framework analysis.Results: Caregivers reported a number of issues relating to eating out with their FH child, or allowing their child to eat out without their supervision. Through themes of 'family context', 'child-focused concerns', and 'venue issues', caregivers described how they managed these and explained the limitations and sacrifices that FH imposed on their child, themselves, and family members.Conclusions: Through deeper understanding of the anxieties, negotiations and compromises experienced by caregivers of children with FH when they are eating out, clinicians and support charities can tailor their support to meet the needs of caregivers and children. Support and education provision should focus on providing caregivers of children with FH the tools and strategies to help enable safe eating out experiences. [ABSTRACT FROM AUTHOR]

Avoidance of allergens in the treatment of asthma has hitherto not achieved significant benefit despite the strong evidence that allergy both increases severity and contributes to exacerbations of asthma. House dust mite, cat and dog allergens are the most common perennial allergic triggers and most avoidance strategies have focused on reducing exposures in bedrooms. Cochrane reviews have suggested that they neither significantly reduce allergen levels nor improve asthma. While the lack of efficacy may be assumed to be a consequence of exposures occurring outside the bedroom, prolonged sleep is associated with increased susceptibility to bronchospasm and airway inflammation. Thus, if efficient reductions in allergen exposure could be achieved during sleep, it might be expected that this would result in significant improvements in control of asthma. The temperature-controlled laminar airflow (TLA) is a system which can be employed over beds in a domestic environment and results in massive reductions in particulate exposure of recumbent subjects, including highly respirable allergens such as Fel. D1 from cats. Trials of TLA have demonstrated highly significant improvements in asthma quality of life and reductions on airway inflammation as monitored by exhaled nitric oxide levels. Furthermore, in patients with the worst disease, severe exacerbation frequency was significantly reduced. Based on UK health-service costs, the use of TLA falls well below the National Institute for Health and Care Excellence (NICE) threshold for the incremental cost effectiveness ratio (ICER) per quality adjusted life year (QALY). Indeed, for those with frequent exacerbations, it is cost saving and should be prescribed for such allergic asthmatic patients. [ABSTRACT FROM AUTHOR]

Objective: We investigated the best strategy for adult asthmatics to avoid exposure toDermatophagoidesgroup (Der-1) allergens.Methods: Adult atopic asthmatics (n= 111) followed a 32-item checklist for avoiding Der-1 allergen exposure. Twenty-five patients were excluded through incomplete sampling; 50 remaining patients encased their pillows/futons/mattresses in microfine-fiber covers, 13 used vacuum cleaners with dust-mite-collection nozzles, and 23 acted as non-intervention controls. During August–October 2010 and August–October 2011, dust samples were collected in Petri dishes placed in bedrooms for 2 weeks and from mattresses/futons by using adhesive tape on one morning. A Der-1 level decrease was defined as a mean 2011 Der-1 level of <1 as a ratio of the 2010 level on tape or Petri dish samples. We analyzed the associations between Der-1 level change (by ELISA) and % weekly variability in peak expiratory flow (PEF) or fraction of exhaled nitric oxide (FeNO) after intervention.Results: Der-1 levels decreased significantly in the covers group but not the vacuuming group. FeNO levels and PEF variability were unchanged in both groups. In patients whose Petri dish or tape samples showed decreased Der-1 levels, the % PEF variability was lower in 2011 than in 2010, but FeNO levels were unchanged. Three interventions (vacuuming all family members' mattress/futon surfaces at least weekly or after exposure of the futons to sunlight, and floor wiping before vacuuming), plus using covers, were the most effective management strategy in reducing Der-1 levels.Conclusions: This environmental and bedding maintenance program may help manage adult atopic asthma. [ABSTRACT FROM AUTHOR]

To evaluate the extent of exposure to airborne mite allergens, we measured major mite allergens in indoor environments with an immunoassay using allergen-specific antibodies. The levels of mite allergens trapped by the sampler were measured with a highly sensitive immunoassay. We found heavy exposure to mite allergens from bedding during sleep. Bedding is likely one of the major reservoirs of mite allergens. When the used bedding was replaced with new allergen-free bedding, we detected a decrease in the airborne allergen levels. The use of new bedding seems to be an effective countermeasure against airborne mite allergen exposure.

