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  • EAACI Thematic Month


    The “Thematic Month” is a feature that focuses on the different aspects, activities, and relevant research fields of the EAACI Sections and Interest Groups. This special report on the EAACI’s main “linchpins of action” aims to familiarize all eaaci.net visitors with the activities, aims and scopes of the Sections and Interests Groups, and invite them to take actively part to any of the groups that they find compatible to their needs and work field.

     

    Issues highlighted under the “Thematic Months” column include hot topics, new publications, related current European and/or international projects, useful tips and resources, upcoming events and postgraduate courses, comments on recent must-read papers, lists of prestigious research centers across Europe and/or worldwide, running Task Forces and any other scientific activities of the group in question.

     

    The EAACI “Thematic Month” feature provides a unique platform for Sections and Interest groups to promote their work and activities, motivating further action in the relevant field.

  • EAACI Thematic Month: Interest Group on Allied Health

    The formation of an Allied Health Interest group was first discussed in 2010 at the London meeting of EAACI. A group of dietitians, who had already formed an independent network called INDANA (international network of diet and nutrition in allergy), were invited to set up the group. The inaugural meeting was held at the EAACI conference in Istanbul 2011, and the group is currently chaired by Dr Berber Vlieg-Boerstra, with Dr Isabel Skypala as secretary. Its major topic of interest is the nutritional and dietary assessment and management of patients with b. 

    Educational Activities
    The Allied Health IG has collaborated closely with the Paediatric Section and the Food Allergy IG in the setting up and running of a Food Allergy Summer School, which took place in Vienna, Austria in August 2012. Members of the Allied health IG were on the Faculty and the programme included some interesting discussions on nutritional and dietary issues.

    In September, several members of the IG were invited to attend the International Congress of Dietetics in Sydney Australia, to take part in a workshop entitled ‘Practical cases: From dietary history to food challenges and beyond in food allergy’. The pictures below show IG members participating in the discussion and a also delegates tasting food challenge materials.

    alliedhealthig1 alliedhealthig2


    The chair of the Allied Health IG has also been involved in the programme for the Food Allergy and Anaphylaxis meeting due to be held in Nice, France in 2012. The group has scheduled a postgraduate course during EAACI 2013 in Milan, specifically designed for dietitians. The course, entitled ‘Dietary management of patients with food allergy’ will take place on the 22nd June from 14:00-17:30 and includes the following sessions and speakers:

    • Signs and symptoms of IgE-mediated and non-IgE-mediated food allergy
    • Hanneke Oude Elberink, The Netherlands
    • Allergy-focused diet history taking
    • Isabel Skypala, United Kingdom
    • Home introduction or oral food challenge?
    • Berber Vlieg-Boerstra, The Netherlands
    • The role of dietitians in oral food challenge tests
    • Carina Venter, United Kingdom
    • Management of food allergy: avoidance, nutritional adequacy and precautionary labeling
    • Kate Grimshaw, United Kingdom

    Strategic Developments
    Members of the Allied health IG were invited to take part in the Task Force for the development of guidelines for the diagnosis and management of food allergy, with the chair of the IG being invited onto the Steering Committee for this group. In addition, the IG has undertaken a complementary activity, through the establishment of a group to develop diet history tools. The Diet History Task Force was set up in February 2012, and involved clinicians and dietitians with expertise in both paediatric and adult food allergy. The group members are:
    • Louiza Diamandi
    • Adam Fox
    • Marion Groetch
    • Nicolette de Jong
    • Rosan Meyer
    • Hanneke Oude Elberink
    • Isabel Skypala (Chair)
    • Aline Sprikkelman
    • Carina Venter
    • Berber Vlieg-Boerstra
    The group met three times in 2012, and two diet history tools have been produced, one for paediatric patients and one for adult patients, which are planned to be published in 2013.

    Future Challenges
    The main challenge for the coming year is to attract more members, including dietitians, nurses and any other members of EAACI who are especially interested in nutrition and allergy. Through the development of our activities, we hope to encourage more dietitians to join the EAACI. To assist with this, the IG is now planning to contact European dietetic organisations, to encourage their members to consider joining. In addition to increasing membership, the IG is keen to improve educational opportunities in nutrition and allergy, including e-learning modules and/or a summer school.


    References
    1. Venter C, Laitinen K, Vlieg-Boerstra BJ. Nutritional Aspects in Diagnosis and Management of Food. Review. Special issue Food hypersensitivity. J. Allergy (Cairo). 2012;2012:269376
    2. Meyer R, Venter C, Fox AT, Shah N. Practical dietary management of protein energy malnutrition in young children with cow's milk protein allergy. Pediatr Allergy Immunol. 2012;23:307-314
    3. Skypala I. Adverse food reactions--an emerging issue for adults. J Am Diet Assoc. 2011;111:1877-1891.
    4. Sampson HA, Gerth van Wijk R, Bindslev-Jensen C, Sicherer S, Teuber SS, Burks AW, Dubois AE, Beyer K, Eigenmann PA, Spergel JM, Werfel T, Chinchilli VM. (2012) Standardizing double-blind, placebo-controlled oral food challenges: American Academy of Allergy, Asthma & Immunology-European Academy of Allergy and Clinical Immunology PRACTALL consensus report. J Allergy Clin Immunol. ;130:1260-1274.
    5. Papadopoulos NG, Agache I, Bavbek S, Bilo BM, Braido F, Cardona V, Custovic A, Demonchy J, Demoly P, Eigenmann P, Gayraud J, Grattan C, Heffler E, Hellings PW, Jutel M, Knol E, Lötvall J, Muraro A, Poulsen LK, Roberts G, Schmid-Grendelmeier P, Skevaki C, Triggiani M, Vanree R, Werfel T, Flood B, Palkonen S, Savli R, Allegri P, Annesi-Maesano I, Annunziato F, Antolin-Amerigo D, Apfelbacher C, Blanca M, Bogacka E, Bonadonna P, Bonini M, Boyman O,Brockow K, Burney P, Buters J, Butiene I, Calderon M, Cardell LO, Caubet JC, Celenk S, Cichocka-Jarosz E, Cingi C, Couto M, Dejong N, Del Giacco S,Douladiris N, Fassio F, Fauquert JL, Fernandez J, Rivas MF, Ferrer M, Flohr C, Gardner J, Genuneit J, Gevaert P, Groblewska A, Hamelmann E, Hoffmann HJ,Hoffmann-Sommergruber K, Hovhannisyan L, Hox V, Jahnsen FL, Kalayci O, Kalpaklioglu AF, Kleine-Tebbe J, Konstantinou G, Kurowski M, Lau S, Lauener R,Lauerma A, Logan K, Magnan A, Makowska J, Makrinioti H, Mangina P, Manole F, Mari A, Mazon A, Mills C, Mingomataj E, Niggemann B, Nilsson G, Ollert M,O'Mahony L, O'Neil S, Pala G, Papi A, Passalacqua G, Perkin M, Pfaar O, Pitsios C, Quirce S, Raap U, Raulf-Heimsoth M, Rhyner C, Robson-Ansley P, Alves RR, Roje Z, Rondon C, Rudzeviciene O, Ruëff F, Rukhadze M, Rumi G, Sackesen C, Santos AF, Santucci A, Scharf C, Schmidt-Weber C, Schnyder B, Schwarze J, Senna G, Sergejeva S, Seys S, Siracusa A, Skypala I, Sokolowska M, Spertini F, Spiewak R, Sprikkelman A, Sturm G, Swoboda I, Terreehorst I, Toskala E,Traidl-Hoffmann C, Venter C, Vlieg-Boerstra B, Whitacker P, Worm M, Xepapadaki P, Akdis CA. Research needs in allergy: an EAACI position paper, in collaboration with EFA. Clin Transl Allergy. 2012 Nov 2;2(1):21. doi: 10.1186/2045-7022-2-21
  • EAACI Thematic Month: Interest Group on Allergy, Asthma & Sports

    The EAACI Thematic Month issue focuses on the Interest Group on Allergy, Asthma & Sports (IGAAS). Priorities of IGAAS are to promote research on prevalence, pathogenesis, diagnosis, and treatment with regards to sport-related allergic diseases, including exercise-induced asthma, rhinitis, urticaria and anaphylaxis.

