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MASK-air , a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK-air is a Good Practice of DG Santé on digitally-enabled, patient-centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co-operation and Development). MASK-air data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK-air data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as-needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combined symptom-medication score (ARIA-EAACI-CSMS) has been validated for clinical practice and trials. The implications of the novel MASK-air results should lead to change management in rhinitis and asthma.

MASK‐air®, a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK‐air® is a Good Practice of DG Santé on digitally‐enabled, patient‐centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co‐operation and Development). MASK‐air® data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK‐air® data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as‐needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combined symptom‐medication score (ARIA‐EAACI‐CSMS) has been validated for clinical practice and trials. The implications of the novel MASK‐air® results should lead to change management in rhinitis and asthma.

Background and objectives: Management of severe allergic transfusion reactions (ATR) is challenging. In this study, we investigate the usefulness of skin tests and basophil activation tests (BAT) in chronically transfused patients for the prevention of future ATR. Materials and methods: BAT and skin tests were carried with the supernatant of red blood cell (RBC) units for a sickle-cell disease patient under chronic exchange transfusion who has presented a severe ATR, in order to prevent potential future ATR. If the results for both BAT and skin tests were negative, the RBC units could be transfused to the patient. If either one of the results was positive, the tested RBC unit was discarded for the patient. Results: 192 RBC units were tested with both tests. The level of results concordance between the two tests was 95%. Out of the 169 negative units with both tests, 118 units were transfused to the patient for which he presented no ATR. Conclusion: In our study, combining both BAT and skin tests was associated with a good negative predictive value since we were able to safely transfuse our patient. Further studies are still necessary to confirm this result but this pilot study indicates that skin tests and BAT might help prevent ATR. When BAT is not available, skin tests may also be useful in preventing ATR., SCOPUS: ar.j, info:eu-repo/semantics/published

Irritant-induced asthma (IIA) is a phenotype of asthma caused by the inhalation of irritant agents. Definite IIA, probable IIA, or possible IIA have been described depending on the concentration of the inhaled irritants and the onset of respiratory symptoms respective to the time of exposure. Definite IIA represents approximately 4% to 14% of all cases of new-onset work-related asthma. The agents responsible of IIA can be encountered as fumes, gases, aerosols, or dusts. The most frequent are chlorine, nitrogen oxides, sulphur dioxide, ammonia, acetic acid, solvents, and cleaning materials. Although the diagnosis of definite IIA is based upon a suggestive clinical history along with evidence of reversible airflow limitation and/or non-specific bronchial hyperresponsiveness, possible IIA cannot be diagnosed with certainty as the relationship between exposure and the onset of symptoms is difficult to establish. The present article reviews the epidemiology, pathophysiology, diagnostic approach, and management of IIA.

Les maladies allergiques ont fortement augmenté dans les pays industrialisés depuis les années qui ont suivi la 1ère guerre mondiale. Parmi les hypothèses proposées celle de l’implémentation de l’hygiène dans l’environnement urbain et ses conséquences sur l’exposition aux agents pathogènes a été bien documentée. Comparé à la vie rurale, l’environnement urbain entraine une exposition plus faible aux microbes et à leurs constituants moléculaires tels que les endotoxines et quasi nulle aux parasites intestinaux tels que les helminthes. Au contraire, l’exposition aux allergènes de l’environnement domestique est plus importante.Dans ce travail nous avons investigué certains aspects de la réponse inflammatoire induite par les endotoxines (une molécule pro-inflammatoires des bactéries Gram négatives) et immunitaire associée aux helminthes.1/ L'exposition chronique à l'endotoxine inhalée produit des effets paradoxaux :une protection contre le développement d'allergies IgE-médiées, d'une part, et une réaction inflammatoire des voies aériennes, d'autre part. Comme les régions de la déposition bronchique et alvéolaire pourraient jouer un rôle dans ce processus, nous avons évalué la réponse inflammatoire locale et systémique après exposition à de l'endotoxine par inhalation d'aérosols de particules de dimensions différentes. Les résultats montrent une relation entre la déposition au niveau pulmonaire et l’amplitude de la réponse inflammatoire systémique.2/ Les infections parasitaires ont une relation complexe avec les maladies allergiques. Ces deux pathologies se caractérisent par une réponse immunitaire de type Th2 (impliquant éosinophiles, immunoglobulines E (IgE), interleukine (IL)-4, IL-13,IL-5, …). Cependant, certaines helminthiases protègent des maladies allergiques. Dans cette seconde partie du travail, nous avons étudié la réponse immune induite par une infection chronique par ankylostomes chez l’humain et son évolution après traitement de l’infection. Nous confirmons q, Doctorat en Sciences médicales (Médecine), info:eu-repo/semantics/nonPublished

