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  • 1.
    Cardona, V.
    et al.
    Hosp Univ Vall dHebron, Allergy Sect, Dept Internal Med, Barcelona, Spain..
    Demoly, P.
    UPMC Paris 06, Hop Arnaud Villeneuve, Dept Pneumol & Addictol, UMR S 1136,IPLESP,Equipe EPAR,CHRU Montpellier, Paris, France.;Sorbonnes Univ, Paris, France..
    Dreborg, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Kalpaklioglu, A. F.
    Kirikkale Univ Hosp, Dept Immunol & Allerg Dis, Kirikkale, Turkey..
    Klimek, L.
    Ctr Rhinol & Allergol, Wiesbaden, Germany..
    Muraro, A.
    Padua Gen Univ Hosp, Dept Women & Child Hlth, Food Allergy Referral Ctr Veneto Reg, Padua, Italy..
    Pfaar, O.
    Ctr Rhinol & Allergol, Wiesbaden, Germany.;Heidelberg Univ, Univ Med Mannheim, Dept Otorhinolaryngol Head & Neck Surg, Med Fac Mannheim, Mannheim, Germany..
    Popov, T. A.
    Med Univ, Clin Allergy & Asthma, Sofia, Bulgaria..
    Hoffmann, H. J.
    Aarhus Univ, Dept Resp Dis & Allergy, Dept Clin Med, Aarhus C, Denmark..
    Current practice of allergy diagnosis and the potential impact of regulation in Europe2018In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 73, no 2, p. 323-327Article in journal (Refereed)
    Abstract [en]

    In the European Union (EU), the regulatory framework regarding diagnostic allergen extracts is currently in the process of being implemented at the national level. Due to these regulations, the initial and periodic renewal expenses for the registration of diagnostic allergen extracts may render extract production unprofitable. Consequently, many extracts may be at risk of removal from the market. The current survey, which was conducted by a task force of the European Academy of Allergy and Clinical Immunology, aimed to assess the current practice of allergy diagnosis in Europe. This survey revealed that skin tests continue to be the main diagnostic procedure and are used as the first option in almost two-third of all types of allergic diseases and in 90% of individuals suffering from respiratory allergies. Therefore, there is a need to ensure the availability of high-quality allergen extracts to maintain the common diagnostic procedures used by EU professionals. To reach this goal, it is necessary to align efforts and establish active partnerships between manufacturers, relevant scientific societies, consumer organizations and authorities to maintain the availability of these diagnostic tools.

  • 2.
    Dreborg, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Allergen skin prick test results should be adjusted to the histamine reactivity2015In: International Archives of Allergy and Immunology, ISSN 1018-2438, E-ISSN 1423-0097, Vol. 166, no 1, p. 77-80Article in journal (Refereed)
    Abstract [en]

    Background: Skin prick test results are mostly reported as mean wheal diameter obtained with one concentration of allergen. Differences in technique between personnel causes variation in wheal size. The research question was whether the influence of differences in skin prick test technique among assistants and centers can be reduced by relating the allergen wheal response to that of histamine. Methods: Two methods for estimating skin reactivity, the method of Nordic Guidelines using histamine as a reference and the method of Brighton et al. [Clin Allergy 1979; 9: 591-596] not using histamine as a reference, were applied to data from two biological standardization trials, using the same batch of freeze-dried timothy pollen preparation. Results: The concentration defining the Nordic biological unit, defined as a concentration of allergen eliciting a wheal of the same size as that of histamine dihydrochloride 10 mg/ml, did not differ between the centers. When not using histamine as a reference, applying the method of Brighton et al., there was a 15-fold difference in the estimate of the biological activity between the trials that was eliminated by adjusting the allergen response to that of the histamine reference. Conclusions: To reduce the influence of differences in test technique among assistants and centers responses to allergen-induced skin prick tests should be compared to that of histamine.

  • 3.
    Dreborg, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Barn- och Ungdomsallergologi i Sverige och Europa2011In: Lung & allergiforum, ISSN 2000-5237, no 4, p. 17-18Article in journal (Other academic)
  • 4.
    Dreborg, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Cow's milk protein allergy and common gastrointestinal symptoms in infants2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 3, p. 253-254Article in journal (Refereed)
    Abstract [en]

    In their review on the management of functional gastrointestinal disorders and cow's milk protein allergy (CMPA) in infants (1), Vandenplas et al discuss infantile colic, regurgitation and constipation and the relationship between these symptoms, which are common in infants, to CMPA. The group starts by stating that CMPA can only be diagnosed by a double blind placebo controlled food challenge. However, this can be replaced by an open challenge in infants as long as the challenge is performed under the supervision of an experienced team (2, 3). The authors acknowledge that sensitisation to cow's milk indicates possible CMPA and the need for a challenge to reach a proper diagnosis of CMPA. But then they make some some statements that I feel blur the message (1).

