Toll-like receptors have a critical role in innate immunity and host defence. However their role in allergic disease has not been studied in great detail. The presence of these receptors on mast cells opens up new possibilities concerning the role of Toll-like receptors in the pathogenesis of asthma and atopic dermatitis. The current review examines the biology of Toll-like receptors expressed on mast cells. In particular, mast cell expression of Toll-like receptors and the diverse responses observed following Toll-like receptor-mediated activation are considered. Several pathogens such as Staphylococcus aureus and respiratory syncytial virus are known to contribute to the development or maintenance of allergic disease and also express potent activators of the Toll-like receptor pathways. The importance of such interactions and the full role of pathogens in chronic allergic disease remain to be elucidated. The unusual ability of Toll-like receptor 2 activators to selectively induce leukotriene production by mast cells opens up new possibilities concerning mechanisms of disease exacerbation during infection.

Rate of resolution of mastocytosis is only shown in urticaria pigmentosa and mastocytoma. Better management guidelines are required to improve the health of these patients.

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RATIONALE: Several groups have made recommendations for adjustments during COVID-19 to facilitate the care of urgent/high-risk patients.Here we describe our Canadian multi-allergist tertiary allergy & clinical immunology clinic's observational data with intensive infection control measures to provide crucial services. METHODS: After instituting an intensive infection control protocol, we measured the daily number of patients seen (virtually and in-person), skin tests, target biologic therapy (TBT), venom (VIT) and allergy immunotherapy (AIT) administered as well as adverse safety events (allergy related and viral transmission related). RESULTS: Our protocol consisted of scheduling in-person visits by appointment-only, health screening during the reminder call (ensuring no COVID-19 symptoms, exposures, and recent high-risk travel history) and before clinic entry, providing obligatory hand sanitizer and mask at the door, scanning body temperature, disinfecting rooms in-between patients, daily deep cleaning after-hours, donning full personal protective equipment for any direct patient care, and performing spirometry in outdoor tents with plexiglass. AIT patients waited in their own vehicle, if possible, to be directly monitored by staff for 30 minutes to maximize physical distancing. For any concerns, patients immediately called over front door staff or honked their car horn. Since the pandemic, we provided virtual care and accommodated over 18,000 patients. On average per day, there were 25 new teleconsults, 12 skin tests, 40 TBT, 30 VIT, and 80 AIT patients. There have been no adverse safety events. CONCLUSIONS: By adopting intensive infection control measures, we can optimize reduction of viral transmission and maintain crucial allergy services to keep high-risk allergic conditions under control.