Background: Endotoxin exposure may cause asthma exacerbations and contribute to non-atopic respiratory diseases. Viet Nam, a country with multiple house types, is lacking data on indoor contamination by endotoxin in regard with house types.Objectives: The comparison of measured settled dust endotoxin levels among house types in Ho Chi Minh city will allow to classify the house types regarding health risks.Methods: This study is a cross-sectional study. Five identified house types were selected: apartment (APA), rental (REN), rural (RUR), slum (SLU) and tube house (TUB). One hundred house’s endotoxin contamination was evaluated by ques- tionnaire and dust sampling. Endotoxin concentration was measured by kinetic chromogenic Limulus assay.Results: Endotoxin concentration (geometric mean 126.0 EU/mg, 95%CI 118.3-133.7) is particularly high in settled house dust compared to western countries and is significantly associated with the house type. The highest level was found in RUR in each room (p = 0.002 for living room; p < 0.0001 for bedrooms and for kitchens). Concerning levels in the different rooms, APA and TUB form a low group while REN and SLU (p < 0.001) form a median group and RUR the highest (p < 0.001). Differences in endotoxin levels were associated to the presence of dog, chicken and farm animals, wood cooking, air-conditioning usage.Conclusions: Further understanding of the relevant factors to endotoxin levels would contribute to prevent asthma exacerbations and chronic respiratory diseases. Public health interventions to reduce exposure to endotoxin include improving housing conditions, eliminating risk factors and a priority to high-risk house types., info:eu-repo/semantics/published

Fish allergy is one of the most common food allergies. It is usually considered to be immunoglobulin (Ig) E-mediated and correlated well with diagnostic tests such as prick tests and/or specific IgE. Recommended treatment is avoidance, generally extended to all fishes. However, new clinical presentations have been described, including non-IgE-mediated disease, mono-sensitization, and new syndromes that are sometimes associated with surprising cross-reactivity. Advances in molecular allergy have provided insights into new allergens and have increased our understanding of cross-reactivity. This paper focuses on recent publications providing information for clinicians involved in the management of fish allergy., info:eu-repo/semantics/published

Background: Rapid urbanization combined with rural migration to urban areas in southern Vietnam could be risk factors for allergen sensitization, contributing to chronic respiratory diseases (CRD). We aimed to evaluate the prevalence of mite sensitization and its relation to house dust characteristics among rural and urban native and migrating populations with CRD. Methods: Rural (n = 19) and urban (n = 46) dwellings were defined on the basis of a home typology. Controls were western Belgian houses (n = 14). Besides the house characteristics, both endotoxin and mite allergens were measured in the settled dusts. The sensitization to mite allergens was defined by positive skin prick test (SPT) and concentration of specific IgE (sIgE)≥ 0.7 U/mL. The prevalence of mite sensitization was evaluated among 610 patients with CRD and compared according to both their home types and places of birth and residences. Results: The concentration of endotoxin (but not mite allergen) was higher in rural compared to urban dusts (440 (95%CI: 314–566) versus 170 (95%CI: 115–226) EU/mg; p < 0.0001). The prevalence of positive sIgE to Der p1 and Der p2 was significantly lower in rural (9% and 5%) compared to urban (15% and 9%) population, consistent with the positive SPT to mite (14% and 21%, respectively). Among the urban migrants, the risk of mite sensitization (SPT) was higher compared to the rural natives (OR: 1.79 (1.02–3.15), p < 0.05) and not different to the urban ones (OR: 1.35 (0.82–2.23) p NS). Conclusion: In Vietnam, associated with higher endotoxin (but not allergen) dust concentrations, the risk of mite sensitization was lower in rural compared to the native urban population, but this protective effect could disappear among rural to urban migrants., SCOPUS: ar.j, info:eu-repo/semantics/published

Anaphylaxis is a serious systemic allergic reaction with rapid onset and potentially life-threatening. We report in detail a case of severe nocturnal anaphylaxis due to pigeon tick bite showing the diagnostic value of the extract and the recombinant allergen in the diagnostic procedures (basophil activation test, IgE immunoblot, and experimental ImmunoCAP). Apart from the presented case, we describe that during the last 10 years, we have collected 28 cases of allergy to Argas reflexus from several European countries. We suspect that this allergy is underdiagnosed because of the lack of diagnostic reagents. Because of the growing number of pigeons in Middle and Southern Europe cities, some cases of idiopathic anaphylaxis could potentially be caused by A. reflexus in those countries. The identification of pigeon ticks as a trigger of anaphylaxis would greatly improve medical care and advice for these patients as the parasite can be exterminated by eradication measures to avoid further incidents., SCOPUS: ar.j, info:eu-repo/semantics/published

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Anaphylactic reaction to food is the most severe type of type 1 hypersensitivity reaction. While the factors affecting the expression of IgE sensitisation are little-known, certain conditions that lower the reactivity threshold and/or increase the severity of clinical reaction have been identified. According to available records, a number of such cofactors, are involved in around one third of cases of anaphylaxis. Questioning of the patient is crucial, and challenge tests may also be useful in some situations. The physiopathology is poorly understood and a number of hypotheses exist but do not provide satisfactory answers in terms of actual clinical needs. The study of these factors could prove useful for understanding the trigger mechanisms of anaphylaxis., SCOPUS: sh.j, info:eu-repo/semantics/published

