Journal of Investigational Allergology and Clinical Immunology
Latest Publications

Background: The prevalence of hypersensitivity reactions to radiological contrast media (RCM) is increasing due to the greater performance of diagnostic and therapeutic tests that require RCMs. Objective: We carried out a year-long real-life observational study to prospectively evaluate the patients referred to the Allergy Service from Primary Care, Emergency Room, and other Services with suspected moderate to severe RCM hypersensitivity. Methods: To study the costs of RCM hypersensitivity evaluation, we systematically recorded direct and indirect costs. Results: Sixty-nine patients with previous reactions to RCM were evaluated in the Allergy Service from June 1st, 2017, to May 31st, 2018. Total direct health care costs were € 10715.84, with a mean cost per patient of € 155.30 ± 77.08. Specifically, direct non-health costs reached € 1605.42 (mean € 23.27 ± 41.14), and indirect costs were € 6490.85 (mean € 94.07 ± 110.61). In summary, the total cost was € 18812.11, which means a mean cost of € 272.64 ± 164.77. Conclusions: Our study reflects that the costs of an elective evaluation of hypersensitivity to RCM are low. This fact reaffirms that correct and safe management of these patients could be cost-effective, so our efforts should be directed to implement the necessary logistics.

The epithelial barrier has been classically considered as only the first line of defense against irritants, pathogens, and allergens, but it is now known that it also plays an essential role in the immunological response against exogenous agents. In fact, recent reports postulate the epithelial barrier hypothesis as a possible explanation for the increasing incidence and severity of allergic diseases. The epithelial barrier preserves the isolation of the inner tissues from potential external threats. Moreover, a coordinated interaction between epithelial and immune cells ensures the unique immune response taking place in mucosal tissues and that is has been reported to be dysregulated in allergic diseases. Herein, we and others have demonstrated that in severe allergic phenotypes, the epithelial barrier experiments several histological modifications and increased in immune cells infiltration, leading to its dysfunction. This is common in atopic dermatitis, asthma, and/or food allergy. However, the precise role of the epithelial barrier in the mucosal biology during allergic diseases progression is not well understood yet. In this review, we aim to compile recent knowledge regarding the histological structure and immunological function of the epithelial barrier and to shed light on the role of this compartment in the onset, and progression of allergic diseases.

Objective: To assess the consensus level among a multidisciplinary expert panel on the transition of adolescents with severe asthma from pediatric to adult care. Methods: A 61-item survey was developed based on guidelines for other chronic pathologies, covering transition planning, preparation, effective transfer, and follow-up. A two-round Delphi process assessed the consensus level among 98 experts (49 pediatricians, 24 allergists and 25 pulmonologists). Consensus was established with ≥70% agreement. Results: Forty-two items (70%) reached consensus. No age range to initiate the transition was agreed upon by the panelists. The main goal to achieve during the transition identified by the experts is that adolescents gain autonomy to manage their severe asthma and prescribed treatments. The panelists agreed on the importance of developing an individualized plan, promoting patient’s autonomy, and identifying home environment factors. They agreed that the adult healthcare team should have expertise in severe asthma, biologics and management of adolescent patients. Pediatric and adult healthcare teams should share clinical information, agree on the criteria to maintain the biological therapy, and have an on-site joint visit with the patient before the effective transfer. Adult healthcare professionals should closely follow the patient after the effective transfer to ensure correct inhaler technique, treatment adherence and attendance to healthcare appointments. Conclusions: This consensus document provides the first roadmap for Spanish pediatric and adult teams to ensure that key aspects of the transition process in severe asthma are covered. The implementation of these recommendations will improve the quality of care offered to the patient.

Background: Previous studies suggest that asthma mortality rates in Spain are decreasing but this trend was not observed for younger age groups. Objetive: To analyse mortality rates of asthma from the last 40 years, focusing on changes related with the development of new therapeutic approaches. Methods: Death records and mid-year population data were collected from the National Statistics Institute. By using the direct method, age-standardized mortality rates were calculated for overall population and for each sex and age group. Significant changes in mortality trends were identified by Joinpoint regressions. The independent effects of age, period and cohort (APC) and Potential Years of Life Lost (PYLL) due to asthma were also analysed. Results: Age-standardized asthma mortality rates decreased in Spain from 7.38 to 2.03 deaths per 100 000 from the first to the last quinquennium of the study (1980–1984 to 2015–2019) for the overall population. This decrease is more intense among men, where a decrease from 10.37/100.000 to 0.91/100.000 was observed versus 5.53 to 2.77/100.000 in women. All age groups have decreased mortality. While> 64 have stabilized their decline and 35-64 have even increased in the last 3 years, <35 maintain a rapid decline since the 1990s. Conclusion: There is a decline in asthma mortality rates starting in 1980, including younger cohorts starting in the 1990s, confirming earlier trends. Improved diagnosis and development of new therapies for asthma may they have a role in this event. Close monitoring of asthma mortality rates is necessary to confirm these trends.