Research needs in allergy: an EAACI position paper, in collaboration with EFA

Abstract In less than half a century, allergy, originally perceived as a rare disease, has become a major public health threat, today affecting the lives of more than 60 million people in Europe, and probably close to one billion worldwide, thereby heavily impacting the budgets of public health systems. More disturbingly, its prevalence and impact are on the rise, a development that has been associated with environmental and lifestyle changes accompanying the continuous process of urbanization and globalization. Therefore, there is an urgent need to prioritize and concert research efforts in the field of allergy, in order to achieve sustainable results on prevention, diagnosis and treatment of this most prevalent chronic disease of the 21 st century. The European Academy of Allergy and Clinical Immunology (EAACI) is the leading professional organization in the field of allergy, promoting excellence in clinical care, education, training and basic and translational research, all with the ultimate goal of improving the health of allergic patients. The European Federation of Allergy and Airways Diseases Patients' Associations (EFA) is a non-profit network of allergy, asthma and Chronic Obstructive Pulmonary Disorder (COPD) patients' organizations. In support of their missions, the present EAACI Position Paper, in collaboration with EFA, highlights the most important research needs in the field of allergy to serve as key recommendations for future research funding at the national and European levels. Although allergies may involve almost every organ of the body and an array of diverse external factors act as triggers, there are several common themes that need to be prioritized in research efforts. As in many other chronic diseases, effective prevention, curative treatment and accurate, rapid diagnosis represent major unmet needs. Detailed phenotyping/endotyping stands out as widely required in order to arrange or re-categorize clinical syndromes into more coherent, uniform and treatment-responsive groups. Research efforts to unveil the basic pathophysiologic pathways and mechanisms, thus leading to the comprehension and resolution of the pathophysiologic complexity of allergies will allow for the design of novel patient-oriented diagnostic and treatment protocols. Several allergic diseases require well-controlled epidemiological description and surveillance, using disease registries, pharmacoeconomic evaluation, as well as large biobanks. Additionally, there is a need for extensive studies to bring promising new biotechnological innovations, such as biological agents, vaccines of modified allergen molecules and engineered components for allergy diagnosis, closer to clinical practice. Finally, particular attention should be paid to the difficult-to-manage, precarious and costly severe disease forms and/or exacerbations. Nonetheless, currently arising treatments, mainly in the fields of immunotherapy and biologicals, hold great promise for targeted and causal management of allergic conditions. Active involvement of all stakeholders, including Patient Organizations and policy makers are necessary to achieve the aims emphasized herein

Lactose Maldigestion, Malabsorption, and Intolerance: A Comprehensive Review with a Focus on Current Management and Future Perspectives

Milk is a fundamental component of the diet of every mammal; nevertheless, not every individual can tolerate this kind of food, especially in adulthood. However, lactose intolerance has only been recognized in the last 50 years, and currently, lactose intolerance is defined as a clinical syndrome characterized by pain, abdominal distention, flatulence, and diarrhoea that occur after lactose consumption. Lactose is currently a common disaccharide in human nutrition, both in breastfed infants and in adults, but its digestion requires a specialized enzyme called lactase. The genetically programmed reduction in lactase activity during adulthood affects most of the world’s adult population and can cause troublesome digestive symptoms, which may also vary depending on the amount of residual lactase activity; the small bowel transit time; and, especially, the amount of ingested lactose. Several diagnostic tests are currently available for lactose intolerance, but the diagnosis remains challenging. The treatment for lactose intolerance mainly consists of reducing or eliminating the dietetic amount of lactose until the symptoms disappear, but this is hard to achieve, as lactose is present in dairy products and is even commonly used as a food additive. In addition to dietetic restriction of lactose-containing foods, lactase can be administered as an enzymatic food supplement, but its efficacy is still controversial. Recently, probiotics have been proposed for the management of lactose intolerance; certain probiotic strains have shown specific β-galactosidase activity, thus aiding in the digestion of lactose. The aim of this paper was to review the current knowledge about lactose intolerance and to discuss the potential for the use of specific probiotic strains such as dietary supplements in lactose-intolerant patients

Editorial: Probiotics, Gut Microbiota and Immunomodulation: Is this the Key to Counteract the Allergy Epidemics?

