RAST, Inmunoblot, Inmunocap e ISAC en alergia alimentaria

Después del descubrimiento de la IgE, los avances tecnológicos han proporcionado nuevas herramientas de laboratorio para la cuantificación de anticuerpos IgE específicos de alérgenos en suero y en la superficie de basófilos-mastocitos. Las pruebas in vitro ofrecen numerosas ventajas: cuantificación precisa, falta de interferencia de fármacos, seguridad y almacenamiento a largo plazo de las muestras. Los inmunoensayos cuantitativos para anticuerpos IgE pueden ser un complemento de las pruebas cutáneas. El reactivo de alergeno en fase sólida (alergosorbente) o líquida es el componente principal del ensayo que confiere especificidad a la prueba de anticuerpos IgE. Es el reactivo más complejo y altamente variable en los ensayos de anticuerpos IgE. La elección de utilizar recombinantes de diagnóstico en una única plataforma en lugar de múltiples se realiza caso por caso (considerando el historial previo y el perfil clínico) y de manera dependiente de los alérgenos. Aunque la mayor parte de las alergias alimentarias se limitan a una pequeña cantidad de posibles desencadenantes, estos alimentos son muy complejos al momento de evaluar su potencial alergénico. La posibilidad de fraccionar el alérgeno y entender algunos de sus componentes como potencialmente importantes para definir el riesgo de reacción clínica, reactividad cruzada o persistencia de la alergia, abrió una nueva era en el campo de la alergia, denominada alergia molecular. La identificación del componente alergénico responsable de las reacciones supone una herramienta importante para confirmar la información y gravedad de los síntomas, historia natural de la enfermedad, posibilidad de reactividad cruzada y clínica (marcadores de alergia).

A concept for integrated care pathways for atopic dermatitis-A GA2^{2} LEN ADCARE initiative

Introduction: The integrated care pathways for atopic dermatitis (AD‐ICPs) aim to bridge the gap between existing AD treatment evidence‐based guidelines and expert opinion based on daily practice by offering a structured multidisciplinary plan for patient management of AD. ICPs have the potential to enhance guideline recommendations by combining interventions and aspects from different guidelines, integrating quality assurance, and describing co‐ordination of care. Most importantly, patients can enter the ICPs at any level depending on AD severity, resources available in their country, and economic factors such as differences in insurance reimbursement systems. Methods: The GA$^{2}$LEN ADCARE network and partners as well as all stakeholders, abbreviated as the AD‐ICPs working group, were involved in the discussion and preparation of the AD ICPs during a series of subgroup workshops and meetings in years 2020 and 2021, after which the document was circulated within all GAL$^{2}$EN ADCARE centres. Results: The AD‐ICPs outline the diagnostic procedures, possible co‐morbidities, different available treatment options including differential approaches for the pediatric population, and the role of the pharmacists and other stakeholders, as well as remaining unmet needs in the management of AD. Conclusion: The AD‐ICPs provide a multidisciplinary plan for improved diagnosis, treatment, and patient feedback in AD management, as well as addressing critical unmet needs, including improved access to care, training specialists, implementation of educational programs, assessment on the impact of climate change, and fostering a personalised treatment approach. By focusing on these key areas, the initiative aims to pave the way for a brighter future in the management of AD

Beliefs and preferences regarding biological treatments for severe asthma

Background: Severe asthma is a serious condition with a significant burden on patients' morbidity, mortality, and quality of life. Some biological therapies targeting the IgE and interleukin-5 (IL5) mediated pathways are now available. Due to the lack of direct comparison studies, the choice of which medication to use varies. We aimed to explore the beliefs and practices in the use of biological therapies in severe asthma, hypothesizing that differences will occur depending on the prescribers’ specialty and experience. Methods: We conducted an online survey composed of 35 questions in English. The survey was circulated via the INterasma Scientific Network (INESNET) platform as well as through social media. Responses from allergists and pulmonologists, both those with experience of prescribing omalizumab with (OMA/IL5) and without (OMA) experience with anti-IL5 drugs, were compared. Results: Two hundred eighty-five (285) valid questionnaires from 37 countries were analyzed. Seventy-on percent (71%) of respondents prescribed biologics instead of oral glucocorticoids and believed that their side effects are inferior to those of Prednisone 5 mg daily. Agreement with ATS/ERS guidelines for identifying severe asthma patients was less than 50%. Specifically, significant differences were found comparing responses between allergists and pulmonologists (Chi-square test, p < 0.05) and between OMA/IL5 and OMA groups (p < 0.05). Conclusions: Uncertainties and inconsistencies regarding the use of biological medications have been shown. The accuracy of prescribers to correctly identify asthma severity, according to guidelines criteria, is quite poor. Although a substantial majority of prescribers believe that biological drugs are safer than low dose long-term treatment with oral steroids, and that they must be used instead of oral steroids, every effort should be made to further increase awareness. Efficacy as disease modifiers, biomarkers for selecting responsive patients, timing for outcomes evaluation, and checks need to be addressed by further research. Practices and beliefs regarding the use of asthma biologics differ between the prescriber's specialty and experience; however, the latter seems more significant in determining beliefs and behavior. Tailored educational measures are needed to ensure research results are better integrated in daily practice