Drug hypersensitivity reactions in Asia: regional issues and challenges

There are geographical, regional, and ethnic differences in the phenotypes and endotypes of patients with drug hypersensitivity reactions (DHRs) in different parts of the world. In Asia, aspects of drug hypersensitivity of regional importance include IgE-mediated allergies and T-cell-mediated reactions, including severe cutaneous adverse reactions (SCARs), to beta-lactam antibiotics, antituberculous drugs, nonsteroidal anti-inflammatory drugs (NSAIDs) and radiocontrast agents. Delabeling of low-risk penicillin allergy using direct oral provocation tests without skin tests have been found to be useful where the drug plausibility of the index reaction is low. Genetic risk associations of relevance to Asia include human leucocyte antigen (HLA)-B*1502 with carbamazepine SCAR, and HLA-B*5801 with allopurinol SCAR in some Asian ethnic groups. There remains a lack of safe and accurate diagnostic tests for antituberculous drug allergy, other than relatively high-risk desensitization regimes to first-line antituberculous therapy. NSAID hypersensitivity is common among both adults and children in Asia, with regional differences in phenotype especially among adults. Low dose aspirin desensitization is an important therapeutic modality in individuals with cross-reactive NSAID hypersensitivity and coronary artery disease following percutaneous coronary intervention. Skin testing allows patients with radiocontrast media hypersensitivity to confirm the suspected agent and test for alternatives, especially when contrasted scans are needed for future monitoring of disease relapse or progression, especially cancers.

Asia Pacific Association of Allergy Asthma and Clinical Immunology White Paper 2020 on climate change, air pollution, and biodiversity in Asia-Pacific and impact on allergic diseases

Air pollution, climate change, and reduced biodiversity are major threats to human health with detrimental effects on a variety of chronic noncommunicable diseases in particular respiratory and cardiovascular diseases. The extent of air pollution both outdoor and indoor air pollution and climate change including global warming is increasing-to alarming proportions particularly in the developing world especially rapidly industrializing countries worldwide. In recent years, Asia has experienced rapid economic growth and a deteriorating environment and increase in allergic diseases to epidemic proportions. Air pollutant levels in many Asian countries especially in China and India are substantially higher than are those in developed countries. Moreover, industrial, traffic-related, and household biomass combustion, indoor pollutants from chemicals and tobacco are major sources of air pollutants, with increasing burden on respiratory allergies. Here we highlight the major components of outdoor and indoor air pollutants and their impacts on respiratory allergies associated with asthma and allergic rhinitis in the Asia-Pacific region. With Asia-Pacific comprising more than half of the world's population there is an urgent need to increase public awareness, highlight targets for interventions, public advocacy and a call to action to policy makers to implement policy changes towards reducing air pollution with interventions at a population-based level.

Actions needed for “Allergy in Asia-Pacific”

No abstract available.

The sticky relationship between allergies and infections

No abstract available.

The Innate Immune Response in House Dust Mite-Induced Allergic Inflammation

Hypersensitivity to house dust mite (HDM; Dermatophagoides sp.) allergens is one of the most common allergic responses, affecting up to 85% of asthmatics. Sensitization to indoor allergens is the strongest independent risk factor associated with asthma. Additionally, >50% of children and adolescents with asthma are sensitized to HDM. Although allergen-specific CD4+ Th2 cells orchestrate the HDM allergic response through induction of IgE directed toward mite allergens, activation of innate immunity also plays a critical role in HDM-induced allergic inflammation. This review highlights the HDM components that lead to activation of the innate immune response. Activation may due to HDM proteases. Proteases may be recognized by protease-activation receptors (PARs), Toll-like receptors (TLRs), or C-type lectin receptors (CTRs), or act as a molecular mimic for PAMP activation signaling pathways. Understanding the role of mite allergen-induced innate immunity will facilitate the development of therapeutic strategies that exploit innate immunity receptors and associated signaling pathways for the treatment of allergic asthma.

What Taiwan contributes to the world of allergy and clinical immunology?

In commemorate the 9th Asia Pacific Congress of Allergy, Asthma, and Clinical Immunology (APCAACI) in Taipei, Taiwan in November this year, some of the seminar works and contributions by the researchers from Taiwan to the advance in the field of allergy and clinical immunology, such as DNA vaccine, traditional Chinese medicine, anti-IgE antibody, and personalized medicine for severe drug allergic reaction, are summarized in this special review.

Health care utilization and medical costs for childhood asthma in Taiwan: using Taiwan National Health Insurance Research Database

Asthma is an important health problem worldwide and the prevalence is increasing in most part of the world. The burden of this disease to governments, health-care systems, and patients and their families have been greater more than ever despite efforts advocated by Global Initiative for Asthma for total asthma controls. Using Taiwan National Health Insurance Research Database, in this review, the population-based prospective studies showed the costs and health care utilization of childhood asthma in Taiwan was 2 folds higher than non-asthmatic children, and the prescription patterns of anti-asthmatic medications among physician in different discipline were all far from satisfied. The appropriateness of combinational therapy of inhaled corticosteroids and long acting β-agonists for moderate to severe childhood asthma was only 62%. In a government-sponsored disease management program for asthmatic patients within national health insurance, though the total mean costs (26.5%) and outpatient costs (26.1%) increased, the mean emergency department visits and hospitalization rates were significantly reduced by 34.4% and 51.74%, respectively, compared to the previous year. Therefore, in the real-world situation, asthmatic patients as well as medical professions who take care of asthmatic children still have much space for their symptoms controls and knowledge improvement to reduce the burden of asthma. From the experience of care and management of childhood asthma in Taiwan may reveal same problems of childhood asthma care in the similar cultural and ecological environments of Asian pacific countries, and suggest government-sponsored program may also have significant impact aimed at improving the care of patients with asthma.