EAACI: A European Declaration on Immunotherapy. Designing the future of allergen specific immunotherapy.

Allergy today is a public health concern of pandemic proportions, affecting more than 150 million people in Europe alone. In view of epidemiological trends, the European Academy of Allergy and Clinical Immunology (EAACI) predicts that within the next few decades, more than half of the European population may at some point in their lives experience some type of allergy.Not only do allergic patients suffer from a debilitating disease, with the potential for major impact on their quality of life, career progression, personal development and lifestyle choices, but they also constitute a significant burden on health economics and macroeconomics due to the days of lost productivity and underperformance.

Aspirin challenge/desensitisation before coronary stenting in subjects with history of hypersensitivity. A pragmatic approach.

Background: Aspirin hypersensitivity may represent a major problem in patients with ischemic coronary disease who need a stenting procedure. In those patients, clinically unsettled reasonably quick desensitisation procedures are needed. In our study we attempted to select the most suitable procedure on the basis of characteristics and severity of ASA hypersensitivity.

Allergic Rhinitis and its Impact on Asthma (ARIA): achievements in 10 years and future needs.

Allergic rhinitis (AR) and asthma represent global health problems for all age groups. Asthma and rhinitis frequently coexist in the same subjects. Allergic Rhinitis and its Impact on Asthma (ARIA) was initiated during a World Health Organization workshop in 1999 (published in 2001).

Uncontrolled allergic rhinitis and chronic rhinosinusitis: where do we stand today?

State-of-the-art documents like ARIA and EPOS provide clinicians with evidence-based treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS), respectively. The currently available medications can alleviate symptoms associated with AR and RS. In real life, a significant percentage of patients with AR and CRS continue to experience bothersome symptoms despite adequate treatment.

The perception of allergen-specific immunotherapy among Italian general practitioners.

Background: Allergen specific immunotherapy is the only causal therapy for respiratory allergies, and the only treatment that can modify the natural course of the disease. Information and education of patients is essential to successful treatment and, since the General Practitioner is the primary referral, a cooperation between him and the allergy specialists is crucial. We carried out a survey among Italian GPs to asses their knowledge about immunotherapy and their attitude towards it.

Effects of different up-dosing regimens for hymenoptera venom immunotherapy on serum CTLA-4 and IL-10.

Background: Cytotoxic T lymphocyte associated antigen-4 (CTLA-4) is involved in the activation pathways of T lymphocytes. It has been shown that the circulating form of CTLA-4 is elevated in patients with hymenoptera allergy and can be down regulated by immunotherapy.

Objective: to assess the effects on CTLA-4 of venom immunotherapy, given with different induction protocols: conventional (6 weeks), rush (3 days) or ultra rush (1 day).

The role of basophil activation test in special populations with mastocytosis and reactions to hymenoptera sting.

Background: Systemic mastocytosis (SM) may be associated with hymenoptera allergy. In such cases, immunotherapy is a life-saving treatment, but a circumstantiated diagnosis is needed for its prescription. Patients with SM and previous reactions to stings, but with negative tests represent a diagnostic dilemma.

Evidences of efficacy of allergen immunotherapy in atopic dermatitis: an updated review.

Purpose Of Review: To update and assess the quality of the evidence concerning the efficacy of allergen immunotherapy for atopic eczema. Desensitization for eczema as a clinical manifestation of food allergy was not a target of this review.

Recent Findings: In the past 5 years, from the last comprehensive systematic review of Bussmann et al.

Oral immunotherapy for cow's milk allergy.

Purpose Of Review: Cow's milk allergy (CMA) is common in children and may lead to severe systemic reactions. Avoidance of the ingestion of cow milk is the only effective approach, but this does not exclude the inadvertent or accidental ingestion, or the assumption of milk hidden in other foods. As no pharmacological treatment is available, specific desensitization has been considered an attractive strategy.

Allergens and bacteria interaction in the induction of basophil activation: is this the lost ring between allergy and infections in pediatric patients?

Purpose Of Review: The aim of this review is to describe the relationships between allergy and infectious diseases, with specific attention on bacterial infection. According to the most recent literature, bacteria could be considered also as one of the major causes of asthma exacerbations that we need to further explore.

