The impact of oral food challenges for food allergy on quality of life:a systematic review

BACKGROUND: Food allergy significantly impairs health-related quality of life (HRQL). Currently, it is still unknown whether diagnostic interventions for food allergy improve HRQL. We aim to assess the impact of diagnostic interventions for food allergy on HRQL. METHODS: A systematic search was performed in MEDLINE, Embase, Cochrane Library and CINAHL focused on patients with a (suspected) food allergy who underwent diagnostic interventions (i.e. skin prick test, specific IgE or oral food challenges (OFC)), and in whom HRQL was assessed. The mean difference between HRQL before and after the diagnostic intervention was calculated. A minimal clinically important difference of 0.5 was considered clinically relevant for the Food Allergy Quality of Life Questionnaire . RESULTS: Seven of 1465 original identified publications were included in which the impact of an OFC on HRQL was investigated (total patients n=1370). No other diagnostic interventions were investigated. Food allergy specific parent-reported HRQL improved significantly after an OFC irrespective of the outcome in children with a suspected food allergy in two publications. The change was considered clinically relevant in one of two publications. In addition, parent-reported HRQL improved after an OFC to assess the eliciting dose in children with a confirmed food allergy. The parental burden was significantly reduced after an OFC to assess resolution of food allergy. A meta-analysis could not be performed due to the limited numbers of, and considerable heterogeneity between, eligible publications. CONCLUSION: An OFC is associated with an improved food allergy specific HRQL and a reduced parental burden of food allergy. This article is protected by copyright. All rights reserved

The Role of Mobile Health Technologies in Allergy Care:an EAACI Position Paper

Mobile health (mHealth) uses mobile communication devices such as smartphones and tablet computers to support and improve health-related services, data and information flow, patient self-management, surveillance, and disease management from the moment of first diagnosis to an optimized treatment. The European Academy of Allergy and Clinical Immunology created a task force to assess the state of the art and future potential of mHealth in allergology. The task force endorsed the "Be He@lthy, Be Mobile" WHO initiative and debated the quality, usability, efficiency, advantages, limitations, and risks of mobile solutions for allergic diseases. The results are summarized in this position paper, analyzing also the regulatory background with regard to the "General Data Protection Regulation" and Medical Directives of the European Community. The task force assessed the design, user engagement, content, potential of inducing behavioral change, credibility/accountability, and privacy policies of mHealth products. The perspectives of healthcare professionals and allergic patients are discussed, underlining the need of thorough investigation for an effective design of mHealth technologies as auxiliary tools to improve quality of care. Within the context of precision medicine, these could facilitate the change in perspective from clinician- to patient-centered care. The current and future potential of mHealth is then examined for specific areas of allergology, including allergic rhinitis, aerobiology, allergen immunotherapy, asthma, dermatological diseases, food allergies, anaphylaxis, insect venom, and drug allergy. The impact of mobile technologies and associated big data sets are outlined. Facts and recommendations for future mHealth initiatives within EAACI are listed

Vertebroplastia: ¿Alternativa terapéutica para las fracturas vertebrales osteoporóticas dolorosas que no responden a tratamiento conservador? Revisión y puesta al día

Objetivos: Realizar una actualización y revisión de la vertebroplastia como alternativa terapéutica para las fracturas vertebrales osteoporóticas dolorosas que no responden a tratamiento conservador. Materiales y métodos: Revisión de la literatura sobre procedimiento, indicaciones, complicaciones y resultados en PubMed y Google académico utilizando las palabras clave: vertebroplastia, fractura por compresión vertebral, polimetilmetacrilato (PMMA) y osteoporosis. Resultados: Descripción del procedimiento, indicaciones y complicaciones. Diversos estudios con número limitado de pacientes indicaban alta tasa de éxitos y baja de complicaciones. Recientemente se han publicado dos ensayos clínicos a doble ciego, randomizados, comparando la vertebroplastia con una simulación de ésta. Los resultados de estos ensayos no avalan la realización de la vertebroplastia como tratamiento del dolor en las fracturas osteoporóticas por compresión. Conclusiones: Los resultados clínicos de la vertebroplastia eran prometedores. La reciente publicación de dos ensayos clínicos randomizados, con mayor grado de evidencia que los anteriores, los contradicen. Surgen preguntas pendientes de contestar: ¿Esta técnica puede ser efectiva en un subgrupo de pacientes? ¿Podría ser efectiva a medio-largo plazo? ¿Qué otras alternativas terapéuticas nos quedan para pacientes no respondedores a tratamiento convencional

