Patient-centred screening for primary immunodeficiency, a multi-stage diagnostic protocol designed for non-immunologists: 2011 update

Members of the European Society for Immunodeficiencies (ESID) and other colleagues have updated the multi-stage expert-opinion-based diagnostic protocol for non-immunologists incorporating newly defined primary immunodeficiency diseases (PIDs). The protocol presented here aims to increase the awareness of PIDs among doctors working in different fields. Prompt identification of PID is important for prognosis, but this may not be an easy task. The protocol therefore starts from the clinical presentation of the patient. Because PIDs may present at all ages, this protocol is aimed at both adult and paediatric physicians. The multi-stage design allows cost-effective screening for PID of the large number of potential cases in the early phases, with more expensive tests reserved for definitive classification in collaboration with a specialist in the field of immunodeficiency at a later stage

The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria

This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell–driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. © 2021 GA²LEN. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd

COVID-19 pandemic: Practical considerations on the organization of an allergy clinic—An EAACI/ARIA Position Paper

Background: The coronavirus disease 2019 (COVID-19) has evolved into a pandemic infectious disease transmitted by the severe acute respiratory syndrome coronavirus (SARS-CoV-2). Allergists and other healthcare providers (HCPs) in the field of allergies and associated airway diseases are on the front line, taking care of patients potentially infected with SARS-CoV-2. Hence, strategies and practices to minimize risks of infection for both HCPs and treated patients have to be developed and followed by allergy clinics. Method: The scientific information on COVID-19 was analysed by a literature search in MEDLINE, PubMed, the National and International Guidelines from the European Academy of Allergy and Clinical Immunology (EAACI), the Cochrane Library, and the internet. Results: Based on the diagnostic and treatment standards developed by EAACI, on international information regarding COVID-19, on guidelines of the World Health Organization (WHO) and other international organizations, and on previous experience, a panel of experts including clinicians, psychologists, IT experts, and basic scientists along with EAACI and the “Allergic Rhinitis and its Impact on Asthma (ARIA)” initiative have developed recommendations for the optimal management of allergy clinics during the current COVID-19 pandemic. These recommendations are grouped into nine sections on different relevant aspects for the care of patients with allergies. Conclusions: This international Position Paper provides recommendations on operational plans and procedures to maintain high standards in the daily clinical care of allergic patients while ensuring the necessary safety measures in the current COVID-19 pandemic. © 2020 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd

Management of anaphylaxis due to COVID-19 vaccines in the elderly

Older adults, especially men and/or those with diabetes, hypertension, and/or obesity, are prone to severe COVID-19. In some countries, older adults, particularly those residing in nursing homes, have been prioritized to receive COVID-19 vaccines due to high risk of death. In very rare instances, the COVID-19 vaccines can induce anaphylaxis, and the management of anaphylaxis in older people should be considered carefully. An ARIA-EAACI-EuGMS (Allergic Rhinitis and its Impact on Asthma, European Academy of Allergy and Clinical Immunology, and European Geriatric Medicine Society) Working Group has proposed some recommendations for older adults receiving the COVID-19 vaccines. Anaphylaxis to COVID-19 vaccines is extremely rare (from 1 per 100,000 to 5 per million injections). Symptoms are similar in younger and older adults but they tend to be more severe in the older patients. Adrenaline is the mainstay treatment and should be readily available. A flowchart is proposed to manage anaphylaxis in the older patients. © 2021 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd

