Anne K. Ellis

BackgroundGuidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology.ObjectiveTo produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD.MethodsA multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group …

Atopic diseases are classified as a group of type I hypersensitivity disorders often mediated by immunoglobulin E (IgE) following exposure to an antigen that a patient is sensitized to. It is estimated that 35% of children suffer from allergic diseases, with increasing frequency (Chad, Paediatr Child Health 6(8):555–566, 2001). The development of allergic disease can be credited to a complex interplay between environmental and hereditary factors, of which family history and genetic predisposition tend to be the most important. Children with one or both parents who have allergies have a 40% and 70% chance of developing allergies, respectively, compared to 12% for children without a family history of allergies (Ownby, J Allergy Clin Immunol 86(3 Pt 1):279–287, 1990). This group of immune-modulated diseases can exist independently or comorbidly in patients, with the “Atopic March” theory stipulating a progression …

MethodsFive healthy volunteers were recruited from the Kingston, Ontario region. NASOSORPTION TM FX• i was placed against the interior turbinate of one nostril for one minute. Next, a Merocel® sponge was inserted in the middle meatus region of the opposite nostril for 5 minutes. Both samples were processed according to previously published protocols. Measurements of EGF, G-CSF, IL-1ra, IL-6, IL-8, IL-10, IL-12p70, IL-13, IP-10, MCP-1, MIP-1b, and VEGF-A were performed using the MILLIPLEX® Human Cytokine/Chemokine/Growth Factor Panel A Magnetic Bead Panel.ResultsUsing the Wilcoxon matched-pairs signed rank test to investigate sponge versus NASOSORPTION TM FX• i across all cytokines, the observed concentration of cytokines collected with sponge was significantly higher (p< 0.0001). There were no significant differences (p> 0.05) found between sponge and NASOSORPTION TM FX• i …

TaggedAPTARAPWe read with interest the article entitled “Managing Anaphylaxis-Epinephrine, Antihistamines, and Corticosteroids: Over 10 years of C-CARE Registry Data” by Colli et al 1 in which they reported that prehospital epinephrine and antihistamine are associated with a decrease in the likelihood of uncontrolled anaphylaxis in the emergency department. Data for the study was collected from 10 centers in Canada and a single hospital in Israel. Colli et al 1 concluded that “Reactions not treated with prehospital epinephrine before arrival at the ED were more likely to be triggered by shellfish, or to occur at home, or to occur in Israel.” TaggedAPTARAEnd TaggedAPTARAPThe statistical analysis section specifies “reactions taking place in Israel” as a variable that was evaluated. However, data from Israel comprised only a small portion of the data set. In fact, the Canadian patient cohorts are markedly …

This practice parameter update focuses on 7 areas in which there are new evidence and new recommendations. Diagnostic criteria for anaphylaxis have been revised, and patterns of anaphylaxis are defined. Measurement of serum tryptase is important for diagnosis of anaphylaxis and to identify underlying mast cell disorders. In infants and toddlers, age-specific symptoms may differ from older children and adults, patient age is not correlated with reaction severity, and anaphylaxis is unlikely to be the initial reaction to an allergen on first exposure. Different community settings for anaphylaxis require specific measures for prevention and treatment of anaphylaxis. Optimal prescribing and use of epinephrine autoinjector devices require specific counseling and training of patients and caregivers, including when and how to administer the epinephrine autoinjector and whether and when to call 911. If epinephrine is used …

MethodsChildren with moderate-to-severe type 2 asthma (baseline blood eosinophil count≥ 150 cells/μL or FeNO≥ 20 ppb) received add-on dupilumab 100/200 mg q2w (by bodyweight), or placebo for 52 weeks. They were stratified according to low, medium, or high tertile subgroups based on the change from baseline in pre-bronchodilator percent predicted forced expiratory volume in 1 second [ppFEV 1] at Week 52 in pooled dupilumab and placebo treatment arms. Using a logistic regression model adjusted for baseline characteristics, we compared the proportion of children with well-controlled asthma (Interviewer-Administered 5-item Asthma Control Questionnaire [ACQ-5-IA] score≤ 0.75) at Week 52 between tertile subgroups.ResultsMean (SD) change from baseline in pre-bronchodilator ppFEV 1 was− 6.87 (8.92), 7.52 (3.25), and 26.89 (16.04) percentage points in the low (n= 102), medium (n= 109), and …

Background: There is a documented double peak phenomenon following the intramuscular injection of epinephrine, however these peaks are typically representative of mean epinephrine concentrations and not individual subjects.Objective: An examination of epinephrine pharmacokinetics was conducted to explore the nature of the double peak phenomenon and to determine if the double peaks observed in mean concentration profiles were also observed in individual subjects.Methods: A GCP compliant study was conducted in 36 adult volunteers with a history of type I allergies. Blood samples were collected before and at multiple timepoints after subjects self-administered two FDA-approved epinephrine auto-injectors (EpiPen 0.3 mg and Symjepi 0.3 mg). Pharmacokinetic parameters (C max and t max) and concentration-time curves were determined based on individual subjects. Subjects were categorized by their t max (≤ 4 min,> 4 min-≤ 10 min,> 10 min-≤ 20 min,> 20 min-≤ 30 min,> 30 min-≤ 45 min, and> 45 min, presented as≤ 4 min,≤ 10 min,≤ 20 min,≤ 30 min,≤ 45 min, and> 45 min, respectively).Results: The majority of individual subjects did not have double peaks. Double peaks in mean concentration-time profiles were observed when t max was≤ 4 min following EpiPen and Symjepi, t max≤ 30 min following EpiPen, and t max≤ 45 min following EpiPen. The individual epinephrine concentration curves for subjects with at max≤ 4 min following EpiPen and Symjepi and t max≤ 45 min following EpiPen demonstrate that the majority of individual subjects do not have double peaks.Conclusion: These data suggest that the …

BackgroundAsthma is a chronic airway inflammatory disease that affects millions of Canadians and often contributes to higher levels of anxiety among patients. Since the coronavirus disease 2019 (COVID-19) pandemic was a time of increased anxiety and fear among the Canadian population, it was thought that those with asthma may experience heightened anxiety levels due to uncertain access to care, the potential to misinterpret asthma symptoms for symptoms of COVID-19 (or vice versa), and the concern about being treated differently by those around them when experiencing asthma symptoms. Therefore, this study sought to perform a cross-sectional analysis of the asthma-anxiety relationship in adults with and without asthma in the unique context of the COVID-19 pandemic from a Canadian perspective.MethodsThis study employed the COVID-19 Associated Anxiety in Allergic Rhinitis and Asthma patients …

BackgroundChronic rhinosinusitis with nasal polyposis (CRSwNP) often coexists with lower airway disease. With the overlap between upper and lower airway disease, optimal management of the upper airways is undertaken in conjunction with that of the lower airways. Biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of both upper and lower airway diseases. Knowledge gaps nevertheless exist in how best to approach patient care as a whole. There have been sixteen randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL- 5R, IL-33, and immunoglobulin (Ig)E. This white paper considers the perspectives of experts in various disciplines such as rhinology, allergy, and respirology across Canada, all of whom have unique and …

MethodsSerum samples and epidemiologic data were collected prospectively from FHS students. Serum was tested for Ig-A, M, G to four SARS-CoV-2 proteins using MILLIPLEX®(MilliporeSigma) assays and Bio-Plex TM 200 analyser.ResultsBetween May 2020-June 2021, 1,229 serum samples were collected, 85.9% were unvaccinated (n= 1,056), 11.1% received 1-dose (n= 137), 2.5% received 2-doses (n= 31), and 0.41%(n= 5) were recovered. Serum was collected an average of 42 days [1-120days] and 29 days [1-68days] following first-and second-doses, respectively. Average days between doses was 56.2 days [21-107days]. Vaccinated samples had significantly higher Ig-A, M, G antibody levels, compared to unvaccinated samples, measured by median fluorescent intensity minus background (MFI-Background) to the three proteins (S1, S2, RBD) within the COVID-19 vaccine (all, p< 0.0001) with the …

Background Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). Methods Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence‐based review (EBR), or evidence‐based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. Results The ICAR:AR document addresses over …

BackgroundWomen in medicine continue to be underrepresented at medical conferences. Previous studies have evaluated the proportion of invited female speakers across multiple specialties and evaluated factors that may have led to this disparity. The field of Allergy and Immunology has often been excluded and analyses have not illustrated how the trends have changed over the past decade.ObjectiveTo evaluate the distribution of invited speakers by gender over time at the 3 largest North American Allergy and Immunology conferences.MethodsThis retrospective longitudinal analysis used conference programs from 2008 to 2020 from the American Academy of Allergy, Asthma, and Immunology (AAAAI), the American College of Allergy, Asthma, and Immunology (ACAAI), and the Canadian Society of Allergy and Clinical Immunology (CSACI). The gender (binary definition, man or woman, based on names …