    EAACI Interest Group on Allergy, Asthma and Sports

    For many years, sports medicine was concerned chiefly with orthopedics and cardiology. Over the last two decades, however, this focus has been changing, and now the issue of asthma and allergy among competitive athletes has captured the attention not only of medical doctors, but also of general public.

    The ''Allergy, Asthma, & Sports'' Interest Group was approved by the EAACI ExCom in December 2000 and first convened during the Berlin 2001 Congress with 30 members.

    Today, the Interest Group on Allergy, Asthma and Sports of the EAACI now comprises more than 50 registered members including a valid representative of EAACI junior members. The present Board (2011-2013) began its activity at the Warsaw 2009 Congress, with Matteo Bonini as chairperson, Marcin Kurowski as secretary, Paula Robson-Ansley as board member, Les Ansley and Musa Khaitov as members-at-large, as well as Mariana Couto as webmaster and JMA representative.

    The priorities of the EAACI Interest Group on Allergy, Asthma and Sports are:
    To promote research on prevalence pathogenesis, diagnosis and , treatment with regards to sport-related allergic diseases, including exercise-induced asthma, rhinitis, urticaria and anaphylaxis;
    To promote the awareness and knowledge among patients and general public about factors contributing to health problems in allergic or asthmatic athletes during recreational and competitive sports, (e.g. the environment, food, contact allergens, drug treatment and doping roles);
    To promote a forum of scientific discussion within the EAACI with the aim of establishing high and evidence-based standards of allergy care in the field of Allergy, Asthma and Sports;
    To disseminate the latest information regarding the allergic athlete care.


    Hot Topics

    A recent publication has reviewed some of the current working hypothesis for Food Dependent Exercise Induced Anaphylaxis (Robson-Ansley P, Toit GD. Pathophysiology, diagnosis and management of exercise-induced anaphylaxis. Curr Opin Allergy Clin Immunol. 2010 Aug;10(4):312-7). Many of the explaining hypotheses seem inappropriate for the physiological changes that occur during exercise.

    Among other, main current Hot Topics in Allergy, Asthma and Sports include:
    The potential diagnostic value of a microarray technology for the diagnosis and management of poly-sensitized athletes.
    The impact of Changes in Anti-doping Regulations on Asthma Care in Athletes.
    Airway remodeling and inflammation in competitive swimmers training in indoor chlorinated swimming pools.
    The seasonal effect on exercise challenge tests for the diagnosis of exercise-induced bronchoconstriction
    The role of growth factor serum levels (i.e. nerve growth factor – NGF) in elite athletes


    Task Forces

    IGAAS has been involving over years in several Task Forces. One of them focused on the topic of “Recognizing and diagnosing exercise related asthma, respiratory and allergic disorders in Sports” and included members from EAACI: Bonini S. (Italy), Canonica G.W. (Italy), Del Giacco St. (Italy), Delgado L. (Portugal), Galatas J. (Greece), Haahtela T. (Finland), Popov T. (Bulgaria), Van Cauwenberge P. (Belgium); from ERS: Anderson S.D. (Australia), Bjermer L. (Sweden), Brusasco V. (Italy), Carlsen K.H. (Norway), Drobnic F. (Spain), Larsson K. (Sweden), Palange P. (Italy); and from IOC: Cummiskey J, (Ireland); and as Observer: Khaltev N (WHO). The outputs of this TF were published in Allergy, part I relating to diagnosis (Allergy 2008, 63: 387–403) and part II relating to the treatment and its relation to doping (Allergy 2008, 63: 492–505).
    Later on, the Task Force members worked with experts of the American Academy of Allergy Asthma and Immunology in a PRACTALL consensus report on Exercise-induced hypersensitivity syndromes in recreational and competitive athletes. This report focused on what the general practitioner should know about sports and allergy, and was also published on EAACI official journal (Allergy 2008, 63: 953–961).

    The second Task Force, on the topic “Lifestyle interventions in allergy and asthma: EAACI Evidence-Based Clinical Practice Guideline Task Force Report”, has just finalized the first chapter recommendations. “Weight loss interventions in asthma” from André Moreira, Matteo Bonini, Vanessa Garcia-Larsen, Sergio Bonini, Stefano R.Del Giacco, Ioana Agache, João Fonseca, Nikos Papadopoulos, Kai-Håkon Carlsen, Luís Delgado, and Tari Haahtela will shortly be published as a Position Paper in Allergy.

    A third and most recent Task Force is on Exercise-induced Anaphylaxis (EIAn). It is chaired by Dr Paula Robson-Ansley and consists of 8 clinicians and 2 exercise physiologists from 5 European countries. The intention is to provide a Position Statement on (FD) EIAn with respect to proposed exercise-induced pathophysiological mechanisms that may underlie EIAn. Exercise-induced anaphylaxis (EIAn) is a rare, unpredictable, potentially fatal, syndrome characterized by anaphylaxis related to exercise. Anaphylaxis, in general, is associated with a mortality rate of between 1-2%; importantly, 5-15% of anaphylactic episodes are caused by /or are associated with exercise. EIAn may occur independently of food allergen ingestion, or may require the ingestion of a food allergen around the time of exercise, known as FDEIAn. The symptoms of FDEIAn may vary in severity but reassuringly, fatalities are rare.  EIAn occurs in all ages, in both sexes, and is more common in atopic individuals. EIAn is generally reported following sub-maximal exercise of a relatively short duration; this fact alone eliminates the majority of the proposed pathophysiological mechanisms. EIAn has been described in high-performance athletes and in individuals undertaking only occasional exercise. Even regular physical activity e.g. raking garden leaves, has been reported as a trigger for EIAn. The aim of this task force is therefore to examine and determine the scientific evidence of the current working hypotheses for food-dependent exercise-induced anaphylaxis in the context of exercise physiology and immunology. The Task Force met initially in Geneva at the EACCI 2013 conference and recently again in London at the Royal Society of Medicine (December 2012) where significant progress is being made on the development of the Position Statement.

    Allergy Asthma & Sports Allergy Asthma and Sports
    Dr Les Ansley is in photo 1 exploring the changes in pH in the cell; photo 2 is the engaged Task Force.


    Upcoming events

    EAACI – WAO Congress in Milan 2013 is approaching and hopefully will represent an excellent occasion to meet all members interested in this field and to present research findings as well as exchange ideas. The program of sessions on various aspects of exercise, sports and allergy will be appealing and following this “Sports and allergy” track during Milan meeting may be fruitful and exciting.

    All EAACI members are cordially invited to the IGAAS Business meeting on Sunday 23th June starting 10:30 am. This will be devoted to current issues of the Interest Group but, first of all, according to tradition, an opening lecture will be held by an expert in this field.


    Recent European/International projects


    The relevant impact of the “Olympic Study” carried out within the GA2LEN network, should be outlined, with many IGAAS members involved investigating allergy in 2008 Olympic participants. While publication is pending, preliminary reports indicate that allergic athletes are underdiagnosed and undertreated.

    Also, the perfect organisation and the great success of the Allergy School on “Lifestyle modifications in allergy” organized in 2010 in Sardinia must be highlighted.

    This year, in the 2012 London Olympics several teams screened athletes for allergy and some of the IGAAS members were active in these issues in their countries, contributing to hallmarks of raising awareness of athletes’ allergy and asthma.

    Future plans of the group include the improvement of communication within the IGAAS as well as between IGAAS and other EAACI structural entities These will include the use of both EAACI web platform and external tools (eg, facebook and/or other community portals/social media platforms).


    Must read papers of the last months


    Robson-Ansley P, Howatson G, Tallent J, Mitcheson K, Walshe I, Toms C, DU Toit G, Smith M, Ansley L. Prevalence of allergy and upper respiratory tract symptoms in runners of the London marathon. Med Sci Sports Exerc. 2012 Jun;44(6):999-1004.

    Couto M, Horta L, Delgado L, Capão-Filipe M, Moreira A. Impact of Changes in Anti-doping Regulations (WADA Guidelines) on Asthma Care in Athletes. Clin J Sport Med. 2012 Aug 31. [Epub ahead of print]

    Bonini M, Marcomini L, Gramiccioni C, Tranquilli C, Melioli G, Canonica GW, Bonini S; on behalf of the ISAC Study Group. Microarray evaluation of specific IgE to allergen components in elite athletes. Allergy. 2012 Dec;67(12):1557-1564.