Management of anaphylaxis due to COVID-19 vaccines in the elderly

none149siOlder adults, especially men and/or those with diabetes, hypertension, and/or obesity, are prone to severe COVID-19. In some countries, older adults, particularly those residing in nursing homes, have been prioritized to receive COVID-19 vaccines due to high risk of death. In very rare instances, the COVID-19 vaccines can induce anaphylaxis, and the management of anaphylaxis in older people should be considered carefully. An ARIA-EAACI-EuGMS (Allergic Rhinitis and its Impact on Asthma, European Academy of Allergy and Clinical Immunology, and European Geriatric Medicine Society) Working Group has proposed some recommendations for older adults receiving the COVID-19 vaccines. Anaphylaxis to COVID-19 vaccines is extremely rare (from 1 per 100,000 to 5 per million injections). Symptoms are similar in younger and older adults but they tend to be more severe in the older patients. Adrenaline is the mainstay treatment and should be readily available. A flowchart is proposed to manage anaphylaxis in the older patients.noneBousquet J.; Agache I.; Blain H.; Jutel M.; Ventura M.T.; Worm M.; Del Giacco S.; Benetos A.; Bilo B.M.; Czarlewski W.; Abdul Latiff A.H.; Al-Ahmad M.; Angier E.; Annesi-Maesano I.; Atanaskovic-Markovic M.; Bachert C.; Barbaud A.; Bedbrook A.; Bennoor K.S.; Berghea E.C.; Bindslev-Jensen C.; Bonini S.; Bosnic-Anticevich S.; Brockow K.; Brussino L.; Camargos P.; Canonica G.W.; Cardona V.; Carreiro-Martins P.; Carriazo A.; Casale T.; Caubet J.-C.; Cecchi L.; Cherubini A.; Christoff G.; Chu D.K.; Cruz A.A.; Dokic D.; El-Gamal Y.; Ebisawa M.; Eberlein B.; Farrell J.; Fernandez-Rivas M.; Fokkens W.J.; Fonseca J.A.; Gao Y.; Gavazzi G.; Gawlik R.; Gelincik A.; Gemicioglu B.; Gotua M.; Guerin O.; Haahtela T.; Hoffmann-Sommergruber K.; Hoffmann H.J.; Hofmann M.; Hrubisko M.; Illario M.; Irani C.; Ispayeva Z.; Ivancevich J.C.; Julge K.; Kaidashev I.; Khaitov M.; Knol E.; Kraxner H.; Kuna P.; Kvedariene V.; Lauerma A.; Le L.T.T.; Le Moing V.; Levin M.; Louis R.; Lourenco O.; Mahler V.; Martin F.C.; Matucci A.; Milenkovic B.; Miot S.; Montella E.; Morais-Almeida M.; Mortz C.G.; Mullol J.; Namazova-Baranova L.; Neffen H.; Nekam K.; Niedoszytko M.; Odemyr M.; O'Hehir R.E.; Okamoto Y.; Ollert M.; Palomares O.; Papadopoulos N.G.; Panzner P.; Passalacqua G.; Patella V.; Petrovic M.; Pfaar O.; Pham-Thi N.; Plavec D.; Popov T.A.; Recto M.T.; Regateiro F.S.; Reynes J.; Roller-Winsberger R.E.; Rolland Y.; Romano A.; Rondon C.; Rottem M.; Rouadi P.W.; Salles N.; Samolinski B.; Santos A.F.; S Sarquis F.; Sastre J.; M. G. A. Schols J.; Scichilone N.; Sediva A.; Shamji M.H.; Sheikh A.; Skypala I.; Smolinska S.; Sokolowska M.; Sousa-Pinto B.; Sova M.; Stelmach R.; Sturm G.; Suppli Ulrik C.; Todo-Bom A.M.; Toppila-Salmi S.; Tsiligianni I.; Torres M.; Untersmayr E.; Urrutia Pereira M.; Valiulis A.; Vitte J.; Vultaggio A.; Wallace D.; Walusiak-Skorupa J.; Wang D.