Monitoring is a major component of asthma management in children. Regular monitoring allows for diagnosis confirmation, treatment optimization and natural history review. Numerous factors that may affect disease activity and patient wellbeing need to be monitored: response and adherence to treatment, disease control, disease progression, comorbidities, quality of life, medication side-effects, allergen and irritant exposures, diet and more. However, the prioritization of such factors and the selection of relevant assessment tools is an unmet need. Furthermore, rapidly developing technologies promise new opportunities for closer, or even ‘real-time’, monitoring between visits. Following an approach that included needs assessment, evidence appraisal and Delphi consensus, the PeARL Think Tank, in collaboration with major international professional and patient organizations, has developed a set of 24 recommendations on pediatric asthma monitoring, to support healthcare professionals in decision-making and care pathway design.

Article Type: Letter to the EditorTitle : The impact of maternal-fetal omalizumab transfer on peanut-specific responses in an ex vivo placental perfusion model

Background: Pollen-allergy is common in Austria. The present study investigated if the use of major pollen-allergens on top of extract-based diagnosis may improve the diagnostic accuracy and if this additional knowledge helps to identify patients eligible for allergen-specific immunotherapy (AIT). Methods: In this retrospective database analysis patients sensitized to a grass, birch, ash-tree, mugwort or ragweed were investigated and results of pollen extracts compared to the respective major allergens (Phl p 1, Bet v 1, Ole e 1, Art v 1, Amb a 1) were assessed. Furthermore, extract- and MD- results of patients double-sensitized to both tree-extracts or both weed-extracts were compared. In patients with discrepant results, their charts were reviewed to define if this difference was clinically relevant in regard to their doctors´ AIT-decision. Results: 4234 patients (age 1.2-89.7yrs) could be included in the analyses. There was high agreement between extract-based IgE results and major allergens concerning single-sensitization to grass/Phl p 1+5 (94.4%), birch/Bet v 1 (94.4%), and ash-tree/Ole e 1 (82.9%), with lower agreement between mugwort/Art v 1 (64.1%) and ragweed/Amb a 1 (73.8%). Among patients double-sensitized to both tree pollen extracts only 76% were also sensitized to both major allergens (Bet v 1 and Ole e 1) and therefore suitable for AIT. In patients double-sensitized to both weeds, only 25% were also sensitized to both major allergens (Art v 1 and Amb a 1), 46.2% of mugwort extract positive patients tested negative for Art v 1. Of these patients, 41.3% were recommended a ragweed AIT as their Amb a 1 results were positive. Conclusion: MD can improve diagnostic accuracy in patients with pollen-allergy and should be implemented in standard clinical care, especially when double-sensitization to allergens of plants with overlapping pollen seasons cannot be clearly discerned by patients´ symptoms alone.

Background: Peanut allergy has a rising prevalence in high-income countries, affecting 0.5–1.4% of children. This study aimed to better understand peanut anaphylaxis in comparison to anaphylaxis to other food triggers in European children and adolescents. Methods: Data was sourced from the European Anaphylaxis Registry via an online questionnaire, after in-depth review of food induced anaphylaxis cases in a tertiary paediatric allergy centre. Results: 3514 cases of food anaphylaxis were reported between July 2007 - March 2018, 56% in patients younger than 18 years. Peanut anaphylaxis was recorded in 459 children and adolescents (85% of all peanut anaphylaxis cases). Previous reactions (42% vs 38%; p=0.001), asthma comorbidity (47% vs 35%; p<0.001), relevant co-factors (29% vs 22%; p=0.004) and biphasic reactions (10% vs 4%; p=0.001) were more commonly reported in peanut anaphylaxis. Most cases were labelled as severe anaphylaxis (Ring&Messmer grade III 65% vs 56% and grade IV 1.1% vs 0.9%; p=0.001). Self-administration of intramuscular adrenaline was low (17% vs 15%), professional adrenaline administration was higher in non-peanut food anaphylaxis (34% vs 26%; p=0.003). Hospitalisation was higher for peanut anaphylaxis (67% vs 54%; p=0.004). Conclusions: The European Anaphylaxis Registry data confirmed peanut as one of the major causes of severe, potentially life-threatening allergic reactions in European children, with some characteristic features e.g. presence of asthma comorbidity and increased rate of biphasic reactions. Usage of intramuscular adrenaline as first line treatment is low and needs to be improved. The Registry, designed as the largest database on anaphylaxis, allows continuous assessment of this condition.

Background: Multiplex tests allow for measurement of allergen-specific IgE responses to multiple allergen extracts and components and have several advantages for large cohort studies. Due to significant methodological differences, test systems are difficult to integrate in meta-analyses/systematic reviews since there is a lack of datasets with direct comparison. We aimed to create models for statistical integration of allergen-specific IgE to peanut/tree nut allergens from three IgE-test platforms. Methods: Plasma from Canadian and Austrian children with peanut/tree nut sensitization and a cohort of sensitized, high-risk, pre-school asthmatics (total n=166) were measured with three R&D multiplex IgE test platforms: Allergy Explorer, ALEX (Macro Array Dx), MeDALL-chip (Mechanisms of Development of Allergy) (Thermo Fisher), and EUROLINE (EUROIMMUN). Skin prick test (n=51) and ImmunoCAP (n=62) results for extracts were available in a subset. Regression models (Multivariate Adaptive Regression Splines, local polynomial regression) were applied if >30% of samples were positive to the allergen. Intra-test correlations between PR-10 and nsLTP allergens were assessed. Results: Using two regression methods, we demonstrated the ability to model allergen-specific relationships with acceptable measures of fit (r2=94-56%) for peanut and tree nut sIgE testing at the extract and component-level, in order from highest to lowest: Ara h 2, Ara h 6, Jug r 1, Ana o 3, Ara h 1, Jug r 2, Cor a 9. Conclusion: Our models support the notion that conversion is reasonably possible between sIgE multiplex platforms for allergen extracts and components and may provide options to aggregate data for future meta-analysis.