    Bonini M, Fioretti D, Sargentini V, et al. Increased Nerve Growth Factor (NGF) serum levels in top athletes. Clin J Sport Med 2012 in press

    Bonini M, Bachert C, Baena-Cagnani CE et al  What we should learn from the London Olympics. Curr Opin Allergy Clin Immunol. 2012 Dec 7. [Epub ahead of print]

    Couto M, Moreira A, Delgado L. Diagnosis and Treatment of asthma in athletes. Breathe 2012;8(4)287-296.

    Carlsen KH. Sports in extreme conditions: the impact of exercise in cold temperatures on asthma and bronchial hyper-responsiveness in athletes. Br J Sports Med. 2012 Sep;46(11):796-9.

    Carlsen KH. Mechanisms of asthma development in elite athletes. Breathe 2012; 8: 279-284.

    Del Giacco S.R. Exercise-induced anaphylaxis: an update. Breathe 2012; 8: 299-306.

    Bougault V, Loubaki L, Joubert P, Turmel J, Couture C, Laviolette M, Chakir J, Boulet LP. Airway remodeling and inflammation in competitive swimmers training in indoor chlorinated swimming pools. J Allergy Clin Immunol. 2012 Feb;129(2):351-8, 358

    Romano A, Scala E, Rumi G, Gaeta F, Caruso C, Alonzi C, Maggioletti M, Ferrara R, Palazzo P, Palmieri V, Zeppilli P, Mari A. Lipid transfer proteins: the most frequent sensitizer in Italian subjects with food-dependent exercise-induced anaphylaxis. Clin Exp Allergy. 2012 Nov;42(11):1643-53.

    Goldberg S, Mimouni F, Joseph L, Izbicki G, Picard E. Seasonal effect on exercise challenge tests for the diagnosis of exercise-induced bronchoconstriction. Allergy Asthma Proc. 2012 Sep-Oct;33(5):416-20.

    Bray SM, Fajt ML, Petrov AA. Successful treatment of exercise-induced anaphylaxis with omalizumab. Ann Allergy Asthma Immunol. 2012 Oct;109(4):281-2.

    Sastre B, Fernández-Nieto M, Rodríguez-Nieto MJ, Aguado E, Sastre J, Del Pozo V. Distinctive bronchial inflammation status in athletes: basophils, a new player. Eur J Appl Physiol. 2012 Aug 24 [Epub ahead of print].

    Kippelen P, Fitch KD, Anderson SD, Bougault V, Boulet LP, Rundell KW, Sue-Chu M, McKenzie DC. Respiratory health of elite athletes - preventing airway injury: a critical review. Br J Sports Med. 2012 Jun;46(7):471-6.

    Ramalho R, Almeida J, Beltrão M, Pirraco A, Costa R, Sokhatska O, Guardão L, Palmares C, Guimarães JT, Delgado L, Moreira A, Soares R. Substance P antagonist improves both obesity and asthma in a mouse model. Allergy 2013 Jan [E-pub ahead of print]


    On behalf of the Interest Group on Allergy, Asthma & Sports,
    Mariana Couto
    IGAAS JMA Representative


  • EAACI Thematic Month: Infection & Allergy Interest Group (IG)

    In 1911, Sir William Osler was the first to make the clinical observation that the common cold can cause asthma exacerbations. 100 years on, we are still studying the complex association between infections and allergy. While some infections, such as viruses and bacteria, can trigger allergic respiratory disease, other pathogens, such as parasites, can suppress allergic sensitisation and disease. Understanding the interactions between infections and allergy is of increasing interest to both scientists and clinicians and is of considerable relevance for clinical practice. However, our understanding of the mechanisms involved remains insufficient and more work needs to be done to develop preventive and curative interventions.


    The Aims of the Infection & Allergy IG are:

    To promote the study of the dynamic relationship between infections and allergy.
    To highlight the mutual influence of both infections and allergic disorders on each other in order to optimise patient care and to develop preventive measures, which may extend beyond healthcare services.
    To provide an active interaction between scientists, clinicians and experts, in order to integrate research from basic science and experience from medical practice regarding infections and allergy development.


    Membership of the Infection & Allergy IG (2010-2012)

     

    MembersInfection&AllergyIG2010_2012

     

     Fig.1: Members of Infection & Allergy IG (EAACI) 2010-2012

     

    Board 2011-2013

    Chairperson
    Jürgen Schwarze
    United Kingdom

    Secretary
    Chrysanthi Skevaki
    Greece

    Members

    Carsten Flohr

    Philippe Gevaert


    JMA Affiliate
    Heidi Makrinioti

    Webmaster
    Chrysanthi Skevaki


    Infection & Allergy related events

    Past events

    1. EAACI/GA2LEN Allergy School: Clinical Impact and Mechanisms of Infections in Allergy, 15 – 18 September 2011 Edinburgh, UK
    2. Pediatric Allergy and Asthma Meeting, Barcelona, 2011
    3. ESWI Flu Summit, 23 May 2012, Brussels, Belgium
    4. 31st Congress of the European Academy of Allergy and Clinical Immunology, Geneva, 2012
    5. EAACI/GA2LEN Allergy School: Asthma Exacerbations Risk Factors and Management, 2-5 August 2012, Tallinn, Estonia

    Upcoming Events

    1. EAACI – WAO World Allergy & Asthma Congress 2013, 22 – 26 June 2013, Milan, Italy
    2. Pediatric Allergy and Asthma Meeting, 13-15 October 2013, Athens


    Infection & Allergy IG Taskforce: Clinical relevance of Superantigens in IgE mediated disease.

    There is growing evidence in the literature that superantigens are involved in and can amplify IgE mediated diseases such as atopic dermatitis, nasal polyposis, severe asthma, and food allergy in children and in adults. However, to date, this evidence has not been translated to clinical practice nor used to classify disease, predict outcome, or to treat allergic disorders which arise as a consequence of superantigen involvement. The purpose of this task force is to summarize all evidence on the involvement of superantigens in IgE mediated disease and evaluate the clinical relevance of the findings. A summary of the task force findings has been presented at the business meeting of the EAACI I&A Interest Group at the 31st EAACI congress in Geneva. Finally, this work will result in a position paper that weighs the evidence of superantigen involvement and possible clinical implications on diagnosis, prognosis, classification and treatment of IgE mediated disease, both in its initial stages in early life and following adult onset.

     

    Infection & Allergy IG Survey

    The EAACI Infection & Allergy Interest Group conducted a survey in order to trace influenza vaccination practices in the allergy community and to gauge the interest of its members in participation in and promotion of related awareness campaigns. The survey took place during March and April 2012 and 241 EAACI members responded, 50% of which belonged to the Infection & Allergy IG, 30% to the Asthma Section and the remaining were Pediatrics Section members.

    Data coming from this survey suggest that additional resources are required in order to support vaccination campaigns (Fig. 2a). Vaccination rates among asthmatic and allergic patients remain low despite recommendations from physicians, possibly due to misconceptions (Fig. 2b), which may be cleared up with suitable education.

     

    a) Does your department provide adequate staff and resources for influenza vaccination campaigns?

     

    staffresourcesinfluenzavaccinationcampaign

     

    b) What are the reasons, beliefs, attitudes affecting declination rates among allergic individuals?

     

    declinationratesamongallergicindividuals
    Fig 2. Responses of EAACI members to the Infection & Allergy IG online survey

     


    PreDicta

    The European collaborative project PreDicta (Post‐infectious immune reprogramming and its association with persistence and chronicity of respiratory allergic diseases) was launched in October 2010 in Athens (Greece) and mainly focuses on answering a simple but yet unanswered question: Why do asthma symptoms persist?

    The PreDicta consortium integrates 14 partners from 9 European countries that will work together during five years under the coordination of Prof Nikos Papadopoulos from the National and Kapodistrian University of Athens.

    The final objective of PreDicta is, by the end of the programme, to be able to predict more accurately the predisposing risk factors for the development of respiratory allergies and to interfere more effectively with the disease process by targeting causative agents rather than symptoms. More information about this fascinating project may be found here.


