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1.  Insights and advances in chronic urticaria: a Canadian perspective 
In the past few years there have been significant advances which have changed the face of chronic urticaria. In this review, we aim to update physicians about clinically relevant advances in the classification, diagnosis and management of chronic urticaria that have occurred in recent years. These include clarification of the terminology used to describe and classify urticaria. We also detail the development and validation of instruments to assess urticaria and understand the impairment on quality-of-life and the morbidity caused by this disease. Additionally, the approach to management of chronic urticaria now focuses on evidence-based use of non-impairing, non-sedating H1-antihistamines given initially in standard doses and if this is not effective, in up to 4-fold doses. For urticaria refractory to H1-antihistamines, omalizumab treatment has emerged as an effective, safe option.
doi:10.1186/s13223-015-0072-2
PMCID: PMC4336710
Chronic urticaria; Diagnosis; Classification; Management; Immunology; Antihistamines; Up-dosing; Omalizumab
2.  Reviewer acknowledgement 2014 
Contributing reviewers
The editors of Allergy, Asthma & Clinical Immunology would like to thank all of our reviewers who have contributed to the journal in Volume 10 (2014).
doi:10.1186/s13223-015-0070-4
PMCID: PMC4320480  PMID: 25663841
3.  Clinical validation of controlled grass pollen challenge in the Environmental Exposure Unit (EEU) 
Rationale
The Environmental Exposure Unit (EEU), a controlled allergen exposure model of allergic rhinitis (AR), has traditionally utilized ragweed pollen. We sought to clinically validate the use of grass pollen in the EEU.
Methods
Healthy volunteers with a history of AR symptoms during grass pollen season and supportive skin test responses attended the EEU for 3 hrs of rye grass pollen exposure (Lolium Perenne). Non-atopic controls were also recruited. Participants assessed individual rhinoconjunctivitis symptoms to generate Total Nasal Symptom Score (TNSS; max 12) and Total Symptom Score (TSS; max 24) and recorded Peak Nasal Inspiratory Flow (PNIF) q30min while in the EEU. Participants returned the following day for an additional 3 hrs of pollen exposure. Two separate groups allowed for the exploration of lower vs. higher pollen concentrations and subsequent effects on symptoms.
Results
78 participants were screened, of whom 39 were eligible and attended the 2x3h EEU visits, plus 8 non-atopic controls. Mean TSS, TNSS and PNIF values amongst participants in the higher pollen concentration group (target 3500 grains/m3) after the first 3 hr exposure were 18.9, 9.7 and 68 L/min, respectively. In comparison, mean TSS, TNSS and PNIF values in the lower pollen concentration (2500 grains/m3) group were only 13.3, 7.6, and 82 L/min, respectively. The subsequent day of pollen exposure did not appreciably alter the maximal TSS/TNSSs, but rather resulted in a more rapid onset of symptomatology, with higher mean scores at the 30 min, 60 min and 90 min timepoints. The non-atopic controls remained asymptomatic.
Conclusions
This study provides clinical validation of the ability to generate allergic rhinoconjunctivitis symptoms amongst grass-allergic individuals in the EEU.
doi:10.1186/s13223-015-0071-3
PMCID: PMC4316395  PMID: 25653682
Allergic rhinitis; Environmental exposure unit; Grass pollen; Controlled allergen challenge
4.  Asian sand dust aggregate causes atopic dermatitis-like symptoms in Nc/Nga mice 
Background
Asian sand dust (ASD) originates from the arid and semiarid areas of China, and epidemiologic studies have shown that ASD exposure is associated with various allergic and respiratory symptoms. However, few studies have been performed to assess the relationship between skin inflammation and ASD exposure.
Methods
Twelve-week-old NC/Nga mice were divided into 6 groups (n = 8 for each group): hydrophilic petrolatum only (control); hydrophilic petrolatum plus ASD (ASD); hydrophilic petrolatum and heat inactivated-ASD (H-ASD); Dermatophagoides farinae extract (Df); Df and ASD (Df + ASD), and; Df and H-ASD (Df + H-ASD). The NC/Nga mice in each group were subjected to treatment twice a week for 4 weeks. We evaluated skin lesions by symptoms, pathologic changes, and serum IgE levels.
