In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR‐Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR‐Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence‐based findings and recommendation from the full document.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/alr.23090

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

Allergen immunotherapy (AIT) is the sole disease-modifying treatment for allergic rhinitis; it prevents rhinitis from progressing to asthma and lowers medication use. AIT against mites, insect venom, and certain kinds of pollen is effective. The mechanism of action of AIT is based on inducing immunological tolerance characterized by increased IL-10, TGF-β, and IgG4 levels and Treg cell counts. However, AIT requires prolonged schemes of administration and is sometimes associated with adverse reactions. Over the last decade, novel forms of AIT have been developed, focused on better allergen identification, structural modifications to preserve epitopes for B or T cells, post-traductional alteration through chemical processes, and the addition of adjuvants. These modified allergens induce clinical-immunological effects similar to those mentioned above, increasing the tolerance to other related allergens but with fewer side effects. Clinical studies have shown that molecular AIT is efficient in treating grass and birch allergies. This article reviews the possibility of a new AIT to improve the treatment of allergic illness.

/pdf/allergen-immunotherapy-current-and-future-trends-j4hceyxt.pdf

Allergen Immunotherapy: Current and Future Trends

Shellfish allergy caused by undesirable immunological responses upon ingestion of crustaceans and mollusks is a common cause of food allergy, especially in the Asia-Pacific region. While the prevalence of shellfish allergy is increasing, the mainstay of clinical diagnosis for these patients includes extract-based skin prick test and specific IgE measurement while clinical management consists of food avoidance and as-needed use of adrenaline autoinjector should they develop severe allergic reactions. Such a standard of care is unsatisfactory to both patients and healthcare practitioners. There is a pressing need to introduce more specific diagnostic methods, as well as effective and safe therapies for patients with shellfish allergy. Knowledge gained on the identifications and defining the immuno-molecular features of different shellfish allergens over the past two decades have gradually translated into the design of new diagnostic and treatment options for shellfish allergy. In this review, we will discuss the epidemiology, the molecular identification of shellfish allergens, recent progress in various diagnostic methods, as well as current development in immunotherapeutic approaches including the use of unmodified allergens, hypoallergens, immunoregulatory peptides and DNA vaccines for the prevention and treatment of shellfish allergy. The prospect of a "cure "for shellfish allergy is within reach.

/pdf/overcoming-shellfish-allergy-how-far-have-we-come-4mlvrtiij3.pdf

Overcoming Shellfish Allergy: How Far Have We Come?

Edible insects are a unique food source, requiring extensive allergenic risk assessment before its safe introduction in the food market. In a recent systematic review, crustacean allergic subjects ...

Edible insects and food safety: allergy

Seafood is a major cause of food allergy and anaphylaxis worldwide. Shellfish is included among the "big eight" food groups, which are responsible for more than 90% of all cases of food allergy. Approximately 2.5% of the world's population has experienced an adverse reaction to seafood. Seafood allergy is one of the most frequent and lethal allergies that exist. The several allergenic proteins involved in allergic reactions that have been described in recent years include tropomyosin, arginine kinase, myosin light chain, and sarcoplasmic calcium-binding protein. Despite all the data reported in the last few years, shellfish allergy is still diagnosed and treated as it was 50 years ago. The only effective treatment to prevent allergic reactions to shellfish is avoidance. This review aims to update recently published data on shellfish allergy and to highlight those areas that have yet to be resolved.

/pdf/shellfish-allergy-unmet-needs-in-diagnosis-and-treatment-lxd6isowtj.pdf

Shellfish Allergy: Unmet Needs in Diagnosis and Treatment.

