Progress of Home-Based Food Allergy Treatment during the Coronavirus Disease Pandemic in Japan: A Cross-Sectional Multicenter Survey

The coronavirus disease 2019 (COVID-19) pandemic’s impact on food allergy treatment such as home-based oral immunotherapy (OIT) is not known. This cross-sectional, questionnaire-based anonymized survey screened 2500 parents of children with allergic diseases and was conducted in the pediatric outpatient clinics of 24 hospitals. Basic clinical data of the children were collected along with the degree of allergy control, parental anxiety about emergency visits, and the risk of COVID-19 in the first state of emergency. A total of 2439 (97.6%) questionnaires were collected, and 1315 parents who were instructed to initiate home-based OIT for their children were enrolled (OIT group). Subjective OIT progress compared to before the COVID-19 pandemic was ascertained as “Full”, “Middle”, “Low”, “Little”, and “Stop” in 264 (20.1%), 408 (31.0%), 384 (29.2%), 203 (15.4%), and 56 (4.3%) participants, respectively. Anxiety about emergency visits and the risk of COVID-19 were negatively associated with the subjective OIT progress. In Japan, approximately half of the children continued smoothly the home-based OIT during the COVID-19 pandemic. Parents with high levels of anxiety about the disruption of the medical care system due to COVID-19 and the risk of COVID-19 did not experience a smooth continuation of home-based OIT.

Indonesia-based Study of the Clinical and Cost-saving Benefits of Subcutaneous Allergen Immunotherapy for Children with Allergic Rhinitis in Private Practice

Background. Until now, cost of allergy treatment in insured public health care system and non-insured self-financing private health care system in Indonesia has not been well documented and published, as well as the cost of allergy treatment with subcutaneous immunotherapy. Objective. To evaluate the clinical and cost benefits of allergic rhinitis treatment in children with subcutaneous immunotherapy in non-insured self-financing private health care system. Methods. A retrospective cohort study conducted from 2015 until 2020, compared clinical improvement and health care costs over 18 months in newly diagnosed AR children who received SCIT versus matched AR control subjects who did not receive SCIT, with each group consisting of 1,098 subjects Results. Decrease of sp-HDM-IgE level (kU/ml) from 20.5 + 8.75 kU/ml to 12.1 + 3.07 kU/ml had been observed in the SCIT group. To reduce the symptom score of allergic rhinitis by 1.0 with SCIT it costs IDR 21,753,062.7 per child, for non SCIT it costs IDR 104,147,878.0 per child. Meanwhile, to reduce the medication score (MS) by 1.0 with SCIT it costs Rp. 17,024,138.8 while with non SCIT it costs Rp. 104,147,878.0. Meanwhile, to lower combination symptoms and medication score (CSMS) by 1.0, with SCIT it costs IDR 9,550,126.6, while with non SCIT it costs IDR 52,073,938.9. Conclusion. In conclusion, this first Indonesia-based study demonstrates substantial health care cost savings associated with SCIT for children with AR in an uninsured private health care system and provides strong evidence for the clinical benefits and cost-savings benefits of AR treatment in children.

Allergic rhinitis from the otorhinolaryngologist’s perspective

Allergic rhinitis remains one of the most pressing problems of modern otorhinolaryngology. Allergic rhinitis is an allergic inflammation of the nasal mucosa characterised by the following symptoms (one or more): stuffiness, rhinorrhoea, nasal itching, sneezing. In recent years the incidence of allergic rhinitis in the economically developed countries has been shown to be close to 40–50%. Allergic rhinitis is now characterised by an early onset, often continuously relapsing course and resistance to antiallergic therapy. Allergic rhinitis has a negative impact on a person’s social and daily activities, mental well-being and general health, regardless of age. Allergic rhinitis significantly reduces job performance, physical and mental activity, communication skills, causes snoring, anxiety, depression, sleep disorders and erectile dysfunction. Studying the mechanisms of the disease provides the basis for a rational therapy that addresses the complex inflammatory response rather than just the symptoms of allergy. Treatment is either in outpatient settings or inpatient – in specialised departments. A recent priority of pharmacotherapy is the use of intranasal corticosteroids, both as basic therapy for allergic rhinitis and as part of a combined regimen. The use of intranasal corticosteroids is considered to be the therapy of choice in allergic rhinitis. The paper demonstrates the efficacy and safety of topical corticosteroids for use in clinical practice. Intranasal corticosteroids have a wide range of reported indications, an extensive evidence base and can be recommended for the treatment of allergic rhinitis. For best result intranasal corticosteroids should be used at first signs of allergic rhinitis onset.

Cryo-EM structure of the human histamine H1 receptor/Gq complex

Histamine receptors play important roles in various pathophysiological conditions and are effective targets for anti-allergy treatment, however the mechanism of receptor activation remain elusive. Here, we present the cryo-electron microscopy (cryo-EM) structure of the human H1R in complex with a Gq protein in an active conformation via a NanoBiT tethering strategy. The structure reveals that histamine activates receptor via interacting with the key residues of both transmembrane domain 3 (TM3) and TM6 to squash the binding pocket on the extracellular side and to open the cavity on the intracellular side for Gq engagement in a model of “squash to activate and expand to deactivate”. The structure also reveals features for Gq coupling, including the interaction between intracellular loop 2 (ICL2) and the αN-β junction of Gq/11 protein. The detailed analysis of our structure will provide a framework for understanding G-protein coupling selectivity and clues for designing novel antihistamines.

Development of the concept of exosome in assessing the interaction between the internal and external environment in allergy

This publication extends RAACI education in the field of allergology and immunology for allergologists, immunologists and other specialists, as well as for practitioners. It presents recent data and innovative approaches to the study of complex interactions of genetic, non-genetic and environment factors in allergies. It explains the importance of exposome-oriented approaches aimed to increase the treatment effectiveness and to decrease risks of allergy in addition to genome-oriented models of human diseases. Exposome concepts can be integrated into existing research programmes which are crucial in shaping new approaches to allergy treatment and prevention

Management of Recurrent Acute Rhinosinusitis: A Systematic Review

Background Objective Study Design RARS is a challenging clinical problem that impacts many patients. This article seeks to systematically review the literature on RARS management. Methods Cochrane, PubMed, EMBASE, and other databases were queried for articles related to RARS dating from 1990 to present, according to PRISMA guidelines. Inclusion criteria included articles specifically addressing RARS management; studies with 3 or more patients; and articles in English. Results A total of 1022 titles/abstracts potentially related to RARS were identified. Of these, sixty-nine full texts were selected for review, and 10 met inclusion criteria (five with level 4 evidence, four with level 3 evidence, one with level 2 evidence). The studies included a total of 890 patients (Age range 5.8 to 53.5 years), with follow up ranging from 1 to 19 months. Endpoints were primarily based on symptomatic improvement, although some articles also reported post-treatment endoscopic and radiographic findings. Management options included medical therapy (intranasal steroids, antibiotics, nasal saline irrigations, N-acetylcysteine, allergy treatment, and decongestants), balloon sinus dilation (BSD), and endoscopic sinus surgery (ESS). Surgical patients (BSD and ESS) had a trend towards greater symptom control than medically-treated patients, but meta-analysis was not possible. Conclusion Despite increasing interest in the treatment of RARS, there remains a lack of consensus regarding optimal management. The literature thus far, largely based on expert opinion, suggests that surgical management, either through balloon sinus dilation or endoscopic sinus surgery, may be helpful in improving symptoms and quality of life in those who do not respond to initial trials of medical management.