This guidance updates 2021 GRADE (Grading of Recommendations Assessment, Development and Evaluation) recommendations regarding immediate allergic reactions following coronavirus disease 2019 (COVID-19) vaccines and addresses revaccinating individuals with first-dose allergic reactions and allergy testing to determine revaccination outcomes. Recent meta-analyses assessed the incidence of severe allergic reactions to initial COVID-19 vaccination, risk of mRNA-COVID-19 revaccination after an initial reaction, and diagnostic accuracy of COVID-19 vaccine and vaccine excipient testing in predicting reactions. GRADE methods informed rating the certainty of evidence and strength of recommendations. A modified Delphi panel consisting of experts in allergy, anaphylaxis, vaccinology, infectious diseases, emergency medicine, and primary care from Australia, Canada, Europe, Japan, South Africa, the …

MethodsPeripheral blood was collected from participants at a screening visit before a titration challenge (21-28 days before NAC), pre-NAC (baseline), and post-NAC (1-hour, 6-hours, and 24-hours). IgE concentrations were measured from isolated serum using ImmunoCAP TM assays on the Phadia® 100 instrument. Results, including sIgE as a percentage of tIgE (%-sIgE), were analyzed using GraphPad Prism 9.4. 1.ResultsIgE levels were measured in 19 ragweed allergic and 12 non-allergic participants. Allergic participants had significantly higher levels of sIgE (p< 0.001), tIgE (p< 0.05), and%-sIgE (p< 0.001) compared to non-allergics at all time points. For allergic participants only, sIgE was significantly elevated from screening at baseline (p< 0.001), 1-hour (p< 0.0001), and 24-hours (p< 0.01). sIgE levels were highest at 1-hour and significantly greater than at 6-hours post-NAC (p< 0.01). The levels of tIgE were …

Background: Anaphylaxis is the most severe manifestation of a systemic allergic reaction, and, in the community setting, the immediate administration of an epinephrine autoinjector (EAI) can be life-saving. Physicians are tasked with selecting the most appropriate EAI for each individual and counseling patients and/or their caregivers to maximize the likelihood of successful deployment of the EAI. Objective: To offer an evidence-based expert clinical perspective on how physicians might best tailor EAI selection to their patients with anaphylaxis. Methods: A group of eight adult and pediatric allergists with expertise in anaphylaxis management reviewed and assessed the published data and guidelines on anaphylaxis management and EAI device selection. Results: Personalized EAI selection is influenced by intrinsic individual factors, extrinsic factors such as the properties of the individual EAI (eg, dose, needle length …

Epinephrine has been the first-line treatment for severe allergic reactions including anaphylaxis for several decades. Historically, the approved epinephrine injection products by the US Food and Drug Administration (FDA) have been considered clinically comparable, with nearly identical product labeling. However, a growing body of evidence now suggests that there are substantive pharmacokinetic and pharmacodynamic differences among these products. 1− 4 A series of pharmacokinetic studies compliant with Good Clinical Practice was conducted to evaluate the comparative bioavailability of a novel intranasal epinephrine spray against epinephrine injection products. As part of these studies, we evaluated the plasma concentrations of FDA-approved manual intramuscular and subcutaneous injections of epinephrine.Patients with a history of allergic rhinitis were randomly assigned to receive a single dose of …

BackgroundEpinephrine is the first-line treatment for severe allergic reactions, and rapid treatment is associated with lower rates of hospitalization and death. Current treatment options (epinephrine auto-injectors and manual intramuscular injection) are considered cumbersome, and most patients/caregivers fail to use them, even during severe reactions. An intranasal epinephrine delivery device, neffy, has been designed to provide an additional option for patients/caregivers.ObjectiveWe sought to assess the comparative pharmacokinetics and pharmacodynamics of neffy 2.0 mg, EpiPen 0.3 mg, and manual intramuscular injection 0.3 mg.MethodsThis was a phase 1, randomized, 6-treatment, 6-period, 2-part crossover study in 59 healthy subjects. Pharmacokinetic and pharmacodynamic parameters following single and repeat doses of epinephrine were assessed before dosing and at various postdose intervals …

Available since the 1940s, H1-antihistamines are mainstay treatments for allergic conditions such as allergic rhinitis and urticaria. They function as inverse agonists that bind to the H1 receptor to inhibit histamine-induced inflammation. The older, first-generation drugs are no longer recommended for patient use due to their well documented negative side effect profile. Evidence has been accumulating to support a newer generation of H1-antihistamines in oral and intranasal formulations, including in combination with intranasal corticosteroids. The literature is replete with large meta-analyses and systematic reviews establishing the safety and efficacy of second-generation H1-antihistamines in adult and pediatric allergic rhinitis populations including combination nasal spray agents (ex, MP29-02 or MP-AzeFlu). While intra-class differences do exist, patient preference, access and costs should the priority. Robust data …

These evidence-based guidelines support patients, clinicians, and other stakeholders in decisions about the use of intranasal corticosteroids (INCS), biologics, and aspirin therapy after desensitization (ATAD) for the management of chronic rhinosinusitis with nasal polyposis (CRSwNP). It is important to note that the current evidence on surgery for CRSwNP was not assessed for this guideline nor were management options other than INCS, biologics, and ATAD. The Allergy-Immunology Joint Task Force on Practice Parameters formed a multidisciplinary guideline panel balanced to include the views of multiple stakeholders and to minimize potential biases. Systematic reviews for each management option informed the guideline. The guideline panel used the Grading of Recommendations Assessment, Development and Evaluation approach to inform and develop recommendations. The guideline panel reached …

The novel coronavirus disease of 2019 (COVID-19) pandemic has severely impacted the training of health care professional students because of concerns of potential asymptomatic transmission to colleagues and vulnerable patients. From May 27th, 2020, to June 23rd 2021; at a time when B.1.1.7 (alpha) and B.1.617.2 (delta) were the dominant circulating variants, PCR testing was conducted on 1,237 nasopharyngeal swabs collected from 454 asymptomatic health care professional students as they returned to their studies from across Canada to Kingston, ON, a low prevalence area during that period for COVID-19. Despite 46.7% of COVID-19 infections occurring in the 18–29 age group in Kingston, severe-acute-respiratory coronavirus-2 was not detected in any of the samples suggesting that negligible asymptomatic infection occurred in this group and that PCR testing in this setting may not be warranted as a …

IntroductionMediators released during acute allergic reactions elicit vascular reactions, including vasodilation and increased vascular permeability. However, acute changes in systemic cardiovascular physiology during allergic rhinitis have received little attention.MethodsIn a series of pharmacokinetic studies conducted to evaluate the comparative bioavailability of a novel intranasal epinephrine spray relative to epinephrine injection, we performed two cross-over studies in allergic rhinitis patients who underwent nasal allergen challenge (NAC) (Study 1, n=36) or a 3-hour OHIO Chamber exposure (Study 2, n=36). In these studies, endogenous epinephrine levels were assessed during both normal conditions and after rhinitis symptoms were induced.ResultsThe results showed that induced allergic rhinitis symptoms increased circulating epinephrine. In Study 1, mean epinephrine levels in the normal conditions …

BackgroundDespite available treatments for allergic rhinitis (AR), patients are often dissatisfied with their treatment and experience uncontrolled symptoms. Measurement-based care is the systematic use of standardized measurements used during office visits to inform treatment decisions. The Improving Symptom Control of Allergic Rhinitis (ICAR) study determined if the assessment and management of AR through measurement-based care could improve patient outcomes.MethodsICAR was a real-world, open-label, prospective, multicenter study conducted in Canada between September 2021 and December 2021. Enrolled adult patients (n= 503) with AR were categorized as treatment-naïve, uncontrolled despite AR treatment, or requiring a treatment switch due to adverse effects. AR symptoms and symptom control were assessed by the patient using the Rhinitis Control Assessment Test (RCAT) and, by both the patient and the clinician, on a visual analog scale (VAS) at baseline and after 4 weeks of 10 mg daily oral rupatadine.ResultsThe majority of patients were uncontrolled (36%) or partially controlled (51%) at baseline, while 20% were treatment-naïve, 32% were uncontrolled despite treatment, and 30% needed treatment switch.

