Occupational asthma and rhinitis due to wheat flour: sublingual specific immunotherapy treatment.

BACKGROUND: There are several potential sensitizers in the bakery environment and wheat flour appears to be the dominant sensitizer in most bakeries. Apart from traditional drug therapy or a change in profession, there are no effective therapies for workers who develop serious respiratory symptoms in the workplace. OBJECTIVES: To describe clinical and laboratory findings in workers with asthma and/or rhinitis induced by wheat flour who underwent sublingual specific immunotherapy (SLIT). METHODS: Since drug therapy and prevention strategies were not effective, five bakers were elected to undergo SLIT. A three-year study was led by administering a sublingual wheat flour extract. Questionnaires, allergy and respiratory tests were performed before and after SLIT. RESULTS: After SLIT an improvement in symptoms is observed in every patient: Asthma Control Test and a quality-of-life questionnaire show higher scores and as a result, workers have reduced the use of drug therapy. We observed significantly reduced exhaled nitric oxide (FeNO) and eosinophil cationic protein (ECP) levels after SLIT, hypothesizing that these parameters may be used to monitor the effectiveness of immunotherapy. The improvement of FEV1 (forced expiratory volume in 1second) and responsiveness to bronchoprovocative tests with methacholine denotes a possible role of SLIT in treating patients with low-respiratory tract involvement, even though more data are needed. DISCUSSIONS: This is the first report in the literature on the use of SLIT for baker's asthma and rhinitis. SLIT for occupational wheat flour allergy should be possible and efficient, saving vocational training, professionalism, and avoiding job loss.

Successful adalimumab graded challenge after allergic delayed reaction to golimumab in a woman with rheumatoid arthritis.

A graded challenge with adalimumab could be safe in case of a delayed allergic reaction to golimumab, after a detailed allergological evaluation and the exclusion of allergic sensitization using skin tests.

Asthma improvement in patients treated with dupilumab for severe atopic dermatitis.

Introduction: Atopic dermatitis (AD) is considered a systemic type 2 immune driven disease, and it is associated to many atopic comorbidities including asthma. The aim of our study was to prospectively evaluate the respiratory outcomes in patients with persistent allergic asthma treated with dupilumab due to severe AD (sAD). Methods: We enrolled eligible patients with sAD for dupilumab treatment from September 2018 to December 2020. We then selected the subgroup of patients sensitized to perennial allergens. Dupilumab's efficacy and safety on AD and comorbid asthma were assessed at baseline, one month, four months, and then every 4 months up to one year. Results: A total of 437 patients with sAD were enrolled for dupilumab treatment due to sAD, and 273 reached 48 weeks of therapy. Respiratory outcomes were evaluated in the 85 asthmatic patients with positivity only to perennial allergens. Our patients showed statistically and clinically significant improvement in asthma control (Asthma Control Test and Asthma Control Questionnaire) and airway obstruction parameters (FEV1), in addition to the expected AD-related skin outcomes. Specifically, a significant improvement was achieved at the fourth month of dupilumab therapy, and this trend was maintained up to twelve months, regardless of asthma severity. Conclusions: Our results showed the overall improvement of the clinical picture that dupilumab offers for patients with severe AD and persistent allergic asthma of any severity, highlighting the importance of a global multidisciplinary approach of type 2 driven disease.

Remission of a case of multiple Hymenoptera stings-associated chronic urticaria during venom immunotherapy.

Hymenoptera stings mostly cause acute urticaria but we describe a case of CU after wasp stings which remitted during venom immunotherapy. IgE-mechanisms have not been fully clarified in CU, except for isolated circumstances. In our case immunotherapy has played a positive role reducing immune cells reactivity and improving urticaria symptoms.