September 2022

Sep 29

Update on pathomechanisms and treatments in allergic rhinitis

By Bilastina Selected articles

Zhang Y, Lan F, Zhang L

Allergy. 2022 Jul 27. doi: 10.1111/all.15454. Online ahead of print.

Allergic rhinitis represents a worldwide health problem with increasing prevalence and relationship to a growing medical and socioeconomic burden. The objective of this review was to recognize immune cells such as type 2 innate lymphocytes (ILC2s), T helper (Th2) 2 cells, follicular helper T cells, follicular regulatory T cells, regulatory T cells, B cells, dendritic cells, and epithelial cells in allergic rhinitis pathogenesis.

It is important to have an in-depth understanding of the mechanisms of allergic rhinitis to help with the identification of biomarkers and eventually provide valued parameters o guide tailored targeted therapy. Allergen-specific immunotherapy is the only etiological treatment option for allergic rhinitis with evidence for effectiveness and that has been gaining increased attention. This immunotherapy recently demonstrated effectiveness and evidence in several randomized controlled trials and long-term real-life studies. The research of biologics as therapeutic options for allergic rhinitis has only involved anti-IgE and anti-type 2 inflammatory agents; nevertheless, the cost-effectiveness of these agents still needs to be explained.

During the COVID-19 pandemic, allergic rhinitis has not showed a risk factor for severity and mortality of COVID-19, however this needs to be confirmed in multi-centre, real-life studies worldwide.

This document is only available for registered healthcare professionals

Sep 29

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In silico Identification of Immune Cell-Types and Pathways Involved in Chronic Spontaneous Urticaria Connor Prosty

By Bilastina Selected articles

Prosty C, Gabrielli S, Ben-Shoshan M, Le M, Giménez-Arnau AM, Litvinov IV, Lefrançois P, Netchiporouk E

Front Med (Lausanne). 2022 Jul 7;9:926753. doi: 10.3389/fmed.2022.926753. eCollection 2022.

Chronic spontaneous urticaria (CSU) is defined by the presence of wheals and/or angioedema that occur in the absence of specific external stimuli and persist for more than 6 weeks. Its immunopathogenesis is not yet fully understood, but there are new trends on dividing patients into auto allergic and autoimmune subtypes.

The aim of this study was to investigate immune cells and pathways of CSU through the reanalysis of available transcriptomic data.

Investigators obtained microarray data of CSU and healthy control skin and blood from the Gene Expression Omnibus. Differentially expressed genes were analyzed using ToppGene and KEGG and cell-type enrichment was determined by CIBERSORT and xCell and correlated with clinical characteristics.

Th2 (IL-4/13 signaling) and Th17-related (IL-17/23 signaling) patways were found to be upregulated in lesional samples. CIBERSORT analysis showed that non-lesional samples had increased regulatory T-cells and resting mast cells. The xCell analysis revealed no significant differences between samples, however, Th2 scores in both types of samples correlated positively with disease severity. There were few differentially expressed genes and pathways identified between CSU and healthy control blood samples.

These results revealed and supported the connection of Th2 and Th17-related genes and pathways in CSU. Th2 scores related to disease severity, where increased resting mast cell and Treg scores in non-lesional samples indicate local suppression of wheal formation. Furthermore, disease activity seemed to be restricted to the skin as there were limited findings from blood. More studies are needed to further support this information.

This document is only available for registered healthcare professionals

Sep 29

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Mechanism of Lower Airway Hyperresponsiveness Induced by Allergic Rhinitis Yiting Liu

By Bilastina Artículos seleccionados, Selected articles

Liu Y, Sha J, Meng C, Zhu D

J Immunol Res. 2022 Jul 12;2022:4351345. doi: 10.1155/2022/4351345. eCollection 2022.

Allergic rhinitis affects up to 40% of adults and 25% of children globally, however its mechanisms are not yet well elucidated. The majority of people with allergic rhinitis also have lower airway hyperresponsiveness, and an allergic rhinitis occurrence can increase this hyperresponsiveness.

The aim of this review was to understand the mechanism of the effect of allergic rhinitis on the lower airways. The effects of allergic rhinitis on the lower airways were studied in terms of epidemiology, anatomy, pathophysiology, nasal function loss, inflammation drainage, nasobronchial reflex, and whole-body circulatory flow to elucidate the mechanisms involved and provide patterns for future diagnosis, treatment, and experiments.