Background Allergy immunotherapy (AIT), in the form of subcutaneous immunotherapy (SCIT) with alum-precipitated aqueous extracts, SCIT with a modified ragweed pollen allergen tyrosine adsorbate (MRPATA; Pollinex®-R), or a sublingual immunotherapy (SLIT)-tablet are options for the treatment of ragweed pollen allergic rhinoconjunctivitis (ARC) in Canadian children. A cost minimization analysis evaluated the economic implications of the use of the ragweed SLIT-tablet vs SCIT in Canadian children with ragweed ARC. Methods A cost minimization analysis was conducted comparing the short ragweed SLIT-tablet, 12 Amb a 1-U, preseasonally with preseasonal ragweed SCIT, annual ragweed SCIT, or MRPATA. The analysis was conducted over a time horizon of 3 years from a public payer perspective in Ontario and Quebec. Resources and costs associated with medication and services of healthcare …

IntroductionEducational programs on chronic cough may improve patient care, but little is known about how Canadian physicians manage this common debilitating condition. We aimed to investigate Canadian physicians’ perceptions, attitudes, and knowledge of chronic cough.MethodsWe administered a 10-min anonymous, online, cross-sectional survey to 3321 Canadian physicians in the Leger Opinion Panel who managed adult patients with chronic cough and had been in practice for > 2 years.ResultsBetween July 30 and September 22, 2021, 179 physicians (101 general practitioners [GPs] and 78 specialists [25 allergists, 28 respirologists, and 25 ear/nose/throat specialists]) completed the survey (response rate: 5.4%). In a month, GPs saw a mean of 27 patients with chronic cough, whereas specialists saw 46. About one-third of physicians appropriately identified a duration of > 8 weeks as the definition …

BackgroundThe Champlain BASE™ and Ontario eConsult services are virtual platforms that serve to facilitate contact between primary care providers and specialists across Ontario, relaying patient-specific questions to relevant specialists via a secure web-based platform. Despite ample evidence regarding the general effectiveness of these platforms, their utility as it pertains to clinical concerns regarding COVID-19 vaccines has not yet been explored.MethodsWe performed a cross-sectional descriptive analysis of COVID-19 vaccine related eConsults on Ontario patients completed by five allergy specialists between February and October of 2021. 4318 COVID-19 vaccine-related eConsults were completed in total during this time; with 1857 completed by the five allergists participating in this analysis. Question types/content were categorized using a taxonomy developed through consensus on a weighted monthly …

Background: During the COVID-19 pandemic, threats to mental health, psychological safety, and well-being are evident, particularly among the first responders and the health care staff.Objective: This study aims to examine the prevalence and potential predictors of the likely stress, generalized anxiety disorder, and major depressive disorder among health care workers (HCWs).Methods: A cross-sectional survey was used through a survey link sent to gather demographic information and responses on several self-report scales, including the Perceived Stress Scale, the Generalized Anxiety Disorder 7-item scale, and the Patient Health Questionnaire-9 among HCWs enrolled in the Text4Hope program.Results: The result from this study suggests that during the COVID-19 pandemic, HCWs reported a high likelihood of moderate-to-high perceived stress (n= 840, 81.2%), moderate-to-severe anxiety (n= 369, 38.6%), and depression (n= 317, 32.7%) symptoms. Nurses and other HCWs were significantly more likely to report depressive symptoms compared to physicians (F (2, 159.47)= 15.89, 95% CI–5.05 to–2.04). Younger age groups of HCWs (≤ 30 years) were more prone to report likely stress, anxiety, and depressive symptoms compared to HCWs 41-50 and> 50 years old (odds ratio [OR] 1.82-3.03). Similarly, females and those who reported a lack of social support (separated/divorced and single) among HCWs had a higher likelihood to report likely stress and depressive symptoms, respectively (OR 1.8 and 1.6, respectively).Conclusions: This cross-sectional study explored a high level of mental health burdens during the COVID-19 pandemic …

Intramuscular epinephrine is the first-line treatment for anaphylaxis, including anaphylaxis caused by food allergy. Antihistamines and glucocorticoids are considered second-line treatments for anaphylaxis due to slow onset of action and inability to reverse life-threatening cardiovascular and pulmonary symptoms. Antihistamines can help with cutaneous symptoms while glucocorticoids can reduce inflammatory mediators. The role of these drugs in preventing biphasic anaphylaxis is unclear. Nebulized adrenaline, glucagon, and beta-2 agonists in some cases are helpful as adjunctive medications in managing the symptoms of anaphylaxis. Following anaphylaxis, patients should receive education on how to identify signs of anaphylaxis and treat it with an epinephrine auto-injector, a prescription for an epinephrine auto-injector, an anaphylaxis management plan, and a referral to an Allergist and Immunologist. Strict …

MethodsThe SPAC-EEU is a micro-controlled room within the established EEU in Kingston, Ontario, Canada, used to study perennial AR. Cat dander (Greer®, USA) was visualized using light and scanning electron microscopy and distributed in the SPAC-EEU over 2-hour exposure periods. Sampling cassettes (Zefon International, USA) were arranged throughout the facility to sample the air over the course of the exposure, and particles sized 2.5 μm, 5.0 μm, 10.0 μm, 20.0 μm, and 25.0 μm were tracked in real-time using a laser particle counter (LPC). Fel d 1 concentrations were assessed using a Fel d 1-specific enzyme-linked immunosorbent assay (Indoor Biotechnologies, USA).ResultsThe cat dander product contained particles of various sizes, including hair. When distributed in the SPAC-EEU using similar equipment settings, five independent runs showed statistically similar concentrations of Fel d 1 (p= 0 …

Background and aimsWith an increasing number of Clinical Practice Guidelines (CPGs) addressing primary prevention of food allergy and atopic dermatitis, it is timely to undertake a comprehensive assessment of the quality and consistency of recommendations and evaluation of their implementability in different geographical settings.MethodsWe systematically reviewed CPGs from 8 international databases and extensive website searches. Seven reviewers screened records in any language and then used the AGREE II and AGREE REX instruments to critically appraise CPGs published between January 2011 and April 2022.ResultsOur search identified 2138 relevant articles, of which 30 CPGs were eventually included. Eight (27%) CPGs were shortlisted based on our predefined quality criteria of achieving scores >70% in the “Scope and Purpose” and “Rigour of Development” domains of the AGREE II …

Respiratory viruses are transmitted and acquired via the nasal mucosa, and thereby may influence the nasal metabolome composed of biochemical products produced by both host cells and microbes. Studies of the nasal metabolome demonstrate virus-specific changes that sometimes correlate with viral load and disease severity. Here, we evaluate the nasopharyngeal metabolome of COVID-19 infected individuals and report several small molecules that may be used as potential therapeutic targets. Specimens were tested by qRT-PCR with target primers for three viruses: Influenza A (INFA), respiratory syncytial virus (RSV), and SARS-CoV-2, along with unaffected controls. The nasopharyngeal metabolome was characterized using an LC–MS/MS-based screening kit capable of quantifying 141 analytes. A machine learning model identified 28 discriminating analytes and correctly categorized patients with a viral …

Introduction: Global guidelines define chronic cough (CC) as cough lasting >8 weeks.Objective: To understand physicians’ perceptions, attitudes and knowledge of different aspects of CC.Methods: Anonymous Canadian web-based survey completed by 101 primary care physicians (PCP) and 78 specialists (25 allergists, 28 pulmonologists, and 25 ENTs). Diagnostic tests performed were rated from 1 (never perform) to 10 (always perform).Results: The recognition of CC as a cough lasting longer than 8 weeks by PCP and specialists was 30% and 38%, respectively. PCP reported that patients with CC comprise 6% of their patient visits in a month vs specialists reporting 16%. The estimated time spent in a typical visit related to CC (PCP: 17 minutes; specialists: 23 minutes) was similar to a typical type 2 diabetes visit (17 minutes). PCP and specialists rated high (≥8/10) that they routinely perform a chest x-ray when …

BackgroundCanadian children are widely exposed to phthalates and polycyclic aromatic hydrocarbons (PAHs) from indoor sources. Both sets of compounds have been implicated in allergic symptoms in children.ObjectiveWe characterize concentrations of eight phthalates and 12 PAHs in floor dust from the bedrooms of 79 children enrolled in the Kingston Allergy Birth Cohort (KABC).MethodFloor dust was collected from the bedrooms of 79 children who underwent skin prick testing for common allergens after their first birthday. Data were collected on activities, household, and building characteristics via questionnaire.ResultsDiisononyl phthalate (DiNP) and phenanthrene were the dominant phthalate and PAH with median concentrations of 561 µg/g and 341 ng/g, respectively. Benzyl butyl phthalate (BzBP) and chrysene had the highest variations among all tested homes, ranging from 1–95% to 1–99 …

MethodsVenous peripheral blood was collected pre-NAC, 6-hours, and 24-hours post-NAC, then processed and frozen. Thawed serum aliquots were evaluated using Milliplex MAP magnetic bead panels and the Bio-Plex 200 system and the following cytokines were measured: IL-4, IL-5, IL-6, IL-10, IL-13, TNF-a, IFNg, IL-1b, MIP-1b, RANTES and MCP-1. Using GraphPad Prism 9.0, mixed effect analysis with multiple comparisons tests and the Bonferroni correction was used to assess cytokine concentrations over time across both populations. T-tests were used to compare the percent change in cytokines levels from pre-NAC.ResultsFifteen RW-allergic and nine non-allergic participants completed the NAC. There were no significant changes in serum cytokine concentrations post-NAC in both groups (P> 0.05). However, the percent change in IL-10 (P= 0.0269), MIP1-b (P= 0.0181), and RANTES (P= 0.0302 …

IntroductionThe intranasal (IN) epinephrine spray (ARS-1) is an investigational, needleless alternative to epinephrine injection for patients with severe systemic allergic reactions.MethodsThis single-dose, partially randomized crossover phase 1 study investigated the pharmacokinetics (PK) and pharmacodynamics (PD) of ARS-1 2 mg IN (under normal conditions and with induced rhinitis) and manual intramuscular (IM) injection (0.3 mg and 0.5 mg) in subjects with seasonal allergies. IRB approval was obtained for this study.ResultsThirty-six subjects were included in the study. Mean Cmax values (pg/mL) with ARS-1 (491) and ARS-1 with rhinitis (309) were higher than or similar to those for 0.3 mg (283) or 0.5 mg (452) IM injection. Median tmax values (minutes) were lowest with ARS-1 (20.0) and ARS-1 with rhinitis (6.00) compared with either IM dose (both 45.00). Mean Emax for systolic blood pressure (SBP …

