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Advances in upper airway diseases and allergen immunotherapy

The purpose of this review is to highlight recently published important articles on upper airway diseases and immunotherapy. We review articles on rhinitis, sinusitis, conjunctivitis, and immunotherapy. New insights into epidemiology, pathophysiology, diagnosis, and therapy are described for each of the above diseases.

Regarding immunotherapy, we discuss numerous clinical trials on sublingual and subcutaneous immunotherapy, mechanisms of immunotherapy, safety, and use of modified allergens and biological agents for immunotherapy.

Altered T-cell receptor signaling in the pathogenesis of allergic disease

Mounting evidence from animal models has demonstrated that alterations in T-cell receptor (TCR) signaling alone can lead to dramatically skewed differentiation of naive T cells into TH2 cells, to TH2 effector functions, and to TH2-related diseases.

There is significant potential relevance of these observations to human disease. Specifically, a number of immunodeficiencies associated with atopic disease might have atopy as a manifestation because of aberrant TCR signaling. It is therefore important to attempt to identify a role for defects in TCR signaling in the pathogenesis of common atopic diseases.

Efficacy and safety of immunotherapy for allergies to Alternaria alternata in children

The safety and efficacy of specific immunotherapy for mold allergy are not known in children and adolescents.

Objective: We evaluated the efficacy and safety of specific immunotherapy with a standardized allergen extract in a randomized, double-blind, placebo-controlled, 3-year prospective study of patients who were allergic to only Alternaria alternata.

Methods: Fifty children and adolescents (25 girls; 5-18 years of age) with A alternata–induced seasonal allergic rhinoconjunctivitis and/or bronchial asthma were randomly assigned to groups given treatment (Novo-Helisen Depot, A alternata 100%) or placebo. The primary end point was the combined symptom medication score. Secondary end points included safety, quality of life, and sensitivity to allergen-specific nasal challenge.

Results: Forty-five children completed the 3-year study. Although there was no significant change in year 1, the combined symptom medication score decreased in years 2 and 3 of the study (by 38.7% and 63.5%, respectively; P < .001 for each). The reduction in symptoms was associated with a significant improvement in quality of life (P < .05) and decrease in sensitivity after allergen-specific nasal challenge. Side effects were observed in 7 patients; the most common (edema at the site of injection) occurred after 11 injections.

Conclusions: Allergen-specific immunotherapy with standardized A alternata extract reduces symptoms of asthma and rhinoconjunctivitis in children and adolescents without serious side effects.

Idiopathic Nonspecific Interstitial Pneumonia Linked to Autoimmune Disorders

Idiopathic nonspecific interstitial pneumonia (NSIP) may be associated with autoimmune disorders, researchers from Italy report in the January 27th online European Respiratory Journal Express. Reuters Health Information (Source: Medscape Infectious Diseases Headlines)

Prescribing of {beta}-adrenoceptor antagonists in asthma: an observational study

The authors regret to inform you that they have retracted the manuscript, Prescribing of β-adrenoceptor antagonists in asthma: an observational study, 1 from publication in Thorax due to concerns over the reliability of the oral steroid outcome following a new β-blocker prescription. One of the aims of this observational study was to determine the relative incidence of asthma patients …

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