Allergic diseases have been described since the antiquities [1], but major advancements on understanding of their pathogenic mechanisms and clinical implications date to the end of the 19th and the first half of the 20th century [2, 3]. In the meantime, during the last decades, the prevalence of allergic diseases remarkably increased, paving the way to the definition of “allergy epidemics” [4]. But what happened in the second half of the 19th century that gave rise to this phenomenon? As far as we know, at least two major changes took place, which led to an increase of allergic diseases. The first one was a major change in life and social conditions, with decrease of family size, people progressively moving from the countryside to the cities, and consistent improvements in public hygiene, with widespread availability of clean water and use of antibiotics, just to name two [4]. The second one was the increasing concentration of airborne pollens, due to the diffusion of new grasses, such as Lolium perenne in England in the late 19th century, and to the increasing presence of infesting grasses due to changes in farming techniques and increase in arable farming. By the mid-forties, hay fever became such a severe health problem in the New York city area that a ragweed eradication campaign was initiated by the city council [5]. If the link between the increase of airborne pollens in the air and allergic diseases caused by the pollens themselves is clear, this is not the same for the first explanation. In 1989, David P. Strachan published on The Lancet the results of his epidemiologic investigation on 17414 British children who were followed-up until the age of 23 [6]. He aimed to investigate the relationship between the increase of hay fever and sixteen different perinatal, social and environmental factors. What he found was a striking association of hay fever with family size and position in the household during childhood [6]. In his evaluation, the single most influential variable was the number of older children in the household, and he hypothesized that allergies could be prevented – during childhood – by cross-infections among family members, facilitated by unhygienic contact with other siblings. This was the birth of the “hygiene hypothesis”, which is still today a milestone to explain the rise of allergic diseases [6, 7]. In the last decades of the 20th century, new information came from in vitro studies about CD4+ T-lymphocyte subpopulations [8]. T Helper-1 (Th1) cells were characterized as T lymphocytes capable of prevalent production, in response to microbial stimuli, of interleukin-2 (IL-2), interferon γ (IFN-γ), and transforming growth factor β (TGF-β), subsequently referred to as “Th1-cytokines”; these cytokines were recognized a prominent role in defense against most infectious agents [8]. Th2 cells, on the contrary, were characterized by the prevalent production of IL-4, IL-5, IL-9, and IL-13 (Th2-cytokines) who gave rise to an eosinophilic-rich immune response, primarily implicated in immunity against parasites and multicellular organisms but less crucial for immune responses in modern westernized countries [8]

House dust mite-related respiratory allergies and probiotics: a narrative review

Abstract The socio-economic burden of allergic respiratory conditions on continental Europe is even higher than that of mainstream diseases, such as diabetes and cardiovascular disease, as allergic rhinitis alone accounts for billions of Euros in healthcare expenses across Europe. House dust mites (HDM) are one of the most common triggers behind allergic rhinitis and asthma. The role of probiotics in the treatment and prevention of some allergic conditions, such as atopic dermatitis, is already well recognized, whereas evidence about their efficacy in patients with respiratory allergies—while increasing—is still limited. Here the current evidence for the use of probiotics in patients with allergic rhinitis and/or asthma is discussed

Lactose Maldigestion, Malabsorption, and Intolerance: A Comprehensive Review with a Focus on Current Management and Future Perspectives

Milk is a fundamental component of the diet of every mammal; nevertheless, not every individual can tolerate this kind of food, especially in adulthood. However, lactose intolerance has only been recognized in the last 50 years, and currently, lactose intolerance is defined as a clinical syndrome characterized by pain, abdominal distention, flatulence, and diarrhoea that occur after lactose consumption. Lactose is currently a common disaccharide in human nutrition, both in breastfed infants and in adults, but its digestion requires a specialized enzyme called lactase. The genetically programmed reduction in lactase activity during adulthood affects most of the world’s adult population and can cause troublesome digestive symptoms, which may also vary depending on the amount of residual lactase activity; the small bowel transit time; and, especially, the amount of ingested lactose. Several diagnostic tests are currently available for lactose intolerance, but the diagnosis remains challenging. The treatment for lactose intolerance mainly consists of reducing or eliminating the dietetic amount of lactose until the symptoms disappear, but this is hard to achieve, as lactose is present in dairy products and is even commonly used as a food additive. In addition to dietetic restriction of lactose-containing foods, lactase can be administered as an enzymatic food supplement, but its efficacy is still controversial. Recently, probiotics have been proposed for the management of lactose intolerance; certain probiotic strains have shown specific β-galactosidase activity, thus aiding in the digestion of lactose. The aim of this paper was to review the current knowledge about lactose intolerance and to discuss the potential for the use of specific probiotic strains such as dietary supplements in lactose-intolerant patients