Introduction: Although no licensed treatments for chronic cough (CC) exist, clinicians manage patients by treating underlying respiratory diseases or administering guideline recommended treatments.Objective: To describe the perceptions of primary care physicians (PCP), and specialists on the management and effectiveness of treatments for CC.Methods: Canada-wide survey of 101 PCP and 78 specialists (25 allergists, 28 pulmonologists, and 25 ENTs. Frequency of prescription of drugs for CC patients and perception of efficacy were rated from 1 (low) to 10 (high).Results: 62% of PCP and 53% of specialists report they often initiate treatment and assume follow up of patients with CC. Many patients are lost to follow up in primary (17%) and secondary (41%) care. 25% of PCP often refer to pulmonologists for a second opinion, while only 11% often refer to an ENT and 7% to an allergist. Top rated (≥8/10 rating …

MethodsFifty-five participants were divided between modest and higher HDM concentration sessions. We collected peripheral blood and nasal brushings pre-and post-exposure. Cytokine concentrations from isolated serum were measured using the Milliplex xMAP kit and BioPlex-200 system including: IL-4, IL-5, IL-6, IL-10, IL-13, and TNF-α. RNA isolated from nasal brushing samples (QIAGEN AllPrep DNA/RNA Mini Kit) was reverse transcribed (QIAGEN QuantiTect Reverse Transcription Kit) with cDNA evaluated using qPCR. Our gene targets were IL-33, IL-13, with ubiquitin C (UBC) as the reference gene. GraphPad Prism 9.0 was used for statistical analyses.ResultsChange in IL-5 and post-exposure IL-13 concentrations were significantly decreased for allergics compared to non-allergics (p< 0.05) and baseline (p< 0.05), respectively. Post-exposure TNF-α concentrations were significantly decreased (p< 0.05 …

IntroductionAlthough considered clinically indistinguishable, pharmacokinetics (PK) and pharmacodynamics (PD) between epinephrine intramuscular (IM) injection devices and manual IM injection are different. Differences in PD profiles of epinephrine products affecting blood pressure (BP) were investigated.MethodsThis integrated analysis was based on 4 randomized, cross-over, phase 1 studies (175 participants) comparing epinephrine manual IM 0.3 mg injection, epinephrine 0.3 mg injection devices, and epinephrine 1 mg nasal spray (ARS-1) once and twice dosing. IRB approval was obtained by all clinical sites.ResultsHighest mean Cmax values (pg/mL) were observed following epinephrine auto-injector (503), with ARS-1 (258) comparable to manual IM (254), with the trend similar with twice-dosing. Mean systolic BP (SBP) Emax change from baseline (mm Hg) and heart rate (HR) Emax change from …

Patients with asthma frequently over rely on short-acting beta-agonists (SABA) to treat acute symptoms. This can adversely impact quality of life and increase the risk of exacerbations. SABA overuse is also associated with an increased risk of mortality. In their 2021 update on the diagnosis and management of mild asthma, the Canadian Thoracic Society (CTS) newly recommended that a combination inhaled corticosteroid (ICS) and long-acting beta-agonist, specifically budesonide/formoterol, may be used as-needed (PRN) as an alternative reliever to SABA. The CTS developed an algorithm as a guide for deciding for whom PRN budesonide/formoterol versus PRN SABA is appropriate as a reliever. While the CTS algorithm provides necessary and precise guidance, the somewhat complicated requirements for determining control and exacerbation risk may still end up leaving some patients at-risk of SABA …

Introduction: Allergic rhinitis (AR) is an inflammatory disease of the nasal mucosa that can be modeled using Controlled Allergen Exposure Facilities (CACF). Recently, we clinically validated the house dust mite (HDM) Environmental Exposure Unit (EEU) facility. In the current study, we aimed to assess biological responses in the blood following HDM exposure in the HDM-EEU. Methods: Fifty-five participants passed a screening visit, where they provided consent and completed a skin prick test (SPT), then attended a modest or higher HDM exposure session. Baseline and post-exposure blood samples were collected. Complete blood counts with differentials were measured, and isolated serum was used to determine Dermatophagoides farinae- and Dermatophagoides pteronyssinus-specific IgE (sIgE) and cytokine concentrations (IL-4, IL-5, IL-6, IL-10, IL-13, TNF-α). Results: HDM-allergic participants had significantly greater SPT wheal sizes than healthy controls. sIgE concentrations were significantly greater in allergic participants, with a strong correlation between Dermatophagoides farinae and Dermatophagoides pteronyssinus. Serum eosinophil counts were significantly decreased post-exposure for allergic participants. White blood cell, neutrophil, and lymphocyte counts were significantly increased for both allergic and non-allergic participants post-exposure. Serum IL-13 concentrations were significantly reduced post-exposure in allergics while TNF-α was significantly reduced in non-allergics. Conclusion: The HDM-EEU is a useful model for investigating biologic mechanisms of HDM-induced AR. Allergic participants produced measurable …

Background and aimsAllergy prevention strategies have gained significant traction as a means to attenuate the growing burden of allergic diseases over the past decade. As the evidence base for primary prevention of food allergy (FA) and atopic dermatitis (AD) is constantly advancing, clinical practice guideline (CPG) recommendations on interventions for FA and AD prevention vary in quality and consistency among professional organizations. We present a protocol for a systematic review of CPGs on primary prevention of FA and AD.MethodsWe will systematically review and appraise all CPGs addressing primary prevention of FA and AD and report our findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases and manual website searches from January 2011 to March 2021 without language or geographical restrictions, and …

Resolving conflict of interest The Joint Task Force on Practice Parameters (JTFPP) is committed to ensuring that all guidelines are based on the best scientific evidence at the time of publication, and that such evidence is free of commercial bias to the greatest extent possible. Before confirming the selection of the workgroup chairpersons and members, the JTFPP discusses and resolves all relevant potential conflicts of interest (COI) of each potential workgroup member. The JTFPP recognizes that experts in a field are likely to have interests that could come into conflict with the development of a completely unbiased and objective guideline. Therefore, a process has been developed to acknowledge potential COI when making specific recommendations. To preserve the greatest transparency regarding potential COI, all members of the JTFPP and workgroup complete a COI disclosure form prior to beginning work on the practice parameter and again prior to the guideline submission for publication. These disclosure forms are published on the JTFPP website. During the review process there are additional measures to avoid bias. At the workgroup level, all the recommendations and discussion sections are reviewed by all workgroup members to ensure that content is appropriate and without apparent bias. If any recommendation or section is deemed to have apparent bias, it is appropriately revised, without the section author’s involvement, in an attempt to remove potential bias. In addition, the entire document is also reviewed by the JTFPP and any apparent bias is acknowledged and removed at that level. For each and every recommendation, a …

Allergic rhinitis (AR) is an inflammatory condition affecting the nasal mucosa mediated byimmunoglobulin-E (IgE). It impacts an estimated 25% of Canadians, of whom most report inadequatesymptom control despite treatment as well as highrates of asthma comorbidity. First line pharmacologic options include non-sedating, 2nd generation oral H1-antihistamine (OAH) and/or intranasal corticosteroid (INCS) therapeutic agents. Allergen immunotherapy (AIT) is a possible treatment option for moderate-to-severe disease which is uncontrolled with the use of first-line therapies or for those patients wishing to avoid pharmacologic intervention. However, patient education, engagement, and empowerment are central to optimal clinica outcomes. This supplement summarizes the literature to present the future of AR management.

BackgroundDespite the symptom overlap between allergic rhinitis (AR) and coronavirus disease 2019 (COVID-19), pandemic-time anxiety in people with AR remains an area of limited study.ObjectiveTo assess the AR-anxiety relationship in the unique context of the COVID-19 pandemic from a Canadian perspective.MethodsThe COVID-19 Associated Anxiety in patients with Asthma and AR Experiencing Symptoms survey was distributed on the “Qualtrics XM” platform, with 835 adult participants responding to the first iteration from April to August 2020. Anxiety was assessed on the Generalized Anxiety Disorder Assessment-7 (GAD-7), and AR burden of disease was assessed on the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). All analyses were conducted using IBM SPSS Statistics 27.ResultsHigh levels of anxiety were found, with 28.0% of the AR group and 27.5% of the control group meeting the …

The Annual Literature Review, Section on Anaphylaxis and Stinging Insect Allergy, highlighted a number of new and different findings. The study of Park et al entitled" Combining discordant serum IgE and skin testing improves diagnostic and therapeutic accuracy for Hymenoptera venom hypersensitivity immunotherapy" found the novel occurrence of increased sensitivity and specificity from serum-specific immunoglobulin E (IgE) testing to vespids over intradermal skin testing and suggested that this test should be performed first to help make the best selection of antigens to include in a venom immunotherapy treatment set.