  • 5.
    Dreborg, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Debates in allergy medicine: food intolerance does not exist.2015In: World Allergy Organization Journal, ISSN 1731-3317, E-ISSN 1939-4551, Vol. 8, no 37Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The term "intolerance" is not mentioned in the World Allergy Organization (WAO) document on allergy nomenclature. "Intolerance" has been used to describe some non-immunological diseases. However, pediatric gastroenterologists mix allergy and intolerance, e.g. by using the term "cow's milk protein allergy/intolerance (CMPA/I)", lumping together all types of mechanisms for not tolerating cow's milk. The basis for this mix is the fact that double-blind oral food challenges are time-consuming and expensive. Therefore, cow's milk exclusion and reintroduction is proposed to be used in primary care for the diagnosis of CMPA in children with common gastrointestinal (GI) problems such as colic and constipation. This may lead to a widespread use of hypoallergenic formulas in children without proven CMPA. In lay language, intolerance describes "not tolerating".

    OBJECTIVE: To discuss the reasons why the term "intolerance" should not be used in the area of allergy.

    RESULTS: Presently, intolerance is not part of the allergy nomenclature. It is used by lay persons to describe "not tolerating". Pediatricians use intolerance to describe non-immunological hypersensitivity such as lactose intolerance which is acceptable. However, using the mixed term CMPA/I describing a variety of gastrointestinal symptoms in children, should be avoided. The WAO Nomenclature does not clearly distinguish between non-IgE-mediated allergy and non-allergic hypersensitivity.

    CONCLUSION: The term "intolerance" should not be used within the area of allergy. Intolerance should be better defined and the term restricted to some non-immunological/non-allergic diseases and not mixed with allergy, e.g. by using the term CMPA/I. A revision of the WAO nomenclature is proposed.

  • 6.
    Dreborg, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Evaluation of Allergen Immunotherapy2015In: JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, ISSN 2213-2198, Vol. 3, no 2, p. 267-268Article in journal (Other academic)
  • 7.
    Dreborg, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    IgE:s historia och betydelse2013In: Fagbladet Allergi i praksis, ISSN 0806-5462, no 1, p. 6-14Article in journal (Other academic)
    Abstract [sv]

    Upptäckten/isoleringen av IgE har lagt grunden för snart sagt all klinisk och laboratoriemässig forskning, diagnostik och till viss del också terapi inom allergiområdet och en stor del av forskningen kring parasitsjukdomar.

    Denna översikt försöker belysa utvalda delar av främst skandinaviska forskares insatser inom allergiforsk-ningen under mer än fyra decennier och resultatens praktiska tillämpning, in vitro-IgE-bestämning, definition av enskilda allergen och allergena komponenter. All denna forskning och de hjälpmedel som vi numera dagligen använder inom vardagsallergologin vilar på upptäckten av IgE.

    Även kunskapen inom områden som allergisk inflammation hade inte varit tillgängliga utan IgE och IgE-baserade metoder. men ur vardaglig klinisk synpunkt är bestämningen av IgE-antikroppar, och studiet och karakteriseringen av allergen, de viktigaste.

    Det senaste decenniet har rutin- metoder för bestämning av aller-genspecifikt IgE mot allergena kompo- nenter, utvecklingen av CD-sens, tillgången till humaniserade mus- antikroppar för bindning av IgE in vivohaft stor praktisk betydelse.slutligen är atopisk sensibilisering och IgE-allergeninteraktion den enda väl definierade mekanismen för allergisksjukdom.

