Summary
This statement was written by a group of pulmonologists and pediatric pulmonologists belonging to the corresponding professional associations ÖGP (Austrian Society for Pulmonology) and ÖGKJ ...(Austrian Society for pediatric and adolescent medicine) to provide a concise overview of the latest updates in the 2015 GINA Guidelines and to include aspects that are specific to Austria.
Most of the subjects vaccinated with the rBet v 1 fragments developed IgG against Bet v 1 and both fragments after the second injection and a significant increase in Bet v 1–specific IgG was found in ...all 6 actively treated subjects after the third injection (Fig E2, A; see Fig E4 in this article's Online Repository at www.jacionline.org). ...the primary end point of the study was reached (Online Repository: ClinicalTrials.gov Identifier: NCT01353924). The lack of birch pollen–specific skin reactions despite the presence of Bet v 1–specific IgE antibodies is most likely due to the protective effects of treatment-induced IgG antibodies, which were shown to also block IgE binding to Bet v 1 in patients with allergy (Fig 2). ...treatment of nonallergic subjects seems to have induced only clinically silent IgE sensitization. The only treatment-related side effects were mild (ie, local injection site reactions; n = 4), which occurred in 3 of the actively treated subjects (Table E3). ...vaccination of nonallergic subjects with recombinant hypoallergenic Bet v 1 derivatives was safe and well tolerated.
Allergen-specific immunotherapy (AIT) is the only treatment for type I allergy, which achieves long-lasting effects. Repeated subcutaneous applications of allergen extracts cause a protective ...antibody response and an immune deviation of T cells. In AIT with allergoids, chemically modified allergen extracts are injected. During a so-called special pre-seasonal application scheme, after the initial phase of applying increased doses of allergoids is followed by natural allergen exposure as a maintenance phase. The effectiveness of allergoid vaccines has been described regarding the improvement of clinical symptoms and the development of protective humoral responses.
In this longitudinal observational study, we sought to investigate changes at the T cell level in pre-seasonal AIT with allergoid. Different subsets within CD4+ and CD8+ T cells were monitored by flow cytometry in PBMC of patients known to possess protective antibody responses.
Compared to before treatment, a small early boost among allergenic Th cells was observed after 4 months of AIT. In line, a slight Th2 bias was observed after 4 months within circulating T follicular T cells, Tfh and Tfc, representing pre-existing memory Th2 cells. Furthermore, it was demonstrated that responsiveness of CD8+ T cells to allergen stimulation decreased during the course of treatment. Apart from that, we found an influence of the meteorological season on the activation profile of Tfh and Tfc over the course of the treatment.
Together, this is the first study investigating changes of different T cell subsets over the course of an allergoid AIT against airborne allergens. Our findings match previous reports on conventional AIT, especially the initial increase of Th2 responses. However, the observed changes were less pronounced which may be either due to the modification of allergens or to the reduced maintenance dose provided by natural allergen exposure compared to a perennial protocol.
Respiratory allergies of children and adolescents are an important issue in allergology. In parallel to increasing prevalence rates also research has rapidly been developing for the last 10 years. ...Today we can better understand complex systems to improve our diagnostic and therapeutic accuracy. In addition to medical history, skin-prick-testing and analysis of specific IgE to allergen extracts, component resolved diagnosis has gained importance in the last years. While being increasingly helpful in the diagnosis of insect-venom and food-allergies, component-based diagnosis can also improve the management of patients with respiratory allergies. Concerning different therapeutic approaches like allergen-avoidance or symptomatic therapy, specific immunotherapy (SIT) is one of the most interesting therapy-options, as it is still the only causal therapy available. After reasonable patient-selection and the selection of the right allergen and product, SIT has a very good risk/benefit-ration and can induce long-term immuno-tolerance to specific allergens.
Zusammenfassung
In der Allergologie nehmen respiratorische Allergien bei Kindern und Jugendlichen einen großen Stellenwert ein. Parallel zur steigenden Prävalenz hat sich auch die Forschung in den ...letzten 10 Jahren rasant entwickeln. Wir verstehen heute besser komplexe Zusammenhänge und können gezielter eine Diagnose stellen und die geeignete Therapie einleiten.
Neben der Anamnese, dem Haut-Pricktest und der Bestimmung des spezifischen IgEs auf verschiedene Allergen-Extrakte hat die Komponentendiagnostik in den letzten Jahren an Bedeutung gewonnen. Gerade auch im Bereich der Nahrungsmittel und Insektengifte findet sie schon verbreitet Anwendung. Aber auch bei respiratorischen Allergien kann bei einer gezielten Fragestellung die Komponententestung helfen, die Diagnostik zu verbessern.
Im Bereich der Therapie stellt die Spezifische Immuntherapie neben der Allergenkarenz und der rein symptomatischen Therapie den interessantesten Therapieansatz dar. Bei einer vernünftigen Patientenselektion und der richtigen Wahl des Allergens und des Präparates, zeigt sie ein sehr gutes Nutzen/Risiko-Profil und kann auch langfristig zu einer Toleranzentwicklung des Immunsystems führen.
