Allergy and Immunology

Cystic fibrosis (CF) is the most common autosomal recessive disease in Caucasians. The dysfunction of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) causes the disease by disrupting epithelial salt and water transport. Characteristic manifestations of the disease such as chronic respiratory infections, pancreatic enzyme insufficiency, and infertility are caused by the accumulation of mucus in the ducts. Nowadays nearly 2000 CFTR mutatioans are known. The most common mutation is F508del. F508del/F508del mutation is not always accompanied by severe manifestations. The clinical expression is different among patients, taking into account the mutations and another factor, among them, enviromental and modifier genes. In the case of rare mutations symptoms vary from patient to patient being influenced by environmental factors and modifier genes. We present a case with a less common combination of mutations and an atypical clinical presentation.

Acute inflammation is accompanied by changes in the concentrations of acute phase proteins (APPs), While much is known about the cytokines involved in the initiation of inflammation, less is known about the mediators involved in its resolution. Recent data suggest that interleukin 6 (IL-6) and IL-6-regulated APPs are anti-inflammatory and immuno-suppressive, and may negatively regulate the acute phase response.

Objective: To compare the enzyme activity of different presentations of papain solution to validate in-house preparations. Methods: Two papain solutions were prepared, and the third presentation was a commercial solution. Tests were carried out with samples of red cells typed as weak RhD. Results: In-house prepared papain solutions showed similar enzyme reactivity, and statistically no differences compared to the enzyme activity of the commercial solution. Conclusion: Evaluating the cost-benefit ratio, the in-house prepared papain solutions present more economic advantages, and can be incorporated into immunohematological routines as a way to cope with periods of financial crisis and cost-containment policies.

OBJETIVO: Rever as publicações recentes mais relevantes sobre alergia medicamentosa e oferecer ao clínico subsídios para uma maior compreensão dessa problemática de grande relevância para a saúde pública. FONTES DOS DADOS: Busca de artigos originais e revisões indexados nas bases MEDLINE, Pubmed e Lilacs, publicados na última década, relacionando o tema de alergia a medicamentos com mecanismos imunológicos, epidemiologia, diagnóstico laboratorial, lesões cutâneas, manejo clínico e reexposição ao fármaco. SÍNTESE DOS DADOS: As reações alérgicas representam um terço das reações adversas a medicamentos. São consideradas eventos raros, mas com elevada morbimortalidade. Apesar da descrição de Gell & Coombs, útil para classificar reações alérgicas a fármacos, algumas permanecem sem classificação devido ao desconhecimento dos mecanismos imunológicos envolvidos. A existência de subpopulações de células T com características diversas daquelas comumente descritas revela a complexidade do tema e, ao mesmo tempo, elucida inúmeras questões inerentes ao mesmo. Recentemente, um novo conceito de apresentação de fármaco a linfócitos T surgiu, diante de evidências crescentes do seu envolvimento nas lesões cutâneas decorrentes de reações alérgicas a medicamentos. Na prática clínica, é muito difícil a correlação de sinais e sintomas das reações alérgicas a medicamentos com o mecanismo imunológico envolvido sem o auxílio de testes laboratoriais. Testes cutâneos in vivo e testes in vitro têm sido empregados nas suspeitas de reações alérgicas a medicamentos. No entanto, há poucos produtos comerciais adequados para sua execução. CONCLUSÕES: As reações alérgicas a fármacos constituem uma fração importante dos eventos adversos a medicamentos. É importante enfatizar a necessidade de notificação dessas reações pelos profissionais envolvidos no tratamento do paciente de forma sistematizada, por meio de ações de farmacovigilância, bem como a identificação dos possíveis mecanismos imunológicos envolvidos através de testes laboratoriais, história e avaliação clínica detalhadas.

ABSTRAK Pendahuluan: Reaksi hipersensitivitas tipe I merupakan reaksi alergi yang dipicu oleh aktivitas IgE. Hipersensitivitas tipe I dapat berupa reaksi anafilaktik sistemik atau reaksi lokal yang ditandai oleh inflamasi dan kerusakan epitel mukosa. Udang dikenal sebagai makanan yang sering memicu alergi akibat kandungan protein di dalamnya merangsang reaksi system imun secara berlebihan pada pasien tertentu. Tujuan: Laporan kasus ini bertujuan membahas penatalaksanaan stomatitis alergika yang disebabkan alergi udang. Kasus: Seorang wanita berusia 36 tahun datang ke RSGM Trisakti dengan keluhan terasa gatal pada bibir atas dan bawah bagian dalam sejak 1 hari sebelum kedatangan. Keluhan tersebut dirasakan setelah memakan udang sehari sebelumnya.Tatalaksana: Pasien diberikan Aloclair gel 3x1 hari, dan kontrol dilakukan satu minggu setelah kunjungan pertama. Kata kunci :Alergi makanan, stomatitis alergika, alergi, hipersensitivitas tipe I

Lesi Vesikobulosa merupakan lesi berisi cairan jernih dan berada pada lapisan epitel, ruptur serta menimbulkan ulserasi. Lesi vesikobulosa dalam rongga mulut memiliki gambaran klinis, sehingga dibutuhkan pemeriksaan penunjang dalam menentukan diferensial diagnosis untuk tatalaksana perawatan yang tepat.