-Y.; Waserman S.; Yorgancioglu A.; Yusuf O.M.; Zernotti M.; Zidarn M.; Chivato T.; Akdis C.A.; Zuberbier T.; Klimek L.Bousquet, J.; Agache, I.; Blain, H.; Jutel, M.; Ventura, M. T.; Worm, M.; Del Giacco, S.; Benetos, A.; Bilo, B. M.; Czarlewski, W.; Abdul Latiff, A. H.; Al-Ahmad, M.; Angier, E.; Annesi-Maesano, I.; Atanaskovic-Markovic, M.; Bachert, C.; Barbaud, A.; Bedbrook, A.; Bennoor, K. S.; Berghea, E. C.; Bindslev-Jensen, C.; Bonini, S.; Bosnic-Anticevich, S.; Brockow, K.; Brussino, L.; Camargos, P.; Canonica, G. W.; Cardona, V.; Carreiro-Martins, P.; Carriazo, A.; Casale, T.; Caubet, J. -C.; Cecchi, L.; Cherubini, A.; Christoff, G.; Chu, D. K.; Cruz, A. A.; Dokic, D.; El-Gamal, Y.; Ebisawa, M.; Eberlein, B.; Farrell, J.; Fernandez-Rivas, M.; Fokkens, W. J.; Fonseca, J. A.; Gao, Y.; Gavazzi, G.; Gawlik, R.; Gelincik, A.; Gemicioglu, B.; Gotua, M.; Guerin, O.; Haahtela, T.; Hoffmann-Sommergruber, K.; Hoffmann, H. J.; Hofmann, M.; Hrubisko, M.; Illario, M.; Irani, C.; Ispayeva, Z.; Ivancevich, J. C.; Julge, K.; Kaidashev, I.; Khaitov, M.; Knol, E.; Kraxner, H.; Kuna, P.; Kvedariene, V.; Lauerma, A.; L. T. T., Le; Le Moing, V.; Levin, M.; Louis, R.; Lourenco, O.; Mahler, V.; Martin, F. C.; Matucci, A.; Milenkovic, B.; Miot, S.; Montella, E.; Morais-Almeida, M.; Mortz, C. G.; Mullol, J.; Namazova-Baranova, L.; Neffen, H.; Nekam, K.; Niedoszytko, M.; Odemyr, M.; O'Hehir, R. E.; Okamoto, Y.; Ollert, M.; Palomares, O.; Papadopoulos, N. G.; Panzner, P.; Passalacqua, G.; Patella, V.; Petrovic, M.; Pfaar, O.; Pham-Thi, N.; Plavec, D.; Popov, T. A.; Recto, M. T.; Regateiro, F. S.; Reynes, J.; Roller-Winsberger, R. E.; Rolland, Y.; Romano, A.; Rondon, C.; Rottem, M.; Rouadi, P. W.; Salles, N.; Samolinski, B.; Santos, A. F.; S Sarquis, F.; Sastre, J.; M. G. A. Schols J., ; Scichilone, N.; Sediva, A.; Shamji, M. H.; Sheikh, A.; Skypala, I.; Smolinska, S.; Sokolowska, M.; Sousa-Pinto, B.; Sova, M.; Stelmach, R.; Sturm, G.; Suppli Ulrik, C.; Todo-Bom, A. M.; Toppila-Salmi, S.; Tsiligianni, I.; Torres, M.; Untersmayr, E.; Urrutia Pereira, M.; Valiulis, A.; Vitte, J.; Vultaggio, A.; Wallace, D.; Walusiak-Skorupa, J.; Wang, D. -Y.; Waserman, S.; Yorgancioglu, A.; Yusuf, O. M.; Zernotti, M.; Zidarn, M.; Chivato, T.; Akdis, C. A.; Zuberbier, T.; Klimek, L

Rhinitis associated with asthma is distinct from rhinitis alone : The ARIA-MeDALL hypothesis

Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of "one-airway-one-disease," coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the "Epithelial Barrier Hypothesis." This review determined that the "one-airway-one-disease" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme "allergic" (asthma) phenotype combining asthma, rhinitis, and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitization patterns (mono- or pauci-sensitization versus polysensitization), (iii) severity of symptoms, and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and autoimmune diseases.Peer reviewe