Recent Findings: The availability of novel methods to detect large panels of pathogens, including viruses and bacteria specific for the upper respiratory tract, together with the capacity of evaluating how basophils are activated, has changed the point of view of the mechanisms related to asthma exacerbations.

Severe chronic allergic (and related) diseases: a uniform approach--a MeDALL--GA2LEN--ARIA position paper.

Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-up.

Clinical and cytologic characteristics of allergic rhinitis in elderly patients.

Background: The constant increase in the elderly population worldwide has led to a greater interest in immunologic responses during aging. Thus, special attention to allergic diseases in elderly people has begun to emerge, but little is known about the effect and features of allergic rhinitis in elderly people.

Objective: To evaluate the clinical and cytologic characteristics of respiratory allergy and its impact on the quality of life in elderly people.

Sensitization profiles in polysensitized patients from a restricted geographical area: further lessons from multiplexed component resolved diagnosis.

Background: The micro-array techniques for the detection of specific IgE has improved the diagnostic procedures for allergic diseases. This method also allows to define sensitisation profiles from an epidemiological point of view. We studied the sensitisation pattern in a population of polysensitized patients with respiratory allergy, living in a restricted geographical area in the north-west Italy.

Chemoembolization of unresectable hepatocellular carcinoma: Decreased toxicity with slow-release doxorubicin‑eluting beads compared with lipiodol.

Chemoembolization with lipiodol (TACE) improves survival of selected patients with unresectable hepatocellular carcinoma (HCC), but results in substantial toxicity. To improve treatment tolerance, we conducted this phase II study using doxorubicin-loaded beads (DC Beads®) delivered by selective transcatheter arterial chemoembolization (DEB-TACE). We compared the results with those obtained with TACE in our historical controls.

The functional connection between oral allergy syndrome and united airways disease assessed by oral challenge.

Background: The airways and the upper digestive tract have a common embryonic origin. In sensitized subjects they can respond to allergens with an immediate reaction (asthma, rhinitis, or oral allergy syndrome [OAS]).

Objective: To investigate the possible functional connection between respiratory and upper digestive tract by means of specific oral allergen challenges.

Improvement of shrimp allergy after sublingual immunotherapy for house dust mites: a case report.

The appropriateness of house dust mite specific immunotherapy in patients allergic to shrimps still remains unclear We present a clinical case as an immunological model for the strong sensitization to tropomyosin with symptoms of anaphylaxis due to shrimps and coexisting asthma due to house dust mite. The improvement in respiratory symptoms for house dust mite and in the food challenge for shrimps during mite immunotherapy with a known and high dosage of tropomyosin suggests the hypothesis that efficacy of mite immunotherapy in food allergy to tropomyosin may be dose dependent.

The IgE repertoire in children and adolescents resolved at component level: a cross-sectional study.

Background: It is well known that allergy evolves at clinical level from the birth to adulthood, and this has been clearly demonstrated also at a level of sensitization. However, little information is available on the evolution of the IgE repertoire directed to single allergenic components. In this cross-sectional, observational study, the evolution of the IgE repertoire was analysed at component level.

Practical guide to skin prick tests in allergy to aeroallergens.

This pocket guide is the result of a consensus reached between members of the Global Allergy and Asthma European Network (GA(2) LEN) and Allergic Rhinitis and its Impact on Asthma (ARIA). The aim of the current pocket guide is to offer a comprehensive set of recommendations on the use of skin prick tests in allergic rhinitis-conjunctivitis and asthma in daily practice. This pocket guide is meant to give simple answers to the most frequent questions raised by practitioners in Europe, including 'practicing allergists', general practitioners and any other physicians with special interest in the management of allergic diseases.

Specific immunotherapy: beyond the clinical scores.

Objective: The efficacy of specific immunotherapy always has been evaluated by clinical scores (symptoms or medication intake). Nonetheless, specific immunotherapy possesses some special or "additional" effects, including the carryover effect and the preventive actions, which are unique. Those effects are the consequence of the complex mechanism of action, which induces profound and persistent modifications in the immune response to allergens.

The clinical stage of allergic rhinitis is correlated to inflammation as detected by nasal cytology.

Allergic rhinitis (AR) is the most common allergic disease. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines classify AR according to its duration and severity and suggest recommended treatments, but there is evidence that these guidelines are insufficiently followed. Considering the validity of histopathological data, physicians are more likely to be persuaded by such information on AR.