Background
Evidence has accumulated that birch pollen immunotherapy reduces rhinoconjunctivitis to pollen of birch homologous trees. Therapeutic efficacy has been associated with IgE‐blocking IgG ...antibodies. We have recently shown that sera collected after 16 weeks of sublingual immunotherapy with recombinant Bet v 1 (rBet v 1‐SLIT) display strong IgE‐blocking bioactivity for Bet v 1. Here, we assessed whether rBet v 1‐SLIT‐induced IgG antibodies display cross‐blocking activity to related allergens in Fagales pollen.
Methods
IgE, IgG1 and IgG4 reactivity to recombinant Bet v 1, Aln g 1, Car b 1, Ost c 1, Cor a 1, Fag s 1, Cas s 1 and Que a 1 were assessed in pre‐ and post‐SLIT samples of 17 individuals by ELISA. A basophil inhibition assay using stripped basophils re‐sensitized with a serum pool containing high Bet v 1‐specific IgE levels was established and used to assess CD63 expression in response to allergens after incubation with pre‐SLIT or post‐SLIT samples. IgG1 and IgG4 were depleted from post‐SLIT samples to assess its contribution to IgE‐cross‐blocking.
Results
Sublingual immunotherapy with recombinant Bet v 1 boosted cross‐reactive IgE antibodies and induced IgG1 and IgG4 antibodies with inter‐ and intra‐individually differing reactivity to the homologs. Highly variable cross‐blocking activities of post‐SLIT samples to the different allergens were found. IgG1 and IgG4 antibodies displayed cross‐blocking activity with individual variance.
Conclusions
Our mechanistic approach suggested that immunotherapy with the reference allergen Bet v 1 induces individual repertoires of cross‐reactive IgG1 and IgG4 antibodies. The cross‐blocking bioactivity of these antibodies was also highly variable and neither predictable from protein homology nor IgE‐cross‐reactivity.
Bet v 1‐allergic individuals show IgE cross‐reactivity with allergens from Fagales. Sublingual immunotherapy with the reference allergen Bet v 1 induces individually diverse repertoires of cross‐reactive IgG1 and IgG4 antibodies. The cross‐blocking bioactivity of IgG1 and IgG4 antibodies is highly variable and not predictable from IgE‐cross‐reactivity.
Over more than 50 years, the nocuous effects of smoking in pregnancy on the fetus are well known. In the first years of science the focus was primarily on restricted fetal growth while in more recent ...years over 10.000 studies investigated the incomparably big sum of detrimental effects for the unborn's health. In this statement we want to present the recent scientific findings on this topic. The statement is aimed to show all doctors who treat pregnant women the present situation and evidence. In the beginning we give a short overview about the epidemiological situation in Europe. Then we present step by step the health effects with regards to pathophysiology and clinics. Furthermore the reader will learn about possibilities for smoking cessation in pregnancy. The problem of passive-smoking in pregnancy will be dealt with in a separate chapter. At present there is strong evidence that pregnant smoking has a detrimental effect on birth-weight, placenta-associated disease, stillbirth, sudden infant death syndrome (SIDS), childhood overweight, clefts, lung function, asthma, cardiovascular diseases and mental developmental disorders. These factors can be summarized by the term Fetal Tobacco Syndrome. There is supply for more studies for less investigated health effects. Pregnancy is a chance to stop smoking as most women show a high motivation in this period. Hence doctors of all disciplines should inform pregnant women about the detrimental effects of smoking on their unborn child and show them possibilities for smoking cessation.
Summary
Montelukast, a leukotriene receptor antagonist (LTRA) has been approved for use in Europe since 1998. Indications for use (from the age of 6 months) include mild to moderate asthma, seasonal ...allergic rhinitis with asthma, and the prevention of exercise-induced asthma episodes. The psychiatric side effects of montelukast have been known for the last 10 years; in the case of such symptoms benefits and risks should be considered. Due to potential life-threatening psychiatric adverse events, particularly suicide, a black box warning was issued. In this statement the Austrian working group of pediatric pulmonology and allergology advises that treatment with montelukast should be started only after critical evaluation. Treatment should be stopped on the occurrence of any neuropsychiatric side effects.
The management of asthma has fundamentally changed during the past decades. The present guideline for the diagnosis and treatment of asthma was developed for respiratory specialists who need detailed ...and evidence-based information on the new diagnostic and therapeutic options in asthma. The guideline shows the new role of biomarkers, especially blood eosinophils and fractional exhaled NO (FeNO), in diagnostic algorithms of asthma. Of note, this guideline is the first worldwide to announce symptom prevention and asthma remission as the ultimate goals of asthma treatment, which can be achieved by using individually tailored, disease-modifying anti-asthmatic drugs such as inhaled steroids, allergen immunotherapy or biologics. In addition, the central role of the treatment of comorbidities is emphasized. Finally, the document addresses several challenges in asthma management, including asthma treatment during pregnancy, treatment of severe asthma or the diagnosis and treatment of work-related asthma.
Summary
The coronavirus disease 2019 (COVID-19) pandemic is currently a challenge worldwide. In Austria, a crisis within the healthcare system has so far been prevented. The treatment of patients ...with community-acquired pneumonia (CAP), including SARS-CoV‑2 infections, should continue to be based on evidence-based CAP guidelines during the pandemic; however, COVID-19 specific adjustments are useful. The treatment of patients with chronic lung diseases has to be adapted during the pandemic but must still be guaranteed.
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