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Although a minority of asthma patients suffer from severe asthma, they represent a major clinical challenge in terms of poor symptom control despite high-dose treatment, risk of exacerbations, and side effects. Novel biological treatments may benefit patients with severe asthma, but are expensive, and are only effective in appropriately targeted patients. In some patients, symptoms are driven by other factors than asthma, and all patients with suspected severe asthma (‘difficult asthma’) should undergo systematic assessment, in order to differentiate between true severe asthma, and ‘difficult-to-treat’ patients, in whom poor control is related to factors such as poor adherence or co-morbidities. The Nordic Consensus Statement on severe asthma was developed by the Nordic Severe Asthma Network, consisting of members from Norway, Sweden, Finland, Denmark, Iceland and Estonia, including representatives from the respective national respiratory scientific societies with the aim to provide an overview and recommendations regarding the diagnosis, systematic assessment and management of severe asthma. Furthermore, the Consensus Statement proposes recommendations for the organization of severe asthma management in primary, secondary, and tertiary care.

The aim of the current study was to describe the incidence of respiratory symptoms and allergic sensitisation and the sequence of events leading to respiratory symptoms among Danish baker apprentices (BA). A total of 114 BA were surveyed over a 20-month period. Questionnaires were completed along with spirometric analysis and skin-prick tests to common and work-related allergens. Bronchial hyperresponsiveness (BHR) was determined at baseline and at the end of the follow-up period.The incidences of work-related rhinitis and asthma-like symptoms were 22.1 and 10.0 cases?100 person-yrs -1 , respectively. At 20 months the cumulative incidence proportion was 40.2 and 20.5% for rhinitis and asthma-like symptoms, respectively. The cumulative incidence of occupational sensitisation was 6.1%.An increased risk of asthma-like symptoms was found in both atopic subjects and in females. In the BA with new onset respiratory symptoms, an increase in BHR from baseline was observed. Forced expiratory volume in one second and forced vital capacity did not change during the follow-up period. No relationship was observed between new sensitisation and new symptoms.In conclusion rhinitis-and asthma-like symptoms were found to develop commonly in Danish baker apprentices. The mechanism by which symptoms arose was perceived to reflect the development of an inflammation rather than the production of a specific immunoglobulin E pathway, as sensitisation to occupational allergens was rarely observed. Hence, respiratory symptoms and allergy may develop through separate pathways.

Desensitization attenuated basophil response rapidly and non-specifically at a stage before p38 MAPK phosphorylation.

To the Editor, Intralymphatic immunotherapy, ILIT, has emerged as a symptomreducing immune treatment of allergic rhinoconjunctivitis as most studies find significant efficacy. 1,2 In ILIT, a dose of allergen 100-fold lower than in SCIT is injected into a lymph node. Precise injection may therefore be essential to give a clinical and immunological response.Conversely, allergic side effects may develop if the allergen is injected extra-nodally. In a multicenter trial (EudraCT 2014-004031-40), we studied the relationship between the number of successful ILIT injections and clinical response and adverse events to ILIT.One hundred and seventy five patients suffering from allergic rhinoconjunctivitis in the grass pollen season and with a positive skin prick test to grass pollen extract were included (Table S1). Three ILIT injections of 1.000 SQU of ALK Alutard, Phleum Pratense were given off label in 1-month intervals. Injections were performed by allergists undergoing a training program in ultrasound-guided lymph node

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Among patients managed for severe asthma in a specialist setting, only half had the asthma diagnosis confirmed objectively, and adherence and inhaler technique were infrequently assessed.

The prevalence of atopy in bakers' apprentices was of the same magnitude in the general Danish population. Significantly, more male bakers' apprentices had atopy. This finding has major impact on the diagnostic procedures of occupational allergy in bakery workers emphasizing the need for standardization of the clinical tests. The main reasons for non-participation were, fear of blood-sampling (57%) and the 3 years commitment to the follow-up study (39%).