Researchers concluded that these mechanisms cannot be explained by a single mechanism, but by an interaction of several ones. The hyperresponsiveness of the lower airway may be caused by the rhinopulmonary reflex, lower airway drainage of allergens and nasal obstruction. However, it may also be caused by circulating factors such as IL-5 that stimulate bone marrow cells to differentiate into eosinophils and for IL-4 and IL-13 to upregulate adhesion- and chemotaxis-related proteins. More studies are needed to design future diagnosis and treatment approaches.

This document is only available for registered healthcare professionals

Sep 29

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Urticaria in Pregnancy and Lactation

By Bilastina Artículos seleccionados, Selected articles

Kocatürk E, Podder I, Zenclussen AC, Kasperska Zajac A, Elieh-Ali-Komi D, Church MK, Maurer M

Front Allergy. 2022 Jul 7;3:892673. doi: 10.3389/falgy.2022.892673. eCollection 2022.

More women than men suffer from chronic urticaria, and they are mostly affected in their reproductive age, including pregnancy. Sex hormones affect mast cell biology and the hormonal changes that occur in pregnancy modulate inflammatory conditions such as chronic urticaria.

Pregnancy-related changes in the immune system, involving local adaptation of innate and adaptive immune responses and skewing of adaptive immunity toward a Th2/Treg profile were found to be related to changes in inflammatory diseases. The PREG-CU study provided the first insights on the effect of pregnancy on chronic urticaria, the outcomes of pregnancy in pregnant women with chronic urticaria and safety of urticaria medications and revealed that chronic urticaria improves during pregnancy in half of pregnant women, whereas it worsens in one-third. Also, two of five pregnant women with chronic urticaria experience flare-ups during pregnancy.

The international EAACI/GALEN/EuroGuiDerm/APAAACI guideline for urticaria recommends the same management strategy in pregnant and lactating women with chronic urticaria: start with standard doses of second-generation (non-sedative) H1 antihistamines and increase the dose up to 4-folds in case of no response. Antihistamine-refractory patients should be given omalizumab.

The PREG-CU study assessed treatments and their outcomes during pregnancy: H1 antihistamines, montelukast, omalizumab, cyclosporine-A and systemic steroids, however there isn’t still enough information on the management of chronic urticaria during pregnancy.

This document is only available for registered healthcare professionals

Sep 29

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Usage patterns of oral H1-antihistamines in 10 European countries: A study using MASK-air® and Google Trends real-world data

By Bilastina Artículos seleccionados, Selected articles

Vieira RJ, Sousa-Pinto B, Anto JM, Sheikh A, Klimek L, Zuberbier T, Fonseca JA, Bousquet J

World Allergy Organ J. 2022 Jun 24;15(7):100660. doi: 10.1016/j.waojou.2022.100660. eCollection 2022 Jul.

Real-world data may help provide important data on different conditions, namely allergic rhinitis. However, evaluating this information can represent a challenge, as results from internet users may be influenced by different factors, from the real epidemiology of the conditions being evaluated, but also by the attention they get in the media.

This study compared real-world data from MASK-air^®, a mobile app for allergic rhinitis on the usage of oral H1-antihistamines from 2016 to 2020 in 10 European countries with Google Trends data on the relative volume of search for these antihistamines.

5 different oral H1-antihistamines were selected for each country and the investigators perceived a perfect agreement on the order of antihistamine use in MASK-air^® and Google Trends in France, Germany, Sweden, and the United Kingdom. Different levels of agreement were observed in the remaining countries (Italy, Poland, Portugal, Spain, Switzerland, Netherlands). Sales data-wise, there was a consistency in data from Google Trends and MASK-air® in France, Germany and the United Kingdom.

In conclusion, these results suggest that the mobile app MASK-air® data may have a common trend in relation to other real-world data, however, more studies are needed.

This document is only available for registered healthcare professionals

Update on pathomechanisms and treatments in allergic rhinitis

In silico Identification of Immune Cell-Types and Pathways Involved in Chronic Spontaneous Urticaria Connor Prosty

Mechanism of Lower Airway Hyperresponsiveness Induced by Allergic Rhinitis Yiting Liu

Urticaria in Pregnancy and Lactation

Usage patterns of oral H1-antihistamines in 10 European countries: A study using MASK-air® and Google Trends real-world data

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