The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis are a widely disseminated and used resource for information about anaphylaxis. They focus on patients at risk, triggers, clinical diagnosis, treatment in health care settings, self-treatment in the community, and prevention of recurrences. Their unique strengths include a global perspective informed by prior research on the global availability of essentials for anaphylaxis assessment and management and a global agenda for anaphylaxis research. Additionally, detailed colored illustrations are linked to key concepts in the text [Simons et al.: J Allergy Clin Immunol 2011;127:593.e1-e22]. The recommendations in the original WAO Anaphylaxis Guidelines for management of anaphylaxis in health care settings and community settings were based on evidence published in peer-reviewed, indexed medical journals to the end of 2010. These recommendations remain unchanged and clinically relevant. An update of the evidence base was published in 2012 [Simons et al.: Curr Opin Allergy Clin Immunol 2012;12:389-399]. In 2012 and early 2013, major advances were reported in the following areas: further characterization of patient phenotypes; development of in vitro tests (for some allergens) that help distinguish clinical risk of anaphylaxis from asymptomatic sensitization; epinephrine (adrenaline) research, including studies of a new epinephrine auto-injector for use in community settings, and randomized controlled trials of immunotherapy to prevent food-induced anaphylaxis. Despite these advances, the need for additional prospective studies, including randomized controlled trials of interventions in anaphylaxis is increasingly apparent. This 2013 Update highlights publications from 2012 and 2013 that further contribute to the evidence base for the recommendations made in the original WAO Anaphylaxis Guidelines. Ideally, it should be used in conjunction with these Guidelines and with the 2012 Guidelines Update.

We generated > 10⁷ mast cells by culturing 10⁷ cord blood mononuclear cells for > 10 weeks in the presence of Steel factor, interleukin-6 and prostaglandin E₂. 99% of the cultured cells had tryptase-positive granules, while 18% had chymase-positive granules. Cultured mast cells contained 3.6 μg histamine and 3.5 μg tryptase per 10⁶ cells. Cells sensitized with 1 μg/ml human IgE released 58.5% histamine and 1.55 ng tumor necrosis factor (TNF)-α per 10⁶ cells when challenged with 1 μg/ml antihuman IgE, whereas the control cells spontaneously released 3.7% histamine and 0.18ng TNF-α. Analysis for surface antigens revealed that cultured mast cells expressed the following CD molecules: 9, 13, 14, 29, 33, 38, 43, 44, 45RA, 45RB, 46, 47, 48, 49d, 50, 51, 53, 54, 55, 58, 59, 60, 61 and 117 (c-Kit). Taken together, these cultured cells seem to be functionally mature mast cells.

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Human mast cells are derived from CD34+ hematopoietic cells present in cord blood, bone marrow, and peripheral blood. However, little is known about the properties of the CD34+ cells. We demonstrated here that mast cell progenitors that have distinct phenotypes from other hematopoietic cell types are present in cord blood by culturing single, sorted CD34+ cells in 96-well plates or unsorted cells in methylcellulose. The CD34+ mast cell-committed progenitors often expressed CD38 and often lacked HLA-DR, whereas CD34+ erythroid progenitors often expressed both CD38 and HLA-DR and CD34+ granulocyte-macrophage progenitors often had CD33 and sometimes expressed CD38. We then cultured single cord blood-derived CD34+CD38+ cells under conditions optimal for mast cells and three types of myeloid cells, ie, basophils, eosinophils, and macrophages. Of 1,200 CD34+CD38+ cells, we were able to detect 13 pure mast cell colonies and 52 pure colonies consisting of either one of these three myeloid cell types. We found 17 colonies consisting of two of the three myeloid cell types, whereas only one colony consisted of mast cells and another cell type. These results indicate that human mast cells develop from progenitors that have unique phenotypes and that committed mast cell progenitors develop from multipotent hematopoietic cells through a pathway distinct from myeloid lineages including basophils, which have many similarities to mast cells.

Background: Although there are many asymptomatic patients, one of the problems of COVID-19 is early recognition of the disease. COVID-19 symptoms are polymorphic and may include upper respiratory symptoms. However, COVID-19 symptoms may be mistaken with the common cold or allergic rhinitis. An ARIA-EAACI study group attempted to differentiate upper respiratory symptoms between the three diseases.Methods: A modified Delphi process was used. The ARIA members who were seeing COVID-19 patients were asked to fill in a questionnaire on the upper airway symptoms of COVID-19, common cold and allergic rhinitis.Results: Among the 192 ARIA members who were invited to respond to the questionnaire, 89 responded and 87 questionnaires were analysed. The consensus was then reported. A two-way ANOVA revealed significant differences in the symptom intensity between the three diseases (p < .001). Conclusions:This modified Delphi approach enabled the differentiation of upper respiratory symptoms between COVID-19, the common cold and allergic rhinitis. An electronic algorithm will be devised using the questionnaire.

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Rationele: Polllen-apple allergy syndrome affects approximately 50% of birch tree pollen-allergic adults. Allergy to apple results from cross-reactivity between apple and birch pollen proteins. Subcutaneous immunotherapy with birch pollen was reported to improve apple allergy in a subset of adult subjects. Skin tests and serum allergen-specific IgE antibody levels correlate poorly with clinical expression of apple allergy in birch-allergic individuals. Oral food challenge to apple remains the most accurate diagnostic test, however, standardized protocol is not easily available and the procedure is labourintense. We sought to determine whether RBL passive sensitization assay might be used to evaluate effects of birch pollen immunotherapy in subjects with pollen-food allergy syndrome to apple. Methods: Birch-allergic individuals had apple allergy confirmed with doubleblind placebo-controlled oral food challenge and were randomized to birch pollen immunotherapy arm or to control arm (no immunotherapy, continued standard medical management). RBL-2H3 cells transfected with human Fc? receptor were passively sensitized with sera from birch-allergic individuals with oral allergy to apple at 1:40 dilution and following overnight incubation were stimulated with serial dilutions (Aim: Development of an evidenced based intervention programme to help children and parents to manage the biopsychosocial impact of food allergy on their everyday lives. Methods: 6 focus groups with parents of confirmed food allergic children and 10 focus groups with food allergic children aged 5-13 years. Qualitative analysis using grounded theory was used to analyse transcripts. Results:The transcripts gave rise to categories relating to risk perception, illness cognitions, coping strategies, understanding of health and well-being, meanings given to diet and food. Transcripts also revealed developmental, parent/child, and sex differences vital to creating a targeted and food allergy sensitive intervention. A psycho-education intervention was then developed and is currently being validated with strong initial findings. Conclusion: Middle childhood is a period when problems with anxiety, low self-esteem, peer comparison, and malconstructive coping strategies emerge, leading to higher risk in adolescence. Our data suggests that an intervention at this critical point in the food allergy developmental perspective is vital to ensuring successful biopsychosocial adjustment in day-to-day life. Despite clinical expertise suggest that food allergy has a substantial burden on patients' life, little data is now available on its impact and treatment on quality of life.The aim of our study is to evaluate patients? answers to the preliminary version of a QoL questionnaire specifically addressed to food allergy. During the development phase of the new tool, 32 items were administered to 27 patients (9 M, 18 F, mean age 40, SD 7,2) suffering from food allergy. Patients had to indicate, on a Likert scale with multiple options (1: not at all; 5: very much), how much...