Background Ingredient labels on products used by consumers and workers every day, such as food, cosmetics, and detergents, can be difficult to read and understand. Objective To assess whether typographical design and ordering of ingredients can improve the readability of product ingredient labels. Methods The study subjects (n = 16) had to search for two target ingredients in 30 cosmetic product labels and three alternative formats of each. Outcome measures were completion time (reading speed), recognition rate, eye movements, task load and subjective rating when the reading of ingredient labels was assessed by video recording, an eye tracking device, and questionnaires. Results The completion time was significantly lower ( p < 0.001) when subjects were reading all alternative formats than when they were reading the original. The recognition rate was generally high, and improved slightly with the alternative formats. The eye movement measures confirmed that the alternative formats were easier to read than the original product labels. Mental and physical demand and effort were significantly lower ( p < 0.036) and experience rating was higher ( p < 0.042) for the alternative formats. There were also differences between the alternative formats. Conclusions Simple adjustments in the design of product ingredient labels would significantly improve their readability, benefiting the many allergic individuals and others in their daily struggle to avoid harmful or unwanted exposure. [ABSTRACT FROM AUTHOR]

Background Although allergen avoidance can lead to significant improvements in symptoms of allergic rhinitis, there are very few studies in this area. Sunglasses could be effective for protection of eyes from pollen as a cheap, comfortable, and simple avoidance option for allergens. The aim of this study is to determine if wearing sunglasses can decrease ocular symptoms. Methods Ocular symptomatic patients (39 total) who had a confirmed history of seasonal rhinitis by skin prick tests and negative skin prick tests for perennial allergens were included in the study. The duration of the study was 4 weeks with 3 required visits. At the onset of the 1-week run-in period, patients were randomized and divided into 2 groups. Group I (n = 18) received topical aqueous nasal budesonide regularly and loratadine once daily as a rescue medication. Group II (n = 21) wore sunglasses during daytime as an addition to this medication. Subjective data included a daily diary recording nasal and ocular symptom scores and antihistamine need during the study period. Results Sunglasses significantly reduced ocular symptoms ( p = 0.002) and use of antihistamines ( p = 0.009). Conclusion Sunglasses are an inexpensive and simple treatment for patients with allergic conjunctivitis. [ABSTRACT FROM AUTHOR]

Background: Since barrier protection measures to avoid contact with allergens are being increasingly developed, we assessed the clinical efficacy and tolerability of a topical nasal microemulsion made of glycerol esters in patients with allergic rhinitis. Methods: Randomized, controlled, double-blind, parallel group, multicentre, multinational clinical trial in which adult patients with allergic rhinitis or rhinoconjunctivitis due to sensitization to birch, grass or olive tree pollens received treatment with topical microemulsion or placebo during the pollen seasons. Efficacy variables included scores in the mini-RQLQ questionnaire, number and severity of nasal, ocular and lung signs and symptoms, need for symptomatic medications and patients' satisfaction with treatment. Adverse events were also recorded. Results: Demographic characteristics were homogeneous between groups and mini-RQLQ scores did not differ significantly at baseline (visit 1). From symptoms recorded in the diary cards, the ME group showed statistically significant better scores for nasal congestion (0.72 vs. 1.01; p = 0.017) and mean total nasal symptoms (0.7 vs. 0.9; p = 0.045). At visit 2 (pollen season), lower values were observed in the mini-RQLQ in the ME group, although there were no statistically significant differences between groups in both full analysis set (FAS) and patients completing treatment (PPS) populations. The results obtained in the nasal symptoms domain of the mini-RQLQ at visit 2 showed the highest difference (-0.43; 95% CI: -0.88 to 0.02) for the ME group in the FAS population. The topical microemulsion was safe and well tolerated and no major discomforts were observed. Satisfaction rating with the treatment was similar between the groups. Conclusions: The topical application of the microemulsion is a feasible and safe therapy in the prevention of allergic symptoms, particularly nasal congestion. [ABSTRACT FROM AUTHOR]

In the past years, a wide range of epidemiological, clinical, and experimental studies have produced remarkable advances in the field of respiratory allergies in childhood. By the recent investigations on epidemiological trends, risk factors, and prevention of asthma and allergic rhinitis, various exiting concepts have been challenged, and novel innovative approaches have been developed. Pediatric Allergy and Immunology ( PAI), with a number of highly relevant contributions between 2010 and 2012, has become an important forum in this area. The prevalence of asthma in some developed countries may have reached a plateau, while in developing countries, where the prevalence was previously low, allergic diseases are still on the increase. A wide array of risk and protective factors, including hygiene, infections, outdoor and indoor air pollution, allergen exposure, breast-feeding practices, nutrition, and obesity, play a multifaceted role in shaping the observed worldwide trends of respiratory allergies. Under the guidance of recent research, prediction and prevention strategies in the clinical practice are progressively changing, the focus moving away from avoidance of allergen exposure and toward tolerance induction. [ABSTRACT FROM AUTHOR]

The prevalence of food allergy has continued to rise over the last 10-15 years, with building concern over the underlying causes and the best strategies to reverse this. Although it is still not clear if infant feeding practices play any significant role in either the aetiology of this epidemic or in its prevention, these have nonetheless been core to many previous prevention strategies. Early 'allergen avoidance' strategies have not only failed, but have instead been increasingly associated with increased risk of allergic disease. Together with other observations in humans and animals, this suggests that earlier introduction of allergenic foods may be a more logical preventive strategy. Based on this, there are several randomised controlled trials world-wide assessing the merits of early introduction of complementary feeding and/or allergenic foods. Until the results of these studies are available it is difficult to provide definitive recommendations regarding the role of early feeding in the induction of oral tolerance and prevention of food allergy. [ABSTRACT FROM AUTHOR]