Cannabis is the most widely used recreational drug in the world. Cannabis sativa and Cannabis indica have been selectively bred to develop their psychoactive properties. The increasing use in many countries has been accelerated by the COVID‐19 pandemic. Cannabis can provoke both type 1 and type 4 allergic reactions. Officially recognized allergens include a pathogenesis‐related class 10 allergen, profilin, and a nonspecific lipid transfer protein. Other allergens may also be relevant, and recognition of allergens may vary between countries and continents. Cannabis also has the potential to provoke allergic cross‐reactions to plant foods. Since cannabis is an illegal substance in many countries, research has been hampered, leading to challenges in diagnosis since no commercial extracts are available for testing. Even in countries such as Canada, where cannabis is legalized, diagnosis may rely solely on …

BackgroundChronic rhinosinusitis with nasal polyposis (CRSwNP) is associated with a significant disease burden. The optimal use of and administration route for intranasal corticosteroids (INCS) when managing CRSwNP are unclear.ObjectiveWe systematically synthesized the evidence addressing INCS for CRSwNP.MethodsWe searched studies archived in Medline, Embase, and Central from database inception until September 1, 2021, for randomized controlled trials comparing INCS using any delivery method to placebo or other INCS administration types. Paired reviewers screened records, abstracted data, and rated risk of bias (CLARITY revision of Cochrane Risk of Bias version 1 tool) independently and in duplicate. We synthesized the evidence for each outcome using random effects network meta-analyses. We critically appraised the evidence following the GRADE (Grades of Recommendation …

IntroductionAnaphylaxis is a severe, potentially fatal multiorgan system manifestation of an allergic reaction. The highest incidence of anaphylaxis is in children and adolescents. Biphasic anaphylaxis (BA) is defined as the recurrence of allergic symptoms after resolution of an initial reaction. It has been reported to occur in 10%–20% of cases within 1–48 hours from the onset of the initial reaction. The dilemma for physicians is determining which patients with resolved anaphylaxis should be observed for BA and for how long. Guidelines for duration of postanaphylaxis monitoring vary, are based on limited evidence and can have unintended negative impacts on patient safety, quality of life and healthcare resources. The objectives of this study are to derive a prognostic model for BA and to develop a risk-scoring system that informs disposition decisions of children who present to emergency departments (ED) with …

The prevalence of cat allergen-induced AR is increasing worldwide, prompting its study using controlled methodology. Three general categories of allergen exposure models currently exist for the study of cat allergen-induced AR: natural exposure cat rooms, allergen exposure chambers (AEC), and nasal allergen challenges (NAC). We evaluated existing literature surrounding the use of these models to study cat allergen induced AR using online research databases, including OVID Medline, Embase, and Web of Science. We report that natural exposure cat rooms have been important in establishing the foundation for our understanding of cat allergen-induced AR. Major limitations, including variable allergen ranges and differing study designs highlight the need for a more standardized protocol. In comparison, AECs are an exceptional model to mimic real-world allergen exposure and study long-term implications of AR with large sample sizes. Existing AECs are limited by heterogenous facility designs, differing methods of cat allergen distribution, and issues surrounding cost and accessibility. Conversely, NACs allow for smaller participant cohorts for easier biological sampling and are ideal for phase I, phase 2 or proof-of-concept studies. NACs generally have a standardized protocol and are less expensive compared to AECs. Nevertheless, NACs solely capture acute allergen exposure and have the further limitation of using allergen extracts rather than natural allergen. As the use of combined controlled methodologies is sparse, we recommend concurrent use of AECs and NACs to study short- and long-term effects of AR, thereby providing a …

Background:COVID-19 symptoms overlap with allergic rhinitis (AR) and asthma, potentially impacting mental well-being [1]. Research regarding the effects of anxiety and stress on Health Care Professional (HCP) students throughout the COVID-19 pandemic is beginning to emerge. It is currently unknown if trainees with atopic conditions experience different stress levels than their non-atopic peers. In Canadian adults, the estimated prevalence for AR and food allergy (FA) is 44% and 6.1%, respectively [2, 3].Methods:Between August 2020 to June 2021, Faculty of Health Sciences students (n= 266) completed a one-time questionnaire using the QualtricsXMTMsurvey platform of which 114 respondents disclosed their atopic status. The following data was collected Self-reported atopy status, Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionaire-9 (PHQ-9), and Perceived Stress Score-10 (PSS-10). Participants were then classified based on the type and number of atopic conditions they reported. A follow-up visit involving skin prick testing (SPT) to a standard panel of 9 aeroallergen and food extracts, and/or fresh fruits, where applicable, was completed (n= 34) to determine how accurately allergies were self-reported. Statistical analyses were performed using SPSS 27.Results:Having a self-reported allergic condition or asthma did not impact GAD-7, PSS, and PHQ-9 scores, in HCP students. Further stratifying the dataset by the type and number of allergic conditions also did not impact GAD-7, PSS, and PHQ-9 scores or severity. The self-reported prevalence of asthma, AR and FA was 5.71%, 64.71%, and 29.41%, respectively. SPT …

ObjectiveTo summarize the current literature of the psychological impacts of coronavirus disease 2019 (COVID-19) on people with allergic diseases and to identify gaps in need of future research.Data SourcesOvid MEDLINE(R) and Embase Classics + Embase from 1947 to present (October 18, 2021) were searched using a search strategy that included the following keywords: allergic diseases, covid*, and psychological disorders.Study SelectionsPrimary manuscripts and abstracts using online and telephone surveys, mixed-method studies capturing patient and caregiver experiences, case studies, and published guidelines from allergic disease-specific expert groups were included.ResultsPeople with asthma and other chronic respiratory conditions are at higher risk of negative psychological outcomes, and risk factors include asthma severity, female sex, and previous history of anxiety and depression, likely …

BackgroundIncreased cannabis consumption worldwide challenges allergists because of an upsurge in cannabis allergy and need to discuss cannabis with patients.ObjectiveTo determine the knowledge, attitudes, and practices regarding cannabis among allergists and their approach to recognizing and diagnosing suspected cannabis allergy.MethodsThe International Allergist Canna Knowledge, Attitudes, and Practices Survey was completed by members from 3 International Allergy Societies. Survey questions included the following: 13 on cannabis attitudes, 7 on cannabis knowledge, and 4 on real-world allergy practices. Knowledge level was dichotomized and Statistical Package for the Social Sciences TwoStep Cluster Analysis grouped participants by attitudes. Multivariate analysis determined the relationship of knowledge and attitude to practice delivery.ResultsOf 570 eligible surveys started, 445 (78.1 …

IntroductionBuilding capacity to improve sex/gender knowledge and strengthen patient engagement in clinical trials requires training and support. The overall goal of this 2-year project is to refine, translate and evaluate two web-based open-access patient and investigator decision aids aimed to improve patient engagement partnerships in clinical trials.Methods and analysisTwo decision aids were designed in Phase 1 of this programme of research and this protocol describes a subsequent sequential phased approach to refine/translate (Phase 2A) and conduct alpha/usability (Phase 2B) and beta/field (Phase 3) testing. Decision aid development is guided by the International Patient Decision Aid Standards, User-Centred Design, Ottawa Decision-Support Framework and the Ottawa Model of Research Use. We have integrated patient-oriented research methods by engaging patient partners across all phases of our …

IntroductionARS-1, an intranasal (IN) epinephrine spray, is under development as a needle-free alternative to manual intramuscular (IM) injection and epinephrine injection devices for allergic reactions.MethodsA two-part, single- and repeat-dose, randomized, crossover, phase 1 study of ARS-1 (2.0 mg), epinephrine auto-injector (0.3 mg), and IM injection (0.3 mg) was conducted in healthy volunteers. Pharmacokinetic (PK) and pharmacodynamic (PD) parameters were examined. IRB approval was obtained for this study.ResultsForty-two subjects were included. Following single dose, mean Cmax values were 753, 481, and 339 pg/mL for auto-injector, ARS-1, and IM injection, respectively. Median tmax (minutes) was shortest for auto-injector (7.5), then ARS-1 (30), and IM injection (45). After repeat dosing, PK characteristics were similar for ARS-1 and auto-injector. Cmax was 992 and 1000 pg/mL for both ARS-1 …

MethodsHDM-allergic volunteers, deemed eligible to participate based on relevant clinical history and positive skin prick test (SPT) results, and healthy control participants were invited to one of two exposure sessions in the HDM-EEU. Following a baseline collection, symptomatic data including Total Nasal Symptom Score (TNSS) and Peak Nasal Inspiratory Flow (PNIF) were collected every half hour for the 3-hour HDM exposure, on an hourly basis until 12 hours post-exposure, and at 24 hours.ResultsFollowing the screening visit, 20 HDM-allergic and 4 non-allergic participants were exposed to a moderate target of HDM while 24 atopics and 6 non-atopics received a high HDM dose. Both groups of allergics had significantly greater (moderate target: p< 0.01; high target: p< 0.001) SPT wheal sizes against D. pteronyssinus and D. farinae compared to controls. Elevated TNSS responses were sustained for up to 5 …

