Impact of climate change-related environmental factors on the allergens production and the epidemiology and severity of allergic pathologies.

BACKGROUND: Allergic disease affects up to 40% of the global adult population, a proportion that is increasing with environmental changes related to global warming. METHODS: We undertook a systematic review of the literature to identify and evaluate the current evidence of the impact of climate change-related environmental factors on the allergen production and the epidemiology and severity of allergic pathologies. PECO criteria were established and guided the literature searches of the PubMed and Cochrane databases (Jan 1, 2016 to Dec 31, 2021). Study outcomes were categorized and grouped to facilitate data synthesis. Outcomes were classified as significant (statistical significance <0.05), non-significant (p>0.05) or undetermined (p value not reported). Study quality was assessed using MMAT analysis. RESULTS: Of 195 studies, 40 were considered relevant and 9 of them provided data to be included in the data quantitative synthesis. Environmental factors, including the presence of pollutants, temperature, and drought, influenced the type, volume, and timing of exposure to local aeroallergens. The most relevant environmental factor was the presence of environmental pollutants, of which tropospheric ozone was the most frequently associated to changes in allergen production, prevalence, and severity of allergic disease. Also, several publications demonstrated the impact of environmental factors on the healthcare burden. CONCLUSIONS: Climate-change related environmental factors increased allergic disease in terms of prevalence, severity, and healthcare burden due to alterations in allergen exposure (volume and type) with the presence of pollutants such as ozone being the most commonly reported driver of such increase.

Positioning of Tezepelumab in Severe Asthma / Posicionamento do Tezepelumabe na Asma Grave

Asthma is one of the most common chronic diseases and is estimated to be severe in 3%-10% of affected patients. There is a need for additional biologic treatments that are highly efficacious across the spectrum of severe uncontrolled asthma. Currently available drugs inhibit 1 or 2 specific cytokines or IgE antibodies and thus only partially suppress the complex type 2 (T2) inflammatory cascade. Biologics targeting more upstream molecules in the pathophysiological pathway of asthma could treat asthma more effectively. Tezepelumab is a human monoclonal immunoglobulin G2λ antibody that targets the cytokine thymic stromal lymphopoietin (TSLP). It is the first marketed biologic against an epithelial cell–derived cytokine, preventing binding of TSLP to its receptor and reducing the immune stimuli that TSLP can trigger in different asthma endotypes. Tezepelumab reduces downstream biomarkers of inflammation, such as blood and airway eosinophils, FeNO, IgE, IL-5, and IL-13. Tezepelumab provides a clinical benefit in severe asthma, reducing the annualized asthma exacerbation rate in patients with either high or low levels of biomarkers of T2 inflammation, although the effect is greater among those with high levels. The drug has been shown to improve asthma control, quality of life, and lung function and reduce airway hyperresponsiveness. Therefore, tezepelumab can be used across the spectrum of patients with severe uncontrolled asthma, especially in T2-high patients. This review includes a positioning statement by the authors, all of whom are members of the SEAIC Asthma Committee (AU)

A asma é uma das doenças crônicas mais comuns e estima-se que seja grave em 3% a 10% dos pacientes afetados. Há necessidade de tratamentos biológicos adicionais que sejam altamente eficazes em todo o espectro da asma grave não controlada. Os medicamentos atualmente disponíveis inibem 1 ou 2 citocinas específicas ou anticorpos IgE e, portanto, suprimem apenas parcialmente a cascata inflamatória complexa tipo 2 (T2). Os produtos biológicos que visam moléculas mais a montante na via fisiopatológica da asma poderiam tratar a asma de forma mais eficaz. Tezepelumab é um anticorpo monoclonal humano imunoglobulina G2λ que tem como alvo a citocina linfopoietina estromal tímica (TSLP). É o primeiro produto biológico comercializado contra uma citocina derivada de células epiteliais, impedindo a ligação da TSLP ao seu receptor e reduzindo os estímulos imunológicos que a TSLP pode desencadear em diferentes endótipos de asma. Tezepelumabe reduz biomarcadores de inflamação a jusante, como eosinófilos no sangue e nas vias aéreas, FeNO, IgE, IL-5 e IL-13. O tezepelumab proporciona um benefício clínico na asma grave, reduzindo a taxa anualizada de exacerbação da asma em pacientes com níveis elevados ou baixos de biomarcadores de inflamação T2, embora o efeito seja maior entre aqueles com níveis elevados. Foi demonstrado que o medicamento melhora o controle da asma, a qualidade de vida e a função pulmonar e reduz a hiperresponsividade das vias aéreas. Portanto, o tezepelumabe pode ser usado em todo o espectro de pacientes com asma grave não controlada, especialmente em pacientes com T2 elevado. Esta revisão inclui uma declaração de posicionamento dos autores, todos membros do Comitê de Asma da SEAIC (AU)

