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Psoriasis and atopic dermatitis (AD) are the most common inflammatory skin conditions that share similarities, including epidermal hyperplasia, marked T-cell and dendritic cell infiltration, and a relatively increased Th1 axis. However, T cell polarization differs and therapeutic targeting has confirmed that TNF-α, IL-17, and IL-23 are the main cytokine drivers of psoriasis while AD has been recently characterized as Th2/Th22 polarized, with some Th17 involvement. Noda et al detail the different therapeutic approaches that have been approved or being tested for these diseases ( J Allergy Clin Immunol 2015; 135: 324-336 ). Up to 3% of adults have psoriasis, which is associated with red scaly lesions, a shorter life span, and a high risk for cardiovascular diseases, obesity, and diabetes. Up to 20% of these patients have severe disease which requires systemic therapies. Conventional treatments for psoriasis such as phototherapy, methotrexate, cyclosporine, and aceitretin are associated ...

Asthma has traditionally been defined using non-specific clinical and physiologic variables which encompass multiple different phenotypes and is treated with non-specific anti-inflammatory therapies. However, it is increasingly recognized that human asthma is a heterogeneous disease. In their review, Fajt and Wenzel analyzed randomized double blind placebo controlled trials of molecularly targeted therapies in defined allergic disease and asthma phenotypes ( J Allergy Clin Immunol 2015; 135: 299-310 ). There is an increasing appreciation of heterogeneity within asthma and allergic diseases, based primarily on recent cluster analyses, molecular phenotyping, biomarkers and differential responses to targeted and non-targeted therapies. These pioneering studies have led to successful therapeutic trials of molecularly targeted therapies in defined phenotypes. Pathobiologic studies combined with therapeutic trials of type-2 targeted therapies either approved or in clinical trials include tho...

Food allergy is an immune-mediated response to food proteins leading to symptoms affecting the skin, gastrointestinal tract or respiratory tract. Up to 8% if children and 5% if adults self-reported an allergy to at least one food. The incidence of food allergy has steadily increased over 18% between 1997-2007, suggesting that environmental influences may play a role. Despite this increase in prevalence, there are currently no approved treatments beyond allergen avoidance and treatment of reactions to accidental ingestion. Though the incidence of food allergy-related mortality is low, avoidance and fear of accidental ingestion significantly impairs the quality of life for children with food allergy and their caregivers. In their review, Bauer et al discuss the mechanisms that contribute to allergy with emphasis on future targets for biologics for the treatment of IgE mediated food allergy ( J Allergy Clin Immunol 2015; 135(2): 312-323 ). Recently there has been increased interest in th...

The health of our modern society is being threatened by a plethora of chronic inflammatory non-communicable diseases (NCDs) which share in common, an underlying low-grade inflammation. These include early onset NCDs such as allergy, asthma and some autoimmune diseases and later onset NCDs including cardiovascular disease (CVD), metabolic disease and neurodegenerative disorders. While inflammation and the pathways to disease are multifactorial, the altered gut colonization patterns associated with declining microbial diversity is a central theme, and increasingly implicated in the physiological, immunological and metabolic dysregulation seen in many NCDs. Upon review of the current literature, West et al discuss the relationships between gut colonization and inflammatory NCDs, and gut microbiota modulation strategies for their treatment and prevention ( J Allergy Clin Immunol 2015; 135: 3-13 ). The critical role of the gut microbiota in immune development has been well documented in ge...

Newly developed culture-independent methods for microbial detection are deepening the understanding of their role in lung disease. A persuasive body of evidence suggests that the microbiome of the lower airways differs distinctly in the obstructive lung disease, including asthma. Huang and Boushey provide their perspective on the findings of studies of differences in the airway microbiome in patients with asthma vs. healthy subjects, and of studies of relationships between environmental microbiota, gut microbiota, immune function, and the development of asthma ( J Allergy Clin Immunol 2015; 135: 25-30 ). Additionally, they provide a rationale for approaches involving directed manipulation of the gut and airway microbiome for treatment and prevention of allergic asthma. Alterations in respiratory tract immune function are at least theoretically linked to the immunomodulatory activity of gut microbiota through the concept of a “common mucosal response”. This proposes that antigen present...

Chronic inflammatory diseases, including allergies and asthma, are the result of complex interactions between the genetic predisposition and environmental factors.  Epigenetics comprises the umbrella of such biochemical reactions and mechanisms including DNA methylation and chromatin modifications on histones and other structures. In their review, Harb and Renz review the recent developments in this context with emphasis on allergy and asthma research ( J Allergy Clin Immunol 2015; 135: 15-24 ) . There are many different epigenetic modifications affecting the status of the transcription of genes. For example, epigenetic modifications of T-cells start very early during the activation/differentiation program with naïve non-committed precursors during fetal immune development. DNA methylation is a biochemical process by the addition of a methyl group to the DNA nucleotides cysteine or adenine. This process leads mainly to gene silencing and subsequently to the inhibition of gene trans...

Few studies have comprehensively examined the role the school environment plays in asthma and how effectively changing the environment may reduce morbidity, when adjusting for exposures in the home. In their review, Huffaker and Phipatanakul summarize the importance and common challenges of school-based environmental assessment and intervention studies linked to health effects ( J Allergy Clin Immunol 2014; 134: 1232-1237 ). They discuss the challenges and potential benefits of comprehensive environmental assessment and health outcomes in inner-city schools. The school environment has been shown to be a significant reservoir for allergens and pollutants. Indoor allergens known to be important in urban home environments may also be important in schools, including cockroach, cat, dog, mouse, dust-mite, and molds. Studies have identified children with asthma in inner-cities have markedly higher levels of mouse allergen in their schools compared to levels in their individual bedrooms. Give...