These formalized expert guidelines were written by the French Society of Emergency Medicine (SFMU), in partnership with the French Allergology Society (SFA) and the French Speaking Group in Pediatric Intensive Care and Emergency (GFRUP). Their goal is to educate emergency physicians to early diagnosis of this potentially fatal reaction of severe hypersensitivity, the specific features associated with age, and risk factors identification. Anaphylaxis diagnosis is clinical and used Sampson’s clinical criteria. The authors offer helps sheets for emergency medical services dispatch and triage criteria for emergency department nurses. As underlined by the international guidelines, the main treatment is early administration of intramuscular epinephrine. If an epinephrine auto-injector is available, the emergency medical services dispatch center on-call physician (112-call) should encourage its immediate use. The second line of treatment is based on the eviction of the triggering factor, the appropriate waiting position, oxygen therapy, and depending on the symptoms, fluid therapy, bronchodilator and epinephrine nebulization. The severity of the prognosis and the unpredictability of developments justify the deployment of a mobile intensive care unit. A minimum six-hour hospital observation is indicated. Tryptase kinetics evaluation contributes to a posteriori diagnosis. At emergency department discharge, the patient must have a prescription of an emergency kit (containing two epinephrine
auto-injectors and β2-agonists), written instructions and a detailed written hospital report. A specialized consultation with an allergologist is essential after the emergency department discharge.

This article was initially published as a French version in Annales Françaises de Médecine d’Urgence (Gloaguen A, Poussel G, Cesareo E, et al. Ann Fr Med Urg 2016; 6: 342-64; erratum published in Ann Fr Med Urg, Erratum to: Prise en charge de l’anaphylaxie en médecine d’urgence. Recommandations de la Société française de médecine d’urgence (SFMU) en partenariat avec la Société française d’allergologie (SFA) et le Groupe
francophone de réanimation et d’urgences pédiatriques (GFRUP), et le soutien de la Société pédiatrique de pneumologie et d’allergologie (SP2A)

IgE to alpha-gal poses a significant threat to public health. While eating meat may seem innocuous to most, if IgE to alpha-gal is present in a human at the time of consumption it can cause urticaria to delayed-onset anaphylaxis resulting in death. The primary vector of transmission, the Lone star tick (Ambylomma americanum), is prevalent in central and eastern parts of Virginia, and will continue to increase in number of intensity burgeoning the entire eastern half of the state in the near future. Considering habitat and land use, modeling predictive bite forecasting will result in a thorough analysis of the distribution of the alpha-gal vector, A. americanum in Virginian counties. Combined with IRB-approved subject research on the alpha-gal allergy, the aim is to identify a categorical projection of potential incidence of tick bites and IgE allergy acquisition. Results indicate that location of tick bites in relation to tick distribution does not directly correlate. It appears people typically travel west of their home locations to
where the ticks are most populated. These factors suggest the ticks are more prevalent in the same areas people are settling due to climate and habitat rather than population of people.

J. Bousquet1, N. Khaltaev2, AA Cruz3, J. Denburg4, WJ Fokkens5, A. Togias6, T. Zuberbier7, CE Baena-Cagnani8, GW Canonica9, C. van Weel10, I. Agache11, N. Aït-Khaled12, C. Bachert13, MS Blaiss14, S. Bonini15, L.-P. Boulet16, P.-J. Bousquet17, ...

Allergic diseases represent a major health problem in Europe. They are increasing in prevalence, severity and costs. GA2LEN (Global Allergy and Asthma European Network), an FP6 Network of Excellence, was created in 2005 as a vehicle to ensure excellence in research bringing together research and clinical institutions to combat fragmentation in the European research area and to tackle Allergy in its globality. GA2LEN benefited greatly from the voluntary efforts of researchers who are strongly committed to this model of pan-European collaboration. The network was organized in order to increase networking for scientific projects in allergy and asthma around Europe and to make GA2LEN the world leader in the field. Besides these activities, research has been jointly made and the first papers are being published. GA2LEN achievements in general can be grouped as those for a durable infrastructure built up during the project phase those which are project-related work based on these novel in...

The hematopoietic and the immune systems in all their com-ponents are characterized by a multifrequency time structure with prominent rhythms in cell proliferation and cell function in the circadian, infradian, and circannual frequency ranges. The circulating formed ...

Ocular allergy (OA) includes a group of common and less frequent hypersensitivity disorders frequently misdiagnosed and not properly managed. The diagnosis of OA is usually based on clinical history and signs and symptoms, with the support of in vivo and in vitro tests when identification of the specific allergen is required. To date, no specific test is available for the diagnosis of the whole spectrum of the different forms of OA. The lack of recommendations on diagnosis of OA is considered a medical need not only for allergists but also for ophthalmologists. This position paper aims to provide a comprehensive overview of the currently available tools for diagnosing OA to promote a common nomenclature and procedures to be used by different specialists. Questionnaires, sign and symptom grading scales, tests, and potential biomarkers for OA are reviewed. We also identified several unmet needs in the diagnostic tools to generate interest, increase understanding, and inspire further investigations. Tools, recommendations, and algorithms for the diagnosis of OA are proposed for use by both allergists and ophthalmologists. Several unmet needs in the diagnostic tools should be further improved by specific clinical research in OA.

Background: The Allergic Rhinitis and Its Impact on Asthma (ARIA) workshop proposes a classification of allergic rhinitis severity. It does not take into account impairment in quality of life and treatment should be adapted accordingly. Methods: Two cross-sectional surveys were designed:a spring survey, for which 1,321 practitioners enrolled 3,026 patients consulting for seasonal allergic rhinitis and an autumn-winter survey, for