    Recent publications in the field

    a. Virus infection and allergy
    1. Skevaki, C.L. et al., Rhinovirus-induced basic fibroblast growth factor release mediates airway remodeling features. Clin Transl Allergy, 2012. 2:14 (21 August 2012)
    2. Xepapadaki, P., Skevaki, C.L, Papadopoulos, N.G. The role of viral and bacterial infections on the development and exacerbations of asthma. European Respiratory Society Monographs 2012; 56 (Paediatric Asthma):115-127; DOI: 10.1183/1025448x.10016810
    3. Sumino, K., et al., Antiviral IFN-gamma responses of monocytes at birth predict respiratory tract illness in the first year of life. J Allergy Clin Immunol, 2012. 129(5): p. 1267-1273 e1.
    4. Schneider, D., et al., Neonatal rhinovirus infection induces mucous metaplasia and airways hyperresponsiveness. J Immunol, 2012. 188(6): p. 2894-904.
    5. Miller, E.K., et al., A mechanistic role for type III IFN-lambda1 in asthma exacerbations mediated by human rhinoviruses. Am J Respir Crit Care Med, 2012. 185(5): p. 508-16.
    6. Holt, P.G., D.H. Strickland, and P.D. Sly, Virus infection and allergy in the development of asthma: what is the connection? Curr Opin Allergy Clin Immunol, 2012. 12(2): p. 151-7.
    7. Forbes, R.L., et al., Impaired type I and III interferon response to rhinovirus infection during pregnancy and asthma. Thorax, 2012. 67(3): p. 209-14.
    8. Alcantara-Neves, N.M., et al., The effect of single and multiple infections on atopy and wheezing in children. J Allergy Clin Immunol, 2012. 129(2): p. 359-67, 367 e1-3.
    9. Sly, P.D. and P.G. Holt, Role of innate immunity in the development of allergy and asthma. Curr Opin Allergy Clin Immunol, 2011. 11(2): p. 127-31.
    10. Papadopoulos, N.G., et al., Viruses and bacteria in acute asthma exacerbations--a GA(2) LEN-DARE systematic review. Allergy, 2011. 66(4): p. 458-68.
    11. Hasegawa, S., et al., Characteristics of atopic children with pandemic H1N1 influenza viral infection: pandemic H1N1 influenza reveals 'occult' asthma of childhood. Pediatr Allergy Immunol, 2011. 22(1 Pt 2): p. e119-23.
    12. Gern, J.E., The ABCs of rhinoviruses, wheezing, and asthma. J Virol, 2010. 84(15): p. 7418-26.
    13. Jartti, T., et al., Allergic sensitization is associated with rhinovirus-, but not other virus-, induced wheezing in children. Pediatr Allergy Immunol, 2010. 21(7): p. 1008-14.
    14. Jackson, D.J. and S.L. Johnston, The role of viruses in acute exacerbations of asthma. J Allergy Clin Immunol, 2010. 125(6): p. 1178-87; quiz 1188-9.
    15. Sigurs, N., et al., Asthma and allergy patterns over 18 years after severe RSV bronchiolitis in the first year of life. Thorax, 2010. 65(12): p. 1045-52.
    16. Sly, P.D., M. Kusel, and P.G. Holt, Do early-life viral infections cause asthma? J Allergy Clin Immunol, 2010. 125(6): p. 1202-5.

    b. Bacterial infection and allergy
    17. Oertli, M., et al., DC-derived IL-18 drives Treg differentiation, murine Helicobacter pylori-specific immune tolerance, and asthma protection. J Clin Invest, 2012. 122(3): p. 1082-96.
    18. Melioli, G., et al., Allergens and bacteria interaction in the induction of basophil activation: is this the lost ring between allergy and infections in pediatric patients? Curr Opin Allergy Clin Immunol, 2012. 12(2): p. 164-70.
    19. Kasraie, S., et al., Macrophages from patients with atopic dermatitis show a reduced CXCL10 expression in response to staphylococcal alpha-toxin. Allergy, 2012. 67(1): p. 41-9.
    20. Jeong, Y.C., et al., Mycoplasma pneumoniae Infection Affects the Serum Levels of Vascular Endothelial Growth Factor and Interleukin-5 in Atopic Children. Allergy Asthma Immunol Res, 2012. 4(2): p. 92-7.
    21. Schwerk, N., et al., Wheeze in preschool age is associated with pulmonary bacterial infection and resolves after antibiotic therapy. PLoS One, 2011. 6(11): p. e27913.
    22. Simon, G.C., et al., Up-regulation of MUC18 in airway epithelial cells by IL-13: implications in bacterial adherence. Am J Respir Cell Mol Biol, 2011. 44(5): p. 606-13.
    23. Preston, J.A., et al., Streptococcus pneumoniae infection suppresses allergic airways disease by inducing regulatory T-cells. Eur Respir J, 2011. 37(1): p. 53-64.
    24. Peters, J., et al., Persistence of community-acquired respiratory distress syndrome toxin-producing Mycoplasma pneumoniae in refractory asthma. Chest, 2011. 140(2): p. 401-7.
    25. Penders, J., I. Kummeling, and C. Thijs, Infant antibiotic use and wheeze and asthma risk: a systematic review and meta-analysis. Eur Respir J, 2011. 38(2): p. 295-302.
    26. Navarini, A.A., L.E. French, and G.F. Hofbauer, Interrupting IL-6-receptor signaling improves atopic dermatitis but associates with bacterial superinfection. J Allergy Clin Immunol, 2011. 128(5): p. 1128-30.
    27. Sachse, F., et al., Staphylococcus aureus invades the epithelium in nasal polyposis and induces IL-6 in nasal epithelial cells in vitro. Allergy, 2010. 65(11): p. 1430-7.
    28. Niebuhr, M., et al., Staphylococcal exotoxins are strong inducers of IL-22: A potential role in atopic dermatitis. J Allergy Clin Immunol, 2010. 126(6): p. 1176-83 e4.

    c.    Parasites  infection and allergy
    29. Pritchard, D.I., et al., Parasitic worm therapy for allergy: is this incongruous or avant-garde medicine? Clin Exp Allergy, 2012. 42(4): p. 505-12.
    30. Hussaarts, L., et al., Regulatory B-cell induction by helminths: implications for allergic disease. J Allergy Clin Immunol, 2011. 128(4): p. 733-9.
    31. Feary, J., J. Britton, and J. Leonardi-Bee, Atopy and current intestinal parasite infection: a systematic review and meta-analysis. Allergy, 2011. 66(4): p. 569-78.
    32. Capron, M., Effect of parasite infection on allergic disease. Allergy, 2011. 66 Suppl 95: p. 16-8.
    33. Amberbir, A., et al., The role of acetaminophen and geohelminth infection on the incidence of wheeze and eczema: a longitudinal birth-cohort study. Am J Respir Crit Care Med, 2011. 183(2): p. 165-70.
    34. Feary, J.R., et al., Experimental hookworm infection: a randomized placebo-controlled trial in asthma. Clin ExpAllergy, 2010. 40(2): p. 299-306.
    35. Wills-Karp, M., et al., Trefoil factor 2 rapidly induces interleukin 33 to promote type 2 immunity during allergic asthma and hookworm infection. J Exp Med, 2012. 209(3): p. 607-22.
    36. Bager, P., et al., Trichuris suis ova therapy for allergic rhinitis: a randomized, double-blind, placebo-controlled clinical trial. J Allergy Clin Immunol, 2010. 125(1): p. 123-30 e1-3.

  • EAACI Thematic Month: Immunotherapy IG

    100 years of allergen-specific immunotherapy – the future has just begun.

    Since 1911, when Noon first administered inoculations of timothy pollen to avoid idiosyncratic reactions, allergen-specific immunotherapy (SIT) has evolved as the key treatment of allergic rhinitis, which is consider a pandemic disease affecting 25% of western populations. A wide range of evidence has been found on the clinical-and immunological efficacy of SIT, its long-term effects as well as its ability to prevent the progression of the disease and to improve the quality of life of our allergic patients. In this year, the 100’s anniversary of this innovative therapy is celebrated by the EAACI.

    A new board of the Immunotherapy Interest Group (IT IG) has been elected and officially presented at the last IT IG Business Meeting during EAACI congress in Istanbul 2011. Dr Moises A. Calderon as Chairman and Dr Oliver Pfaar as Secretary will be working with an elected an international and interdisciplinary board: Dr Beatrice Bilo, Dr Constantinos Pitsios, Dr Jorg Kleine-Tebbe, Dr Maia Rukhadze and Dr Gianenrico Senna. The core group is supported by Dr Pablo Rodriguez del Rio as webmaster.