Results
ASD alone did not induce atopic dermatitis (AD)-like skin symptoms. However, Df alone, Df + H-ASD and Df + ASD all induced AD-like symptoms, and dermatitis scores in the group of Df + ASD group were significantly greater than that of the Df group (P = 0.0011 at day 21; and P = 0.017 at day 28). Mean serum IgE was markedly increased in the Df and Df + ASD groups, compared to the ASD and control groups (P < 0.0001), and serum IgE levels in the Df + ASD group were significantly higher compared to the Df group (P = 0.003).
Conclusions
ASD alone did not cause AD-like symptoms in NC/Nga mice. However, AD-like symptoms induced by Df, a major allergen, were enhanced by adding ASD. Although no epidemiological studies have been conducted for the association between ASD and symptoms of dermatitis, our data suggest that it is likely that ASD may contribute to the exacerbation of not only respiratory symptoms, but also skin diseases, in susceptible individuals.
doi:10.1186/s13223-015-0068-y
PMCID: PMC4311458  PMID: 25642251
Dermatitis; Atopic; Dermatophagoides farina; Mice
5.  Removal of peanut allergen Ara h 1 from common hospital surfaces, toys and books using standard cleaning methods 
Background
In children, a diagnosis of peanut allergy causes concern about accidental exposure because even small amounts of peanut protein could trigger an allergic reaction. Contamination of toys, books or other items by peanut butter in areas where individuals have eaten may occur in hospital waiting rooms and cafeterias. It is not known if hospital cleaning wipes are effective in removing peanut allergen.
Objectives
The purpose of this study was to determine whether cleaning peanut contaminated items with common household and hospital cleaning wipes would remove peanut allergen.
Methods
5 mL of peanut butter was evenly smeared on a 12 inch by 12 inch (30.5 by 30.5 cm) square on a nonporous (laminated plastic) table surface, a plastic doll, and a textured plastic ball, and 2.5 mL was applied to smooth and textured book covers. Samples for measurement of Ara h 1 were collected prior to the application of the peanut butter (baseline), and after cleaning with a common household wipe and two commercial hospital wipes. A monoclonal-based ELISA for arachis hypogaea allergen 1 (Ara h 1), range of detection 1.95-2000 ng/mL, was used to assess peanut allergen on each item. The samples were diluted 1:50 for testing.
Results
At baseline, there was no detectable Ara h 1 allergen on any item at baseline. Detectable Ara h 1 was detected on all products after applying peanut butter (range 1.2-19.0 micrograms/mL).
After cleaning with any product, no Ara h 1 was detected on any item.
Conclusions
Table surfaces, book covers and plastic toys can be cleaned to remove peanut allergen Ara h 1 using common household and hospital cleaning wipes. Regular cleaning of these products or cleaning prior to their use should be promoted to reduce the risk of accidental peanut exposure, especially in areas where they have been used by many children.
doi:10.1186/s13223-015-0069-x
PMCID: PMC4312450  PMID: 25642252
Food allergy; Peanut allergen; Cleaning; Hospital; Contamination; Ara h 1
6.  Allergy to sunflower seed and sunflower butter as proposed vehicle for sensitization 
Background
It is hypothesized that household exposure to allergenic proteins via an impaired skin barrier, such as atopic dermatitis, may contribute to the development of IgE sensitization. Household presence of peanut is a risk factor for the development of peanut allergy in children. Sunflower seed butter is a peanut-free alternative to peanut butter, and sunflower seed allergy is an uncommon but reported entity.
Case presentation
A 3 year old boy presented with oral discomfort that developed almost immediately after he ate sunflower seeds for the first time. He was given a dose of diphenhydramine. Subsequently he vomited, and his symptoms gradually resolved. A similar episode occurred to a commercial snack made with sunflower seed butter. Skin prick testing demonstrated a large positive (10 mm wheal) wheal-and-flare response to a slurry of fresh sunflower seed within 3–4 minutes associated with severe pruritus.
This child has an older sibling with confirmed peanut allergy (PNA). After the PNA diagnosis was made, the family home became peanut-free. In lieu of peanut butter, sunflower butter was purchased and eaten frequently by family members, but not by the child reported herein.
Subsequent to the episodes above, the child ate a bread roll with visible poppy seeds and developed itchy throat, dyspnea, and urticaria. Epicutaneous skin testing elicited a >10 mm wheal size within 3–4 minutes in response to a slurry of whole poppy seeds and 8 mm to fresh pumpkin seed, which had never been consumed.