  • 8.
    Dreborg, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Proficiency testing: Skin prick test2013In: / [ed] Warner W Carr, Linda Cox, 2013Conference paper (Other academic)
  • 9.
    Dreborg, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Redovisat forskningsfusk bara toppen av isberget?2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 37, p. 1584-1585Article in journal (Other academic)
  • 10.
    Dreborg, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    The risk of allergic reactions to allergen extracts in personnel2012In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 129, no 3, p. 870-871Article in journal (Refereed)
  • 11.
    Dreborg, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    When should adrenaline be given and by whom?2013In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 24, no 1, p. 97-98Article in journal (Refereed)
  • 12.
    Dreborg, Sten
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Basomba, A
    Löfkvist, T
    Holgersson, M
    Moller, C
    Evaluation of skin reactivity during (immuno-) therapy: Validation of methods for estimation of changes in skin reactivity and correlation to shock organ sensitivity2016In: Immunotherapy: Open Access, ISSN 2471-9552, Vol. 2, no 1, article id 1000109Article in journal (Refereed)
    Abstract [en]

    Background: Parallel line bioassay (PLBA) has been acknowledged to be the gold standard for estimation of changes in reactivity, e.g., in RAST and ELISA inhibition tests.

    Objective: To study correlations between two simple methods for evaluation of changes in skin prick test (δSPT), using the slope of the allergen dose response (drra) in relation to PLBA. Methods: Skin prick test data from two published immunotherapy trials were used. In a D. farinae trial we used duplicate tests with three fixed ten-fold concentrations and in a P. judaica trial three tenfold individually chosen allergen concentrations causing wheals of similar size to that of histamine dihydrochloride 10 mg/mL, tenfold lower and tenfold higher concentration. Evaluation of the δSPT by PLBA, and two simple methods were correlated. In the D. farinae trial δSPT was compared to the change of conjunctival threshold concentration.

    Results: The δSPT as measured by both the simple methods gave similar results to that of PLBA (p<0.001). The δSPT was around 30-fold, i.e., about 3% of the pre-treatment reactivity. The δSPT correlated with the δCPT threshold concentration.

    Conclusions: Estimation of the δSPT during therapy expressed as change in concentration using simple methods based on the slope of the drra correlated well to changes by PLBA and CPT and should therefore be used both in clinical research and in practice.

  • 13.
    Dreborg, Sten
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Engström, Inga
    Kjellman, Bengt
    Wennergren, Göran
    Den svenska barnallergologins tidiga historia: Kompletterande och fördjupad bilaga2014Other (Other academic)
  • 14.
    Dreborg, Sten
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Heine, RG
    Höst, A
    Varga, E-M
    Pettoello-Mantovani, M
    Çokugras, H
    Moya, M
    Konstantopoulos, A
    The management of food allergy in infants with special emphasis on cow’s milk allergy2012In: European Paediatric Association Newsletter, no 13, p. 4-5Article in journal (Other academic)
  • 15.
    Dreborg, Sten
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Holgersson, Margareta
    Pharmacia Diagostics AB, Uppsala, Sweden.
    Evaluation of methods for estimation of threshold concentrations by the skin prick test2015In: International Archives of Allergy and Immunology, ISSN 1018-2438, E-ISSN 1423-0097, Vol. 166, no 1, p. 71-76Article in journal (Refereed)
    Abstract [en]

    Background: The allergen dose-response curve is flat; thus, small changes in wheal size reflect large differences in skin sensitivity. The sensitivity as measured by provocation tests is given by the threshold concentration that causes symptoms and/or objective signs. The threshold concentrations differ by several magnitudes between the most and the least sensitive individuals clinically allergic to the same allergen. Variation in technique can be minimized by relating allergen responses to that to histamine. The aim here is to present and validate simple methods for estimation of the skin sensitivity given as the concentration inducing a wheal of the same size as that with the positive reference, 10 mg/ml of histamine HCl, in the same patient. Methods: Data from previously reported trials on the biological equilibration of allergen extracts were used to document a method to calculate the concentration of allergen required to induce a wheal of the same size as that with 10 mg/ml of histamine dihydrochloride in the same patient, and to validate the methods using the parallel line bioassay as the gold standard. Results: The validated methods correlated well with the results obtained using the gold standard method and provide results of skin prick testing based on threshold concentrations of allergen. Conclusions: The validated methods reduce the error of differences in testing techniques and make it possible to report skin sensitivity at threshold concentrations. A simple method to be used in clinical practice and a method suitable to describe changes in skin reactivity over time or during treatment are proposed.

  • 16.
    Dreborg, Sten
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Holgersson, Margareta
    Pharmacia Diagnostics.
    Möller, Christian
    University Hospital, Umeå.
    Evaluation of changes in skin reactivity by skin prick test titration: -2016In: Immunotherapy: open access, ISSN 2471-9552, Vol. 2, no 2, article id 102Article in journal (Refereed)
    Abstract [en]

    Background: Parallel line bioassay (PLBA) has been acknowledged being the gold standard for estimation of changes in skin reactivity during (immuno-)therapy.