ObjectiveTo present a comprehensive, clinically focused scoping review of therapeutic agents and practices comprising the future of allergic rhinitis (AR) management.Data SourcesA review of the published literature was performed using the PubMed database, published abstracts, and virtual presentations from scientific meetings and posted results on ClinicalTrials.gov.Study SelectionsPrimary manuscripts with trial results, case reports, case series, and clinical trial data from ClinicalTrials.gov, PubMed, and articles highlighting expert perspectives on management of AR were selected.ResultsTelemedicine, social media, and mHealth facilitate integrated care for AR management. Pharmacotherapy remains the standard of care for AR management; however, treatment combinations are recommended. Intralymphatic immunotherapy and peptide immunotherapy are the most promising new allergen immunotherapy …

IntroductionAllergen-specific immunotherapy (AIT) is the only disease-modifying treatment option for allergic rhinitis (AR) patients with persistent moderate-severe AR for whom traditional pharmacotherapies are ineffective. The nasal allergen challenge (NAC) and allergen exposure chamber (AEC) are two translational models of AR that can be used to investigate the properties, safety, and efficacy of AIT.Areas CoveredPeer-reviewed, human-centered articles utilizing AEC or NAC models to investigate AIT between 2010 and 2020 were curated from PubMed, EMBASE, and OVID Medline databases. AECs have been used to evaluate traditional subcutaneous and sublingual administrations of AIT, including cross-protective effects and different dosing regimens. More recently, the effectiveness of novel AIT formulations has been evaluated. NACs are another model used to study AIT, including using novel …

BackgroundBirch pollen is a prevalent aeroallergen during the springtime allergy season. In field studies, variable allergen exposure and environmental factors can affect data quality while environmental exposure units (EEUs) deliver controlled, standardized, and reproducible allergen exposures.ObjectiveTo inform study design for EEU trials evaluating antiallergic therapies.MethodsIn this prospective study, 76 participants with birch allergy experienced 3 exposures to birch pollen: (1) an out-of-season EEU challenge (two 3-hour sessions on consecutive days); (2) a natural seasonal exposure; and (3) an in-season EEU challenge (3-hour exposure for 2 weeks after birch pollen season initiation).ResultsThe total nasal symptom score, total ocular symptom score, and total symptom score (TSS = total nasal symptom score plus total ocular symptom score) were assessed every 30 minutes and daily during EEU and …

Background Safe and effective vaccines provide the first hope for mitigating the devastating health and economic impacts resulting from coronavirus disease 2019 (COVID-19) and related public health orders. Recent case reports of reactions to COVID-19 vaccines have raised questions about their safety for use in individuals with allergies and those who are immunocompromised. In this document, we aim to address these concerns and provide guidance for allergists/immunologists. Methods Scoping review of the literature regarding COVID-19 vaccination, adverse or allergic reactions, and immunocompromise from PubMed over the term of December 2020 to present date. We filtered our search with the terms “human” and “English” and limited the search to the relevant subject age range with the term “adult.” Reports resulting from these searches and …

Patients who have experienced anaphylaxis (or suspected anaphylaxis) require evaluation to confirm the diagnosis and determine the cause (s) and possible contributing factors, such as other medical conditions (comorbidities) and concurrent medications.REFERRAL TO AN ALLERGY/IMMUNOLOGY SPECIALIST—Referral to a board-certified allergy specialist is indicated in all cases of certain or suspected anaphylaxis [1-5]. A thorough evaluation is required to accomplish the following objectives:

BackgroundBirch, alder, hazel, and oak are members of the birch homologous group based on cross-reactivity toward the birch pollen allergen Betula verrucosa 1. Theoretically, allergy to these tree pollens may be treated by immunotherapy with one representative allergen extract.ObjectiveTo evaluate post hoc whether treatment of birch pollen–induced allergic rhinoconjunctivitis with a standardized tree sublingual immunotherapy (SLIT)-tablet containing birch pollen extract reduces symptoms and symptom-relieving medication use during the oak pollen season (OPS).MethodsIn a randomized, multinational, double-blind trial (EudraCT-2015-004821-15), 634 participants (ages 12-65 years) received daily tree SLIT-tablet (12 SQ-Bet) or placebo before and during tree pollen season (alder/hazel plus birch pollen season [BPS]). Symptom-relieving medication was allowed. The primary end point was the average total …

Concerns for anaphylaxis may hamper severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunization efforts. We convened a multidisciplinary group of international experts in anaphylaxis composed of allergy, infectious disease, emergency medicine, and front-line clinicians to systematically develop recommendations regarding SARS-CoV-2 vaccine immediate allergic reactions. Medline, EMBASE, Web of Science, the World Health Organizstion (WHO) global coronavirus database, and the gray literature (inception, March 19, 2021) were systematically searched. Paired reviewers independently selected studies addressing anaphylaxis after SARS-CoV-2 vaccination, polyethylene glycol (PEG) and polysorbate allergy, and accuracy of allergy testing for SARS-CoV-2 vaccine allergy. Random effects models synthesized the data to inform recommendations based on the Grading of Recommendation …

Allergic rhinitis (AR) is an immunoglobulin E− mediated hypersensitivity reaction triggered by allergen exposure that causes inflammation of the nasal cavity. Allergens can be seasonal, such as pollens and grasses, or perennial, including house dust mite and animal dander. Historically, evaluations of novel AR therapies have been conducted using outpatient studies in which participants, having received a certain medication, go about their day-to-day routines during the expected pollen season. Though clinically relevant, real-world field studies are inherently limited by the heterogeneity of allergen exposure across different geographic locations and varying daily routines of participants. Field studies can also be associated with irregular compliance of medication and recording of daily symptom scores. Experimental models have been developed to counter these limitations, namely the environmental exposure unit …

Background A cost-minimization analysis (CMA) was performed to evaluate the economic implications of introducing the SQ Tree sublingual immunotherapy (SLIT)-tablets marketed as ITULATEK®(Health Canada regulatory approval in April 2020) for the treatment of pollen-induced (birch, alder and/or hazel) seasonal allergic rhinitis in Canada (Ontario and Quebec), where Tree Pollen subcutaneous immunotherapy (SCIT) is already an available treatment option. Methods A CMA was deemed appropriate and was based on the assumption that the SQ Tree SLIT-tablets have comparable efficacy to Tree Pollen SCIT. A societal perspective was adopted in the model, including relevant costs of medications, costs of health care services, and productivity losses. The time horizon in the model was three years, which corresponds to a minimal treatment course of allergy immunotherapy. Resource use and costs were …

Background Post hoc analyses of randomized placebo-controlled trials have demonstrated efficacy and tolerability of the ragweed sublingual immunotherapy (SLIT)-tablet in Canadian adults with ragweed pollen-induced allergic rhinitis/conjunctivitis (AR/C). This post hoc analysis evaluated the efficacy and tolerability of the ragweed SLIT-tablet in the subpopulation of Canadian children and adolescents with AR/C in a previously described randomized, double-blind, placebo-controlled trial. Methods The trial (NCT02478398) was conducted in North American and European children/adolescents ages 5–17 years with ragweed pollen-induced AR/C with or without asthma (FEV1 ≥ 80% predicted). Participants were randomized to daily ragweed SLIT-tablet (12 Amb a 1-U) or placebo for up to 28 weeks. The primary endpoint was the average total …

Correction to: Patient Engagement Partnerships in Clinical Trials: Development of Patient Partner and Investigator Decision Aids - PMC Back to Top Skip to main content NIH NLM Logo Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation Search PMC Full-Text Archive Search in PMC Advanced Search User Guide Journal List Springer Open Choice PMC7884578 Other Formats PDF (354K) Actions Cite Collections Share Permalink Copy RESOURCES Similar articles Cited by other articles Links to NCBI Databases Journal List Springer Open Choice PMC7884578 As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Logo of springeropen The Patient Patient. 2021; 14(2): 301. Published online …

In recent decades, seasonal allergic rhinitis (SAR) prevalence has increased and recent studies have shown that air pollutants, such as diesel exhaust particles (DEP), can increase inflammatory and allergic biomarkers. The aim of this study was to investigate the effects of DEP on SAR symptoms induced by ragweed and to evaluate the efficacy and safety of fexofenadine HCl 180 mg versus placebo.This phase 3, single-centre, sequential, parallel-group, double-blind, randomised study (NCT03664882) was conducted in an environmental exposure unit (EEU) during sequential exposures: Period 1 (ragweed pollen alone), Period 2 (ragweed pollen+DEP), and Period 3 (ragweed pollen+DEP+single-dose fexofenadine HCl 180 mg or placebo). Efficacy and safety were evaluated in Period 3. Primary endpoints were the area under the curve (AUC) of total nasal symptom score (TNSS) from baseline to hour 12 (AUC …