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]

Over the last 20 years, there has been significant progress in our understanding of the pathophysiology of allergic rhinitis, including the discovery of new inflammatory mediators, the link between asthma and allergic rhinitis ('one airway-one disease' concept) and the introduction of novel therapeutic modalities. These new insights have been documented in the Allergic Rhinitis and its Impact on Asthma guidelines and have led to the creation of evidence-based management algorithms. We now understand the importance of a common strategy for treating allergic inflammation of the upper and lower airway as a way of improving outcome, reducing hospital admissions, providing better quality of life and perhaps, altering the natural course of the 'allergic march'. A therapeutic ladder is suggested: Whereas for mild intermittent allergic rhinitis, allergen avoidance should be the first line of treatment with subsequent addition of a second generation topical or oral antihistamine, nasal saline or cromoglycate, in cases of moderate to severe allergic rhinitis, a nasal steroid is the treatment of choice. If a patient with moderate/severe persistent allergic rhinitis fails to improve after 4 wk of adequate treatment, patient compliance or the diagnosis must be re-assessed. In such cases, when the diagnosis is in doubt, a careful clinical examination including nasal endoscopy is mandatory to assess for other potential causes of nasal obstruction. In children who suffer from concomitant allergic rhinitis and asthma, a management algorithm that addresses concurrently asthma and allergic rhinitis is vital, both from a theoretical and from a practical point of view: Parents overwhelmingly prefer a single strategy for the treatment of their child's upper and lower airway symptoms; however, the overall quality of life in children with severe asthma can be significantly improved if rhinitis is adequately addressed [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]

Occupational asthma (OA) is the most common occupational lung disease in industrialized countries. This respiratory disorder remains poorly diagnosed and managed, and inadequately compensated for worldwide. The most appropriate treatment for OA remains early removal from exposure to ensure that the worker has no further exposure to the causal agent with preservation of income. However, various studies demonstrate that many workers with OA continue to remain exposed to the causative agent or suffer prolonged work disruption and discrimination, and may face unemployment. Despite removal from exposure, OA frequently turns into a chronic condition and requires intensive medical management, including appropriate pharmacotherapy and patient education and counseling. There are very few studies on allergen immunotherapy in OA. Subcutaneous immunotherapy with latex extract in healthcare workers and with wheat-flour extract in subjects with baker's asthma, at adequate doses, appears to be a useful treatment in reducing cutaneous and respiratory symptoms, but should be considered as a high-risk treatment due to the appearance of systemic reactions. [ABSTRACT FROM AUTHOR]

Background: The prevalence of allergic diseases has grown in Finland, similarly to many other western countries. Although the origin of allergy remains unresolved, increasing body of evidence indicates that the modern man living in urban built environment is deprived from environmental protective factors (e.g. soil microorganisms) that are fundamental for normal tolerance development. The current dogma of allergen avoidance has not proved effective in halting the ‘epidemic’, and it is the Finnish consensus that restoring and strengthening tolerance should more be in focus. Aim: The national 10-year programme is aimed to reduce burden of allergies. The main goals are to (i) prevent the development of allergic symptoms; (ii) increase tolerance against allergens; (iii) improve the diagnostics; (iv) decrease work-related allergies; (v) allocate resources to manage and prevent exacerbations of severe allergies and (vi) decrease costs caused by allergic diseases. Methods: For each goal, specific tasks, tools and evaluation methods are defined. Nationwide implementation acts through the network of local co-ordinators (primary care physicians, nurses, pharmacists). In addition, three nongovernmental organizations (NGOs) take care of the programme implementation. The 21 central hospital districts carry out a three step educational process: (i) healthcare personnel; (ii) representatives and educators of NGOs and (iii) patients and the general population. For outcome evaluation, repeated surveys are performed and healthcare registers employed at the beginning, at 5 years, and at the end of the programme. The process will be evaluated by an independent external body. Conclusion: The Finnish initiative is a comprehensive plan to reduce burden of allergies. The aim is to increase immunological tolerance and change attitudes to support health instead of medicalizing common and mild allergy symptoms. It is time to act, when allergic individuals are becoming a majority of western populations and their numbers are in rapid increase worldwide. The Programme is associated with the Global Alliance of Chronic Respiratory Diseases (GARD), WHO. [ABSTRACT FROM AUTHOR]

The article discusses the causes and symptoms of allergies in school children. Background on the allergic response and the production of immunoglobulin E in response to a specific allergen is discussed. Symptoms caused by histamine release are presented. Substances that trigger common allergic diseases include grass pollen, poorly ventilated and humid rooms. Management of allergy in children is also provided.

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]