In this issue: Graphical abstracts

A history of asthma was identified in more than one-third of cases mainly involving food anaphylaxis and children, whereas bronchospasm was documented in the half of the food anaphylaxis cases. GRAPH EPITHELIUM-DERIVED CYSTATIN SN INHIBITS HDM PROTEASE ACTIVITY IN ALLERGIC ASTHMA - P.1507 Lei Yao, Xijing Yuan, Heng Fu, Qinxing Guo, Yunhui Wu, Shurui Xuan, Nazanin Zounemat Kermani, Ian M. Adcock, Xiaoning Zeng, Yi Liu, Min Xie, Xin Yao Sputum and serum CST1 protein levels are elevated in asthma and negatively correlate with lung function. Qiuyan Liang, Jinrong Fu, Xiang Wang, Lijuan Liu, Wenfeng Xiao, Yajing Gao, Lan Yang, Hongmiao Yu, Xueru Xie, Zikun Tu, Saihua Huang, Xiao Han, Liling Qian, Yufeng Zhou circS100A11 was screened out by microarray analysis. [Extracted from the article] Copyright of Allergy is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Rates of New Peanut Allergy and Discontinuation Following Introduction in High-Risk Infants

Rationale: Current guidelines recommend peanut introduction to high-risk infants. However, compliance and rates of new peanut allergy (PA) require further study. Methods: Participants aged 4-11 months with no prior peanut exposure and (i) diagnosis of non-peanut food allergy, (ii) moderate-severe atopic dermatitis, or (iii) first degree relative with PA were enrolled. PA status was determined by skin testing and food challenge. Participants without PA were advised to consume 2 grams of peanut protein three times/week. Monthly questionnaires were administered, with follow-up visits at 18 and 30 months. Results: At baseline, 35/326 (11%) participants were peanut allergic. Of 291 without PA, 78 (27%) discontinued peanut at least temporarily 115 times during follow-up because of suspected participant reaction (40%), fear of reaction (3%), reaction or fear of reaction in a family member (21%), participant refusal (9%), peanut introduction was too much work (3%), or other reasons (23%), including the COVID-19 pandemic. Six of 291 participants (2.1%) who consumed peanut developed PA (2 consistent with FPIES). Among 291 participants without PA at baseline, none of the 17 participants with initial skin prick test of at least 4 mm and <10 mm developed PA. Conclusions: New PA after early introduction recommendations was rare, confirming the LEAP study findings. Transient discontinuation was common, mostly due to suspected participant reaction. High-risk children may require substantial support to keep peanut in their diet.

In this issue: Graphical abstract

Moritz M. Hollstein, Lennart Münsterkötter, Michael P. Schön, Armin Bergmann, Thea M. Husar, Anna Abratis, Abass Eidizadeh, Meike Schaffrinski, Karolin Zachmann, Anne Schmitz, Jason S. Holsapple, Hedwig Stanisz-Bogeski, Julie Schanz, Andreas Fischer, UWE GROß, Andreas Leha, Andreas E. Zautner, Moritz Schnelle, Luise Erpenbeck Booster with BNT162b2 elicits strong humoral and cellular immune responses independent of the prime vaccination, whereas ChAdOx1 nCoV-19 booster does not further enhance the cellular response. We demonstrate that the vaccine candidate (CuMV SB TT sb -RBD) is highly immunogenic in mice and is capable of inducing mucosal and systemic RBD as well as spike specific antibody responses. GRAPH Abbreviations: CDX-0159, anti-KIT inhibitory monoclonal antibody;FcR, Fc receptor;KIT, KIT proto-oncogene, receptor tyrosine kinase;MRGPRX2, mas-related G protein-coupled receptor-X2;SCF, stem cell factor. [Extracted from the article] Copyright of Allergy is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Basophil activation test: current applications and future perspectives

The basophil activation test (BAT) is a flow cytometric assay that evaluates the percentage of activation or degranulation of peripheral blood basophils, after “in vitro” exposure to specific allergens. In sensitized patients, the stimulation of peripheral blood basophils with a specific allergen induces or up-regulates the expression of molecules, such as CD63 and CD203c, which represent, markers of degranulation and activation of basophils, respectively. The validity of the BAT requires a negative control (sterile saline) and a positive control (anti-IgE molecules). Several studies have demonstrated the role of the BAT in supporting the diagnosis of drug, food and hymenoptera venom allergy. The BAT has shown a low sensitivity but good specificity in diagnosing allergy to drugs such as NSAIDs, beta-lactam antibiotics, quinolones and muscle relaxants. In food allergy, the sensitivity and specificity of the BAT depends on the food;in the case of peanut allergy the sensitivity reaches 96% while the specificity the 100%. In addition, the BAT is an useful tool to monitor the natural resolution of allergies and the clinical effects induced by either immunotherapy or anti-IgE treatment. Finally, the BAT has been utilized to study the pathogenetic mechanisms underlying several IgE-mediated diseases. For example, in patients affected by severe bronchial asthma, the BAT has demonstrated the ability of Staphylococcus aureus enterotoxins to induce the activation of basophils supporting the role of these enterotoxins as “triggers” of the inflammatory cascade in bronchial asthma. In patients with cystic fibrosis the BAT can be used to dis-criminate allergic bronchopulmonary aspergillosis from Aspergillus colonization. More recently, the BAT has been demonstrated as a potential diagnostic tool to evaluate allergy to the polyethylene glycol (PEG) present in the anti-SARS-CoV-2 BNT162b2 mRNA vaccine.

