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1. Sjögren Syndrome: Immune signature and prognosis
2. Endocrine-disrupting chemical exposure and childhood allergy
3. Polyunsaturated fatty acids in plasma at 8 years and subsequent allergic disease    
4. The standardization of nasal allergen challenges: EAACI Position paper
5. Invasive Aspergillosis and Severe influenza

1. Sjögren Syndrome (SS): Immune signature and prognosis
O.Fogel et al JACI 2018 July 142 1 258-268
A French group involved in immunologic research on viral infections and auto-immunity was interested in the pathogenesis of primary Sjögren Syndrome (SS). Mouse models and genetic studies suggest the involvement of type 1 and type 2 interferon pathways. Likewise, polymorphisms of the IL-12A gene (IL12A), which encodes for IL-12p35, have been associated with SS. The IL-12p35 subunit is shared by 2 heterodimers: IL-12 and 35.        
The authors sought to confirm in patients this genetic association.
In 673 patients from 2 French SS cohorts and 585 healthy control subjects, functional studies were performed. The association of the IL12A rs485497 polymorphism and SS was confirmed and an increased serum protein level of IL-12p70 in patients was found in patients carrying the risk allele. Serum levels of IL-12p70 were greater in patients than control subjects, especially in patients with more active disease; conversely, IL-35 levels were decreased in such patients.
In conclusion, serum IL-35 levels were associated with low disease activity, in contrast with serum IL-12p70 levels, which were associated with more active disease. This is an excellent example of the role of immunogenetics in the prognosis of autoimmune diseases.

2. Endocrine-disrupting chemical exposure and childhood allergy
K.Lee-Sarwar et al JACI 2018 July 142 1 269-278
An association of triclosan and paraben chemical exposures with childhood allergy has been found in cross-sectional studies. Triclosan and parabens are chemicals with endocrine-disrupting and antimicrobial properties that are present in a wide variety of personal care and other products.                      
In the first study using a prospective longitudinal design, the authors performed an ancillary analysis of enrollees in Antenatal Asthma Trial, quantifying triclosan and parabens in maternal plasma during pregnancy and in the urine of offspring at age 3 or 4 years, and serum specific IgE in high risk children:The analysis included 467 Mother-Child pairs. 
1) There was no overall association of prenatal or childhood triclosan or paraben concentrations with asthma, recurrent wheeze, or allergen sensitization at age 3 years.
2) A trend toward an inverse association between T and P exposure and allergic sensitization was even observed.                                        
3) There was evidence of different effects of triclosan or paraben exposure on allergic outcomes between male and female subjects, with higher odds of environmental sensitization associated with increasing paraben concentration in male compared with female subjects.
This finding warrants further exploration.

3. Polyunsaturated fatty acids in plasma at 8 years and subsequent allergic disease
J. Magnusson et al JACI 2018 August 142  2  510-516
Polyunsaturated fatty acids (PUFAs) are hypothesized to modulate the risk of allergic disease. However, evidence from previous studies is inconclusive, and limited longitudinal data exist using circulating biomarkers of PUFA intake and metabolism. The Swedish authors aimed to investigate associations between n-3 and n-6 PUFAs at age 8 years and asthma, rhinitis, and aeroallergen sensitization at age 16 years. Proportions of n-3 PUFAs) and n-6 PUFAs (linoleic acid and arachidonic acid [AA]) in blood samples at age 8 years were measured for 940 children from the prospective Swedish birth cohort BAMSE. Allergic disease phenotypes were defined by using questionnaires and IgE measures at the ages of 8 and 16 years. Logistic regression was used to examine potential association                                              
Results: A higher proportion of total VLC n-3 PUFAs in plasma at age 8 years was associated with a reduced risk of prevalent asthma, rhinitis, and aeroallergen sensitization at age 16 years and with incidence of asthma between 8 and 16 years (adjusted odds ratio, 0.67; 95% CI, 0.47-0.94). AA was associated with a reduced risk of asthma, aeroallergen sensitization, and allergic rhinitis. The findings were most evident for allergic phenotypes of asthma and rhinitis. Additionally, AA was associated with an increased probability of asthma and rhinitis remission between 8 and 16 years of age.
In conclusion: Higher proportions of VLC n-3 and very long-chain n-6 PUFAs in plasma phospholipids at age 8 years were associated with a reduced risk of allergic disease at age 16 years.

