EAACI guidelines on allergen immunotherapy: Prevention of allergy

Allergic diseases are common and frequently coexist. Allergen immunotherapy (AIT) is a disease‐modifying treatment for IgE‐mediated allergic disease with effects beyond cessation of AIT that may include important preventive effects. The European Academy of Allergy and Clinical Immunology (EAACI) has developed a clinical practice guideline to provide evidence‐based recommendations for AIT for the prevention of (i) development of allergic comorbidities in those with established allergic diseases, (ii) development of first allergic condition, and (iii) allergic sensitization. This guideline has been developed using the Appraisal of Guidelines for Research & Evaluation (AGREE II) framework, which involved a multidisciplinary expert working group, a systematic review of the underpinning evidence, and external peer‐review of draft recommendations. Our key recommendation is that a 3‐year course of subcutaneous or sublingual AIT can be recommended for children and adolescents with moderate‐to‐severe allergic rhinitis (AR) triggered by grass/birch pollen allergy to prevent asthma for up to 2 years post‐AIT in addition to its sustained effect on AR symptoms and medication. Some trial data even suggest a preventive effect on asthma symptoms and medication more than 2 years post‐AIT. We need more evidence concerning AIT for prevention in individuals with AR triggered by house dust mites or other allergens and for the prevention of allergic sensitization, the first allergic disease, or for the prevention of allergic comorbidities in those with other allergic conditions. Evidence for the preventive potential of AIT as disease‐modifying treatment exists but there is an urgent need for more high‐quality clinical trials.     

Comparison of Immunoglobulin G Subclass Concentrations in Severe Community-Acquired Pneumonia and Severe Pandemic 2009 Influenza A (H1N1) Infection

We compared immunoglobulin G (IgG) subclasses in patients with severe noninfluenza community-acquired pneumonia (CAP) to those in patients with severe pandemic 2009 influenza (H1N1) virus infection. Low IgG1 and IgG2 levels occurred often in the CAP group; however, H1N1 patients had lower IgG1 and IgG2 levels (5.4 versus 3.3 g/liter [P = 0.008] and 2.5 versus 1.2 g/liter [P < 0.001], respectively). Low IgG2 levels may be specifically linked to severe H1N1; however, it is not clear whether this association is related to H1N1 or to other features of severity.     

Prediction of spontaneous preterm birth using fetal fibronectin in women with a low-lying placenta

Objective: To determine the effect of a low-lying placenta on the concentration of quantitative fetal fibronectin (qfFN) in the cervicovaginal fluid (CVF), and predictive accuracy for spontaneous preterm birth in asymptomatic high-risk women (18?⁺?⁰–24?⁺?⁰ weeks gestation). Methods: Median concentrations of qfFN were compared in women who had a low-lying placenta, covering the cervical os (n?=?61) to matched controls (n=?61) without a low-lying placenta. Proportions of women with raised qfFN concentrations (>10?ng/ml), and false positive and negative rates (FPR and FNR) for spontaneous preterm delivery were also compared. Results: The median concentration of qfFN in women with low-lying placenta was 5.0?ng/mL, compared with 6.0?ng/mL in controls. Proportion of women with raised levels (>10?ng/mL), positive levels (>50?ng/mL) and very high levels (>200?ng/mL) were similar in both groups (62.3% versus 59.0%, 16.3% versus 22.0% and 6.5% versus 4.9%, p?>?0.05 for all thresholds). The FPR and FNR rate for delivery before 34 and 37 weeks were also comparable (FPR 90.0% versus 85.7% and 80.0% versus 78.6%; FNR 5.8% versus 4.3% and 9.8% versus 8.5%).

Conclusions: CVF qfFN concentrations in asymptomatic high-risk women are not affected by the presence of a low-lying placenta.