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There are many tools that can help suggest the presence of food allergies, but, in the end, the most reliable procedure to confirm or exclude a diagnosis of food allergy remains the oral challenge.  But how should allergists perform them?  In this month’s issue of JACI, Drs. Ballmer-Weber and Beyer provide their insights on how to effectively conduct a food challenge ( J Allergy Clin Immunol 2018; 141(1): 69-71 ).   The majority of children with food allergies require such challenges to diagnose their condition, especially younger children with eczema who have skin prick or blood tests suggesting that allergic sensitization may be a trigger for eczema flares, or in whom a food allergy may no longer be present.  However, not all patients should have challenges.  The risks of a severe, life-threatening anaphylactic reaction have to be balanced with the benefits of more definitively establishing a diagnosis.  In addition, the risks of an oral challenge ma...

The rate of food allergies in the United States keeps on rising, but nobody really knows the exact reasons why.  In this month’s issue of the Journal of Allergy and Clinical Immunology, Du Toit and colleagues review the literature and focus on the ‘dual allergen’ hypothesis ( J Allergy Clin Immunol 2018; 141(1): 30-40 ).  Briefly, they explain that allergic sensitization may occur when there is low-level skin exposure to food allergens, while tolerance is more likely to develop in children to have early exposures to food proteins.  The data are mounting from both animal and human observational studies as well as randomized control studies.  The most notable has been the LEAP study, which showed that infants aged 4 to 11 months who consumed peanut products at least three times per week until age 60 months were far less likely to develop peanut allergies than infants who had complete avoidance.  Only 3.2% in the peanut-eating group developed peanut allergy, compar...

Asthma affects about 1 in 11 American children, making it one of the most common diseases of childhood.  It carries a huge burden on families, especially during exacerbations when disease activity suddenly flares, leading to breathlessness and even death.  In this month’s issue of JACI, Hoch and colleagues discuss their research in validating the Seasonal Asthma Exacerbation Predictive Index, the saEPI ( J Allergy Clin Immunol 2017; 140(4): 1130-1137 ).  The saEPI is a score ranging from 0 to 16 that can help predict how likely a child is to have an asthma flare.  Using data from the Preventative Omalizumab or Step-Up Therapy for Fall Exacerbations (PROSE) study, they looked at 348 children randomized to two groups: one with omalizumab, and another with guideline-based therapy alone.  They then calculated and validated the saEPI, moreover the authors looked at other factors that were associated with exacerbations.  In short, they found that children who req...

Wheezing is a common complaint among parents of infants.  About 1 in 5 children have acute wheezing illnesses in their first two years of life.  This is important because an overwhelming majority of these wheezing illnesses are related to viruses, and are linked to asthma development.  In this month’s issue of JACI, Jartti and Gern review the role of viral infections in the development of asthma in children ( J Allergy Clin Immunol 2017; 140(4): 895-906 ).  They survey the viruses -rhinoviruses, respiratory syncytial viruses, and others – and how they impact the developing set of lungs.  Genetic variation and low interferon responses are two factors that increase the risk of these types of infections.  In addition, increased eosinophil counts in blood and nasal mucus and atopic eczema all increase the risk of later asthma.  Additionally, viral infections can lead to exacerbations in children who already have asthma.  This may explain why the rates...

There are hundreds of viruses that cause respiratory tract infections.  While most of us think about them as nuisances causing cough and wheezing, they bear a huge toll on health, especially in people who have lung diseases like asthma and COPD, as well as an economic toll in lost workdays and inappropriate use of medical resources.  In this month’s issue of JACI, Papadopoulos and colleagues look at the treatment and prevention of these diseases ( J Allergy Clin Immunol 2017; 140(4): 921-932 ).  They look at new medications that target the specific viruses in their reproductive phases.  In addition, they review how natural products like echinacea can prevent recurrent respiratory tract infections.  On the other side, there are promising insights about the use of immunostimulators in order to boost the body’s own responses to these viruses.  Vitamin D, probiotic supplements, exercise and meditation are all helpful in resolving these infections. But perhaps t...

