December 2016

Claude Molina et Jacques Gayraud

1. Unexpected role fo Pneumocystis in the pathogenesis of Asthma
2. Identification of fungal candidates for asthma protection
3. Non Coeliac Gluten Sensitivity
4. Field-testing the new Anaphylaxis classification

1. Unexpected role fo Pneumocystis (PC) in the pathogenesis of Asthma
T.Eddens et al Am.J;Resp.Crit.Care.Med 2016 194 7 779-793

In the 1980, PC jirovecii emerged as the classic lethal opportunistic pathogen in the AIDS epidemic. And now it appears as an aero-allergen which has the ability to induce in mouse and man an adaptative immune response in the lung, highly dependent of CD4+ T cells and eosinophilic perivascular inflammation (without cross-sensitization with other aero-allergens such house-dust-mite and independent of Innate Lymphoid Cells 2 ).

Moreover, comparing a cohort of patients with severe asthma with healthy control patients, the authors found significant elevation of PC IgE and IgG, correlated with worsened lung function on spirometry Of particular interest, the possibility arises that therapeutic intervention could be envisaged in such patients appropriately sensitized and symptomatic with PC-active agents (trimethoprim-sulfamethoxazole) or as prophylactic use, in patients receiving, long term, high doses of inhaled or oral corticosteroids.

2. Identification of fungal candidates for asthma protection
S.Mueller-Rompa et al Ped All.Immunol 2016 Nov Accepted article

Exposure to molds has been related to asthma risk both positively and negatively. The aim of the present analysis was to assess in environmental dust samples, asthma-protective fungal candidates with a comprehensive molecular technique.

Mattress dust samples of 844 children from the GABRIELA study were analyzed by PCR single-strand-SSCP of the fungus-specific (ITS) region. Known asthma candidate species were tested for their association with asthma, and further gel positions were sought to explain the above. As a second, data-driven, analysis, was tested the association of each individual gel position with asthma.

The results reveal that Penicillium chrysogenum emerged significantly as inversely associated with asthma. The effect size was changed by 39% toward the null when adjusting for the two bands 683 and 978. The data-driven approach yielded an additional band (containing DNA of Pseudotaeniolina globosa) with significant reduced risk of asthma.

So large population-based study revealed several fungal taxa with inverse associations with childhood asthma. Molds produce a variety of bioactive compounds with detrimental but also beneficial immunoregulatory capacities, which renders them promising targets for further asthma research.

3. Non Coeliac Gluten Sensitivity (NCGS)
P.Molkhou : Rev. Française d’Allergie Nov 2016 56 7-8

NCGS is a new entity that has been distinguished from other enteropathies associated with Gluten consumption. It differs from Coeliac disease (CD) in terms of absence of mucosal lesions, atrophied villosities, of anti-transglutaminases or extra-digestive symptoms. More frequent that CD, NCGS is characterized by no-specific gastro-intestinal signs; its diagnosis is based on clinical history, elimination of CD or other enteropathy such Food-Allergy to wheat, IgE-mediated, and gluten elimination-reintroduction challenge tests. However in individuals with NCGS a group of researchers found signs of systemic immune activation to microbial products (M.Uhde et al Gut 2016 ahead of print).  At last there appears to be some overlap between NCGS and “irritable bowel syndrome”.

4. Specific Risk factors for childhood Wheeze
Sze Man Tse et al JACI 2016 138 5 1561-1568

This Canadian study aims to identify sex-risk factors for wheeze from birth to mid childhood and identify distinct phenotypes using a large cohort of 1623 children. The authors found that paternal asthma is a stronger predictor of ever wheezing in boys whereas being black or Hispanic was a stronger risk factor in girls. When looking at the trajectories of wheeze over the first 9 years of life, they identify 3 patterns: never or infrequent, early transient and persistent wheeze. Similarly paternal asthma was associated with persistent in boys only whereas being black or Hispanic was associated with persistent wheeze in girls only These observations might have prognostic value in the care of children with asthma

5. Field-testing the new Anaphylaxis classification
L.Kase-Tanno et al   Allergy 2016 November Accepted article

In order to consolidate the new classification model addressed to the allergic and hypersensitivity conditions according to the International Classification of Diseases (ICD)-11 revision timeline, the French authors propose a real-life application of quality assurance methodology to evaluate sensitivity and accuracy of the “Anaphylaxis” subsection.

They applied field-testing methodology by analyzing all the consecutive inpatients’ files documented as allergies from the University Hospital of Montpellier electronic database for the period of one year. The files clinically validated as being anaphylaxis were manually blind-coded under ICD-10 and current ICD-11 beta draft. The correspondence of coding and the impressions regarding sensibility were evaluated.

From all 2,318 files related to allergic or hypersensitivity conditions, 673 had some of the anaphylaxis ICD-10 codes; 309 files (46%) from 209 patients had anaphylaxis and allergic or hypersensitivity comorbidities description. The correspondence between the two coders was perfect for 162 codes from all 309 entities (52.4%) with the ICD-10 and for 221 codes (71.5%)) with the ICD-11. There was a high agreement regarding sensibility of the ICD-11 usability.            

The same authors (Allergy 2017 72 1 120-125) using ICD revision in 2016 state that there is a decrease in the under-notification of cases of deaths due to Anaphylaxis in Brazil between 2008 and 2010.

In conclusion, there are attempts of real-life application to validate the new ICD11 “Anaphylaxis” subsection. By allowing all the relevant diagnostic terms for anaphylaxis to be included into the ICD-11 framework, WHO has recognized their importance. Thus the memory of Charles Richet this great scientist, ancestor of our discipline and Nobel prize in medicine, whose the name has been removed from an hospital of Paris region by a political and dishonorable decision, has been rehabilitated according to a scientific decision of the Ethic Committee of EAACI.

Your comments and questions are welcome at the following addresses:

Claude Molina                                            

Jacques Gayraud