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)
Fig.1: Members of Infection & Allergy IG (EAACI) 2010-2012
Infection & Allergy related 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
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?
b) What are the reasons, beliefs, attitudes affecting declination rates among allergic individuals?
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.