Development of algorithms for the diagnosis and management of acute allergy in primary practice.

Most patients presenting with allergies are first seen in the primary care setting. However, inadequacies in training and available guidance for general practitioners (GP) have been identified as significantly impacting the quality of care for these patients, resulting in inefficient use of healthcare resources. To address the lack of available guidance, a working group of French allergists has developed a series of online tools aimed at GPs. The expert panel developed algorithms for the diagnosis and treatment of common allergies by incorporating deliberations based on clinical guidelines and experience. In addition, they developed tables of common symptoms and detailed clinical cases that guide GPs through the typical decisions they are faced with in line with current best practice. These tools translate evidence-based recommendations from international clinical guidelines, outlining the key steps involved and assisting the physician in making decisions at each step. In addition to targeting improvements in diagnosis and standard of primary care, the tools also aim to reduce the burden on specialist allergy services by enabling GPs to diagnose and treat mild and moderate allergies, referring only severe and/or atypical cases to secondary care. The tools are adapted to the high primary care workload, enabling the physician to access essential information rapidly without unnecessary referrals to specialist allergy services.

A recombinant ω-gliadin-like D-type glutenin and an α-gliadin from wheat (Triticum aestivum): two immunoglobulin E binding proteins, useful for the diagnosis of wheat-dependent allergies.

Among the wheat prolamins, D-type glutenins display a highly repetitive sequence similar to ω-gliadins, but they contain a cysteine, that allows them to be included in the gluten macropolymers. An ω-gliadin-like D-type glutenin, an α-gliadin, and an ω5-gliadin-like D-type glutenin were obtained as recombinant proteins and compared using synchrotron radiation circular dichroism. This technique evidenced the strong thermostability of the ω5-gliadin-like protein. The IgE reactivity of recombinant proteins was evaluated using 45 sera from wheat-allergic patients. The sera from patients diagnosed with cutaneous hypersensitivity to hydrolyzed wheat proteins often reacted with the ω-gliadin-like D-type glutenin and α-gliadin, whereas the IgE reaction was less frequent after dietary sensitization. So, these two proteins could be useful to diagnose these diseases. The sera from patients with exercise-induced anaphylaxis recognized the ω5-gliadin-like protein as a positive control and, less frequently, the other proteins tested. Only some sera from patients with baker's asthma reacted with the proteins tested.

Sublingual-swallow immunotherapy with standardized 3-grass pollen extract: a double-blind, placebo-controlled study.

BACKGROUND: Sublingual immunotherapy (SLIT) is accepted as a safe and effective route for the treatment of grass pollen allergy, but clarification of its clinical and biological efficacy requires more study. OBJECTIVE: To evaluate the efficacy, safety, and compliance of SLIT with a standardized 3-grass pollen extract in patients with grass pollen seasonal allergic rhinoconjunctivitis, with or without mild asthma. METHODS: This multicenter, randomized, double-blind study included 127 patients (aged 12-41 years; mean age, 24.9 years) with grass pollen seasonal allergic rhinoconjunctivitis, with or without mild asthma. They received either SLIT with a high-dose, standardized, 3-grass pollen extract or placebo for 10 months before and during the grass pollen season. The efficacy evaluation compared weekly clinical scores (defined as the sum of the symptom score and rescue medication score) to measure rhinoconjunctivitis and asthma for the first 8 weeks of the pollen season. We also evaluated safety and compliance and measured changes in anti-Dactylis specific IgG4 antibody levels. RESULTS: There was a trend in favor of the study group in the mean adjusted clinical score. The groups were not comparable on inclusion (P = .02): the SLIT group included more subjects with asthma and had a higher mean IgG4 serum level. Additional exploration according to subgroups with and without asthma found that among the patients without asthma, the SLIT group had a significantly better clinical score (P = .045). Anti-Dactylis specific IgG4 levels increased significantly in the SLIT group. CONCLUSION: SLIT with a standardized, high-dose, 3-grass pollen extract is safe and significantly improves the clinical score in patients with hay fever and without asthma during the pollen season.

The en 455-3 modified lowry assay does not yield a reliable estimate of the allergenicity level of latex gloves with low total protein content.

BACKGROUND: Estimation of the allergenicity of latex gloves by measurement of total extractable protein content with the modified Lowry method is not satisfactory. Therefore, complementary methods that are accurate, sensitive, and clinically relevant are needed. The Competitive Immunoassay for Antigenic Latex Proteins (CIALP) method described in a previous study could be a reliable complementary method for estimating the allergenicity of latex gloves. MATERIAL/METHODS: Extracts from 62 powdered or powder-free gloves (16 surgical and 46 examination) were tested by the EN 455-3 modified Lowry assay, IgE-inhibition, and CIALP. The results were compared with those from 36 glove extracts reported in a previous study. RESULTS: Significant correlations were observed between CIALP, IgE-inhibition, and the Lowry assay for the 62 glove extracts (r between 0.79 and 0.87; p<0.001), mostly rich in proteins. After inclusion of results from the previous study, significant correlations between the three methods were again observed (r between 0.76 and 0.90; p<0.001). However, there was no correlation between CIALP or IgE-inhibition and results of the Lowry assay for gloves that had a total protein content <50 micro g/g of glove. Furthermore, 15/16 extracts with undetectable total proteins were positive in both the CIALP and IgE-inhibition methods. CONCLUSIONS: The modified Lowry assay alone is useful for estimating the allergenicity of latex gloves when the total protein content is >/=50 micro g/g of glove. For gloves with a total protein content <50 micro g/g of glove, complementary methods such as CIALP are necessary.