BackgroundAlthough it is known that oral antihistamine-pseudoephedrine combination tablets have a faster onset than intranasal corticosteroid sprays in the treatment of allergic rhinitis after the first dose, the magnitude of change has not been measured in a comparative manner. Furthermore, the sensation of sprayed liquid in the nose may lead patients to mistakenly believe that intranasal steroid sprays work instantly.ObjectiveTo evaluate, numerically, nasal airflow changes provided by a single dose of loratadine-pseudoephedrine tablet (LP) and fluticasone propionate nasal spray (FP) in participants experiencing allergic rhinitis symptoms, including nasal congestion.MethodsThis single-center, double-blinded, placebo-controlled, crossover study evaluated objective nasal airflow changes in patients with a documented sensitivity to ragweed pollen. Participants were randomized to receive 1 of 4 treatment …

We report here the results of a phase 3 study to assess the efficacy, safety, and tolerability of GC5107, a new 10% liquid intravenous immunoglobulin (IVIG) in preventing serious bacterial infections in patients with primary immunodeficiency (ClinicalTrials.gov: NCT02783482). Over a 12-month study period, 49 patients aged 3 to 70 years with a confirmed diagnosis of primary immunodeficiency received GC5107 at doses ranging from 319 to 881 mg/kg body weight every 21 or 28 days, according to their previous IVIG maintenance therapy. A total of 667 infusions of GC5107 were administered comprising a total of 45.86 patient-years of treatment. A single acute serious bacterial infection occurred during the study, resulting in an incidence of 0.02 events per patient-year (upper 99% one-sided confidence interval limit: 0.21), meeting the prespecified primary efficacy endpoint. The mean incidence of infections other than acute serious bacterial infections was 2.9 infections per patient-year. Efficacy was also demonstrated by the low mean annualized rate of hospitalizations due to infection (0.1 day) and the mean annualized duration of hospitalizations (0.1 day). The mean rate of intravenous and oral antibiotic use was 0.1 day and 13.2 days, respectively. There was a mean of 7.1 days of missed work, school, or daycare days. The proportion of infusions with temporally associated adverse events (TAAEs) occurring during or within 72 hours after GC5107 infusion was 0.24 (upper 95% one-sided confidence interval limit: 0.31), meeting the pre-specified primary safety endpoint. Overall, 149 of 667 infusions (22%) were associated with TAAEs. The most …

Introduction: Idiopathic anaphylaxis (IA) is a diagnosis of exclusion and is based on the inability to identify a causal relationship between a trigger and an anaphylactic event, despite a detailed patient history and careful diagnostic assessment. The prevalence of IA among the subset of people who experienced anaphylaxis is challenging to estimate and varies widely, from 10 to 60%; most commonly noted is; 20% in the adult anaphylactic population. Comorbid atopic conditions, such as food allergy, allergic rhinitis, and asthma, are present in up to 48% of patients with IA. Improved diagnostic technologies and an increased understanding of conditions that manifest with symptoms associated with anaphylaxis have improved the ability to determine a more accurate diagnosis for patients who may have been initially diagnosed with IA. Methods: Literature search was conducted on PubMed, Google Scholar and Embase …

Background Sublingual immunotherapy tablets (SLIT-T) are an effective treatment for allergic rhinitis (AR), but some patients experience local allergic reactions (LAR) in the first few weeks of treatment that can lead to treatment discontinuation. Although oral antihistamines are recommended for the treatment and pretreatment of LAR associated with SLIT-T, there are no clinical trial data to support this recommendation. Rupatadine is an H1 antihistamine that also inhibits platelet activating factor activity. The objective of this case series is to describe real-world clinical situations in which rupatadine was used to treat or mitigate SLIT-T–related LAR. Case presentations Five cases are presented by the managing allergist and off-label use of rupatadine is their expert opinion only. Patients in all 5 cases were treated with a SLIT-T (e.g. ragweed, tree, grass, or …

Background Oak pollen is an important allergen in North America. The genus Quercus (oak) belongs to the family Fagaceae under the order Fagales. Objective The objective of this article was to narratively review the oak pollen season, clinical and epidemiologic aspects of allergy to oak pollen, oak taxonomy, and oak allergen cross-reactivity, with a focus on the North American perspective. Methods A PubMed literature review (no limits) was conducted. Publications related to oak pollen, oak-related allergic rhinitis with or without conjunctivitis, and oak-related allergic asthma were selected for review. Results Oak species are common throughout the United States and contribute up to 50% to overall atmospheric pollen loads. Mean peak oak pollen counts can reach >2000 grains/m3. The start of the oak pollen season generally corresponds to the seasonal shift from winter to spring based on latitude and elevation …

The Developing Microbiome: Lessons from Early Life. Edited by Erika C. Claud. Academic Press,Elsevier Ltd,London, England,United Kingdom. Paperback, 224 pages, $165.00. ISBN: 9780128206027.期刊界 All Journals 搜尽天下杂志 传播学术成果 专业期刊搜索 期刊信息化 学术 搜索 首页 | 官方网站 微博 | 高级检索 The Developing Microbiome: Lessons from Early Life. Edited by Erika C. Claud. Academic Press,Elsevier Ltd,London, England,United Kingdom. Paperback, 224 pages, $165.00. ISBN: 9780128206027. Authors: Anne K Ellis Sophia Linton Affiliation: 1. Department of Medicine, School of Medicine, Queen''s University, Kingston, Ontario, Canada;2. Allergy Research Unit, Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada;1. Department of Science Laboratory Technology, Osun State Polytechnic, Iree, Osun State, Nigeria;2. Department of Pure and Applied Chemistry, …

ObjectiveTo present an update of birth cohort study designs and their contributions to allergic risk.Data SourcesThe PubMed database was used to search for relevant articles.Study SelectionsPeer-reviewed prospective and retrospective studies involving the assessment of allergy using human birth cohorts between 2014 and 2021 were evaluated.ResultsParental history of allergic diseases, especially in cases involving both parents, is associated with increased risk of allergy. Exposure to prenatal and postnatal smoking and limited diet diversity were associated with increased allergic burden. The impact of early-life infections and antibiotics on disease development may be associated with the onset of asthma, though this remains debated. Cohort studies also revealed that the mode of delivery and breastfeeding duration affect the odds ratio of asthma and eczema development. Household exposures, including …

The nose provides a route of access to the body for inhalants and fluids. Unsurprisingly it has a strong immune defense system, with involvement of innate (e.g., epithelial barrier, muco- ciliary clearance, nasal secretions with interferons, lysozyme, nitric oxide) and acquired (e.g., secreted immunoglobulins, lymphocytes) arms. The lattice network of dendritic cells surrounding the nostrils allows rapid uptake and sampling of molecules able to negotiate the epithelial barrier. Despite this many respiratory infections, including SARS-CoV2, are initiated through nasal mucosal contact, and the nasal mucosa is a significant “reservoir” for microbes including Streptococcus pneumoniae, Neisseria meningitidis and SARS -CoV-2. This review includes consideration of the augmentation of immune defense by the nasal application of interferons, then the reduction of unnecessary inflammation and infection by alteration of the nasal microbiome. The nasal mucosa and associated lymphoid tissue (nasopharynx-associated lymphoid tissue, NALT) provides an important site for vaccine delivery, with cold-adapted live influenza strains (LAIV), which replicate intranasally, resulting in an immune response without significant clinical symptoms, being the most successful thus far. Finally, the clever intranasal application of antibodies bispecific for allergens and Intercellular Adhesion Molecule 1 (ICAM-1) as a topical treatment for allergic and RV-induced rhinitis is explained.

MethodsAllergists from the American College of Allergy, Asthma, and Immunology (ACAAI), Canadian Society of Allergy and Clinical Immunology, and European Academy of Allergy and Immunology surveyed their respective members about their KAP towards cannabis. Findings from the ACAAI are presented. SPSS Two-Step cluster analysis determined groups based on attitudes (Table). A knowledge score summed the correct answers to 7 cannabis questions. Chi-square determined significance (P< 0.05) between the Attitudes groups and cannabis knowledge and practice (cannabis use and comfort discussing cannabis with patients).ResultsOf the 193 participants, 59.6% were male, 43.5% were 57-74 years old, 34.4% ever used cannabis, 22% never ask patients about cannabis, 61.2% do not ask about cannabis on intake forms, and 32.2% are not comfortable speaking to patients about cannabis. Two cannabis …

Allergen exposure chambers (AECs) can be used for controlled exposure to allergenic and non‐allergenic airborne particles in an enclosed environment, in order to (i) characterize the pathological features of respiratory diseases and (ii) contribute to and accelerate the clinical development of pharmacological treatments and allergen immunotherapy for allergic disease of the respiratory tract (such as allergic rhinitis, allergic rhinoconjunctivitis, and allergic asthma). In the guidelines of the European Medicines Agency for the clinical development of products for allergen immunotherapy (AIT), the role of AECs in determining primary endpoints in dose‐finding Phase II trials is emphasized. Although methodologically insulated from the variability of natural pollen exposure, chamber models remain confined to supporting secondary, rather than primary, endpoints in Phase III registration trials. The need for further …

