Editor’s comment: It is well established that obesity increases the risk for severe asthma; however, the impact of eosinophilic inflammation on obese asthmatic patients remains controversial because of the lack of epidemiological data for the general population. To elucidate the correlations between blood eosinophil count and obesity in the general population, the authors assessed the correlations between BMI and eosinophil counts using a multifaceted approach, including cluster analysis, in a community-based Nagahama study in Japan. They found that there may be a positive association between blood eosinophil counts and BMI in general, but there was a negative correlation in the population with high eosinophil counts. In addition, GWAS and human leukocyte antigen (HLA) imputation identified the rs4713354 variant for elevated eosinophil counts, independent of BMI or IgE.
Editor’s comment: Pediatric atopic dermatitis (PAD) is frequently seen in dermatological and pediatric practices. Therefore, it is important to obtain common views regarding diagnosis, treatment, and evaluation methods for PAD among dermatologists and pediatricians. Based on questionnaire surveys, 24 dermatologists and 25 pediatricians discussed these issues in PAD Consensus Forums. As a result of these discussions, consensus on seven topics (three regarding treatment goals and four on drug therapy) was obtained (see this article for more information). The consensus is expected to help practitioners set appropriate treatment goals in clinical practice and facilitate the choice of drugs for treatment.
Editor’s comment: The prophylactic effects of breastfeeding on food allergy remain controversial. Matsumoto et al. conducted a retrospective cohort study of 46,616 children from the Longitudinal Survey of Newborns in the 21st Century in Japan to uncover the effects of breastfeeding on food allergy, focusing on eczema-mediated percutaneous sensitization. They showed that breastfeeding, especially colostrum, had prophylactic effects on food allergy only among high-risk children with infantile eczema, whereas prolonged breastfeeding increased the risk of food allergy, suggesting that infantile eczema status modifies the associations between breastfeeding and food allergy.
Editor’s comment: Many patients with allergic rhinitis are sensitized to multiple allergens. In this study, Gotoh et al. show the results of a trial of dual SLIT tablet therapy for allergic rhinitis to house dust mites (HDM) and to Japanese cedar pollen (JCP), the most common coexisting perennial and seasonal allergens in Japan. Patients received 4 weeks of monotherapy with either HDM or JCP SLIT tablets, followed by 8 weeks of dual therapy with both tablets. They found that dual therapy with SLIT tablets was well tolerated and induced the expected immunological responses.
Review Series: Current research gaps and unmet clinical needs in food allergy
To prevent percutaneous sensitization to food allergens, skin barrier enhancements have been implemented. Dr. Kelleher et al. reviewed many articles on the topic “prevention of food allergy - skin barrier interventions”. Although a successful RCT to prevent food allergy with skin barrier enhancements has not yet be published, such trials are underway, with a pooled data meta-analysis named SCiPAD. And a large-scale RCT called PACI is ongoing to test the prevention of food allergy via early aggressive intervention in early-onset eczema.
Dr. Inomata mentions in her review that the external application of synthetic gibberellin was introduced as an agricultural treatment to increase and improve crop production and that gibberellin treatment can affect the amount of GRP produced in plant-derived foods and pollens. Thus, fruit GRP allergies brought us to a gap in food allergy research, necessitating a revisit of the mechanism of allergen sensitization, cross-reaction of allergens, oral tolerance induction, and oral tolerance disruption under the influence of artificial environmental change.
The food allergy epidemic in recent decades has raised social concerns around food-induced anaphylaxis and how best to deal with it from a public health perspective. In our clinical practice, avoidance of foods causing anaphylaxis should be advised for all patients and their caregivers as a matter of course. However, it is not easy to accurately identify which foods and how much of them (threshold dose) should be eliminated. Even after an accurate diagnosis has achieved, we still have the heavy task of educating stakeholders, including patients, not only on how to avoid allergenic foods but also on how to manage the patients in case of anaphylaxis. Prof. Muraro stated that the current scenario is still disappointing, in particular the underuse of an adrenaline auto injector as the first line therapy for anaphylaxis. She reviewed the challenges in diagnosing and managing food allergies and food anaphylaxis, focusing on educational interventions and providing insights into the role of a multidisciplinary and multiprofessional integrated approach as the ultimate lifesaver for patients with these allergies.