Using resilience assessments to inform the management and conservation of coral reef ecosystems.

Climate change is causing the decline of coral reef ecosystems globally. Recent research highlights the importance of reducing CO2 emissions in combination with implementing local management actions to support reef health and recovery, particularly actions that protect sites which are more resilient to extreme events. Resilience assessments quantify the ecological, social, and environmental context of reefs through the lens of resilience, i.e., the capacity of a system to absorb or withstand stressors such that the system maintains its structure and functions and has the capacity to adapt to future disturbances and changes. Resilience assessments are an important tool to help marine managers and decision makers anticipate changes, identify areas with high survival prospects, and prioritize management actions to support resilience. While being widely implemented, however, there has not yet been an evaluation of whether resilience assessments have informed coral reef management. Here, we assess the primary and gray literature and input from coral reef managers to map where resilience assessments have been conducted. We explore if and how they have been used to inform management actions and provide recommendations for improving the likelihood that resilience assessments will result in management actions and positive conservation outcomes. These recommendations are applicable to other ecosystems in which resilience assessments are applied and will become increasingly important as climate impacts intensify and reduce the window of opportunity for protecting natural ecosystems.

Omalizumab facilitates rapid oral desensitization for peanut allergy.

BACKGROUND: Peanut oral immunotherapy is a promising approach to peanut allergy, but reactions are frequent, and some patients cannot be desensitized. The anti-IgE medication omalizumab (Xolair; Genentech, South San Francisco, Calif) might allow more rapid peanut updosing and decrease reactions. OBJECTIVE: We sought to evaluate whether omalizumab facilitated rapid peanut desensitization in highly allergic patients. METHODS: Thirty-seven subjects were randomized to omalizumab (n = 29) or placebo (n = 8). After 12 weeks of treatment, subjects underwent a rapid 1-day desensitization of up to 250 mg of peanut protein, followed by weekly increases up to 2000 mg. Omalizumab was then discontinued, and subjects continued on 2000 mg of peanut protein. Subjects underwent an open challenge to 4000 mg of peanut protein 12 weeks after stopping study drug. If tolerated, subjects continued on 4000 mg of peanut protein daily. RESULTS: The median peanut dose tolerated on the initial desensitization day was 250 mg for omalizumab-treated subjects versus 22.5 mg for placebo-treated subject. Subsequently, 23 (79%) of 29 subjects randomized to omalizumab tolerated 2000 mg of peanut protein 6 weeks after stopping omalizumab versus 1 (12%) of 8 receiving placebo (P < .01). Twenty-three subjects receiving omalizumab versus 1 subject receiving placebo passed the 4000-mg food challenge. Overall reaction rates were not significantly lower in omalizumab-treated versus placebo-treated subjects (odds ratio, 0.57; P = .15), although omalizumab-treated subjects were exposed to much higher peanut doses. CONCLUSION: Omalizumab allows subjects with peanut allergy to be rapidly desensitized over as little as 8 weeks of peanut oral immunotherapy. In the majority of subjects, this desensitization is sustained after omalizumab is discontinued. Additional studies will help clarify which patients would benefit most from this approach.