    Fifty percent of the active members of the EAACI have signed up for the IT IG. This represents an important challenge and reflects the outstanding importance of this treatment in our medical community and in our daily practice (see table below). Therefore, the aim of the IT-IG is to continue and to coordinate ongoing projects as well as to stimulate cooperation and prospective scientific projects amongst all members. All interested EAACI members are cordially invited to support our group and take part in all our activities.

    *Source: EAACI headquarters


    Projects for 2011-2012:


    1. Task Force on “Dose-Effect of SIT” (already completed)
    Coordinator: MA Calderon
    Start date: 2009; Finish date: 2011

    Rationale: Clinical and immunological efficacy of SIT have been documented in many double-blind, placebo-controlled clinical trials. However, no consensus indication about dose-effect has been established. Different pre-seasonal or perennial schedules of treatment have been proposed and evaluated, all of them using different concentrations of single or multiples allergens. As a consequence, direct comparison of different preparations as reported in clinical trials is not feasible.

    Main objectives of the project were:
    To collect and compare clinical and immunological data on dose-efficacy of SIT for allergic rhinoconjunctivitis and asthma
    To analyse dose-efficacy and dose-safety of venom SCITTo define optimal doses regarding systemic adverse reactions

    The results of this TF have already been published in a TF-report in Allergy:
    http://www.ncbi.nlm.nih.gov/pubmed/21707645
    http://www.ncbi.nlm.nih.gov/pubmed/21668851

    2. Task Force on “European Survey on Systemic Adverse Reactions due to Allergen Immunotherapy in real life setting”

    Renamed: "European Adverse Systemic Reactions Survey in Allergen Specific Immunotherapy" EASSI

    Ongoing

    TF-coordinator: MA Calderon
    Start date:  2011
    Finish dates:
    •    2012 (Phase I): Survey design
    •    2013 (Phase II): pilot-study (4 European countries)
    •    2016 (Phase III): Pan-European survey

    Rationale: To date, clinical trials on SIT are based on carefully controlled clinical protocols in experimental conditions with pre-defined patient numbers and therefore specific information on side-effects. Therefore, the aim of this prospective survey is to collect  on all adverse reactions which may occur on daily practice in the allergy clinics.

    Main objective:
    To describe the safety profile of immunotherapy, prospectively, in real life setting in Europe.
    To estimate the incidence of clinically relevant systemic adverse reactions due to immunotherapy.
    To determine the number of systemic, anaphylactic and life-threatening allergic reactions occurring per patient and per treatment-year.

    3. Task Force on “Evaluation of adherence to SCIT and SLIT in Europe”

    Ongoing

    Coordinators: Gianenrico Senna and Giovanni Passalacqua
    Start-date: 2011; Finish-date: 2014

    Rationale: A good therapy-adherence of patients is essential for the efficacy of both SLIT and SCIT. However, only few clinical reports focus on adherence and underlying factors influencing this issue.

    Main objective of this project is:
    To evaluate and compare the adherence rate to SLIT and SCIT in Europe and search for the reasons underlying its lack of adherence.
    About 100 members from EAACI will be requested to join this study and follow their SIT prescriptions each 4 months and in case of lack of adherence, address the possible reason: lack of efficacy, cost, tolerance, GP acceptance or any other reason. This study will be conducted electronically.

    4. Task Force on “Standardization of (Primary) Clinical Outcomes for Clinical Trials in SIT”

    Ongoing

    TF-Coordinators: Oliver Pfaar and Sabina Rak
    Start-date: 2011
    Finish date: 2012

    Rationale: Generally accepted and authoritative national and international guidelines are still lacking with respect to the assessment of the therapeutic effects of SIT by using clearly-defined symptom- and medication-scores. Therefore, the aim of the task-force will be to propose a position statement clearly defining how symptoms and medications should be assessed, analysed and adequately weighted in prospective clinical trials on both SLIT and SCIT.

    Main objectives:
    To gather all scoring-systems so far used in trials on SLIT and SCIT.
    To l produce a rostrum paper to be published in Allergy.

    5. Project on “Seasonal Allergic Rhinitis: In search of the cut-off points”

    Ongoing

    Coordinator: Glennis Scadding and Moises Calderon
    Start date: 2011
    Finish date: 2012

    Rationale: The evaluation of patient’s assessments of any particular therapeutic intervention during a clinical trial is very important. This can be measured using the validated RQLQ.

    Main objective:
    To identify the cut-off point between adequately and inadequately controlled rhinoconjunctivitis/rhinitis using the mini Rhinitis-Quality-of-Life-Questionnaire (RQLQ).
    Members of the IT IG and EAACI ENT Section will be requested their voluntary participation to take part in a “one” page electronic survey.
    Already positive approval has been given by members of the EAACI ExCom.

    6. Project “Semantics in SIT”

    Ongoing

    Coordinator: Pascal Demoly and Moises Calderon
    Start date:  2011
    Finish date: 2012

    Rationale:  Current semantic use to characterize allergen immunotherapy is heterogeneous depending on the countries and/or the scientific societies. 

    Main objective:
    To create a common language for all audiences regarding immunotherapy and identify semantic keys to reinforce the impact of communication on allergy immunotherapy.

    7. Task force on “Contraindications of SIT”

    Ongoing

    Coordinator: Constantinos Pitsios
    Start date:  2011
    Finish date: 2012

    Rationale: Despite the large number of papers published on SCIT and SLIT, there is still no common agreement on the “contra-indications” for SIT.

    Main objective: To collect and compare clinical data on the effect of SIT in the known contraindications.
    A systematic literature search will be performed to re-assess SIT contraindications and adapt them to current situation of different diseases, co-morbidities and certain drugs.

    8. An “EAACI Scholarship-program on SIT”

    Postponed

    Coordinators: Oliver Pfaar and Moises Calderon
    Start date:  2011
    Finish date: 2012

    Rationale: In European countries, there is a broad range of several academic “schools” of IT with different scientific and clinical focuses, these may include SLIT, short-time schedules in SCIT, Cluster-SCIT, adjuvants in SCIT or new innovative forms of IT (ILIT, epicutaneous IT and others).

    Main objective:
    To coordinate  and support fellowships for young colleagues with outstanding interest in SIT aimed to i) elevate the standards of IT throughout whole Europe and ii) stimulate scientific collaborations and working groups.

    9. Reactivation of EAACI IT IG Website
    Pablo Rodriguez del Rio and Jorg Kleine-Tebbe (webmasters)
    Start date: 2011

    Main objective: To establish the IT IG website as a practical tool of communication amongst all members of the EAACI family



    OUTSTANDING INTEREST PAPERS

    General aspects of Allergen-Specific Immunotherapy:

    Calderon MA, Larenas D, Kleine-Tebbe J, Jacobsen L, Passalacqua G, Eng PA, Varga EM, Valovirta E, Moreno C, Malling HJ, Alvarez-Cuesta E, Durham S, Demoly P. European Academy of Allergy and Clinical Immunology task force report on 'dose-response relationship in allergen-specific immunotherapy'. Allergy. 2011 Jun 28. doi: 10.1111/j.1398-9995.2011.02669.x. [Epub ahead of print]
    http://www.ncbi.nlm.nih.gov/pubmed/21707645


    Subcutaneous Immunotherapy:

    Cox L, Calderón M, Pfaar O. Subcutaneous allergen immunotherapy for allergic disease: examining efficacy, safety and cost effectiveness of current and novel formulations. Immunotherapy. 2012 Jun; 4(6): 601-16.

    http://www.ncbi.nlm.nih.gov/pubmed/22788128


    Cox L, Larenas-Linnemann D, Lockey RF, Passalacqua G. Speaking the same language: The World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System. J Allergy Clin Immunol. 2010 Mar;125(3):569-74.
    http://www.ncbi.nlm.nih.gov/pubmed/20144472

    Soyer OU, Akdis M, Akdis CA. Mechanisms of subcutaneous allergen immunotherapy. Immunol Allergy Clin North Am. 2011 May;31(2):175-90, vii-vii.
    http://www.ncbi.nlm.nih.gov/pubmed/21530813

    Cox L, Nelson H, Lockey R et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol. 2011 Jan;127(1 Suppl):S1-55. Epub 2010 Dec 3
    http://www.ncbi.nlm.nih.gov/pubmed?term=21122901

    Sublingual Immunotherapy:

    Canonica GW, Bousquet J, Casale T, et al. Sub-lingual immunotherapy: World Allergy Organization Position Paper 2009. Allergy. 2009 Dec;64 Suppl 91:1-59
    http://www.ncbi.nlm.nih.gov/pubmed/20041860