Impact of Asthma Inhalers on Global Climate: A Systematic Review of Their Carbon Footprint and Clinical Outcomes in Spain

Background: Pressurized metered-dose inhalers (pMDIs) exert an environmental impact resulting from CO2 emissions. Therapeutic alternatives with less environmental impact are widely used. Nevertheless, the choice of device and appropriate therapy should meet the clinical needs and the characteristics of the patient. Objective: The primary objective was to estimate the impact of pMDIs prescribed for any indication on annual CO2 emissions in Spain.The secondary objective was to evaluate the potential impact of switching pMDIs to dry-powder inhalers (DPIs) in patients with asthma. Methods: A systematic review of the evidence published during 2010-2021 was carried out. Average annual CO2 emissions of DPIs and pMDIs were calculated in 2 scenarios: the current situation and a hypothetical situation involving a switch from all pMDIs to DPIs. The impact of the switch on clinical outcomes was also evaluated. Results: The total value of CO2-eq/year due to DPIs and pMDIs accounted for 0.0056% and 0.0909%, respectively, of total emissions in Spain. In the event of switching pMDIs to DPIs, except those used for rescue medication, the percentages were 0.0076% and 0.0579%. The evaluation of efficacy, handling, satisfaction, safety, and use of health care resources was not conclusive. Conclusions: Current CO2 emissions by pMDIs account for a small percentage of the total CO2 footprint in Spain. Nevertheless, there is a need for research into new and more sustainable devices. Suitability and patient clinical criteria such as age and inspiratory flow should be prioritized when prescribing an inhaler (AU)

High Frequency of Smell and Taste Dysfunction in Health Care Professionals With COVID-19 Working in Allergy Departments

Background: Since the early stages of the novel coronavirus 2019 (SARS-CoV-2) outbreak, smell and/or taste dysfunction (STD) has beenreported in 5% to 88% of COVID-19 patients.Objective: We aimed to assess STD in health care professionals (HCPs), mainly allergists, affected by COVID-19. We carried out a survey toevaluate the association between STD and its severity and demographic characteristics, symptoms, comorbidities, and hospital admission.Methods: We designed a 15-item questionnaire comprising various sections, as follows: demographics, diagnostic characteristics, STDpatterns, medication use, and comorbidities. The questionnaire was developed using Google forms. It was distributed to members of theSpanish Society of Allergology and Clinical Immunology (SEAIC) and sent via social media to be completed by HCPs with COVID-19.Results: The survey was completed by HCPs (n=234), of whom 76.5% were aged ≤55 years and 73.5% were female. STD was detected in74.4% of respondents, of whom 95.6% reported moderate-severe impairment. Mean time until recovery of taste dysfunction was 21.6 (24.0)days in HCPs aged ≤55 years and 33.61±26.2 days in those aged >55 years (P=.019). Analysis stratified by severity of STD showed thatmore than a half of COVID-19 patients presented severe loss of smell. Older age (>55 years) was associated with fever, anorexia, lowerfrequency of headache, and longer persistence of taste dysfunction.Conclusion: STD is a common symptom in COVID-19, even as a unique or preceding symptom. HCPs who reported smell dysfunctionwere younger than those not affected with STD. Taste dysfunction may imply more systemic involvement in COVID-19–positive HCPs. (AU)

