Current Opinion in Allergy and Clinical Immunology

Tarlo, Susan M.; Maestrelli, Piero; Giovannini, Mattia; Annesi-Maesano, Isabella; Cianferoni, Antonella

doi: 10.1097/aci.0000000000001062pmid: 40013450

Skypala, Isabel J.

doi: 10.1097/aci.0000000000001064pmid: 39903212

Purpose of reviewTo evaluate the effect of climate change on pollen allergenicity, lengthening of the pollen season, and the spread of invasive species such as ragweed. To assess evidence to determine whether these effects are impacting the prevalence of pollen food syndrome (PFS).Recent findingsThere is good evidence to demonstrate that markers of climate change, including rising temperatures and to some extent greenhouse gases, are responsible for a rise in the allergenicity of pollen and an increase in the duration of the pollen season, especially for trees. These changes are likely to be linked to the increase in the prevalence of seasonal allergic rhinitis (SAR), especially in children. Sensitization to pollen, especially tree pollen, is also a risk factor for the development of PFS. Thought to mainly affect adults, recent evidence suggests that there is a rise in the prevalence of PFS in children, linked to an increase in SAR.SummaryIncreasing SAR due to climate change could lead to a greater number of children and adults developing PFS. Although PFS is generally considered to be a mild condition, severe reactions can occur and there might be numerous plant food triggers, which can adversely affect dietary choice and nutritional intake.

Raulf, Monika; Annesi-Maesano, Isabella

doi: 10.1097/aci.0000000000001060pmid: 39869536

Purpose of reviewClimate change influences working conditions in various ways, affecting employee health and safety across different sectors. Climatic factors like rising temperatures, increased UV radiation, and more frequent extreme weather events pose risks to in both indoor and outdoor workers. Allergic diseases of the respiratory tract and the skin may emerge due to climate change. This review summarizes current aspects of both direct and indirect consequences of climate change and associated exposures in diverse work environments, focusing on occupational allergies.Recent findingsOutdoor workers, in particular, are increasing susceptible to ubiquitous pollen allergens. Additionally, they may experience climate-related increases in allergens typically associated with specific workplaces, such as Cryptostroma corticale. Changes in production processes, along with altered workplaces exposures, can lead to new sensitizations and trigger allergies, representing indirect consequences of climate change. Furthermore, lifestyle changes aimed to promoting climate protection and sustainability (e.g. the introduction of insects as a protein source or using enzymes), may also contribute to the emergence of new allergens.SummaryThe emergence of new occupational sensitization sources from novel or modified allergen exposures must be addressed within the framework of workplace safety and health, necessitating proactive measures to safeguard workers and mitigate risks.

Bellani, Serena; Spagnolo, Paolo

doi: 10.1097/aci.0000000000001055pmid: 39680372

Purpose of reviewTo critically discuss the rationale for the use of drugs approved for idiopathic pulmonary fibrosis (IPF) to treat occupational interstitial lung diseases (OILDs).Recent findingsAlthough IPF and OILDs share several clinical, radiological and probably pathogenetic features, currently, OILDs do not have a standard of care. In recent years, our knowledge and understanding of ILDs has improved substantially. Recently, the progressive pulmonary fibrosis (PPF) phenotype, which refers to non-IPF fibrotic ILDs that progress despite appropriate treatment, has been defined. OILDs may also be progressive. Nintedanib, initially approved for treatment of IPF, is also approved in patients with PPF. On the other hand, pirfenidone is approved in IPF but not in PPF, due to the lack of robust evidence of efficacy in this patient subset.SummaryOILDs are a large and highly heterogeneous group of conditions without a proper standard of care. Nintedanib may slow functional decline and disease progression in progressive OILDs, and new clinical trials are ongoing.

Lin, Chen-Chung; Law, Brandon F.; Hettick, Justin M.

doi: 10.1097/aci.0000000000001043pmid: 39450940

Purpose of reviewTo describe recent findings of diisocyanate-mediated mechanisms in allergy and toxicology by addressing the role of microRNA (miR) in immune responses that may contribute to the development of occupational asthma (OA).Recent findingsStudies of diisocyanate asthma have traditionally focused on the immune and inflammatory patterns associated with diisocyanate exposures; however, recognized knowledge gaps exist regarding the detailed molecular mechanism(s) of pathogenesis. Recent studies demonstrate the critical role endogenous microRNAs play as gene regulators in maintaining homeostasis of the human body, and in the pathophysiology of many diseases including asthma. Given that diisocyanate-OA shares many pathophysiological characteristics with asthma, it is likely that miR-mediated mechanisms are involved in the pathophysiology of diisocyanate-OA. Recent reports have shown that changes in expression of endogenous miRs are associated with exposure to the occupationally relevant diisocyanates, toluene diisocyanate (TDI) and methylene diphenyl diisocyanate (MDI). Continued mechanistic study of these relevant miRs may lead to the development of novel biomarkers of occupational exposure and/or provide efficacious targets for therapeutic strategies in diisocyanate asthma.SummaryThe molecular mechanisms underlying diisocyanate-OA pathophysiology are heterogeneous and complicated. In this review, we highlight recent research into the roles and potential regulation of miRs in diisocyanate-OA.

Nafees, Asaad Ahmed; Cullinan, Paul

doi: 10.1097/aci.0000000000001053pmid: 39635885

Purpose of reviewThe textile manufacturing sector is a major contributor to the economies of several emergent economies in the global South. Respiratory disease, including byssinosis and chronic obstructive pulmonary disease (COPD), among textile workers appears to be common in this setting.Recent findingsNotably, little or no contemporary research has been published from countries, which are major global producers of textiles. Most recent epidemiological studies are of a cross-sectional design, with deficiencies that repeat those of research in this area over the past 20 years and do little to advance the cause of prevention. Their estimates of disease prevalence vary wildly for reasons that are unclear. An important exception was the publication of a successful, randomized trial of a low-cost intervention, the first in this field.SummaryResearch into the respiratory problems of textile work needs to embrace modern approaches to the understanding of (occupational) COPD and move beyond the estimation of disease prevalence. There is an important need for cheaper and simpler techniques for workplace dust measurement. Occupational health researchers should pool their skills, resources and protocols towards the prevention of a problem that is common to many low- and middle-income economies.

Buckey, Timothy M.; Singh, Tarandeep; Sacta, Maria A.

doi: 10.1097/aci.0000000000001063pmid: 39903458

Purpose of reviewEthical dilemmas are a common occurrence in the provision of care to individuals with food allergies. Thus, an understanding of medical ethics is essential for allergists/immunologists.Recent findingsDespite the importance of medical ethics in the clinical practice of food allergy, there has been little published on this topic. Some international allergy societies have published ethical guidelines. Further investigation on medical ethics in food allergy is required.SummaryThis review describes key ethical principles in relation to food allergy testing, oral food challenges, and various management strategies, including avoidance, omalizumab and oral immunotherapy. This review demonstrates the necessity for education and research on medical ethics in food allergy.