    Scadding G, Durham SR. Mechanisms of sublingual immunotherapy. Immunol Allergy Clin North Am. 2011 May;31(2):191-209, viii.
    http://www.ncbi.nlm.nih.gov/pubmed/21530814

    Durham SR, Emminger W, Kapp A, et al. Long-term clinical efficacy in grass pollen-induced rhinoconjunctivitis after treatment with SQ-standardized grass allergy immunotherapy tablet. J Allergy Clin Immunol. 2010 Jan;125(1):131-8.e1-7.
    http://www.ncbi.nlm.nih.gov/pubmed/20109743

    Horak F, Zieglmayer P, Zieglmayer R, et al. Early onset of action of a 5-grass-pollen 300-IR sublingual immunotherapy tablet evaluated in an allergen challenge chamber. J Allergy Clin Immunol. 2009 Sep;124(3):471-7.
    http://www.ncbi.nlm.nih.gov/pubmed?term=19647862

    Radulovic S, Calderon MA, Wilson D, Durham S. Sublingual immunotherapy for allergic rhinitis. Cochrane Database Syst Rev. 2010 Dec 8;(12).
    http://www.ncbi.nlm.nih.gov/pubmed/21154351

    Future approaches:

    Casale TB, Stokes JR. Future forms of immunotherapy. J Allergy Clin Immunol. 2011 Jan;127(1):8-15;
    http://www.ncbi.nlm.nih.gov/pubmed?term=21094518

    Valenta R, Linhart B, Swoboda I, Niederberger V.Recombinant allergens for allergen-specific immunotherapy: 10 years anniversary of immunotherapy with recombinant allergens. Allergy. 2011 Jun;66(6):775-83.
    http://www.ncbi.nlm.nih.gov/pubmed?term=21352238

    Moldaver D, Larche M. Immunotherapy with peptides. Allergy. 2011 Jun;66(6):784-91
    http://www.ncbi.nlm.nih.gov/pubmed?term=21507007

    Senti G, von Moos S, Kundig TM. Epicutaneous allergen administration: is this the future of allergen-specific immunotherapy? Allergy. 2011 Jun;66(6):798-809
    http://www.ncbi.nlm.nih.gov/pubmed?term=21518374

    Martinez-Gomez JM, Johansen P, Erdmann I, Senti G, Crameri R, Kundig TM. Intralymphatic injections as a new administration route for allergen-specific immunotherapy. Int Arch Allergy Immunol. 2009;150(1):59-65.
    http://www.ncbi.nlm.nih.gov/pubmed/19339803

    Suzuki K, Kaminuma O, Yang L, et al Development of transgenic rice expressing mite antigen for a new concept of immunotherapy. Int Arch Allergy Immunol. 2009;149 Suppl 1:21-4
    http://www.ncbi.nlm.nih.gov/pubmed/19494500

    Non respiratory allergens

    Bilo BM, Bonifazi F. Hymenoptera venom immunotherapy. Immunotherapy. 2011 Feb;3(2):229-46.
    http://www.ncbi.nlm.nih.gov/pubmed/21322761

    Niedoszytko M, de Monchy J, van Doormaal JJ, Jassem E, Oude Elberink JN. Mastocytosis and insect venom allergy: diagnosis, safety and efficacy of venom immunotherapy. Allergy. 2009 Sep;64(9):1237-45.
    http://www.ncbi.nlm.nih.gov/pubmed/19627278

    Nowak-Wegrzyn A, Sampson HA. Future therapies for food allergies. J Allergy Clin Immunol. 2011 Mar;127(3):558-73.
    http://www.ncbi.nlm.nih.gov/pubmed/21277625

    Fernandez-Rivas M, Garrido Fernandez S, Nadal JA et al. Randomized double-blind, placebo-controlled trial of sublingual immunotherapy with a Pru p 3 quantified peach extract. Allergy. 2009 Jun;64(6):876-83.
    http://www.ncbi.nlm.nih.gov/pubmed/19183164

    Other:

    Bousquet J, Schunemann HJ, Bousquet PJ et al. How to design and evaluate randomized controlled trials in immunotherapy for allergic rhinitis: an ARIA-GA(2) LEN statement. Allergy. 2011 Jun;66(6):765-74.
    http://www.ncbi.nlm.nih.gov/pubmed?term=21496059

    Ring J, Gutermuth J.100 years of hyposensitization: history of allergen-specific immunotherapy (ASIT). Allergy. 2011 Jun;66(6):713-24
    http://www.ncbi.nlm.nih.gov/pubmed?term=21320133

    Bousquet PJ, Calderon MA, Demoly P, et al.  The Consolidated Standards of Reporting Trials (CONSORT) Statement applied to allergen-specific immunotherapy with inhalant allergens: a Global Allergy and Asthma European Network (GA(2)LEN) article. J Allergy Clin Immunol. 2011 Jan;127(1):49-56.
    http://www.ncbi.nlm.nih.gov/pubmed/21112079


    Document was prepared by:

    Pablo Rodriguez del Rio
    Jorg  Kleine-Tebbe
    Oliver Pfaar
    Moises Calderon

  • EAACI Thematic Month: Drug Allergy

    Adverse drug reactions (ADRs) have been reported to account for 3 to 6% of all hospital admissions and occur in 10 to 15% of hospitalized patients. It is a response to a drug that is noxious and unintended and occurs at doses normally used in man. Drug reactions can be considered as being either predictable or unpredictable. A predictable reaction is the result of the pharmacologic action of the medication, and does not require further workup. An unpredictable reaction might be drug intolerance, idiosyncratic, or might have or imply an immunologic basis, and thus be called drug hypersensitivity. It is potentially dangerous and may lead to fatalities, such as in drug anaphylaxis or in Toxic Epidermal Necrolysis. To come to the correct diagnosis and identify the culprit drug is of great importance. The diagnosis is often hampered by the complexity if this condition: although drug hypersensitivity is altogether frequent, it is rare for each drug. In addition it has very heterogeneous clinical symptoms and may occur as anaphylaxis in immediate (occurring mostly within 1 hour) as well as in various forms of exanthema in non-immediate drug hypersensitivity (occurring mostly after days).
    The Interest Group on Drug Hypersensitivity is based on the European Network on Drug Hypersensitivity (ENDA), which has been founded about 20 years ago and is dedicated to develop practical diagnostic and therapeutic methods in drug hypersensitivity and to promote research in this area. In the last years many position papers and guidelines have been developed. The group remains active and we invite all EAACI members to join the activities of the group. Every year in autumn there is an annual meeting. This year, the chairperson (Knut Brockow) and the secretary (Ingrid Terreehorst) together with the local organizers (Jean Louis Gueant, Annick Barbaud, Gisele Kanny, Michel Mertes) are inviting to this meeting in Nancy from 4th to 5th November.

    Projects

    - the ENDA has three ongoing multicentre studies: Allergic reactions to radio contrast media (project leader: Knut Brockow), the oxaliplatin and chemotherapeutic desensitization protocol (project leader: M Pagani), and a new multicentre study on skin test standardization (location, positivity criteria, amount to inject etc) (project leader: Annick Barbaud).

    Task forces

    - Task Force on Desensitization in Drug Hypersensitivity: In patients with a drug hypersensitivity reaction, most of the time an alternative is sought. For sensitized patients who have a clinical meaningful benefit from a particular drug, however, continuation with the agent is sometimes desirable. One of the options includes desensitization to the eliciting drug. Acute or rapid desensitization protocols have been developed and used in patients with allergic reactions to antibiotics (mainly penicillin) insulin, sulphonamides, aspirin and other NSAIDs, chemotherapeutics agents and many other drugs. It is a high risk procedure as it requires the introduction of medication to which the patient has reacted, done by repetitive increasing sub-therapeutic doses of the medication involved, until the total cumulative therapeutic dose is achieved. Once desensitization is complete this state can only be maintained by continuous administration of the medication. The task force’s goals are to provide standardized protocols for rapid desensitization for antibiotics, aspirin and other NSAIDS, chemotherapeutics, monoclonal agents and other biological agents. In addition, the group now is developing guidelines for desensitization in non-immediate (delayed) drug hypersensitivity. In some situations, e.g. use of trimethoprim/sulfamethoxazole in HIV patients or antibiotics in cystic fibrosis patients, a non-cross-reactive optimal treatment is not available and desensitization is the only mean to achieve a desired effect, even in patients with prior exanthemas to drugs.