Cough is an important reflex we need to remove irritants from the airways, but for many people, a hypersensitive cough reflex can negatively affect quality of life.  A major trigger of chronic cough is airway inflammation from immune cells including type 2 helper T-cells (T H 2), but conventional tests required for diagnosis are technically challenging and often require specialist expertise.  Fortunately, measurement of the fractional exhaled nitric oxide (FENO), a potential marker of T H 2 airway inflammation, has become much more common in allergy and pulmonary practices.  In this month’s issue of JACI, Song and colleagues review the literature on the use of FENO to diagnose Cough-Variant Asthma (CVA) and Eosinophilic Bronchitis (EB), two major causes of T H 2-mediated chronic cough ( J Allergy Clin Immunol 2017; 140(3): 701-709 ). They looked at thousands of articles from multiple databases in order to answer the question “What is the diagnostic accuracy of FENO for CV...

Asthma is a complex disease of the airways characterized by inflammation and dynamic airway obstruction.  Despite the single, more recent evidence suggests that asthma is mediated by a set of distinct immune abnormalities.  In this month’s issue of JACI, Silkoff and colleagues report the results of the ADEPT (Airways Disease Endotyping for Personal Therapeutics) study, in which 83 patients with mild, moderate, and severe asthma as well as 25 healthy non-asthmatic subjects were examined for biomarkers of asthma ( J Allergy Clin Immunol 2017; 140(3): 710-719 ).  They underwent bronchoscopy to obtain tissue samples, and then had the biomarkers measured in the lab to characterize them as having either high or low levels of type 2 inflammatory mediators.  These were then correlated with clinical variables. They determined the presence of type 2 inflammation based on airway expression of CCL26, periostin, and IL-13 in vitro signature (IVS).  They then looked at the cl...

Along with wheezing illnesses, allergic sensitization during infancy is a major risk factor for childhood asthma.  But how exactly this allergic sensitization occurs is not very well known.  In this month’s issue of JACI, Gern and colleagues look at cytokine responses in 467 inner-city children from the URECA study (Urban Environment and Childhood Asthma) at ages 1 and 3 years ( J Allergy Clin Immunol 2017; 140(3): 836-844 ).  They then examined these cytokine responses in relation to environmental exposures to allergens and endotoxin as well as development of allergic sensitization and recurrent wheezing. They found that cytokine responses increased as the children grew older, but responses at birth were not predictive for responses at ages 1 and 3 years. Exposure to cockroach, mouse, and house dust mite was associated with enhanced Interferon-alpha and IL-10 cytokine responses.  This contrasts with reduced IL-10 responses at birth, which was associated with recurre...

Until a few years ago, it was thought that microbes don’t live in the lung’s passages.  But now we know that there is a diverse range of microbiota that lives there.  In this month’s issue of JACI, Sverrild and colleagues examine the relationship between these microbes and patterns of airway inflammation in healthy patients and in asthmatics who have not taken steroids ( J Allergy Clin Immunol 2017; 140(2): 407-417 ).  In order to do so, they took 10 healthy participants and 23 nonsmoking steroid-free asthmatics and had them undergo bronchoscopy so that they could get fluid from the lower passageways.  They then sequenced bacterial DNA and looked at the number and type of immune cells.  The 33 participants also had their asthma better characterized through other standardized measures of disease severity like airway hyperresponsiveness to mannitol and fraction of exhaled nitric oxide. They found that patients with eosinophilic asthma and those with hyperresponsiv...

Cockroaches are small, scurrying insects that we just don’t like to think about.  But as small as they are, they have a large impact on asthma and allergies.  In this month’s issue of JACI, Rabito and colleagues look at the effect of cockroach elimination on asthma outcomes ( J Allergy Clin Immunol 2017; 140(2): 565-570 ).  They build on previous work showing that integrated pest management (IPM) reduces cockroach levels.  But because IPM is s costly and requires special expertise, it is generally not practical for low-income families.  Instead, the authors looked at the efficacy of insecticidal bait, which is much cheaper and can be done by almost anybody.  They followed 102 children (between the ages of 5 and 17) who live in New Orleans. At the beginning of the study, field technicians laid traps for cockroaches.  Over the next 12 months, 53 of the children’s houses were visited six times to place the bait, and asthma was evaluated every 2 months by ...