Background: Fish is one of the most allergenic foods. While clinical cross-reactivity among different fishes is a widely accepted feature of fish allergy, associations with other food allergies are not well understood. This study aims at analyzing the relevance of clinical cross-reactivity between fish and chicken meat in patients with allergy to chicken meat without sensitization to hen's eggs. Methods: Patients with food allergy to fish and chicken meat (n = 29) or chicken meat only (n = 7) were recruited. IgE-reactive chicken proteins were identified (Edman, MS analysis) and quantified (ELISA). Allergens were used in IgE ELISA and skin testing. Results: Chicken parvalbumin and two new allergens, aldolase and enolase, were identified at 12, 40, and 50 kDa, respectively. They were recognized by sIgE of 61%, 75%, and 83% of all patient sera which were in the majority of the cases positive for the fish homologues as well. Fish and chicken meat allergens were highly cross-reactive while high inhibition rates with fish or chicken allergens correlated with the patients' primary sensitization to fish or chicken. In cooked or roasted foods, enolase and aldolase were detectable in chicken breast while parvalbumin was detectable in chicken legs and wings. Conclusions: Fish and chicken meat are cross-reactive foods; both fish-allergic and chicken meat-allergic patients might be at risk of developing a food allergy to chicken meat or to fish, respectively. This clinical phenomenon is proposed to be termed ‘fish–chicken syndrome’ with cross-reactive allergens involved being parvalbumins, enolases, and aldolases., SCOPUS: ar.j, FLWIN, info:eu-repo/semantics/published

The prevalence of food allergies is more than 5 %, rising currently. The clinical presentations are polymorphic and involve the skin, respiratory, vascular and gut systems. The diagnosis is based on the consistancy between the allergic history and the results of the specific IgE investigations. When the relationship between the history and the IgE sensitization is not significant, an oral challenge test with food is indicated under supervision of a reference center. New approach, based on dosage of specific IgE to different constituent (recombinant protein) of each allergen, can predict the severity of the reaction and the cross reactivity between allergens, in some patients., SCOPUS: ar.j, info:eu-repo/semantics/published

Background: Inhaled endotoxin induces airways'neutrophilia, in human. TNF-a being a key cytokine in the response to endotoxin, the effect of anti-TNF on the endotoxin-induced neutrophilic response was evaluated among healthy volunteers. Methods: Among a population of 30 healthy subjects, an induced-sputum was collected 2 weeks before, and 24 hours after an inhalation of 20 mcg endotoxin (E coli 026:B6). Then, the subjects were randomized into 3 parallel groups treated with control, oral methylprednisolone 20 mg/day during 7 days or anti-TNF (adalimumab, Humira®, Abbott) 40 mg SC. One week later, an induced-sputum was sampled, 24 hours after an inhalation of endotoxin. Results: After endotoxin inhalation, the number of total cells, neutrophils and macrophages was significantly increased (p <0.001). Compared to the response to endotoxin among the control group, anti-TNF inhibited the endotoxin-induced neutrophil influx, both in relative (51.3 (±6.4)% versus 26.2 (±5.3)%, p <0.002) and in absolute values (1321 (443-3935) cells/mcL versus 247 (68-906) cells/mcL, p <0.02). The endotoxin-induced neutrophilic response was not significantly modified among the control group and oral corticosteroid group. Conclusions: While oral corticosteroid had no effect, anti-TNF inhibited the neutrophil influx in sputum, induced by inhalation of endotoxin, in human subject. The endotoxin model could be an early predictor of clinical efficacy of novel therapeutics., SCOPUS: ar.j, SCOPUS: ar.j, info:eu-repo/semantics/published

We report the case of an adult patient with occupational allergy to latex (. Hevea brasiliensis) associated with proven food allergy to buckwheat (. Fagopyrum esculentum). Immunological investigation demonstrated the presence of a 50. kDa allergen in both extracts; they were found to share common epitopes, reflecting their cross-allergenicity. The molecular function of this allergen has not yet been identified, but we suspect that it could be Hev b 13, a major latex allergen, which is not yet available for in vitro diagnosis., SCOPUS: ar.j, info:eu-repo/semantics/published

The authors present a retrospective analysis of reports of severe anaphylactic reactions made by Belgian allergists to the French Allergy Vigilance Network from 2011to 2012. In the absence of a national anaphylaxis registry in Belgium, an incomplete analysis of the available data revealed that immediate management of the cases was inadequate with respect to evaluation of the severity of the reaction, the delay in administration of adrenalin, details of the patients' transport to an Emergency Room, and the duration under medical observation in the Emergency Room, whatever the patients' age. Creation of a national anaphylaxis registry would provide a means for regular evaluation and thus could lead to improvement in the quality of the management; it would also form an excellent data bank, which could serve as a tool for epidemiological studies., SCOPUS: ar.j, info:eu-repo/semantics/published