IgE‐expressing memory B cells and plasmablasts are increased in blood of children with asthma,food allergy,and atopic dermatitis

Despite the critical role of soluble IgE in the pathology of IgE‐mediated allergic disease, little is known about abnormalities in the memory B cells and plasma cells that produce IgE in allergic patients. We here applied a flow cytometric approach to cross‐sectionally study blood IgE+ memory B cells and plasmablasts in 149 children with atopic dermatitis, food allergy, and/or asthma and correlated these to helper T(h)2 cells and eosinophils. Children with allergic disease had increased numbers of IgE+CD27‐ and IgE+CD27+ memory B cells and IgE+ plasmablasts, as well as increased numbers of eosinophils and Th2 cells. IgE+ plasmablast numbers correlated positively with Th2 cell numbers. These findings open new possibilities for diagnosis and monitoring of treatment in patients with allergic diseases.     

Clinical trials in allergen immunotherapy: current concepts and future needs

Allergen immunotherapy (AIT) is a safe, effective treatment for allergic rhinoconjunctivitis and allergic asthma. However, AIT's clinical effect is still contested—primarily due to heterogeneity in clinical trial designs, study populations, therapeutic formulations, and efficacy criteria. After discussing current concepts and unmet needs, an international panel of experts made several recommendations: (i) explore and validate definitions for (clinical) responders in AIT trials; (ii) use of well‐documented, standardized provocation tests prior to inclusion of subjects with relevant diseases in AIT trials; (iii) monitoring neo‐sensitizations and occurrence of new allergy in extended AIT trials, and exclusion of polyallergic participants; (iv) validation of allergen exposure chambers with regard to natural exposure; (v) in studies of seasonal allergies, focus on peak exposure but also consider organizing two parallel, geographically distinct but otherwise identical trials; (vi) discuss adaptive trial designs with the regulatory authorities; (vii) use e‐health and m‐health technologies to capture more information on individual exposure to allergens; (viii) initiate research on potential psychological, biochemical, immune, neural, and even genomic markers of the placebo response; (ix) identify trial designs and primary endpoints that will give children with allergies easier, faster access to AIT formulations; and (x) promote and apply standardized methods for reporting systemic and local adverse events. The latest technologies and trial designs may provide novel, ethical ways of reducing bias and heterogeneity in AIT clinical trials. There is scope for physicians, patient organizations, companies, and regulators to improve clinical trials in AIT and, ultimately, to provide patients with better treatments.     

鼻内镜手术结合鼻后下神经和筛前神经丛集区及下鼻甲低温等离子射频消融治疗常年性变应性鼻炎

目的:探讨鼻内镜手术结合低温等离子射频消融技术治疗常年性变应性鼻炎疗效。方法:对69例药物治疗不能控制症状的常年性变应性鼻炎,采用鼻内镜行鼻中隔粘膜下矫正术,低温等离子射频消融射频鼻后下神经和筛前神经丛集区及下鼻甲。结果:术后3个月:显效91.3%(63/69),有效8.7%(5/69),总有效率100%;术后1年:显效87%(60/69),有效7.2%(5/69),无效5.8%(4/69),总有效率94.2%(65/69);术后2年:显效82.6%(57/69),有效8.7%(6/69),无效8.7%(6/69),总有效率91.3%(63/69)。与单纯行鼻中隔粘膜下矫正术对照组比较,术后1年、2年总有效率(P<0.01)显著提高,均有统计学意义。结论:鼻内镜手术结合加低温等离子射频消融技术治疗常年性变应性鼻炎,具有术区定位准确,疗效好,副作用少等优点。