Thymic Stromal Lymphopoietin (TSLP), Its Isoforms and the Interplay with the Epithelium in Allergy and Asthma

Thymic stromal lymphopoietin (TSLP) is a pleiotropic cytokine that has emerged as a critical player in the development and progression of allergy and asthma. It is primarily produced by epithelial cells and functions as a potent immune system activator. TSLP acts through interaction with its receptor complex, composed of the TSLP receptor (TSLPR) and interleukin-7 receptor alpha chain (IL-7Rα), activating downstream complex signalling pathways. The TSLP major isoform, known as long-form TSLP (lfTSLP), is upregulated in the airway epithelium of patients with allergic diseases. More research is warranted to explore the precise mechanisms by which short-form TSLP (sfTSLP) regulates immune responses. Understanding the dynamic interplay between TSLP and the dysfunctional epithelium provides insights into the mechanisms underlying allergy and asthma pathogenesis. Targeting TSLP represents an important therapeutic strategy, as it may upstream disrupt the inflammatory cascade and alleviate symptoms associated with allergic inflammation

Non-eosinophilic asthma: current perspectives

Ignacio Esteban-Gorgojo,1 Darío Antolín-Amérigo,2 Javier Domínguez-Ortega,3,4 Santiago Quirce3,4 1Department of Allergy, Hospital General de Villalba, Madrid, Spain; 2Department of Allergy, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain; 3Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), 4CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain Abstract: Although non-eosinophilic asthma (NEA) is not the best known and most prevalent asthma phenotype, its importance cannot be underestimated. NEA is characterized by airway inflammation with the absence of eosinophils, subsequent to activation of non-predominant type 2 immunologic pathways. This phenotype, which possibly includes several not well-defined subphenotypes, is defined by an eosinophil count <2% in sputum. NEA has been associated with environmental and/or host factors, such as smoking cigarettes, pollution, work-related agents, infections, and obesity. These risk factors, alone or in conjunction, can activate specific cellular and molecular pathways leading to non-type 2 inflammation. The most relevant clinical trait of NEA is its poor response to standard asthma treatments, especially to inhaled corticosteroids, leading to a higher severity of disease and to difficult-to-control asthma. Indeed, NEA constitutes about 50% of severe asthma cases. Since most current and forthcoming biologic therapies specifically target type 2 asthma phenotypes, such as uncontrolled severe eosinophilic or allergic asthma, there is a dramatic lack of effective treatments for uncontrolled non-type 2 asthma. Research efforts are now focusing on elucidating the phenotypes underlying the non-type 2 asthma, and several studies are being conducted with new drugs and biologics aiming to develop effective strategies for this type of asthma, and various immunologic pathways are being scrutinized to optimize efficacy and to abolish possible adverse effects. Keywords: asthma, non-eosinophilic asthma, asthma phenotype, asthma endotype, neutrophilic asthm

The role of mobile health technologies in allergy care: An EAACI position paper

PubMed: 31230373Mobile health (mHealth) uses mobile communication devices such as smartphones and tablet computers to support and improve health-related services, data and information flow, patient self-management, surveillance, and disease management from the moment of first diagnosis to an optimized treatment. The European Academy of Allergy and Clinical Immunology created a task force to assess the state of the art and future potential of mHealth in allergology. The task force endorsed the “Be He@lthy, Be Mobile” WHO initiative and debated the quality, usability, efficiency, advantages, limitations, and risks of mobile solutions for allergic diseases. The results are summarized in this position paper, analyzing also the regulatory background with regard to the “General Data Protection Regulation” and Medical Directives of the European Community. The task force assessed the design, user engagement, content, potential of inducing behavioral change, credibility/accountability, and privacy policies of mHealth products. The perspectives of healthcare professionals and allergic patients are discussed, underlining the need of thorough investigation for an effective design of mHealth technologies as auxiliary tools to improve quality of care. Within the context of precision medicine, these could facilitate the change in perspective from clinician- to patient-centered care. The current and future potential of mHealth is then examined for specific areas of allergology, including allergic rhinitis, aerobiology, allergen immunotherapy, asthma, dermatological diseases, food allergies, anaphylaxis, insect venom, and drug allergy. The impact of mobile technologies and associated big data sets are outlined. Facts and recommendations for future mHealth initiatives within EAACI are listed. © 2019 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd