Severity and duration of allergic conjunctivitis: are they associated with severity and duration of allergic rhinitis and asthma?

Summary: Objective. The association of allergic conjunctivitis (AC) with rhinitis and/or asthma is poorly understood. The objective of this study was to apply the Consensus Document for Allergic Conjunctivitis (DECA) criteria for the classification of AC to a population of patients with AC to assess the association between the severity and duration of AC and rhinitis and/or asthma. Methods. Patients with ocular symptoms of AC who participated in the 'Alergológica 2015' study were included. The demographics, classification according to the DECA criteria, etiology, and comorbidities were evaluated by age groups (less or equal than 14 and greater than 14 years). Results. A total of 2,914 patients (age range, 1-90 years) were included in the "Alergológica 2015" study. Of these, 965 patients (33.1%) were diagnosed with AC (77.5% > 14 years). AC was classified as severe, moderate, or mild in 1.8%, 46.4%, and 51.8%, respectively; and as intermittent or persistent in 51.6% and 48.4% of the patients. AC alone occurred in 4% of patients. AC was mainly associated with rhinitis (88.4%), asthma (38.2%), food allergy (8.3%) and atopic dermatitis (3.5%). In allergic respiratory disease rhinitis preceded AC and asthma developed later. The severity and duration of AC was significantly associated with severity and duration of rhinitis (p less than 0.001 for both age groups) and asthma (p less than 0.001 only in adults). Conclusions. The application of the new DECA classification for AC reveals a direct relationship between AC, rhinitis and asthma respect to severity and duration. These relationships suggest that AC should be considered an integral part of the "one airway, one disease" hypothesis.

Clinical Approach to Mast Cell Activation Syndrome: A Practical Overview.

The diagnosis of mast cell activation syndrome (MCAS) is defined by 3 criteria: (1) typical clinical signs and symptoms of acute, recurrent (episodic), and systemic mast cell activation (MCA); (2) increase in tryptase level to >20% + 2 ng/mL within 1-4 hours after onset of the acute crisis; and (3) response of MCA symptoms to antimediator therapy. Classification of MCAS requires highly sensitive and specific methodological approaches for the assessment of clonal bone marrow mast cells at low frequencies. The Spanish Network on Mastocytosis score has been used successfully as a predictive model for selecting MCAS candidates for bone marrow studies based on a high probability of an underlying clonal mast cell disorder. In this article, we propose a diagnostic algorithm and focus on the practical evaluation and management of patients with suspected MCAS.

Clinical Approach to Mast Cell ActivationSyndrome: A Practical Overview

The diagnosis of mast cell activation syndrome (MCAS) is defined by 3 criteria: (1) typical clinical signs and symptoms of acute, recurrent (episodic), and systemic mast cell activation (MCA); (2) increase in tryptase level to >20% + 2 ng/mL within 1-4 hours after onset of the acute crisis; and (3) response of MCA symptoms to antimediator therapy. Classification of MCAS requires highly sensitive and specific methodological approaches for the assessment of clonal bone marrow mast cells at low frequencies. The Spanish Network on Mastocytosis score has been used successfully as a predictive model for selecting MCAS candidates for bone marrow studies based on a high probability of an underlying clonal mast cell disorder. In this article, we propose a diagnostic algorithm and focus on the practical evaluation and management of patients with suspected MCAS (AU)

El diagnóstico de síndrome de activación mastocitaria (SAM) se basa en 3 criterios: 1) signos y síntomas específicos de activación mastocitaria aguda, recurrente y sistémica, 2) aumento de los valores de triptasa en un 20% + 2 ng/ml sobre el valor basal de cada individuo en el periodo comprendido entre 1-4 horas desde el inicio del cuadro agudo, y 3) resolución de los síntomas con tratamiento antimediador. Para realizar el diagnóstico de SAM, es preciso emplear métodos diagnósticos altamente sensibles y específicos capaces de detectar bajas cantidades de mastocitos en la médula ósea. El modelo predictivo de la Red Española de Mastocitosis (REMA score) resulta útil para identificar a los pacientes con mayor probabilidad de padecer una patología mastocitaria clonal y que, por tanto, requieren que se nealice un estudio de médula ósea en el proceso diagnóstico. En este artículo, proponemos un algoritmo diagnóstico para SAM y abordamos el manejo de estos pacientes desde un punto de vista práctico en la consulta alergológica (AU)

Pertinence of Telehealth in a Rush Conversion to Virtual Allergy Practice During the COVID-19 Outbreak

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Molecular Allergen Profiling of Dual Mite Sensitization in Severe Allergic Rhinitis.

BACKGROUND: Mites are the most prevalent source of indoor allergens. The present study used a component-resolved diagnosis (CRD) approach to investigate the mite-specific IgE sensitization profile for Dermatophagoides pteronyssinus and Blomia tropicalis. We also assessed the performance of a commercially available CRD approach in patients with severe allergic rhinitis. METHODS: We selected 63 consecutive patients with dual sensitization to D pteronyssinus and B tropicalis and persistent severe rhinitis according to the ARIA guidelines. We performed skin prick tests with standardized extracts and determined specific serum IgE to both mites, along with serum specific IgE to Der p 1, Der p 2, Der p 23, Der p 10, and Blo t 5. RESULTS: Fifty-eight and 59 patients had positive sIgE to the whole extracts of D pteronyssinus and B tropicalis, respectively. While 91.67% of patients were sensitized to specific IgE to Der p 1, Der p 2, and/or Der p 23, specific IgE to Blo t 5 (≥0.3 ISU-E) was not detected in most of the serum samples (55%). CONCLUSIONS: Although the combination panel of the commercially available major allergens Der p 1, Der p 2, and Der p 23 identified more than 90% of the D pteronyssinus-allergic patients, Blo t 5 performed somewhat poorly in those sensitized to B tropicalis. Improvements in CRD and further research concerning the prevalence and clinical relevance of serodominant allergens are needed to achieve a genuine molecular diagnosis, as well as patient-centered mite allergy-specific immunotherapy.

Molecular allergen profiling of dual mite sensitization in severe allergic rhinitis

BACKGROUND: Mites are the most prevalent source of indoor allergens. The present study used a component-resolved diagnosis (CRD) approach to investigate the mite-specific IgE sensitization profile for Dermatophagoides pteronyssinus and Blomia tropicalis. We also assessed the performance of a commercially available CRD approach in patients with severe allergic rhinitis. METHODS: We selected 63 consecutive patients with dual sensitization to D pteronyssinus and B tropicalis and persistent severe rhinitis according to the ARIA guidelines. We performed skin prick tests with standardized extracts and determined specific serum IgE to both mites, along with serum specific IgE to Der p 1, Der p 2, Der p 23, Der p 10, and Blo t 5. RESULTS: Fifty-eight and 59 patients had positive sIgE to the whole extracts of D pteronyssinus and B tropicalis, respectively. While 91.67% of patients were sensitized to specific IgE to Der p 1, Der p 2, and/or Der p 23, specific IgE to Blo t 5 (≥0.3 ISU-E) was not detected in most of the serum samples (55%). CONCLUSIONS: Although the combination panel of the commercially available major allergens Der p 1, Der p 2, and Der p 23 identified more than 90% of the D pteronyssinus-allergic patients, Blo t 5 performed somewhat poorly in those sensitized to B tropicalis. Improvements in CRD and further research concerning the prevalence and clinical relevance of serodominant allergens are needed to achieve a genuine molecular diagnosis, as well as patient-centered mite allergy-specific immunotherapy

INTRODUCCIÓN: Los ácaros son los alérgenos de interior más prevalentes. El presente estudio investiga el perfil de sensibilización a Dermatophagoides pteronyssinus y Blomia tropicalis, así como el rendimiento del diagnóstico por componentes (CRD) disponible comercialmente en pacientes con rinitis alérgica grave persistente. MATERIAL Y MÉTODOS: Seleccionamos 63 pacientes con rinitis grave persistente (Guía ARIA) con sensibilización dual a D. pteronyssinus y B. tropicalis. Se realizaron pruebas cutáneas en prick con extractos estandarizados, IgE sérica específica a ambos ácaros además de IgE específica a alérgenos individuales Der p 1, Der p 2, Der p 23, Der p 10 y Blo t 5. RESULTADOS: Cincuenta y ocho y 59 pacientes presentaron IgE específica positiva a extractos crudos de D. pteronyssinus y B. tropicalis, respectivamente. Aunque el 91,67% mostraron sensibilización a Der p 1, Der p 2 y/o Der p 23, Blo t 5 (≥0,3 ISU-E) no fue detectado en la mayoría (55%) de las muestras estudiadas. CONCLUSIONES: Aunque la combinación de alérgenos principales Der p 1, Der p 2 Der p 23, pudo identificar más del 90% de los pacientes sensibilizados a D. pteronyssinus, Blo t 5 presentó un rendimiento diagnóstico muy limitado para aquellos sensibilizados a B. tropicalis. Conocer la prevalencia y relevancia clínica de los alérgenos acarianos serodominantes en cada territorio contribuiría a una mejor identificación de sensibilizaciones genuinas en la era de la medicina de precisión

Oral immunotherapy for food allergy: A Spanish guideline. Egg and milk immunotherapy Spanish guide (ITEMS GUIDE). Part 2: Maintenance phase of cow milk (CM) and egg oral immunotherapy (OIT), special treatment dosing schedules. Models of dosing schedules of OIT with CM and EGG