Antecedentes: Desde el inicio de la pandemia por el nuevo coronavirus (SARS-CoV-2), la afectación del sentido del olfato y del gusto seha descrito entre el 5% y 88% de la población afecta por COVID-19.Objetivo: Evaluar la alteración del gusto y del olfato en profesionales sanitarios afectos por COVID-19, en relación a parámetros degravedad, características demográficas, síntomas, comorbilidades e ingreso hospitalario.Métodos: Se diseñó un cuestionario de 15 elementos, con las siguientes secciones: demografía, características diagnósticas, patronesde alteración de olfato y del gusto, uso de medicación y efectos adversos asociados y comorbilidades. Dicho cuestionario fue difundidopor las redes sociales de la Sociedad Española de Alergología e Inmunología Clínica, dirigido específicamente a profesionales sanitarios.Resultados: 234 profesionales completaron la encuesta (73,5% mujeres). El 76,5% de los encuestados era ≤55 años. Hubo afectacióndel olfato y/o gusto en el 74,4% de los encuestados. La persistencia media de alteración del gusto fue 21,6± 24,0 días en ≤55 años yde 33,6±26,2 días en >55 años (p=0,019). Ser mayor de 55 años se asociaba estadísticamente con fiebre, anorexia, menos cefalea ymayor persistencia de afectación del gusto.Conclusión: Los profesionales sanitarios que declararon haber padecido SD eran más jóvenes que los que no presentaron STD. La afectacióndel olfato y/o del gusto es un síntoma común entre los profesionales sanitarios con COVID-19 y puede ser patente en fases iniciales ocomo único síntoma en pacientes ≤55 años. La afectación del gusto puede implicar más síntomas sistémicos. (AU)

SEAIC Specialty Forum: Analysis of the Current Situation of Allergology in Spain and Outlook for the Future

Background: Allergology has been a recognized medical specialty in Spain, with fully defined aims and competencies for more than 4 decades. However, in recent years, its visibility seems to have decreased somewhat. Objectives: To identify which specific factors have contributed to the waning of the importance of the specialty and find tangible solutions to consolidate its place as a front-line medical specialty. Material and methods: An online population survey comprising 60 items of interest was prepared. The degree of agreement and the level of satisfaction with each item were assessed, and implementable initiatives in the short, medium, and long terms were defined in order to provide solutions to the issues identified. Results: The survey was completed by a total of 167 specialists with an average of 18 years’ experience. Most were from public reference hospitals, and 29.3% were heads of department. The line of action for which a good degree of agreement was achieved was to promote the inclusion of an allergist in multidisciplinary teams. The priority lines of action were to improve undergraduate and graduate training in allergology and specialized nursing, to identify curricula in Spain, and to develop robust teaching projects. Conclusions: The results revealed a high degree of homogeneity between professionals. The basic pillars highlighted were as follows: quality training, knowledge, and research in immunotherapy; an innovative portfolio of services endorsed by clinical practice guidelines; and presence in multidisciplinary teams and relevant hospital committees. (AU)

Antecedentes: En nuestro país, la alergología constituye una especialidad médica reconocida con fines y competencias completamente definidos desde hace más de cuatro décadas. Sin embargo, en los últimos tiempos parece hacer frente a una cierta disminución de su visibilidad y reconocimiento. Objetivos: Identificar qué factores específicos contribuyen a esta dilución de su peso específico y buscar soluciones tangibles que la afiancen como especialidad médica de primera línea. Material y métodos: Se elaboró una encuesta poblacional online compuesta por 60 ítems considerados de interés. Se valoró el grado de acuerdo y el nivel de satisfacción con cada uno, definiendo iniciativas implantables a corto, medio y largo plazo que aporten soluciones para las cuestiones identificadas. Resultados: La encuesta fue respondida por un total de 167 especialistas con una media de 18 años de experiencia, la mayoría procedentes de hospitales de referencia públicos, siendo un 29,3% jefes del servicio. La línea de acción que obtuvo un mayor grado de acuerdo fue promover la presencia del alergólogo en los equipos multidisciplinares. Como línea de acción más prioritaria se seleccionó mejorar la formación de pregrado y posgrado en alergología, así como la de enfermería especializada, identificando planes de estudio en nuestro país y elaborando proyectos docentes robustos. Conclusiones: Los resultados revelaron un elevado grado de homogeneidad entre los profesionales, destacando como pilares básicos la formación de calidad, los conocimientos e investigación en inmunoterapia, una cartera de servicios novedosa avalada por Guías de Práctica Clínica y la presencia en equipos multidisciplinares y comisiones hospitalarias relevantes. (AU)