    Objective: To study changes in skin prick test (SPT) estimated by skin prick test titration, wheal area and sum of wheal areas in relation to PLBA.

    Methods: Data from a published immunotherapy trial using skin titration with half 10 log steps were evaluated using endpoint titration, wheal areas, histamine equivalent allergen concentration using PLBA as gold standard.

    Results: Endpoint titration and PLBA correlated (r=0.76) and the slope of the correlation, b (0.8) was not significantly different from 1, i.e. expressed the same result, were interchangeable. Furthermore, the result was expressed in change in allergen concentration, Ca. The area of all wheals and the area of the wheal induced by the highest concentration also correlated, but to a lesser degree (b=0.36 and 0.41, respectively), to PLBA significantly different from 1, i.e. did not express the same result.

    Conclusions: Estimation of the SPT during therapy expressed as change in endpoint concentration correlated to changes by PLBA. However, earlier described simple methods, expressing the change in skin sensitivity as change in histamine equivalent concentration, should be preferred.

  • 17.
    Dreborg, Sten
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Lee, T. H.
    Kay, A. B.
    Durham, S. R.
    Immunotherapy Is Allergen-Specific: A Double-Blind Trial of Mite or Timothy Extract in Mite and Grass Dual-Allergic Patients2012In: International Archives of Allergy and Immunology, ISSN 1018-2438, E-ISSN 1423-0097, Vol. 158, no 1, p. 63-70Article in journal (Refereed)
    Abstract [en]

    Background: One hundred years ago, Noon [Lancet 1911;1:1572-1573], using conjunctival provocation testing (CPT), was the first to demonstrate the effectiveness of subcutaneous immunotherapy (SCIT) in grass-allergic subjects with hay fever. In this centenary year, we present data that, by use of CPT and allergen-specific IgG, replicate this observation and additionally confirm the allergen specificity of SCIT by using a double-blind design employing either grass or mite SCIT in dual grass- and mite-allergic individuals. Methods: Twenty adults (11 females) with perennial rhinoconjunctivitis and exacerbation of symptoms during the grass pollen season and in the autumn had immediate skin and conjunctival sensitivity and raised specific IgE to both Dermatophagoides farinae and Phleum pratense. Participants were randomly assigned to either timothy or D. farinae immunotherapy for 3 years. CPT and specific IgG tests to both allergens were performed annually. After 3 years, subjects gave their blinded overall evaluation. Results: Six mild-to-moderate general reactions occurred in 2 timothy- and 4 mite-treated patients. Four of these patients and 2 other patients withdrew from the study. Seven patients in each group completed the study. After 3 years of immunotherapy, the timothy CPT threshold concentration had increased 16-fold in timothy-treated patients (p < 0.05; between-group change, p < 0.05). The increase in the mite CPT threshold in mite-compared to grass-treated patients was 31-fold (p < 0.05). The overall assessment of conjunctival sensitivity was highly significant in favour of treatment (p < 0.015), as was that of allergen-specific IgG (p < 0.0001). Conclusions: Allergen immunotherapy is allergen species-specific, as judged by decreased conjunctival sensitivity and changes in allergen-specific IgG concentrations. 

  • 18.
    Dreborg, Sten
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Roberts, G.
    Lau, S.
    Santos, A. F.
    Halken, S.
    Høst, A.
    The history of pediatric allergy in Europe: From a working group to ESPACI and SP-EAACI2013In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 24, no 1, p. 88-96Article, review/survey (Refereed)
    Abstract [en]

    A Working Group on Pediatric Allergology was formed in 1984, which rapidly developed to become the European Society on Pediatric Allergology and Clinical Immunology (ESPACI) in 1988 with its own journal, Pediatric Allergology and Immunology. ESPACI worked together with the European Academy of Allergology and Clinical Immunology (EAACI) to form a Section of Pediatrics within EAACI (SP-EAACI) in 1996. The ESPACI and the SP-EAACI formally merged in 2001. Within the EAACI organization, the Pediatric Section has continued to grow. The Pediatric Section is working to develop pediatric allergology across Europe, focusing on postgraduate education, facilitating the research agenda and advocating for children and adolescents with allergies.

