Bronchiolitis needs a revisit: Distinguishing between virus entities and their treatments

Current data indicate that the “bronchiolitis” diagnosis comprises more than one condition. Clinically, pathophysiologically, and even genetically three main clusters of patients can be identified among children suffering from severe bronchiolitis (or first wheezing episode): (a) respiratory syncytial virus (RSV)-induced bronchiolitis, characterized by young age of the patient, mechanical obstruction of the airways due to mucus and cell debris, and increased risk of recurrent wheezing. For this illness, an effective prophylactic RSV-specific monoclonal antibody is available; (b) rhinovirus-induced wheezing, associated with atopic predisposition of the patient and high risk of subsequent asthma development, which may, however, be reversed with systemic corticosteroids in those with severe illness; and (c) wheeze due to other viruses, characteristically likely to be less frequent and severe. Clinically, it is important to distinguish between these partially overlapping patient groups as they are likely to respond to different treatments. It appears that the first episode of severe bronchiolitis in under 2-year-old children is a critical event and an important opportunity for designing secondary prevention strategies for asthma. As data have shown bronchiolitis cannot simply be diagnosed using a certain cutoff age, but instead, as we suggest, using the viral etiology as the differentiating factor.</p

Current state and future of pediatric allergology in Europe: A road map

The history of pediatric allergology (PA) in Europe is relatively youthful, dating back to 1984, when a small group of pediatricians founded the European Working Group on Pediatric Allergy and Immunology—later giving rise to ESPACI (European Society on Pediatric Allergology and Clinical Immunology). In 1990, the first dedicated journal, Pediatric Allergy and Immunology (PAI), was founded. There are striking differences across Europe, and even within European countries, in relation to the training pathways for doctors seeing children with allergic disease(s). In 2016, the EAACIClemens von Pirquet Foundation (CvP) organized and sponsored a workshop with the European Academy of Allergy and Clinical Immunology (EAACI) Pediatric Section. This collaboration focussed on the future of PA and specifically on education, research, and networking/ advocacy. The delegates representing many countries across Europe have endorsed the concept that optimal care of children with allergic diseases is delivered by pediatricians who have received dedicated training in allergy, or allergists who have received dedicated training in pediatrics. In order to meet the needs of children and families with allergic disease(s), the pediatric allergist is highly encouraged to develop several networks. Our challenge is to reinforce a clear strategic approach to scientific excellence to across our member base and to ensure and enhance the relevance of European pediatric research in allergy. With research opportunities in basic, translational, clinical, and epidemiologic trials, more trainees and trained specialists are needed and it is an exciting time to be a pediatric allergologist

Allergen immunotherapy for allergic rhinoconjunctivitis : a systematic review and meta-analysis

BACKGROUND: The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. In order to inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost-effectiveness and safety of AIT in the management of allergic rhinoconjunctivitis METHODS: We searched 15 international biomedical databases for published, in progress and unpublished evidence. Studies were independently screened by two reviewers against pre-defined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication and combined symptom and medication scores. Secondary outcomes of interest included cost-effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random-effects meta-analyses. RESULTS: We identified 5932 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD -0.53, 95%CI -0.63, -0.42), medication (SMD -0.37, 95%CI -0.49, -0.26) and combined symptom and medication (SMD -0.49, 95%CI -0.69, -0.30) scores whilst on treatment that were robust to pre-specified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, this suggesting a benefit in relation to symptom scores. CONCLUSIONS: AIT is effective in improving symptom, medication and combined symptom and medication scores in patients with allergic rhinoconjunctivitis whilst on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy. This article is protected by copyright. All rights reserved

Immune response in acute bronchiolitis and association with viral cause and subsequent asthma