Food allergies are seen in up to 1 in 12 school-age children in the United States today, and peanut is one of the most common allergens.  In response, many schools have started to have peanut-free policies, but the effect of these policies has not yet been rigorously assessed.  In this month’s issue of JACI, Bartnikas and colleagues examine how peanut-free policies affect the rate of potentially fatal allergic reactions to peanut ( J Allergy Clin Immunol 2017; 140(2): 465-473 ).  They looked at 2,223 public schools in Massachusetts during a five-year period, of which 6.3-10.3% banned peanuts from being brought from home, 56.6-59.1% banned peanuts from being served in school, 90.1-91.1% had peanut-free tables and 65.6-67.4% had peanut-free classrooms.  Among these schools, 46 (1.5-2.9%) self-designated as being a “peanut-free school,” but there was considerable variability in how these schools defined a self-designated “peanut-free school,” with 28.9% still allowing p...

It’s been known that asthmatic lungs are different from healthy lungs in many aspects, including housing different strains of bacteria.  So far, studies haven’t been able to tell whether these differences are due to asthma, associated allergies (atopy), or treatment with different drugs.  They also haven’t been able to determine how these differences affect the way asthma manifests itself and how asthma can be treated.  In this month’s issue of JACI, Durack and colleagues aim to answer these pressing questions ( J Allergy Clin Immunol 2017; 140(1): 63-75 ). Durack and other investigators looked at the bacterial communities in 84 individuals, split into three groups: (1) 42 atopic asthmatic subjects, (2) 21 atopic non-asthmatic subjects, and (3) 21 non-atopic non-asthmatic, otherwise healthy, subjects.  They also looked at inflammatory markers and changes in bronchial hyperresponsiveness after 6 weeks of treatment with fluticasone, an inhaled steroid commonly used for...

Allergies and asthma are growing public health problems, as rates have continued to increase over the past 50 years.  In that same time period, there has been a dramatic movement of people away from farms into cities and towns.  Previous studies have suggested that these may be related and data do exist to show childhood farm animal exposures and consumption of unpasteurized milk reduces the risk of childhood asthma and allergies.  But what about early-life farm exposures and adult asthma and allergic sensitization?  In this month’s issue of JACI, House and colleagues studied more than 3000 farmers and their spouses to help answer this question ( J Allergy Clin Immunol 2017; 140(1): 249-256 ). Specifically, they looked at 1746 farmers and 1555 spouses from Iowa and North Carolina enrolled in the Agricultural Lung Health Study.  They used questionnaires to identify current asthma and early-life farming exposure, and then measured blood levels of allergen-specific...

Omalizumab is a potent medication approved to treat asthma, which has been shown to improve symptoms as well as decrease flares and use of rescue medications.  When it first became available, its long-term safety was not solidly clarified.  In the May 2017 issue of JACI, Iribarren and colleagues discuss the results of the post-marketing observational study called EXCELS, which followed patients for five years to determine the long-term effects of omalizumab, with a particular focus on cardiovascular (CV) and cerebrovascular (CBV) events, such as heart attacks and strokes ( J Allergy Clin Immunol 2017; 139(5): 1489-1495 ).  Pooled results from previous studies showed a higher incidence of these events, but no clear association with omalizumab use was found.  Iribarren and colleagues looked at nearly 5000 patients on omalizumab and compared them to nearly 3000 that were not on omalizumab.  They found that omalizumab is effective for moderate-to-severe asthma....

It has long been known that many diseases, like asthma, are the result of complex interactions between genes and the environment.  But how exactly do these two factors contribute to atopic asthma?  In the May 2017 issue of JACI, Yang and colleagues discuss the epigenetic factors involved in the development of childhood asthma ( J Allergy Clin Immunol 2017; 139(5): 1478-1488 ).  They looked at nasal brushings from 36 inner-city children with asthma between the ages of 10 and 12 and compared them with nasal brushings from 36 children without asthma.  They then looked at patterns of methylation, a way that genes can be chemically modified in order to change their expression. They found that 186 genes were modified in this way.  The median percentage in methylation changes between allergic patients and non-allergic patients was 6.8%.  This is in line with previous research that shows that there are significant changes in methylation in other airway diseases lik...