BACKGROUND Few studies have directly compared the immunologic responses to specific subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). OBJECTIVE We aimed to directly compare clinical efficacy and immunological responses between SLIT and SCIT in allergic rhinitis (AR) sensitized to house dust mites. METHODS Sixty-seven patients (age 5-55 years) with moderate-severe Dermatophagoides pteronyssinus (Der-p) and Dermatophagoides farinae AR with or without asthma were randomized (2:2:1) into SLIT (n = 27), SCIT (n = 26) and placebo (n = 14) groups. Symptom and medication scores, visual analogue score, serum Der-p specific immunoglobulin G4 (Der-p-sIgG4), CD4+CD25+FoxP3+ regulatory T cells (Tregs) and serum cytokines were measured. RESULTS After 1-year treatment, a significant improvement of total rhinitis score (TRS), total rhinitis medication score (TRMS) and visual analogue score occurred in both SLIT and SCIT. There were no differences in clinical efficacy except for TRMS (p = 0.026) when SLIT and SCIT were directly compared. CD4+CD25+FoxP3+ Tregs had a trend towards upregulation in the 2 modes and inversely correlated with TRS (p = 0.024) only in SLIT. Der-p-sIgG4 significantly increased in SLIT and SCIT (p < 0.05), and it was 30 times higher in SCIT than SLIT after the treatment (p < 0.05). Serum interferon-γ significantly increased only in SCIT after 1 (p = 0.008), 6 (p = 0.007) and 12 (p = 0.008) months of treatment and inversely correlated with TRS (p = 0.032). CONCLUSION While SCIT and SLIT have similar rates of clinical improvement, the 2 modes reveal heterogeneous changes of CD4+CD25+Foxp3+ Tregs, sIgG4 and cytokines.

/pdf/changes-in-cd4-cd25-foxp3-regulatory-t-cells-and-serum-3blzwi5cvz.pdf

Changes in CD4+CD25+FoxP3+ Regulatory T Cells and Serum Cytokines in Sublingual and Subcutaneous Immunotherapy in Allergic Rhinitis with or without Asthma.

Background
Little is known about the prevalence of food allergy (FA) in China.

Objective
To investigate the prevalence of FA and its disparity between urban and rural areas in southern China.

Methods
Europrevall questionnaire responses were obtained from 5,542 school-age-children in urban Guangzhou and 5,319 in rural Shaoguan. A case-control study enrolled 190 children with adverse reactions (ARs) after food intake as cases, and 212 controls in Guangzhou; 116 cases and 233 controls in Shaoguan. These subjects underwent skin-prick test (SPT) and serum IgE measurements to food and inhalant allergens. Allergen extracts from shrimp, house dust mite (HDM), and cockroach were prepared for IgE cross-relativity testing in 23 Guangzhou and 20 Shaoguan shrimp-sensitized subjects.

Results
The prevalence of ARs to shrimp was higher in Guangzhou than Shaoguan children (3.5% vs. 1.4%, p<0.001). However, sensitization rate to shrimp (SPT: 3.7% vs. 11.2%, p=0.015; IgE: 12.6% vs. 36.2%, p<0.001) and cockroach (SPT: 5.3% vs. 33.5%; IgE: 2.6% vs. 27.6%, p<0.001) were lower in Guangzhou. A significant correlation between shrimp and HDM/cockroach IgE was found in Shaoguan children. The proportions of positive IgE to tropomyosin (Pen a 1, Der p 10) were lower than 7.4% in both areas. Cockroach allergen has a significantly higher inhibition rate of binding to IgE to house-dust-mite allergens in Shaoguan sera.

Conclusions
Shrimp is a common allergic food in southern China. Higher proportion of shrimp sensitization in rural subjects could be explained by cross-reactive to cockroach. Tropomyosin was not a major allergen responding for the cross-reactivity.

This article is protected by copyright. All rights reserved.

Cockroach is a major cross-reactive allergen source in shrimp-sensitized rural children in southern China

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Changes in CD4+CD25+FoxP3+ Regulatory T Cells and Serum Cytokines in Sublingual and Subcutaneous Immunotherapy in Allergic Rhinitis with or without Asthma.

Cockroach is a major cross-reactive allergen source in shrimp-sensitized rural children in southern China