Home-Based Peanut Oral Immunotherapy for Low-Risk Peanut-Allergic Preschoolers During the COVID-19 Pandemic and Beyond.

The coronavirus disease 2019 (COVID-19) pandemic has led to the deprioritization of non-emergency services, such as oral food challenges and the initiation of oral immunotherapy (OIT) for food-allergic children. Recent studies have suggested that home-based peanut OIT could be a safe and effective option for low-risk peanut-allergic children. In the period between September 1, 2020, and January 31, 2021, nine preschoolers with a history of mild allergic reactions to peanut underwent home-based peanut OIT. Eight of them (88.9%) completed the build-up phase at home in 11-28 weeks, tolerating a daily maintenance dose of 320 mg peanut protein. During the build-up, six patients (75.0%) reported urticaria, three (33.3%) reported gastrointestinal tract symptoms, and one (14.3%) reported oral pruritis. None of the patients developed anaphylaxis, required epinephrine, or attended emergency services related to OIT. One or two virtual follow-up visits were completed per patient during the build-up phase. Our case series shows that home-based OIT could be offered to the low-risk preschoolers during the COVID-19 pandemic when non-emergency services are limited and could be considered beyond the pandemic, especially for the families living in the rural or remote areas that may otherwise be unable to access OIT.

REAL-WORLD PERSPECTIVES OF HEALTH CARE PROVIDERS DELIVERING THE FIRST APPROVED TREATMENT FOR PEANUT ALLERGY

Introduction: In January 2020, Peanut (Arachis hypogaea) Allergen Powder-dnfp (PTAH) became the first treatment for Peanut Allergy (PA) approved by the US Food and Drug Administration (FDA). The adoption of innovative new therapies requires consideration of the skills, logistics and practicalities required for implementation. Methods: Qualitative interviews were conducted to explore health care providers’ (HCPs) experiences of delivering PTAH, challenges encountered, and successful implementation strategies. HCPs who had initiated PTAH treatment with ≥3 patients since FDA approval were eligible. Semi-structured interviews were conducted via videoconference. Interviews were audio-recorded, transcribed, and analyzed using content analysis. The study was exempted by the Western Institutional Review Board. Results: Eight allergists and three nurse practitioners participated. Their experiences are characterized by four key themes: 1. factors influencing adoption, 2. factors related to delivering the treatment in everyday practice, 3. learnings and reflections, and 4. delivering PTAH during the COVID-19 pandemic. HCPs described how successful implementation of PTAH requires them to be thoughtful about their clinic’s abilities to integrate complex, time-consuming treatments into their practice. Prior experience of oral immunotherapy was deemed beneficial, but not essential for implementation and learning from others’ experience was suggested as a way of helping new prescribers overcome perceived and actual implementation challenges. Conclusion: The experiences described by the treatment pioneers included in this research serve to benefit the wider allergy community by providing practical solutions, successful implementation strategies and opportunities to share information as new innovative treatments become available to patients.

Novel Approaches to Food Allergy Management During COVID-19 Inspire Long-Term Change.

The SARS-CoV2 pandemic has prompted a re-evaluation of our current practice of medicine. The seemingly abrupt worldwide spread of this disease resulted in immediate changes and a reduction in many allergy-focussed services and procedures. The reality of the long-term circulation of this virus in our communities requires us to evolve as a specialty. In this article, we outline current and future challenges in the management of food allergy in light of coronavirus disease 2019 (COVID-19). We focus on infant food allergy prevention, management of anaphylaxis, accurate diagnosis with oral food challenges, and active management of food allergy with oral immunotherapy. This article identifies the challenges of conflicting guidelines, shortcomings of acute management approaches, and inherent system deficiencies. We offer perspectives and strategies that can be implemented now, including an evaluation of virtual care and telemedicine for the management of food allergy. The use of a shared decision-making model results in novel approaches that can benefit our patients and our specialty for years to come. COVID-19 has forced us to re-evaluate our current way of thinking about food allergy management to better treat our patients.