In children with allergic asthma, treatment with omalizumab decreased the duration of RV infections, viral shedding, and the risk of RV illnesses. These findings provide direct evidence that blocking IgE decreases susceptibility to RV infections and illness. Clinical trial registered with www.clinicaltrials.gov (NCT01430403).

Anaphylaxis is a serious and potentially life-threatening allergic reaction that may follow the ingestion of foods. Although these reactions usually follow a common clinical pattern and often demonstrate IgE sensitization to the antigen in question, both the clinical presentation and causative allergen may be atypical, surprising, and difficult to identify. Failure to identify the actual cause of the reaction can compromise treatment and complicate long-term care. Here, we present a patient who had symptoms of anaphylaxis after eating salmon, but confirmation of the causative allergen was not readily apparent. This particular case serves as an insightful lesson for patients undergoing evaluation for anaphylaxis and also provides a framework for navigating through a case involving identification of an underlying allergen.

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In this study, we assessed whether multisystem reactions to egg and extensively-heated (EH) egg during OFCs were associated with a history of multisystem reactions. Records of children, who underwent OFC to egg or EH egg over a five-year period were reviewed. Of the 120 challenges, 26 (21.67 %) failed, with 38.4 % (10/26) having multisystem reactions. Of the 13 who had multisystem reactions on initial presentation, only two (15.4 %) had a similar OFC outcome. Eighty percent (8/10) of those who had a multisystem OFC reaction had a less severe initial presentation. Initial and OFC multisystem reactions were not associated with each other.

Biomarkers of Type-2 (Th2-high) inflammation, such as fractional exhaled nitric oxide (FeNO) and peripheral blood eosinophils (EOS), appear to predict response to biologic treatments in patients with severe asthma. However, the relative value of assessing multiple biomarkers simultaneously in predicting response to biologics in allergic asthma has not been established. METHODS: Predictive properties of FeNO, within high and low EOS subgroups, were evaluated in patients with severe allergic asthma in this post-hoc analysis of the 48-week EXTRA study of omalizumab (Hanania et al, 2011). Patients were divided into predefined subgroups based on cohort median levels of FeNO (low [<19.5 ppb] or high [> _19.5 ppb]) and EOS (low [<260/mL] or high [> _260/mL]). Treatment effect was evaluated as the number of observed protocol-defined exacerbations, controlling for pre-specified protocol-defined covariates. RESULTS: Patients with higher FeNO and treated with omalizumab demonstrated clinically relevant mean reductions in exacerbation frequency vs placebo whether or not their EOS were high (53.1% [95%CI: 18.7%, 72.9%]; n5120; p50.007) or low (51.0% [95%CI: 22.8%, 76.7%]; n568; p50.059). Among patients with lower FeNO, exacerbation reduction response to omalizumab appeared less pronounced (7.1% [95% CI: 2102%, 57.4%]; n570; p50.85) among EOS high and (18.0% [95% CI: 244.9%, 53.6%]; n5108; p50.50) among EOS low. CONCLUSIONS: These findings suggest that multiple biomarkers of T2 may be important in optimally stratifying patients according to possible biologic treatment responses. Caution must be used in interpretation of results, given their post-hoc nature and the availability of both FeNO and EOS data in only a single omalizumab clinical trial.