Introduction: Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. Objectives: To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. Methods: A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. Results: Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. Conclusions: A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts (AU)

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Oral immunotherapy for food allergy: A Spanish guideline. Immunotherapy egg and milk Spanish guide (items guide). Part I: Cow milk and egg oral immunotherapy: Introduction, methodology, rationale, current state, indications contraindications and oral immunotherapy build-up phase

Introduction: Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. Objectives: To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. Methods: A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. Results: Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. Conclusions: A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts (AU)

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Oral Immunotherapy for Food Allergy: A Spanish Guideline. Immunotherapy Egg and Milk Spanish Guide (ITEMS Guide). Part I: Cow Milk and Egg Oral Immunotherapy: Introduction, Methodology, Rationale, Current State, Indications, Contraindications, and Oral Immunotherapy Build-up Phase.

BACKGROUND AND OBJECTIVE: Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available. Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts. METHODS: A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC. RESULTS: Recommendations were established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of adverse reactions. CONCLUSIONS: Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg.

Oral immunotherapy for food allergy: A Spanish guideline. Immunotherapy egg and milk Spanish guide (items guide). Part I: Cow milk and egg oral immunotherapy: Introduction, methodology, rationale, current state, indications contraindications and oral immunotherapy build-up phase.

INTRODUCTION: Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. OBJECTIVES: To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. METHODS: A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. RESULTS: Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. CONCLUSIONS: A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts.

Oral immunotherapy for food allergy: A Spanish guideline. Egg and milk immunotherapy Spanish guide (ITEMS GUIDE). Part 2: Maintenance phase of cow milk (CM) and egg oral immunotherapy (OIT), special treatment dosing schedules. Models of dosing schedules of OIT with CM and EGG.

INTRODUCTION: Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. OBJECTIVES: To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. METHODS: A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. RESULTS: Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. CONCLUSIONS: A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts.

Oral Immunotherapy for Food Allergy: A Spanish Guideline. Egg and Milk Immunotherapy Spanish Guide (ITEMS GUIDE). Part II: Maintenance Phase of Cow Milk (CM) and Egg Oral Immunotherapy (OIT), Special Treatment Dosing Schedules. Models of Dosing Schedules of OIT With CM and Egg.

BACKGROUND AND OBJECTIVE: Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available. Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts. METHODS: A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC. RESULTS: Recommendations were established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of adverse reactions. CONCLUSIONS: Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg.

Estimate of the total costs of allergic rhinitis in specialized care based on real-world data: the FERIN Study.

BACKGROUND: Despite the socioeconomic importance of allergic rhinitis (AR), very few prospective studies have been performed under conditions of clinical practice and with a sufficiently long observation period outside the clinical trial scenario. We prospectively estimated the direct and indirect costs of AR in patients attending specialized clinics in Spain. METHODS: Patients were recruited at random from allergy outpatient clinics in 101 health centers throughout Spain over 12 months. We performed a multicenter, observational, prospective study under conditions of clinical practice. We analyzed direct costs from a funder perspective (healthcare costs) and from a societal perspective (healthcare and non-healthcare costs). Indirect costs (absenteeism and presenteeism [productivity lost in the workplace]) were also calculated. The cost of treating conjunctivitis was evaluated alongside that of AR. RESULTS: The total mean cost of AR per patient-year (n = 498) was €2326.70 (direct, €553.80; indirect, €1772.90). Direct costs were significantly higher in women (€600.34 vs €484.46, P = 0.02). Total costs for intermittent AR were significantly lower than for persistent AR (€1484.98 vs €2655.86, P < 0.001). Total indirect costs reached €1772.90 (presenteeism, €1682.71; absenteeism, €90.19). The direct costs of AR in patients with intermittent asthma (€507.35) were lower than in patients with mild-persistent asthma (€719.07) and moderate-persistent asthma (€798.71) (P = 0.006). CONCLUSIONS: The total cost of AR for society is considerable. Greater frequency of symptoms and more severe AR are associated with higher costs. Indirect costs are almost threefold direct costs, especially in presenteeism. A reduction in presenteeism would generate considerable savings for society.

Oral immunotherapy for food allergy: a Spanish Guideline. Egg and milk immunotherapy Spanish Guide (ITEMS GUIDE). Part II: Maintenance phase of cow milk (CM) and egg oral immunotherapy (OIT), special treatment dosig schedules. Models of dosing Schedules of OIT with CM and egg

Introduction: Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available. Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts. Methods: A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC. Results: Recommendations were established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of adverse reactions. Conclusions: Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg (AU)