  • 19.
    Dreborg, Sten
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Wen, Xia
    McGill Univ, Fac Sci, Montreal, PQ, Canada..
    Kim, Laura
    Univ British Columbia, Fac Med, Vancouver, BC, Canada..
    Tsai, Gina
    Univ Western Ontario, Dept Med, London, ON, Canada..
    Nevis, Immaculate
    Brock Univ, Goodman Sch Business, St Catharines, ON L2S 3A1, Canada..
    Potts, Ryan
    McMaster Univ, Farncombe Family Digest Hlth Unit, Hamilton, ON, Canada..
    Chiu, Jack
    Univ Western Ontario, Dept Med, London, ON, Canada..
    Dominic, Arunmozhi
    McMaster Univ, Dept Med, Hamilton, ON, Canada..
    Kim, Harold
    Univ Western Ontario, Dept Med, London, ON, Canada.;McMaster Univ, Dept Med, Hamilton, ON, Canada..
    Do epinephrine auto-injectors have an unsuitable needle length in children and adolescents at risk for anaphylaxis from food allergy?2016In: Allergy, Asthma & Clinical Immunology, ISSN 1710-1484, E-ISSN 1710-1492, Vol. 12, article id 11Article in journal (Refereed)
    Abstract [en]

    Background: Food allergy is the most common cause of anaphylaxis in children. Intramuscular delivery of epinephrine auto-injectors (EAI) is the standard of care for the treatment of anaphylaxis. We examined if children and adolescents at risk of anaphylaxis weighing 15-30 kg and >30 kg would receive epinephrine into the intramuscular space with the currently available EAI in North America and Europe. Methods: The distance from skin to muscle (STMD) and skin to bone (STBD) on the mid third anterolateral area of the right thigh was measured by ultrasound applying either high pressure ((max)) or slight pressure ((min)) in 102 children weighing 15-30 kg (group 1) and 100 children and adolescents, weighing more than 30 kg (group 2). Results: Using a high pressure EAI (HPEAI), Epipen Jr (R) and Auvi-Q (R)/Allerject (R) 0.15 mg, 11/102 (11 %) children in group 1 and 38/102 (38 %) using another HPEAI, Jext (R), had a STMDmax that showed a risk of intraosseous injection. There was a 1 % risk of subcutaneous injection with these devices. There was no risk of intraosseous injection using a low pressure EAI (LPEAI), Emerade (R). In group 2, the risk of intraosseous injection using a HPEAI was 3 % and no risk using a LPEAI. However, the risk of subcutaneous injection using HPEAI was 9 % and using LPEAI was 2 %. Conclusion: There is a risk of intraosseous injection using HPEAI (Epipen (R)/Epipen Jr (R), Auvi-Q (R)/Allerject (R) and especially Jext (R)) in children at risk of anaphylaxis. There was also a risk of subcutaneous injection using the currently available HPEAI in children and adolescents.

  • 20.
    Dreborg, Sten
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Wen, Xia
    Faculty of Science, McGill University, Montreal, Canada.
    Kim, Laura
    Faculty of Medicine, University British Columbia, Vancouver, Canada.
    Tsai, Gina
    Department of Medicine, Western University, London, Canada.
    Nevis, Immaculate
    Goodman School of Business, Brock University, St. Catharines, Canada.
    Potts, Ryan
    Farncombe Family Digestive Health Unit, McMaster University, Hamilton, Canada.
    Chiu, Jack
    Department of Medicine, Western University, London, Canada.
    Dominic, Arunmozhi
    Department of Medicine, McMaster University, Hamilton, ON Canada.
    Kim, Harold
    Department of Medicine, Western University, London, Canada.
    Erratum to: Do epinephrine auto-injectors have an unsuitable needle length in children and adolescents at risk for anaphylaxis from food allergy?2017In: Allergy, Asthma & Clinical Immunology, ISSN 1710-1484, E-ISSN 1710-1492, Vol. 13, article id 33Article in journal (Refereed)
    Abstract [en]

    This corrects the article DOI: 10.1186/s13223-016-0110-8

  • 21.
    Epstein, Tolly G.
    et al.
    Univ Cincinnati, Coll Med, Dept Med, Div Rheumatol Allergy & Immunol, Cincinnati, OH USA..
    Calabria, Christopher
    Dilley Allergy & Asthma Specialists, San Antonio, TX USA..
    Cox, Linda S.
    Univ Miami, Miller Sch Med, Holy Cross Hosp, Ft Lauderdale, FL USA..
    Dreborg, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Current Evidence on Safety and Practical Considerations for Administration of Sublingual Allergen Immunotherapy (SLIT) in the United States2017In: Journal of Allergy and Clinical Immunology: In Practice, ISSN 2213-2198, E-ISSN 2213-2201, Vol. 5, no 1, p. 34-40Article, review/survey (Refereed)
    Abstract [en]

