As the summer rolls along with its continuing heat wave, the current issue ofAnnals in Allergy, Asthma and Immunology关注的一个热门话题,我们为变态反应等内容e – anaphylaxis.
Dr. Dana Wallace highlights knowledge gaps in the treatment of anaphylaxis, including the differences of definition between World Allergy Organization and NIAID, lack of biomarkers and defining severity of anaphylaxis. The issue of biomarkers is highlighted in the original article by Dr. Petteri Rontynen and colleagues, who examined mediators during cashew food challenges. They found elevation of platelet-activating factors in patients with anaphylaxis, but interestingly, tryptase levels did not differ in patients with mild or severe reactions. Dr. Julie Wang discusses the important issue of severity, as you can have mild anaphylaxis with one sneeze and one hive, compared to severe anaphylaxis with hypotension and airway compromise. Her group investigates eight different scoring systems and the need to reconcile them.
Treatment of anaphylaxis is highlighted in multiple articles and editorials. Dr. Jay Lieberman and colleagues discuss novel epinephrine devices including various intranasal and sublingual epinephrine devices. It is not possible to measure clinical efficacy of individual epinephrine devices, as it would require inducing anaphylaxis, which is not ethical for a clinical trial. It also raises the question of whether epinephrine is truly lifesaving as a clinical trial to determine this is not possible as highlighted by Dr. Matt Greenhawt.
Therefore, Dr. Lieberman’s review article discusses the concentration of epinephrine from different devices and compares them to approved intramuscular devices based on pharmacodynamic and pharmacokinetics. For the treatment of anaphylaxis, Dr. Marcus Shaker and colleagues highlight the issue of need for more than one epinephrine auto-injector and suggest that multiples are only needed for patients with severe anaphylaxis. Dr. David Stukus makes the strong case against the use of corticosteroids in the treatment of anaphylaxis.
The ideal aspect of treatment is prevention of food allergy and anaphylaxis, and it is well known that, as demonstrated by the LEAP study, early introduction of peanut prevents development of peanut allergy. A subsequent post-hoc analysis of the LEAP population by Dr. Tamar Landau examining the avoidance arm shows that peanut consumption of more than five grams of peanut a week in breastfeeding mothers showed decreased peanut sensitization and allergy infants.
And, as always, if you have any comments, please consider sending a correspondence toAnnals(email us atannals@ACAAI.org). We are always excited to hear howAnnalshas helped you improve the lives of your patients!
Jonathan Spergel, MD, PHD, FACAAI
Deputy Editor