Introducción: El huevo y la leche de vaca son la causa más frecuente de alergia alimentaria en los primeros años de vida. Como alternativa terapéutica a la dieta de eliminación se han investigado otras formas de tratamiento como la inmunoterapia oral (ITO). Actualmente no existen guías de práctica clínica para el manejo de la ITO con leche y huevo. Objetivos: Elaborar una guía clínica para el tratamiento con ITO basada en la evidencia científica disponible y en la opinión de expertos. Métodos: Revisión de estudios publicados desde el año 1984 hasta junio de 2016, tesis doctorales publicadas en España, resúmenes de comunicaciones en congresos (SEAIC, SEICAP, EAACI, AAAAI) y consenso de opinión de un grupo de expertos de las sociedades científicas SEICAP y SEAIC. Resultados: Se establecen recomendaciones acerca de la indicación, requerimientos, aspectos prácticos del tratamiento en las diferentes fases de la ITO, y pautas especiales para pacientes de alto riesgo de reacciones adversas. Conclusiones: Se presenta una guía con las directrices para el manejo en la práctica clínica de la ITO con leche y huevo que aúna la opinión consensuada de expertos españoles (AU)

Oral immunotherapy for food allergy: a Spanish Guideline. Immunotherapy Egg and Milk Spanish Guide (ITEMS Guide). Part I: cow milk and egg oral immunotherapy: introduction, methodology, rationale, current state, indications, contraindications, and oral immunotherapy build-up phase

Introduction: Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available. Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts. Methods: A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC. Results: Recommendations were established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of adverse reactions. Conclusions: Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg (AU)

Introducción: El huevo y la leche de vaca son la causa más frecuente de alergia alimentaria en los primeros años de vida. Como alternativa terapéutica a la dieta de eliminación se han investigado otras formas de tratamiento como la inmunoterapia oral (ITO). Actualmente no existen guías de práctica clínica para el manejo de la ITO con leche y huevo. Objetivos: Elaborar una guía clínica para el tratamiento con ITO basada en la evidencia científica disponible y en la opinión de expertos. Métodos: Revisión de estudios publicados desde el año 1984 hasta junio de 2016, tesis doctorales publicadas en España, resúmenes de comunicaciones en congresos (SEAIC, SEICAP, EAACI, AAAAI) y consenso de opinión de un grupo de expertos de las sociedades científicas SEICAP y SEAIC. Resultados: Se establecen recomendaciones acerca de la indicación, requerimientos, aspectos prácticos del tratamiento en las diferentes fases de la ITO, y pautas especiales para pacientes de alto riesgo de reacciones adversas. Conclusiones: Se presenta una guía con las directrices para el manejo en la práctica clínica de la ITO con leche y huevo que aúna la opinión consensuada de expertos españoles (AU)

Relationship between respiratory and food allergy and evaluation of preventive measures

Food allergy and respiratory allergy are two frequently associated diseases and with an increasing prevalence. Several reports show the presence of respiratory symptoms in patients with food allergy, while certain foods may be related to the development or exacerbation of allergic rhinitis and asthma. The present update focuses on this relationship, revealing a pathogenic and clinical association between food and respiratory allergy. This association is even more intense when the food hypersensitivity is persistent or starts in the early years of life. Food allergy usually precedes respiratory allergy and may be a risk factor for allergic rhinitis and asthma, becoming a relevant clinical marker for severe atopic asthma. Furthermore, the presence of co-existing asthma may enhance life-threatening symptoms occurring during a food allergic reaction. Recommendations for dietary restrictions during pregnancy and breastfeeding to prevent the development of respiratory allergy are controversial and not supported by consistent scientific data. Current recommendations from medical societies propose exclusive breastfeeding during the first four months of life, with the introduction of solid food in the fourth to the seventh month period of life. A delayed introduction of solid food after this period may increase the risk of developing subsequent allergic conditions. Further studies are encouraged to avoid unjustified recommendations involving useless dietary restrictions

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Relationship between respiratory and food allergy and evaluation of preventive measures.

Food allergy and respiratory allergy are two frequently associated diseases and with an increasing prevalence. Several reports show the presence of respiratory symptoms in patients with food allergy, while certain foods may be related to the development or exacerbation of allergic rhinitis and asthma. The present update focuses on this relationship, revealing a pathogenic and clinical association between food and respiratory allergy. This association is even more intense when the food hypersensitivity is persistent or starts in the early years of life. Food allergy usually precedes respiratory allergy and may be a risk factor for allergic rhinitis and asthma, becoming a relevant clinical marker for severe atopic asthma. Furthermore, the presence of co-existing asthma may enhance life-threatening symptoms occurring during a food allergic reaction. Recommendations for dietary restrictions during pregnancy and breastfeeding to prevent the development of respiratory allergy are controversial and not supported by consistent scientific data. Current recommendations from medical societies propose exclusive breastfeeding during the first four months of life, with the introduction of solid food in the fourth to the seventh month period of life. A delayed introduction of solid food after this period may increase the risk of developing subsequent allergic conditions. Further studies are encouraged to avoid unjustified recommendations involving useless dietary restrictions.