MethodsNasal carriage was assessed using culture-based screening of nasal swabs in 20 RW-allergic and 11 non-allergic participants for S. aureus. Subsequently, participants received cumulative intranasal doses of RW until the participant achieved the qualifying criteria for a positive NAC (Total Nasal Symptom Score (TNSS)≥ 8 and% Peak Nasal Inspiratory Flow (PNIF) fall≥ 50%). 15 RW-allergic and 9 non-allergic participants qualified for the NAC. The NLs were collected at B, 6H and 24H post-NAC, differentially stained, and counted. All statistical analyses were performed on GraphPad Prism 8.0.ResultsNasal eosinophil counts were significantly elevated in RW-allergics at 6H (p= 0.0465) and 24H (p= 0.0249) post-NAC compared to non-allergics. In RW-allergic participants, the proportion of eosinophils was significantly increased from baseline at 6H (p= 0.0001) and 24H (p= 0.0061). However, no significant …

Immunological changes in peripheral blood following nasal allergen challenge in subjects with allergic rhinitis pre-and post-peptide immunotherapy: An open-label clinical study I To the Editor i, We investigated immunological changes in peripheral blood samples obtained from individuals with allergic rhinitis (AR), triggered by exposure to cat allergen, who were receiving peptide immunotherapy. The association of allergic rhinitis severity with neutrophil-lymphocyte and platelet-lymphocyte ratio in adults.[Extracted from the article]Copyright of Allergy is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original …

Cholinergic synapse pathway gene polymorphisms may play a role in regulating a type of asthmatic airway response triggered upon allergen challengehttp://bit.ly/2lJx1VG

Allergic diseases are type 2 inflammatory reactions with an increasing worldwide prevalence, making the search for new therapeutic options pertinent. Allergen immunotherapy is the only disease-modifying approach for allergic rhinitis, though it can result in systemic reactions. Recently, peptide immunotherapy (PIT), involving T-cell epitope peptides that bind to major histocompatibility complexes, have been developed. It is speculated that they can induce T helper cell type 2 anergy, Treg cell upregulation or immune deviation. Promising results in cat dander, honeybee venom, Japanese cedar pollen, grass pollens, ragweed and house dust mite clinical trials have shown safety, efficacy and tolerability to PIT. Hence, PIT may hold the potential to change the treatment algorithm for allergic rhinitis.

Rationale The Environmental Exposure Unit (EEU), a controlled allergen exposure model of allergic rhinitis (AR), has traditionally utilized seasonal allergens. We sought to clinically validate the use of house dust mite (HDM), a perennial allergen, in the HDM-EEU, a specially designed facility within the larger EEU. Methods Forty-four HDM-allergic and eleven non-allergic participants were screened and deemed eligible for one of two 3-h exposure sessions in the HDM-EEU. Participants were exposed to a modest or higher HDM target, with blood and nasal brushing samples collected before and after allergen exposure. Symptomatic data, including Total Nasal Symptom Score (TNSS), Total Ocular Symptom Score (TOSS), Total Rhinoconjunctivitis Symptom Score (TRSS), and Peak Nasal Inspiratory Flow (PNIF) were collected at baseline, every 30 min …

This comprehensive practice parameter for allergic rhinitis (AR) and nonallergic rhinitis (NAR) provides updated guidance on diagnosis, assessment, selection of monotherapy and combination pharmacologic options, and allergen immunotherapy for AR. Newer information about local AR is reviewed. Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis. Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR. Either intranasal antihistamines or INCS may be offered as first-line monotherapy for NAR. Montelukast should only be used for AR if there has been an inadequate response or intolerance to alternative therapies. Depot parenteral corticosteroids are not …

Atopic diseases, such as allergic rhinitis and asthma, have become common in westernized countries. 1 These conditions occur when there is dysregulation in the immune system and can be influenced by genetic and environmental factors. 1 Exposure to air pollutants has been associated with allergy and asthma outcomes in children. 2-5 In addition, differences have been reported in concentrations of TH2, TH17, and regulatory T celletype cytokines in individuals with atopy. 6, 7The mechanisms for how these exposures contribute to allergy in children and to plasma cytokine concentrations remain unclear. We established the Kingston Allergy Birth Cohort (KABC) to investigate these interactions. The aim of this project was to assess the connections between environmental exposures in early life on allergic and respiratory disease development and plasma cytokine profiles in children.

This article reviews the current understanding of the role of air pollution in both the symptom exacerbation and rising prevalence of allergic rhinitis (AR) for the development of future AR therapeutics and management strategies. We discuss the epidemiological evidence for this relationship through birth cohort studies, the economic impact of AR, and the influence of air pollution through the lens of the exposome framework of allergic disease development. This is followed by a discussion on the influence of diesel exhaust and diesel exhaust particles (DEP) from motor vehicle emissions and their implication in the rising prevalence of allergic disease and allergic sensitization through triggering inflammatory signalling pathways that exacerbate AR symptoms. Finally, a summary is provided of clinical trials assessing the influence of air pollution on AR with a depiction of currently available therapies and management …

Background Allergic rhinitis (AR) is an inflammatory disease of the nasal mucosa impacting up to 25% of Canadians. The standard of care for AR includes a treatment plan that takes into account patient preferences, the severity of the disease, and most essentially involves a shared decision-making process between patient and provider. Body Since their introduction in the 1940s, antihistamines (AHs) have been the most utilized class of medications for the treatment of AR. First-generation AHs are associated with adverse central nervous system (CNS) and anticholinergic side effects. On the market in the 1980s, newer generation AHs have improved safety and efficacy. Compared to antihistamines, intranasal corticosteroids (INCS) have significantly greater efficacy but longer onset of action. Intranasal AH and INCS combinations offer a single medication option that offers broader disease coverage and faster …

Background The Allergy Patient Identification for Immunotherapy (AsPIRe) program was a parallel physician and patient survey. The objectives were to examine physician and patient perceptions of seasonal allergy symptoms and their impact on patients, and to examine patient and physician attitudes to allergen immunotherapy (AIT) for seasonal allergies. AsPIRe was led by a steering committee and received research ethics board clearance from Queen’s University. Methods Allergists (17) from across Canada enrolled in the AsPIRe program and completed an on-line survey to collect demographic information and baseline perceptions. Allergists then recruited patients and completed paper-based parallel physician and patient questionnaires. Patients received an AIT informational booklet with their questionnaire. Patients who were AIT-naïve with no contraindication to AIT and 12 years of age and older met the …

MethodsThis double-blinded, placebo-controlled, crossover study measured nasal airflow in subjects sensitized to ragweed pollen. Subjects were randomized to receive one of four treatment sequences and their PNIF was collected over four hours following pollen exposure in an environmental exposure unit (EEU).ResultsAverage change in PNIF was 31% for LRT/PSE and was significantly greater than placebo and FS over the course of the study. Yet, FS did not demonstrate a significant change from its placebo. At hour one post-dose, change in PNIF reached a clinically-significant level of 31% in the LRT/PSE group and only 8.6% in the FS group–over a twofold difference. A single dose of LRT/PSE significantly improved PNIF during the four-hour study, showing early onset of nasal airflow changes, but FS did not. Measurable nasal airflow changes correlate with the opening of nasal passages, allowing freer …

The vast majority of individuals labelled as allergic are not deemed truly allergic upon appropriate assessment by an allergist. A label of beta-lactam allergy carries important risks for individual and public health. This article provides an overview of beta-lactam allergy, implications of erroneous beta-lactam allergy labels and the impact that can be provided by structured allergy assessment. We provide recommendations on how to stratify risk of beta-lactam allergy, beta lactam challenge protocols as well as management of patients at high risk of beta-lactam allergy.

MethodsHDM-allergic participants with confirmed allergic status given a 2-year clinical history and positive skin prick test to Dermatophagoides pteronyssinus (D. pteronyssinus) and Dermatophagoides farinae (D. farinae), were recruited for a 3-hour exposure session in the HDM-EEU. With non-allergics as controls, participants recorded AR assessments, consisting of Total Nasal Symptom Score (TNSS) and Peak Nasal Inspiratory Flow (PNIF), at baseline and up to 24 hours post-exposure. Baseline and post-exposure blood samples were collected for biological analyses.ResultsHDM-allergic participants (n= 44) had significantly greater mean wheal sizes for Der p and Der f (p< 0.0001) and significantly elevated serum concentrations of Der p 1-and Der f 1-specific immunoglobulin E (p< 0.0001) compared to healthy controls (n= 11). Allergics also experienced significantly greater peak TNSS and peak% PNIF fall …

ObjectiveTo review birth cohorts with an exposomal approach and their key outcomes and challenges. Exposome encompasses all human environmental exposures from conception onward. The impact of environmental exposures is greatest in critical stages of life, including fetal and early childhood. Birth cohorts provide a good study setting to assess exposome in the sensitive periods of life. Here, we review birth cohorts with an exposomal approach and their key outcomes and challenges.Data SourcesMEDLINE was searched for birth cohorts that have used an exposomal approach.Study SelectionsRelevant studies in English language were selected and reviewed.ResultsThe outcomes of birth cohorts with an exposomal approach improve our understanding of the association between environmental exposures and childhood diseases. For example, results from The Canadian Healthy Infant Longitudinal …