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Allergic rhinoconjunctivitis (AR) is the most common of IgE-mediated diseases, with some surveys indicating it affects as much as 40% of the surveyed population. The familiarity of its symptoms such as itching nose, eyes, or throat; watering eyes; compromised ability to smell; and sneezing underscores its ubiquity. Patients with the same sensitivities to various allergens have wide variation in the severity of their AR symptoms. This may be due to varying allergen-concentration in each patient environment. Alternatively, the sum total of the number and kinds of aeroallergens to which one is sensitive may determine symptom severity. There is increasing evidence that supports the hygiene hypothesis as a basis for the development of allergy. This is to say that exposure early in life to certain allergens and bacteria helps to reduce AR symptoms and atopy in later life. He et al have thus investigated whether cockroach sensitization (C+) or its lack (C-), used as an indicator of childhood ...

Allergen immunotherapy (AIT), or the administration of an allergen with the intent of decreasing a patient’s sensitivity to it, remains underused. Numerous clinical trials show it is effective in the treatment of those with allergic rhinitis (AR), but it is estimated to be used in treatment of fewer than 10% of these patients worldwide. AIT can stop the progression of AR to asthma and it can be used to treat controlled allergic asthma. Safer and more effective AIT strategies are being developed, but ongoing barriers to its use include questions on cost-effectiveness, the need for an improved safety profile, a lack of standardization of AIT products between companies, and the lack of high quality studies regarding optimal dosing and disease-modifying potential. The subject calls for a consensus on the best AIT practice, because AIT is the only treatment that can potentially alter the progression of allergic disease and induce allergen-specific immune tolerance. To this end, the Internat...

Asthma and chronic obstructive pulmonary disease (COPD) are often clearly distinguishable diseases. There are, however, many people who demonstrate features of both. This is often termed the asthma-COPD overlap syndrome (ACOS); it is clinically important since these patients have worse health outcomes than those with either disease alone do, and some existing guidelines for treatment of either disease conflict. ACOS patients have also been specifically excluded from major clinical trials related to either condition. There is thus at this time little evidence on how to treat them, many of whom present in primary care settings. Reddel highlights the urgent need for research in this area and summarizes the interim recommendations provided in a collaborative report by Global Initiative for Asthma (GINA) and Global Initiative for chronic Obstructive Lung Disease (GOLD) ( J Allergy Clin Immunol 2015; 136(3): 546-552 ). Patients with ACOS present widely varying clinical histories, from adult ...

While asthma and chronic obstructive pulmonary disease (COPD) are distinct clinical entities, they are often treated with the same medications. There are many patients who present with features of both diseases, a condition called asthma-COPD overlap syndrome (ACOS). ACOS is currently poorly defined or understood, and it encompasses several phenotypes that require specific therapeutic approaches. For example, there are patients with COPD who have eosinophilic inflammation that may respond to inhaled corticosteroids (ICS), or severely asthmatic patients who smoke cigarettes and have COPD inflammation. Barnes summarizes three ACOS phenotypes and addresses the therapies currently available and those in development ( J Allergy Clin Immunol 2015; 136(3): 531-545 ).  The range of phenotypes is a challenge in treating ACOS patients, and the selection of appropriate therapy requires biomarkers that are predictive of a patient’s response to them. These include blood biomarkers such as eosin...

Inhaled corticosteroids (ICSs) constitute the most commonly prescribed therapies for asthma. They are effective, but there are up to 24% of asthma patients who do not achieve significant improvement with them. ICSs produce treatment responses in six clinical phenotypes: lung function, bronchodilator response, airway responsiveness, symptoms, need for oral steroids, and frequency of emergency department visits or need for hospitalization. For the past 15 years and in an escalating prevalence of asthma, researchers have considered these phenotypes to be guided by separate mechanisms. Clemmer et al propose a move away from the focus on single phenotypes to a more holistic approach. They suggest that there is a corticosteroid responsiveness endophenotype that modulates the asthma disease process, is latent in ICS-untreated patients, and is active in ICS-treated patients. Under this hypothesis, the corticosteroid responsiveness endophenotype influences the asthma disease process to produce ...

Allergic reaction to drugs is a serious and often underserved public health concern. In 2013, the National Institute of Allergy and Infectious Diseases (NIAID) Division of Allergy, Immunology and Transplantation convened a workshop on the issue. Representatives from several NIH institutes and from the FDA joined experts in drug allergy for a day-long discussion. Wheatley et al present a summary of the topics and recommendations ( J Allergy Clin Immunol 2015; 136(2): 262-271 ). The authors define “drug allergy” as any adverse drug reaction (ADR) that has a proven immunologic mechanism, including but not limited to IgE-mediated disease. There are currently no systematic epidemiologic studies of drug allergy. Most of the epidemiologic data on adverse drug reactions (ADRs) at this point relies on clinical diagnosis. With few specific diagnostic tests, physician-based assessment remains the gold standard for phenotyping the reactions. ADRs are categorized as type A or type B. Type A reacti...

While means of measurement and estimates differ, in the past ten to fifteen years the prevalence of peanut allergy may have as much as tripled in countries such as the United States. This translates to nearly 100,000 new cases a year in the United States and United Kingdom. Fleischer et al. highlight emerging evidence that supports early, rather than delayed, peanut introduction in the period of complementary food introduction in infants, including many of those considered to be at high risk for peanut allergy. ( J Allergy Clin Immunol 2015; 136(2): 258-261 ) In the Learning Early About Peanut Allergy (LEAP) trial, 640 infants between the ages of four and eleven months, who were considered to be at high-risk because of egg allergy and/or severe eczema, were randomized to consume peanut at least 6 grams of peanut protein three times a week or to completely avoid peanut for the first five years of life. Five hundred and forty-two of these infants had a negative skin prick test (SPT) res...