Erythema multiforme induced by tramadol: an allergy assessment

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Impact of "eHealth" in allergic diseases and allergic patients

The emergence of new technology enables allergists and patients to compile data and receive feedback regarding key symptoms, risk behavior, and/or management. The term "eHealth" refers to a diverse group of tools that use computerized technologies to improve both the efficacy and the efficiency of the health care industry. eHealth comprises a variety of technologies, as follows: mobile devices (mHealth) in medical care, including electronic diaries, wearable sensors, and adherence monitoring; health informatics (eg, electronic health records, computerized physician order entry, clinical decision support); telemedicine, which is the use of information and communication technologies for the management of diseases and medical education; social media platforms, and the analysis of information acquired through these platforms using "big data" technologies.In this review, we summarize the latest findings on the use of eHealth technology and the relevance of eHealth to allergic conditions

La aparición de nuevas tecnologías conlleva para los alergólogos y los pacientes la posibilidad de recopilar datos y recibir información directa sobre los síntomas clave de las enfermedades, los comportamientos de riesgo y/o su manejo. El término "eHealth", o salud electrónica, se refiere a un grupo diverso de herramientas que utilizan tecnologías informáticas para mejorar la eficacia y la eficiencia de la industria de la salud. La "eHealth" comprende varias tecnologías, como el uso de dispositivos móviles aplicados a la salud ("mHealth"), incluyendo diarios electrónicos, sensores ponibles o monitorización de la adherencia terapéutica; la informática biomédica (por ejemplo, la historia clínica electrónica, la prescripción electrónica o los sistemas de ayuda a las decisiones clínicas); la telemedicina, que es el uso de las tecnologías de la información y la comunicación para el manejo de enfermedades y de educación sanitaria; las plataformas de redes sociales, y el análisis de la información adquirida a través de estas plataformas, usando técnicas de "big data" o inteligencia de datos. En esta revisión, resumimos la evidencia que rodea al uso de tecnologías "eHealth" y su relevancia para las enfermedades alérgicas

Identification of lipoproteins from sunflower seeds in 2 monosensitized anaphylaxis patients

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Delayed hypersensitivity reaction to oral dimethyl fumarate

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Validation of the Spanish Version of the Food Allergy Quality of Life Questionnaire-Parent Form (S-FAQLQ-PF)

Background: Food allergy is an emerging health problem. Several questionnaires can be used to establish health-related quality of life (HRQOL) in food allergy patients. Current questionnaires should be translated in such a way that they take account of the culture of the country in which they are to be used. Objective: To translate and perform a cross-sectional validation of the Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF). Methods: The parents of 54 children diagnosed with food allergy were recruited to assess the Spanish version of the FAQLQ-PF (S-FQLQ-PF). Results: The S-FQLQ-PF was translated into Spanish according to WHO guidelines (including a forward-backward translation). The statistical analysis showed that feasibility, reliability, and internal consistency were very good for the global S-FAQLQ-PF score and for the different domains. Assessment of construct validity indicated that S-FAQLQ-PF has reduced capacity for measurement of HRQOL in younger children. ross-sectional validation of the S-FAQLQ-PF demonstrated that HRQOL of a Spanish pediatric population was affected by patient age, severity of symptoms, and number of reactions. HRQOL was not affected by sex, food implicated, number of foods implicated, ingestion of the implicated food, or presence of anaphylaxis. Conclusion: Translation into Spanish and cultural validation of the FAQLQ-PF demonstrated the influence of factors, such as patient age, severity of symptoms, and number of reactions on the HRQOL of a pediatric Spanish population (AU)