    - Task Force Non-steroidal anti-inflammatory drug (NSAID) hypersensitivity: Hypersensitivity to NSAIDs is one of the most common drug hypersensitivity met in general practice and may manifest with different symptoms and syndromes. Several subtypes of hypersensitivity to NSAIDs have been distinguished depending on the symptomatology (respiratory, cutaneous, anaphylaxis), timing (acute, delayed), underlying chronic disease (otherwise healthy subjects, asthmatics, chronic urticaria patients) or putative mechanism of the reaction (allergic versus non-immunologically mediated, single reactors, multiple reactors). The aims of the task force are the collection and analysis of available data on the diagnosis and management of various types of hypersensitivity to NSAIDs including test procedures, the assessment of specificity and sensitivity of available diagnostics tools, establishing of a network of ENDA centers for validation and prospective  collection of  data on concentrations of drugs for skin testing and in vitro testing, to prepare recommendations for alternative drugs selection and tolerance testing and to develop algorithm(s) for diagnosis of various types of specific NSAIDs

    - Task Force on Drug hypersensitivity and Mast Cell Disease: In systemic mastocytosis several stimuli, including IgE-mediated reactions, can massively activate mast cells and provoke severe systemic symptoms, including anaphylaxis. This is well known for hymenoptera venom allergy. Similar to what happens with hymenoptera venom allergy, it can be hypothesized that this could also occur in case of systemic reactions due to other causes, for example drugs. Goal of the task force is to collect data regarding the prevalence of mastocytosis in patients with a drug induced anaphylaxis, to assess the level of tryptase in these patients and a possible relation with the severity of the reaction, to assess the incidence of clonal mast cell disorders and to provide risk criteria for anaphylactic reactions to drugs in these patients. Furthermore, the group wants to establish criteria as to when invasive procedures such as bone marrow biopsy are warranted in patients with drug related anaphylaxis and to establish the class of drugs associated with severe systemic reactions in patients with systemic mastocytosis. A review and/or position paper will be written in the course of the task force activities.

    - Task Force on Skin Test Concentrations in Drug Hypersensitivity: Skin prick, patch, and intradermal tests are the most readily available tools for the evaluation of hypersensitivity drug reactions. A skin test reaction to a drug tested in a concentration that does not cause a reaction in a sufficient number of controls is indicative of a drug allergy and a potentially harmful drug provocation test can be avoided. However, for many drugs, the diagnostic value of skin tests still has not been fully established because optimal skin test concentrations are not readily known. The most important information for allergists is the skin test concentrations, which may be used in drug allergy and this is only well-known for betalactam drugs. Reliable skin test concentrations for other drugs have to be defined, and these test concentrations will have to be validated for later multicenter studies as it is now done in the field of contrast media. For some drugs multiple data on skin test concentrations can be found in the literature, especially for muscle relaxants, insulins, platinum salts, streptokinase, and chymopapain, but for a multitude of other drugs these consist of case reports and case series. As an aid to the practicing allergist in the community, but also as a prerequisite to be able to perform multicenter studies, optimal skin test concentrations should be published. The aim of this task force is to review the literature and own data on optimal test concentrations for all available drugs, evaluate the grade of evidence to support the proposed concentrations and publish the results. A draft of the document will be prepared and discussed during the autumn meeting in Nancy this year.

    Upcoming meetings

    - 3 – 5 November 2010 Autumn meeting in Nancy
    - IG meeting during EAACI Istanbul in 2011
    - Drug Hypersensitivity Meeting V in Munich in 2012

    Recent papers

    - K. Brockow, A. Romano, W. Aberer, A.J. Bircher, A. Barbaud, P. Bonadonna, E. Faria, G. Kanny, M. Lerch, W.J. Pichler, J. Ring, J. Rodrigues Cernadas, E. Tomaz, P. Demoly, C. Christiansen. Skin testing in patients with hypersensitivity reactions to iodinated contrast media – a European multicenter study. Allergy. 2009; 64:234-41.
    - Bousquet PJ, Demoly P, Romano A, Aberer W, Bircher A, Blanca M, Brockow K, Pichler W, Torres MJ, Terreehorst I, Arnoux B, Atanaskovic-Markovic M, Barbaud A, Bijl A, Bonadonna P, Burney PG, Caimmi S, Canonica GW, Cernadas J, Dahlen B, Daures JP, Fernandez J, Gomes E, Gueant JL, Kowalski ML, Kvedariene V, Mertes PM, Martins P, Nizankowska-Mogilnicka E, Papadopulos N, Ponvert C, Pirmohamed M, Ring J, Salapatas M, Sanz ML, Szczeklik A, Van Ganse E, De Weck AL, Zuberbier T, Merk HF, Sachs B, Sidoroff A. Pharmacovigilance of drug allergy and hypersensitivity using the ENDA-DAHD database and the GALEN platform. The Galenda project. Allergy 2009; 64:194-203
    - Blanca M, Romano A, Torres MJ, Fernandez J, Mayorga C, Rodriguez J, Demoly P, Bosquet PJ, Merk HF, Sanz ML, Ott H, Atanaskovic-Markovic M, and ENDA members. Update on the evaluation of hypersensitivity reactions to betalactams. Allergy 2009; 64:183-193.
    J.R. Cernadas, A. Romano, K. Brockow, W. Aberer, M.J. Torres, A. Bircher P. Campi, M.L. Sanz, M. Castells, P. Demoly, W.J. Pichler. General considerations on     rapid desensitization for drug hypersensitivity – a consensus statement. Allergy (in press)
    M. L. Kowalski, J. S. Makowska,  M. Blanca , S.Bavbek, G. Bochenek,  J. Bousquet, P. Bousquet, G.Celik, P. Demoly, E. Rebelo Gomes, E. Nizankowska-Mogilnicka, A.Romano, M. Sanchez-Borges, M.J. Torres, A. De Weck,  A. Szczeklik, K. Brockow Hypersensitivity to Non- Steroidal Anti-Inflammatory Drugs (NSAIDs) – classification, diagnosis and management. Review of the EAACI/ENDA and GA2LEN/HANNA guidelines. Allergy (in press)
    K. Scherer, et al.
    Desensitization in delayed drug hypersensitivity reactions (Manuscripts in preparation)

    Further recommended articles from the Drug Hypersensitivity Interest Group:

    Reducing the risk of anaphylaxis during anaesthesia: guideline for clinical practice. PM Mertes for ENDA. J Investig Allergol Clin Immunol 2005; 15(2):91-101

    Management of hypersensitivity reactions to iodinated contrast media. Brockow K for ENDA. Allergy. 2005 Feb;60(2):150-8

    The Drug Ambassador Project. E. Gomes for ENDA. Allergy Clin Immunol Int - J Worl Allergy Org 2005,17:1

    Diagnosis of nonimmediate reactions to beta-lactam antibiotics. Romano A for ENDA. Allergy. 2004 Nov;59(11):1153-60

    Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. W Aberer for ENDA. Allergy 2003, 58:854-8

    Diagnosis of immediate allergic reactions to beta-lactam antibiotics. MJ.Torres for ENDA. Allergy 2003, 58,10:961-1082

    General Considerations for Skin Tests Procedures in the Diagnosis of Drug Hypersensitivity. K Brockow for ENDA. Allergy 2002, 57:45-51

    Drug Hypersensitivity: Questionnaire. P Demoly for ENDA. ALLERGY 1999, 54:999-1003




  • EAACI Thematic Month: Aerobiology & Air Pollution

    aerobiology&airpolutionAllergy is an environmental disease by definition and pollen, spores and air pollutants are playing a key role in the development and clinical aspects of allergic diseases. Environmental studies had a tremendous development in the last decade for several reasons. First of all studies on climate change raised the issue of the relationship between the environment and human health; for example, there is a link between the effects of climate change on plants and possible consequences on allergic diseases. New technologies allow a new approach in aerobiology, making now possible the measurement of the allergenic load i.e. the allergen content of pollen. Then the molecular era of aerobiology has begun. New models taking into account the dispersion of the pollutants are also more and more used in order to allow to better estimate individual exposure to air pollution. In this context, the interest for taking susceptible and vulnerability individuals into account has increased.
    Multidisciplinarity is the main feature of research groups in the field of environmental allergology and many teams have been created in the last years to address the multifaceted issue of the interaction between the environment and allergic diseases. Nowadays allergists are used to work together with aerobiologists, biologists, botanists, meteorologists and climatologists, chemistries and ongoing projects show this trend very well (see below). To this regard, the increasing number of EU calls for projects in this research area has boosted the creation of multidisciplinary teams. The IG Aerobiology and Air Pollution has grown in the last years thank to the participation of researchers from different fields, creating a platform for new research projects and new initiatives.   For these reasons we invite all members to join the IG activities to grasp the research and educational opportunities.
    New IG board, Lorenzo Cecchi (Chairperson) and Mario Morais Almeida (Secretary), elected in Warsaw in 2009, has been changed in last weeks. The secretary stepped down and he has been replaced by Isabella Annesi-Maesano (France).