Infants hospitalized for acute bronchiolitis hold an increased risk for subsequent asthma development. Although it is not clear whether bronchiolitis is a causal or a risk factor for future asthma, the identification in peripheral blood of immunological prognostic markers, for asthma diagnosis and treatment, is of significant importance.In this study, 27 cytokines were measured with the use of Luminex technology in supernatants derived from peripheral blood mononuclear cells’ (PBMCs) cultures, either from cases or from controls, and in the presence or not of specific stimuli. Th1 immune response deficiency has been demonstrated in infants with acute bronchiolitis (lower levels of PHA-induced IFN-γ and IL-12p70, compared to healthy controls). Moreover, markers of innate immune response (e.g. IL-8, MCP-1 and PDGF-bb) have been found increased during acute bronchiolitis. Upon convalescence, IL-8 levels have been found increased compared to those at acute phase of bronchiolitis as well as to healthy controls, leading to the conclusion that at convalescence innate immune response is still active.Finally, it has been shown that children presenting with wheezing episodes one year after acute bronchiolitis, display lower levels of cytokines related to innate (IL-8, IL-6, MIP-1α, MIP-1β) as well as to adaptive (IFN-γ, IP-10, IL-13, IL10) immunity.Τα βρέφη που νοσηλεύονται με οξεία βρογχιολίτιδα βρίσκονται σε σημαντικά αυξημένο κίνδυνο εμφάνισης άσθματος στην παιδική ηλικία. Αν και δεν είναι σαφές εάν η ιογενής βρογχιολίτιδα είναι αιτιολογικός παράγοντας ή δείκτης για την αναγνώριση των βρεφών σε κίνδυνο, είναι σημαντική η ανεύρεση ανοσολογικών προγνωστικών δεικτών για πρώιμη διάγνωση και αντιμετώπιση του άσθματος.Στην παρούσα μελέτη μελετήθηκαν ex-vivo και με την τεχνική luminex, κυτταροκίνες που προήλθαν από υπερκείμενα καλλιεργειών μονοπύρηνων κυττάρων περιφερικού αίματος (PBMCs), με ή χωρίς διέγερση, σε βρέφη με βρογχιολίτιδα και σε βρέφη-μάρτυρες.Διαπιστώνεται μια ανεπάρκεια του Th1 σκέλους της ειδικής ανοσολογικής απόκρισης στην οξεία βρογχιολίτιδα (χαμηλότερα επίπεδα επαγόμενης από PHA παραγωγής IFN-γ και IL-12p70). Επιπλέον, δείκτες της μη ειδικής ανοσολογικής απόκρισης (π.χ. IL-8, MCP-1 και PDGF-bb) ανευρίσκονται αυξημένοι επί της οξείας βρογχιολίτιδας. Στη φάση δε της ανάρρωσης, η IL-8 ανευρίσκεται σε υψηλότερα επίπεδα συγκριτικά με την οξεία φάση αλλά και με τους υγιείς μάρτυρες οδηγώντας στο συμπέρασμα ότι υπάρχει ακόμα κινητοποίηση μηχανισμών της μη ειδικής ανοσίας.Παράλληλα, διαπιστώνουμε ότι βρέφη που ένα έτος μετά το επεισόδιο της βρογχιολίτιδας εμφανίζουν επεισόδια συριγμού, παρουσιάζουν χαμηλότερα επίπεδα κυτταροκινών σχετικών με την μη ειδική (IL-8, IL-6, MIP-1α, MIP-1β) αλλά και με την ειδική ανοσολογική απόκριση (IFN-γ, IP-10, IL-13, IL10)

The 10th anniversary of the Junior Members and Affiliates of the European Academy of Allergy and Clinical Immunology

This year is the 10th anniversary of the European Academy of Allergy and Clinical Immunology (EAACI) Junior Members and Affiliates (JMAs). The aim of this review is to highlight the work and activities of EAACI JMAs. To this end, we have summarized all the initiatives taken by JMAs during the last 10 yr. EAACI JMAs are currently a group of over 2380 clinicians and scientists under the age of 35 yr, who support the continuous education of the Academy's younger members. For the past decade, JMAs enjoy a steadily increasing number of benefits such as free online access to the Academy's journals, the possibility to apply for Fellowships and the Mentorship Program, travel grants to attend scientific meetings, and many more. In addition, JMAs have been involved in task forces, cooperation schemes with other scientific bodies, organization of JMA focused sessions during EAACI meetings, and participation in the activities of EAACI communication platforms. EAACI JMA activities represent an ideal example of recruiting, training, and educating young scientists in order for them to thrive as future experts in their field. This model may serve as a prototype for other scientific communities, several of which have already adapted similar policies