Conclusions
A case of sunflower allergy in the context of household consumption of sunflower butter has not yet been reported. We suggest that homes which are intentionally peanut-safe may provide an environment whereby infants with impaired skin barrier are at increased risk of allergy to alternative “butter” products being used, via cutaneous exposure to these products preceding oral introduction to the child.
doi:10.1186/s13223-014-0065-6
PMCID: PMC4311509  PMID: 25642250
Sunflower seed; Allergy; Risk factors
7.  The relationship between allergy and asthma control, quality of life, and emotional status in patients with asthma: a cross-sectional study 
Background
Psychiatric comorbidities are prevalent in patients with chronic somatic disorders such as asthma. But, there is no clear evidence regarding the effect of atopic status and the type of sensitized allergen on emotional status. The aim of the present study was to investigate the effects of house dust mites and pollen allergies on emotional status, asthma control and the quality of life in patients with atopic asthma.
Methods
The study included 174 consecutive patients who were diagnosed with asthma accoring to the GINA criteria and who did not receive therapy for their allergy. All patients underwent a skin prick test. The asthma control, quality of life, and emotional status were evaluated using the ACT (asthma control test), AQLQ (asthma-specific quality of life questionnaire), and HAD (hospital anxiety depression questionnaire).
Results
Atopy was detected in 134 (78.7%) patients. Of those patients: 58 (33.3%) had anxiety and 83 (47.7%) had depression. There was no relationship between emotional status, atopic status, and the type of indoor/outdoor allergen. Furthermore, there was no relationship between atopy and asthma severity, asthma control, and the quality of life. The anxiety and depression scores were significantly higher and the quality of life scores lower in the uncontrolled asthma group. The ACT and AQLQ scores were also lower in the anxiety and depression groups.
Conclusions
It was concluded that anxiety and depression are prevalent in patients with uncontrolled asthma, and atopic status did not affect the scores in ACT, AQLQ, and emotional status tests.
doi:10.1186/s13223-014-0067-4
PMCID: PMC4311476  PMID: 25642249
Atopy; Asthma control; Quality of life; Emotional status; Depression; Anxiety
8.  Successful prevention of extremely frequent and severe food anaphylaxis in three children by combined traditional Chinese medicine therapy 
Background
Despite strict avoidance, severely food-allergic children experience frequent and potentially severe food-induced anaphylaxis (FSFA). There are no accepted preventive interventions for FSFA. A Traditional Chinese Medicine (TCM) formula prevents anaphylaxis in murine food allergy models, and has immunomodulatory effects in humans. We analyzed the effects of TCM treatment on three pediatric patients with FSFA.
Case description
Three FSFA patients (P) ages 9–16 years (P1 allergic to milk; P2 and P3 to tree nuts) qualified for case analysis. All experienced numerous reactions requiring administration of rescue medications and emergency room (ER) visits during the 2 years prior to starting TCM. P1 experienced approximately 100 reactions, 50 epinephrine administrations, 40 ER visits, and 3 admissions to intensive care units. P2 experienced 30 reactions, all requiring epinephrine administration, as well as 10 emergency hospitalizations. P3 experienced 400 reactions, five of which required epinephrine administration and ER visits. TCM treatment markedly reduced or eliminated reactions in all. P1 experienced no reactions after 2.5 years of TCM. P2 experienced no reactions after 1 year of TCM treatment, at which time she passed an oral almond food challenge. She continues to be reaction-free 6 months off TCM while consuming nuts. P3 has achieved a 94% reduction in reaction frequency following 7 months of TCM, has discontinued daily antihistamine use, and has required no epinephrine administrations or ER visits.
Conclusions
Three children treated with TCM experienced dramatic reductions or elimination of FSFA. This regimen appears to present a potential option for FSFA, and warrants further investigation in controlled clinical studies.
Electronic supplementary material
The online version of this article (doi:10.1186/s13223-014-0066-5) contains supplementary material, which is available to authorized users.
doi:10.1186/s13223-014-0066-5
PMCID: PMC4322482  PMID: 25670938
Traditional Chinese medicine; Food allergy; Food induced anaphylaxis

Results 1-25 (603)