    Liquid sublingual allergen immunotherapy (SLIT) has been used off-label for decades, and Food and Drug Administration (FDA)-approved grass and ragweed SLIT tablets have been available in the United States since 2014. Potentially life-threatening events from SLIT do occur, although they appear to be very rare, especially for FDA-approved products. Practice guidelines that incorporate safety precautions regarding the use of SLIT in the United States are needed. This clinical commentary attempts to address unresolved issues including controversy regarding the FDA mandate for the prescription of epinephrine autoinjectors for patients on SLIT; how to approach polysensitized patients; optimal timing and duration of SLIT administration; how to address gaps in therapy; whether antihistamines can prevent local reactions, if certain patient populations (such as persistent asthmatics) should not receive SLIT; and when to instruct patients to self-administer epinephrine. Key points are that physicians should focus on educating patients regarding: (1) when not to administer SLIT; (2) how to recognize a potentially serious allergic reaction to SLIT; and (3) when to administer epinephrine and seek emergency care.

  • 22.
    Fiocchi, Alessandro
    et al.
    Dept of Pediatrics – Division of Allergy - Pediatric Hospital Bambino Gesù – Rome, Vatican City.
    Burks, Wesley
    Bahna, Sami L.
    Bielory, Leonard
    Boyle, Robert J.
    Cocco, Renata
    Dreborg, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Goodman, Richard
    Kuitunen, Mikael
    Haahtela, Tari
    Heine, Ralf G.
    Lack, Gideon
    Osborn, David A.
    Sampson, Hugh
    Tannock, Gerald W.
    Lee, Bee Wah
    Dept of Paediatrics, National University of Singapore, Singapore.
    Clinical Use of Probiotics in Pediatric Allergy (CUPPA): A World Allergy Organization Position Paper2012In: The World Allergy Organization journal, ISSN 1939-4551, Vol. 5, no 11, p. 148-167Article in journal (Refereed)
    Abstract [en]

    Background:

    Probiotic administration has been proposed for the prevention and treatment of specific allergic manifestations such as eczema, rhinitis, gastrointestinal allergy, food allergy, and asthma. However, published statements and scientific opinions disagree about the clinical usefulness.

    Objective:

    A World Allergy Organization Special Committee on Food Allergy and Nutrition review of the evidence regarding the use of probiotics for the prevention and treatment of allergy.

    Methods:

    A qualitative and narrative review of the literature on probiotic treatment of allergic disease was carried out to address the diversity and variable quality of relevant studies. This variability precluded systematization, and an expert panel group discussion method was used to evaluate the literature. In the absence of systematic reviews of treatment, meta-analyses of prevention studies were used to provide data in support of probiotic applications.

    Results:

    Despite the plethora of literature, probiotic research is still in its infancy. There is a need for basic microbiology research on the resident human microbiota. Mechanistic studies from biology, immunology, and genetics are needed before we can claim to harness the potential of immune modulatory effects of microbiota. Meanwhile, clinicians must take a step back and try to link disease state with alterations of the microbiota through well-controlled long-term studies to identify clinical indications.

    Conclusions:

    Probiotics do not have an established role in the prevention or treatment of allergy. No single probiotic supplement or class of supplements has been demonstrated to efficiently influence the course of any allergic manifestation or long-term disease or to be sufficient to do so. Further epidemiologic, immunologic, microbiologic, genetic, and clinical studies are necessary to determine whether probiotic supplements will be useful in preventing allergy. Until then, supplementation with probiotics remains empirical in allergy medicine. In the future, basic research should focus on homoeostatic studies, and clinical research should focus on preventive medicine applications, not only in allergy. Collaborations between allergo-immunologists and microbiologists in basic research and a multidisciplinary approach in clinical research are likely to be the most fruitful.

  • 23. Kim, H
    et al.
    Dreborg, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Kim, L
    Tsai, G
    Auto-injector needle length may be inadequate to deliver epinephrine intramuscularly in women with confirmed food allergy: Comments to Letter by Song, T2015In: Allergy, Asthma & Clinical Immunology, ISSN 1710-1484, E-ISSN 1710-1492Article in journal (Refereed)
  • 24.
    Kjellman, Bengt
    et al.
    Barn- och ungdomskliniken, Skaraborgs sjukhus, Skövde.
    Dreborg, Sten
    Den svenska barnallergologins födelse2014In: Barnläkaren, p. 21-22Article in journal (Other academic)
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