Introducción: La alergia a alimentos se ha convertido en un problema de salud en aumento en los últimos años. Existen múltiples cuestionarios que sirven para establecer el nivel de calidad de vida en los pacientes alérgicos a alimentos. Es importante realizar adaptaciones lingüísticas y culturares de los cuestionarios existentes a todos los idiomas. Objetivo: Realizar una adaptación lingüística y cultural al español así como una validación transversal del cuestionario Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF). Métodos: Los padres de 54 pacientes diagnosticados de alergia a alimentos fueron reclutados para llevar a cabo la adaptación lingüística y cultural al español del cuestionario FAQLQ-PF. Resultados: Se realizó la traducción al español del cuestionario FAQLQ-PF (S-FAQLQ-PF) de acuerdo a las guías de la OMS. El análisis estadístico demostró que la viabilidad, fiabilidad y la consistencia interna era buena tanto para los resultados globales del S-FAQLQ-PF como para los diferentes dominios del mismo. La validez de constructo fue evaluada y los resultados sugieren que el S-FAQLQ-PF presenta peor capacidad para medir la calidad de vida en los niños de menor edad (0-3 años). Finalmente, la validación transversal del S-FAQLQPF ha demostrado que la edad de los pacientes, la gravedad de los síntomas o el número de reacciones sufridas afectan a la calidad de vida en una población pediátrica española, mientras que el género, el tipo o el número de alimentos, la presencia de anafilaxia y las transgresiones dietéticas no la afectan. Conclusiones: Presentamos la adaptación lingüística y cultural al español del cuestionario de vida específico para alergia a alimentos S-FAQLQ-PF. Esta adaptación se ha utilizado para demostrar la influencia de diferentes factores, como la edad de los pacientes, la gravedad de los síntomas o el número de reacciones sufridas en la calidad de vida de una población pediátrica española (AU)

Key issues in hymenoptera venom allergy: an update

In this review, the Hymenoptera Allergy Committee of the SEAIC analyzes the most recent scientific literature addressing problems related to the diagnosis of hymenoptera allergy and to management of venom immunotherapy. Molecular diagnosis and molecular risk profiles are the key areas addressed. The appearance of new species of hymenoptera that are potentially allergenic in Spain and the associated diagnostic and therapeutic problems are also described. Finally, we analyze the issue of mast cell activation syndrome closely related to hymenoptera allergy, which has become a new diagnostic challenge for allergists given its high prevalence in patients with venom anaphylaxis (AU)

En esta revisión el Comité de Alergia a Himenópteros de la SEAIC ha analizado la literatura científica más reciente sobre los principales problemas diagnósticos de la alergia a himenópteros, así como sobre las dificultades que pueden surgir durante la inmunoterapia con venenos. Se revisan especialmente las novedades relacionadas con el diagnóstico molecular y los perfiles moleculares de riesgo. También se describe la alergia a himenópteros poco habituales y los problemas diagnósticos y terapéuticos que esta conlleva. Por último, se tratan los síndromes de activación mastocitaria clonal, íntimamente relacionados con la alergia a himenópteros, que se han convertido en un nuevo reto diagnóstico para el alergólogo (AU)

Nonoccupational airborne-induced anaphylaxis caused by anisakis simplex

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Linseed allergy due to LTP: another food for LTP syndrome

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Insect venom immunotherapy: analysis of the safety and tolerance of 3 buildup protocols frequently used in Spain

