Asthma
James M. Rippe in Lifestyle Medicine, 2019
Environmental control measures, such as allergen avoidance, should always be included in asthma management strategies.2 Generally, a comprehensive approach to control of allergen or irritant exposure is needed since single measures for avoidance of allergens is not effective. Exposure of asthma patients to certain irritants or allergens increases asthma symptoms and often precipitates exacerbations. As a team, the physician and patient should do try to identify those allergens and irritants causing asthma symptoms. The common inhalant allergens that are known to cause asthma exacerbations are animal allergens; house dust mites; cockroaches; indoor and outdoor fungi; and outdoor plant allergens such as tree, grass, and weed pollens. The NAEPP guidelines 2007 recommend environmental control at each step and have a questionnaire to help determine environmental factors and other factors that worsen asthma symptoms.2,15 A history of likely sensitivity to seasonal allergens from the questionnaire and positive skin testing or allergen immunoassay IgE blood testing to assess the sensitivity to perennial allergens can be helpful in identifying these allergens.15 Generally, seasonal allergens in early spring are trees; late spring, grasses; late summer to autumn, weeds; summer and fall, Alternaria, Cladosporium, mites; and in cold months in temperate climates, animal dander.2 Allergy skin or allergen immunoassay for allergen-specific IgE blood testing is the only way to reliably determine sensitivity to year-round indoor allergens.
Environment and Lifestyle in Allergic Disease
Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial in Textbook of Allergy for the Clinician, 2021
Outdoor Allergens: Control of exposure to outdoor allergens is difficult to achieve since control involves limitation of exposure to the outdoor environment during the season(s) in which the allergens relevant to clinical allergy are prevalent. Avoidance of being present outdoors during peak exposure times may be a possible strategy since peak presence of the various seasonal allergens is dependent on certain environmental elements including outdoor temperature, humidity, wind, precipitation, time of day and proximity to pollen plants (Martorano and Erwin 2018). However, strategies limiting the spread of or the presence of particles carrying outdoor allergens to the indoor environment such as keeping windows and doors of the home closed and use of HEPA air filtration may be more effective in reducing outdoor allergen levels in the indoor environment.
Therapeutic Nutrition
W. John Diamond in The Clinical Practice of Complementary, Alternative, and Western Medicine, 2017
There are two clinically distinct types of food “allergy.” The first group includes those dramatic “fixed” food allergies that produce severe reactions with occasional death (peanuts, etc.). They are difficult to treat and seem to have a genetic basis. Then, there are the rest of the food “allergies,” best described as food sensitivities or cyclical allergies. These food allergies are only present as long as there is exposure to the offending allergen. When that allergen is avoided, the sensitivity fades away, only to return when the food is again eaten repetively. One of the most interesting clinical observations you will see is the appearance of new sensitivities in those patients who are avoiding their current food allergen. It almost seems as if the body really needs to express this sensitivity in some way, and is just waiting for the next most likely food to do that. This is one of the reasons I stopped using food avoidance, because patients would get into an ever narrower circle of available foods, as they avoided one food and gained yet another sensitivity. This tells us that food “allergy,” the hyper-reaction to completely harmless food sources, is not what it seems on the surface. This reaction represents a fundamental reaction choice, to balance a deeper, usually emotionally or situationally connected issue in a very acceptable and nonthreatening way.
House dust mites–driven allergic rhinitis: could its natural history be modified?
Published in Expert Review of Clinical Immunology, 2021
Giorgio Ciprandi, Maria Angela Tosca
Allergic rhinitis (AR) is the most common immune-mediated disease affecting up to 40% of the general population, this impressive prevalence is even continuously growing [1]. Type 2 inflammation signs AR: namely, allergen-specific functional defect of T regulatory cells, T helper 2 polarization, sensitization, and eosinophilic infiltration of nasal mucosa characterize the allergic reaction [2]. The exposure to the causal allergen triggers the typical nasal symptoms, including itching, sneezing, watery rhinorrhea, and congestion. However, to elicit allergic symptoms, the allergen load should be adequately high, whereas continuous exposure to low allergen levels maintains allergic inflammation, the so-called minimal persistent inflammation [3]. Consequently, these facts underline a paradigmatic concept: allergic inflammation is closely associated with allergen exposure, and therefore as long as there is allergenic exposure, there will always be type 2 inflammation, also in asymptomatic patients [3]. This axiom plays an important role in interpreting various pathophysiological aspects of AR, as discussed further. Moreover, AR has a relevant burden considering the impact on the patient quality of life and on the society about the costs and school/work attendance. Alike asthma is a disease characterized by a profound impact on the patient, concerning the emotional status and the possible limitations, and also on the society for the relevant socio-economic burden [4]. Based on this background, we aimed to review the possible effect of AIT as disease modifier in patients with HDM-driven AR.
Allergen immunotherapy: progress and future outlook
Published in Expert Review of Clinical Immunology, 2023
Lara Šošić, Marta Paolucci, Stephan Flory, Fadi Jebbawi, Thomas M. Kündig, Pål Johansen
The currently best supported approach to achieve long-term tolerance against allergies is a three to 5-year course of AIT with whole-allergen extracts, either via subcutaneous injections or sublingual preparations. However, AIT does not reach all patients, it is not effective in all patients or cannot be offered to all patients. Therefore, new AIT methods are under investigation to meet these needs and to fill the treatment gaps. In this review, we discussed some of the latest and most promising strategies for making AIT a relevant treatment option for a broader range of patients with allergies. We discussed OIT and ILIT as the two most promising routes for AIT and passive immunotherapy as a totally new concept of immunotherapy taking use of the recent technological development for the production of mAbs. Hypoallergenic products for AIT have long been a topic, for instance with allergoids, but new and more efficient routes of administration, such as ILIT, may allow application of more costly purified or recombinant allergens in treatment. Finally, we also discussed biomarkers as an important research field in AIT development, as without clearly defined and standardized biomarkers, development and monitoring of AIT remains difficult.
Pathways of atopic disease and neurodevelopmental impairment: assessing the evidence for infant antibiotics
Published in Expert Review of Clinical Immunology, 2022
Elizabeth Volker, Carmen Tessier, Nicole Rodriguez, Jerome Yager, Anita Kozyrskyj
Food sensitization, determined by skin prick testing or serum IgE levels to the allergen, affects up to 28% of preschool children; while it may not develop into food allergy, food sensitization is a first and strong indication of immune deviation toward the development of atopic disease [60–62]. The resultant immune response involves the production of IgE antibodies to the allergen, which start the inflammation process, or food hypersensitivity or allergy. Repeated allergen exposure increases the likelihood of full-blown allergy. If the allergen is blocked by serum or intestinal immunoglobulins, the immune response will be diminished and tolerance to the allergen will occur. Among the various food allergens, infant sensitization to peanut is the most likely to persist in later childhood and/or to proceed to food allergy [63,64].
Related Knowledge Centers
- Atopy
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- Type I Hypersensitivity
- Immune System
- Allergy
- Antigen
- Immune Response
- House Dust Mite