    Projects

    - The project HIALINE (Health Impacts of airborne ALergen Information Network) is funded by the Executive Agency for Health and Consumers of the European Union and coordinated by Jeroen Buters (Germany). The major allergens from the top 3 airborne allergens in Europe (Phl p 5, Bet v 1 and Ole e 1) are sampled with a cascade impactor and data compared to pollen counts. Expected outcomes are the implementation of a network of European outdoor allergen measurements to better predict allergic symptoms. Also the climatic factors that govern allergen exposure in outdoor air will be established. These can be used to calculate the effect of climate change on the health effects of airborne allergens. The project will end in 2012.

    - The EU COST Action ES0603 (EUPOL), launched in the autumn of 2007, addresses the assessment of production, release, distribution and health impact of allergenic pollen in Europe. It is chaired by Mikhail Sofiev (Finland) and organized in three working groups: Pollen production and release; pollen distribution in the atmosphere; impact assessment, user links and applications. The project will end in 2011.

    - The project MeDALL (FP7, in negotiation) combines the strengths of previous and ongoing EU projects (CHICOS, ENRIECO, ESCAPE, GA2LEN, HiTEA and U-BIOPRED) to develop a novel integrative research approach for the investigation of the initiation of allergy and to reduce the fragmentation of science in this field in Europe.  Among others, the project MeDALL using birth cohort data will allow investigating the interaction between air pollution and pollens in the inception of allergy.


    Task forces

    - “Effects of Climate change on respiratory allergic diseases and on asthma prevalence” (2008-2009). 10 experts from the EAACI and European Respiratory Society (ERS) have produced a document about the contribution of aerobiology to the effects of climate change on asthma which is in press in Allergy. The document has been endorsed by both societies and an interview to some of the authors have been published as press release in the EAACI website

    - “Monitoring allergens in Europe” (2010-). It has been approved two months ago and includes experts from EAACI and from the EU funded COST Action “Assessment of production, release, distribution and health impact of allergenic pollen in Europe” (EUPOL). The aims of the task force are: To prepare a document for policy makers supporting the inclusion of pollen/allergen count among the pollutants in the air quality monitoring; To homogenize the pollen information in Europe according to the patients and allergologists needs; to implement the EAACI website with pollen information and forecasts; to identify research needs and future strategies.


    Recent papers

    1.    Projections of the effects of climate change on allergic asthma: the contribution of aerobiology. Cecchi L, D’Amato G, Ayres JG, Galan C, Forastiere F, Forsberg B, Gerritsen J, Nunes C, Behrendt H, Akdis K, Dahl R, Annesi-Maesano I. Allergy 2010, in press.
    The paper is in press in Allergy as report of the Task force “Effects of Climate change on respiratory allergic diseases and on asthma prevalence” (see section Task Forces) and it represents an official position of both EAACI and ERS. It includes: a state of the art about the effects of changes in climate in the last decades on plants producing allergenic pollen and on pollen allergenicity; a projection on the future taking into account the climate change scenarios; recommendations for policy makers and future directions and needs for research.

    2.    The allergen Bet v 1 in fractions of ambient air deviates from birch pollen counts. Buters JT, Weichenmeier I, Ochs S, Pusch G, Kreyling W, Boere AJ, Schober W, Behrendt H. Allergy. 2010 Feb 4. [Epub ahead of print]
    The paper of Buters et al. from the Center for Allergy and Environment (ZAUM) describes the exposure to airborne allergens Bet v 1 for different PM (particulate matter) fractions of ambient air and birch pollen in Munich, Germany over 4 consecutive years. Qualitatively, the pollen counts well represented allergen exposure. However, quantitatively the potency of pollen to release allergen varied up to 10-fold between different days and also between different years. The explanation the authors is that allergen is absent in pollen for up to 6 days before pollination. Just before pollination Bet v 1 rapidly increased from zero to high levels. Depending on the exact date that pollination occurred, large differences between allergen release from pollen can occur. Although birch pollen looks the same, their potency to release allergen varies substantially.


    Upcoming meetings

    - 9th International Congress on Aerobiology "Expanding Aerobiology"
    quadrennial congress of the International Association for Aerobiology
    August 23 – 27, 2010
    Museo Argentino de Ciencias Naturales “Bernardino Rivadavia” Buenos Aires – Argentina

    - 22nd Conference of the International Society for Environmental Epidemiology
    Seoul, Korea, August 28-September 1, 2010


  • EAACI Thematic Month: Allergy Diagnosis

    allergy_diagnosis_thematic_monthIn modern allergy diagnosis, the responsiveness to allergen suggested by the clinical history of an allergic patient should be confirmed by an ex vivo or in vitro test. These laboratory tests are the realm of the Interest Group for Allergy Diagnosis (IGAD). The commonly used in vitro test is determination of specific IgE, whereas the ex vivo test may be histamine release or up regulation of surface molecules CD63 or CD203c on basophil granulocytes, known as the basophil activation test, BAT.

    In the last decade, specific IgE testing has expanded from using only standardised extracts of allergen sources to more precisely defined purified natural or recombinant allergens. This gives the allergist access to knowledge of the identity of allergenic molecules recognised by specific IgE; are they members of one large Pan allergen group like PR-10 allergens with Bet v1 as an important member, that gives rise to oral allergy syndrome, or is the allergen specific for one particular species (like Fel d1, the major cat allergen) and unlikely to ever cross-react? Allergen-based diagnosis will have an impact on diagnosis of food allergy, and allergies with discordance between clinical history and specific IgE data. We can hope that the regulatory authorities devise methods to develop reagents for immunotherapy that can match the diagnostic potential of this technology.

    The 3rd International Symposium on Molecular Allergy, ISMA, was held in April 2008 in Salzburg, Austria, and Markus Ollert, Stephan Vieths and Adriano Mari will arrange the fourth ISMA as an EAACI Mini-Congress on 29-31 October 2010 in Munich, Germany. The symposium will cover aspects of allergenic molecules with an emphasis on the transition from complex extracts to molecular entities. International top experts will address topics covering structural, allergenic and diagnostic aspects of molecular Allergology. Furthermore, contributions on application of other technologies like microtechnologies and Information Technologies will be discussed during the meeting.

    Whilst measuring specific IgE is a step in the right direction, we still only measure one interaction between IgE and an allergen, whilst an allergic response requires two simultaneous interactions of allergen with IgE on the same effector cell. This is simulated in the ex vivo tests based on basophil granulocytes.

    Edward Knol and IngeTerstappen arranged the fourth EuroBAT meeting on 19-21 September in Rotterdam, NL, with 67 participants from 17 countries together with the ENDA meeting. Preliminary reports of a European collaboration, and application of the BAT in food & drug allergy (no, this is not the new FDA), and insect sting allergy were the major topics of the meeting. Two invited lectures on basic basophil biology broadened the horizon of the participants beyond p-values in clinical trials. The basophil activation group is really divided into the camp that wants to develop the best ex vivo test, and the group that is willing to use a little more time, and explore the responsiveness of the basophil more thoroughly. No doubt, the truth is that both approaches are valid, but are useful in different scenarios.

    Bernadette Eberlein and an international group of BAT enthusiasts will arrange the fifth EuroBAT will be held 31.10 – 1.11. 2010 in Munich, Germany, just after the ISMA 2010. See the programme on www.basophil.org

    We look forward to meeting you at the EAACI Meeting in London – attend our business meeting on Tuesday, 8 June 2010 at 13:30 – 15:00 to meet people you share an interest with, and get involved!

    Hans Jurgen Hoffmann, Denmark
    Adriano Mari, Italy
    Markus Ollert, Germany