Emerging roles of innate lymphoid cells in inflammatory diseases: Clinical implications.

Innate lymphoid cells (ILC) represent a group of lymphocytes that lack specific antigen receptors and are relatively rare as compared to adaptive lymphocytes. ILCs play important roles in allergic and nonallergic inflammatory diseases due to their location at barrier surfaces within the airways, gut, and skin, and they respond to cytokines produced by activated cells in their local environment. Innate lymphoid cells contribute to the immune response by the release of cytokines and other mediators, forming a link between innate and adaptive immunity. In recent years, these cells have been extensively characterized and their role in animal models of disease has been investigated. Data to translate the relevance of ILCs in human pathology, and the potential role of ILCs in diagnosis, as biomarkers and/or as future treatment targets are also emerging. This review, produced by a task force of the Immunology Section of the European Academy of Allergy and Clinical Immunology (EAACI), encompassing clinicians and researchers, highlights the role of ILCs in human allergic and nonallergic diseases in the airways, gastrointestinal tract, and skin, with a focus on new insights into clinical implications, therapeutic options, and future research opportunities.

Stepwise approach towards adoption of allergen immunotherapy for allergic rhinitis and asthma patients in daily practice in Belgium: a BelSACI-Abeforcal-EUFOREA statement.

Allergic rhinitis (AR) affects 23-30% of the European population with equal prevalence reported in Belgium. Despite guidelines on the correct use of effective treatment, up to 40% of AR patients remain uncontrolled. Allergen immunotherapy (AIT) has been shown to improve the level of control up to 84% of patients being controlled by AIT. Recently, new guidelines for AIT have been published, supporting the clinical evidence for effectiveness of various subcutaneous and sublingual products for AIT in patients who are allergic to airborne allergens. AIT in AR patients not only reduces nasal and/or ocular symptoms but also induces tolerance and has preventive potential. Adoption of AIT into daily clinical practice in Belgium and other European countries is hampered primarily by reimbursement issues of each of the single products but also by several patient- and physician-related factors. Patients need to be better informed about the effectiveness of AIT and the different routes of administration of AIT. Physicians dealing with AR patients should inform patients on tolerance-inducing effects of AIT and are in the need of a harmonized and practical guide that supports them in selecting eligible patients for AIT, in choosing evidence-based AIT products and in following treatment protocols with proven efficacy. Therefore, a stepwise and holistic approach is needed for better adoption of AIT in the real-life setting in Belgium.

An abdominal pain syndrome in a lupus patient.

Systemic lupus erythematosus can be complicated by the antiphospholipid syndrome (APS). The clinical manifestations of this syndrome most often documented thus far are recurrent deep venous thrombosis, recurrent spontaneous abortions, and cerebral vascular accidents. Abdominal ischemic events have received relatively little attention in prior reports. We report on a lupus patient with lupus anticoagulant positivity who presented with abdominal pain, anorexia, and weight loss who was subsequently diagnosed with gastric ulcers and pancreatitis. Computerized tomography of the abdomen in addition revealed splenic and kidney infarcts. We conclude that this patient had (ischemic) chronic pancreatitis with pseudocysts and splenic and renal infarcts probably due to secondary APS.

Isotretinoin in severe peanut- and soy-allergic patients: is it safe or not?

No disponible

Initial false-negative specific IgE to gelatin in gelatin-induced anaphylaxis

No disponible

Dysplasia and colorectal cancer in inflammatory bowel disease: a result of inflammation or an intrinsic risk?

Patients with inflammatory bowel disease (IBD) face an increased lifetime risk of developing colorectal cancer (CRC). Although CRC in IBD only accounts for 1-2% of all cases of CRC in the general population, it is responsible for approximately 15% of the mortality of patients with Crohn's disease (CD) and ulcerative colitis (UC). Independent factors associated with increased risk include long disease duration, extensive colonic involvement, young age at onset of IBD, severity of inflammation, primary sclerosing cholangitis, backwash ileitis and a family history of CRC. Many of these factors emphasise the role of inflammation as an underlying mechanism. Despite the differences between the molecular abnormalities found in colitis-associated dysplasia in comparison with sporadic CRC, IBD-associated cancer has a similar dysplasia-cancer sequence, similar frequencies of major chromosomal abnormalities, microsatellite instability and similar glycosylation changes. These similarities seem to outweigh the differences and make it reasonable to suggest that not only IBD-associated CRC but even sporadic colon cancer might be largely secondary to inflammation. Oxidative stress, apoptosis, COX-2 activity and a possible common inherited defective glycosylation are thought to play a key role in the pathogenesis of colitis-associated CRC. DNA alterations initiated in colonic crypts can expand to adjacent crypts through crypt fission. There seems little doubt that the increased risk of cancer in inflammatory bowel diseases is a result of the disease rather than an inherited phenomenon. An understanding of the definition and pathogenesis of CRC in IBD is crucial to optimise patient management. Further investigation is therefore necessary.