Atopic dermatitis is a chronic skin disorder in which the skin becomes dry, itchy and thickened.  Even though it is very common in children, its exact causes are not well-known.  Because water is a known skin irritant and the skin of infants are very sensitive, it has been thought that hard water, that is water that contains high calcium carbonate, may be a risk factor.  In this month’s issue of JACI, Engebretsen and colleagues investigate whether early exposure to hard domestic water is associated with the prevalence of atopic dermatitis ( J Allergy Clin Immunol 2017; 139(5): 1568-1574 ). To do this, they looked at the Danish National Birth Cohort study which collected nearly 100,000 children born between 1996 and 2002.  Out of these, the mothers of 55,092 children completed an interview at 6 and 18 months to get more information on atopic dermatitis.  What the authors found was that hard water is associated with a higher incidence of atopic dermatitis.  T...

Asthma is a disease in which the airways of the lung become very sensitive to certain triggers, leading to spasms, in turn causing shortness of breath, coughing and wheezing.  The ultimate cause of asthma is unclear, but it has been shown in previous studies that there is remodeling of the airways in severe asthma. Airway smooth muscle (ASM) increases, along with fibrosis, infiltration of new blood vessels, and growth of cells that line the airways.   Recently, a procedure called bronchial thermoplasty (BT) has been developed, in which an endoscope is inserted into the airways.  This endoscope then delivers a temperature-controlled radio frequency to the airway wall.  In this month’s issue of JACI, Pretolani and colleagues look at bronchial thermoplasty and its effect on various clinical and histopathological findings ( J Allergy Clin Immunol 2017; 139(4): 1176-1185 ). In order to do this, they recruited 15 patients with severe uncontrolled asthma that did not r...

The immune system is complex, composed of numerous cells, proteins, and other components.  Among them, the T-cells are essential in fighting off infectious agents and regulating the functions of the immune system.  People with reduced or dysfunctional T-cells can have life-threatening complications, and may require interventions like hematopoietic stem cell transplant (HSCT), gene therapy, or enzyme replacement. If a T cell deficiency is severe (severe combined immunodeficiency, SCID), these treatment decisions are clear. However, in patients with moderate T cell deficiency (profound combined immunodeficiency, P-CID), prognosis is unclear and transplant decisions are difficult. These patients have so far received little attention.  In this month’s issue of JACI, Speckmann and colleagues report the first 51 P-CID patients  enrolled in a long-term prospective study ( J Allergy Clin Immunol 2017; 139(4): 1302-1310 ). The patients suffer from heterogenous T cell deficien...

Food allergy is the leading cause of anaphylaxis, a serious and life-threatening systemic allergic reaction, among American children today.  Although it can be managed by avoidance and supportive management, there are few options for disease modification.  Oral immunotherapy (OIT) whereby increasing doses of an allergen are given, has been a promising investigational treatment, but the high rates of adverse reactions and intolerance of symptoms lead to high drop-out rates. In this month’s issue of JACI, MacGinnitie et al look at the use of omalizumab, an anti-IgE medication used in asthma, in helping to facilitate OIT ( J Allergy Clin Immunol 2017; 139(3): 873-881 ) . To do this, they randomized 37 participants to receive either omalizumab or a placebo for 19 weeks, in addition to oral immunotherapy.  Neither the patients nor the researchers knew the assignment of the groups.  6 weeks after stopping the omalizumab, it was found that a majority (79%) of the omalizuma...

Obesity and asthma are two of the most common childhood chronic diseases, seen in 25% and 10% of children, respectively.  There are increasing lines of evidence suggesting that they may be inter-dependent : fat may be the source of proinflammatory mediators and may change the mechanics of lung function.  However, not all fat is considered equal.  The android distribution of fat along the abdomen, compared to gynoid distribution along the hips, is more closely associated with a variety of cardiometabolic diseases.  Similarly, visceral fat, situated just above the guts in the belly, is considered a marker of inflammatory status, compared to more superficial subcutaneous fat deposits.  In this month’s issue of JACI, den Dekker and colleagues discuss the effect of body fat mass distribution on asthma and airway function in children ( J Allergy Clin Immunol 2017; 139(3): 810-816 ). To do this, they looked at the medical histories and physical characteristics of 6178 ...