4. The standardization of nasal allergen challenges (NAC) - EAACI position paper
J. Augé et al  Allergy 2018 August 73 15971608
It is the “gold standard” for the diagnosis of rhinitis or rhinosinusitis, besides clinical history, symptoms, skin tests and IgE, or for initiating specific allergen immunotherapy. or measuring therapeutic success, National recommendations showing, international divergences, 32 members specialists of EAACI, from 15 different countries, decided to initiate a task force to find a consensus in executing a NAC. Apart from indications, contraindications, and preparations for the test procedure, main recommendations are a bilaterally challenge with standardized allergens, with a spray device. An exhaustive list of positivity criteria is given, in form of several tables, for the variety of established subjective and objective assessment methods as well as a schedule for the procedure. A unified protocol is recommended, aiming at eliminating the previous difficulty of comparing NAC results. Presently, all aspects of NAC, such their potential advantages, as well as their respective drawbacks are studied, taking in account the co‐existence of several equally validated methods,                                  
In conclusion, the task force suggests the use of standardized test solutions, to spray 2 puffs (0.1 mL per nostril) bilaterally and to evaluate clinical results, thus providing, a valuable protocol useful for daily clinical practice and epidemiologic studies.

5.Invasive aspergillosis and severe influenza
Alexander FAD Schauwvlieghe, MD – The Lancet Respiratory 2018 7 31
Invasive pulmonary aspergillosis (IPA) typically occurs in an immuno-compromised host. Recently patients with severe influenza were also reported to develop an IPA. The authors from Belgium and Netherland sought to measure in retrospective multicenter cohort study, the incidence of IPA in patients hospitalized in intensive care units (ICU) and to assess whether influenza was an independent risk factor for IPA. Data were collected from adult patients, older than 18 years, with severe influenza admitted to seven ICU centers for more than 24 h with acute respiratory failure, had pulmonary infiltrates on imaging, and a confirmed influenza infection based on a positive airway PCR test.  
Logistic regression analyses were used. Between Jan 1, 2009, and June 30, 2016. IPA was diagnosed in 83 (19%) of 432 patients admitted with influenza. The incidence was similar for influenza A and B. For immunocompromised patients the incidence of IPA was as high as 32% (38 of 117 patients), whereas in the non-immunocompromised influenza case group, incidence was 14% (45 of 315 patients). Only 16 (5%) of 315 patients in the control group (patients with community-acquired pneumonia) developed an IPA. The 90-day mortality was 51% in patients in the influenza cohort with IPA and 28% in the influenza cohort without IPA (p=0·0001) Influenza was found to be independently associated with IPA whatever the sex or use of corticosteroids. In conclusion Influenza was identified as an independent risk factor for IPA and their association (Infl. + IPA) is a factor of high mortality. The authors suggest for a better outcome a faster viral diagnosis or antifungal prophylaxis.
We must add, in immunocompromised patients, a genetic research, like in a recent French and American article (N.Hernandez et al J.Exp.Med August 24 2018) which reports a child with inherited complete IRF9 deficiency who suffered from life-threatening influenza.

Your comments and questions are welcome at the following addresses:
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Please find the previous bibliographic updates of allergology below:
- Archive of 2018
- Archive of 2017
- Archive of 2016
- Archive of 2015
- Archive of 2014
- Archive of 2013
- Archive of 2012
- Archive of 2011
Last updated 06 November 2018
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