Introduction: Hymenoptera venom immunotherapy (VIT) is an effective treatment but not one devoid of risk, as both local and systemic adverse reactions may occur, especially in the initial phases. We compared the tolerance to 3 VIT buildup protocols and analyzed risk factors associated with adverse reactions during this phase. Materials and Methods: We enrolled 165 patients divided into 3 groups based on the buildup protocol used (3, 4, and 9 weeks). The severity of systemic reactions was evaluated according to the World Allergy Organization model. Results were analyzed using exploratory descriptive statistics, and variables were compared using analysis of variance. Results: Adverse reactions were recorded in 53 patients (32%) (43 local and 10 systemic). Local reactions were immediate in 27 patients (63%) and delayed in 16 (37%). The severity of the local reaction was slight/moderate in 15 patients and severe in 13. Systemic reactions were grade 1-2. No significant association was found between the treatment modality and the onset of local or systemic adverse reactions or the type of local reaction. We only found a statistically significant association between severity of the local reaction and female gender. As for the risk factors associated with systemic reactions during the buildup phase, we found no significant differences in values depending on the protocol used or the insect responsible. Conclusions: The buildup protocols compared proved to be safe and did not differ significantly from one another. In the population studied, patients undergoing the 9-week schedule presented no systemic reactions. Therefore, this protocol can be considered the safest approach (AU)

Introducción: La inmunoterapia con veneno de himenópteros (ITV) es un tratamiento eficaz, pero no está desprovisto de riesgo ya que pueden ocurrir reacciones adversas locales o sistémicas, especialmente en las etapas iniciales del tratamiento. Comparamos la tolerancia de tres protocolos de inicio de ITV y analizamos los factores de riesgo asociados con las reacciones adversas que se produjeron en esta fase. Métodos: Se incluyeron 165 pacientes divididos en tres grupos según el protocolo de iniciación utilizado (3, 4 o 9 semanas). Evaluamos la gravedad de las reacciones sistémicas de acuerdo con el modelo de la Organización Mundial de Alergia. Analizamos los resultados mediante estadística descriptiva exploratoria y comparamos variables mediante el análisis de la varianza. Resultados: Cincuenta y tres pacientes (32%) experimentaron algún tipo de reacción adversa; 43 eran locales y 10 sistémicas. Las reacciones locales fueron inmediatas en 27 pacientes (63%) y tardías en 16 (37%). La gravedad de la reacción local fue leve o moderada en 15 pacientes y grave en 13. Las reacciones sistémicas fueron de grado 1 o 2. No encontramos asociación significativa entre la modalidad de tratamiento y la aparición de reacciones adversas locales o sistémicas o el tipo de reacción local. Solo encontramos una asociación estadísticamente significativa de la gravedad de la reacción local con el sexo femenino. En cuanto a los factores de riesgo asociados con las reacciones sistémicas en la fase de inicio, no se encontraron diferencias significativas en estos valores en función del protocolo utilizado o el insecto responsable. Conclusiones: Los protocolos de inicio comparados demostraron ser seguros y no difirieron significativamente entre sí. En la población estudiada, el protocolo de 9-semanas no produjo reacciones sistémicas, por lo que se puede considerar el protocolo más seguro (AU)

Effectiveness of allergy testing in milk induced eosinophilic esophagitis. Description and follow-up of patients

INTRODUCTION: Eosinophilic esophagitis (EoE) is a chronic, local immune-mediated esophageal disease that has been on the increase lately. There is currently enough evidence to conclude that EoE is an allergic disorder triggered by food allergens, with cow's milk (CM) being the most frequent. Dietary intervention is the first-line approach. This study aimed to assess the clinical characteristics, the diagnostic method, and the prognosis of patients whose culprit food was CM, as opposed to other triggers. METHODS: Children with EoE evaluated in our pediatric Allergy Department were retrospectively studied from 2004 to 2017. We collected clinical variables, diagnostic protocol, treatment, and follow-up data. We compared patients whose culprit food was CM and patients with EoE due to other causative agents. RESULTS: We analyzed 31 children with EoE and found the causative food to be cow's milk in 14 (45%). Clinical characteristics were similar in patients with EoE due to milk or any other cause. Eight of 14 patients with milk-induced EoE (57.14%) presented positive skin prick test results against cow's milk. All patients had positive IgE against cow's milk. None of the patients had any other food as the trigger. The median follow-up was 2.68 years (6 months to 9 years) with initial remission of 100%. CONCLUSION: Testing-based elimination diets effectively treated all of the patients with milk-induced EoE. The advantage of this diagnostic protocol is that it required a mean of only two foods to be tested, significantly smaller number than in empiric diets

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