Allergy and Immunology

Asthma is a common problem with a prevalence rate increasing every year. However, not all asthmatic patients receive appropriate treatment, partly due to the disease entity or patients' compliance, and partly due to physicians' knowledge and disposition in terms of treatment. This study was designed to investigate the current status of asthma treatment among clinicians in different practice settings, particularly regarding the acceptance of and adherence to asthma treatment guidelines and asthma patient education. Questionnaires were distributed by randomized sampling to doctors throughout the entire country. The questionnaire had six parts, measuring the following: 1) the use of different kinds of medication in the treatment of asthma; 2) adherence to asthma treatment guidelines; 3) the use of inhaled corticosteroids as part of management; 4) the use of peak flow meters in monitoring asthma; 5) relative efficiency in treating asthma; and 6) the use of a referral system, from general practitioners to specialists. There were 531 respondents out of 1,000 questionnaires distributed. The results revealed the following: 1) 20.2% of physicians use oral corticosteroids for maintenance therapy; 2) 31.8% of physicians do not follow asthma treatment guidelines; 3) 77.2% of physicians use inhaled corticosteroids for maintenance therapy (physicians in medical centers and regional hospitals use inhaled corticosteroids more frequently than private practitioners); 4) 51% of doctors do not use peak flow meters to monitor asthma symptoms because of prohibitive costs; 5) approximately 80% of clinicians have confidence in dealing with asthma problems; and 6) 29.2% of general practitioners do not refer patients to asthma specialists unless there is poor control or a need for further evaluation. Adherence to asthma treatment guidelines is poor, and such guidelines need to be popularized or simplified. There are still many discrepancies among doctors at different levels of hospitals. Re-education and review of asthma knowledge is necessary to keep clinical practitioners at the forefront of standard practice.

Cystic fibrosis (CF) is the most common autosomal recessive disease in Caucasians. The dysfunction of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) causes the disease by disrupting epithelial salt and water transport. Characteristic manifestations of the disease such as chronic respiratory infections, pancreatic enzyme insufficiency, and infertility are caused by the accumulation of mucus in the ducts. Nowadays nearly 2000 CFTR mutatioans are known. The most common mutation is F508del. F508del/F508del mutation is not always accompanied by severe manifestations. The clinical expression is different among patients, taking into account the mutations and another factor, among them, enviromental and modifier genes. In the case of rare mutations symptoms vary from patient to patient being influenced by environmental factors and modifier genes. We present a case with a less common combination of mutations and an atypical clinical presentation.

This study concerns a woman with a very specific phobia of free-flying wasps. Her underlying and disabling belief was that she was allergic to wasp venom and, if stung, would certainly die. A behavioural approach, such as systematic desensitization and exposure, was not thought suitable because of the patient's pattern of fear. Instead, the treatment of choice was an allergy test to directly challenge her belief. The allergy test was negative and led to a dramatic improvement which was maintained 1 year after treatment. r

Acute inflammation is accompanied by changes in the concentrations of acute phase proteins (APPs), While much is known about the cytokines involved in the initiation of inflammation, less is known about the mediators involved in its resolution. Recent data suggest that interleukin 6 (IL-6) and IL-6-regulated APPs are anti-inflammatory and immuno-suppressive, and may negatively regulate the acute phase response.

Objective: To compare the enzyme activity of different presentations of papain solution to validate in-house preparations. Methods: Two papain solutions were prepared, and the third presentation was a commercial solution. Tests were carried out with samples of red cells typed as weak RhD. Results: In-house prepared papain solutions showed similar enzyme reactivity, and statistically no differences compared to the enzyme activity of the commercial solution. Conclusion: Evaluating the cost-benefit ratio, the in-house prepared papain solutions present more economic advantages, and can be incorporated into immunohematological routines as a way to cope with periods of financial crisis and cost-containment policies.

OBJETIVO: Rever as publicações recentes mais relevantes sobre alergia medicamentosa e oferecer ao clínico subsídios para uma maior compreensão dessa problemática de grande relevância para a saúde pública. FONTES DOS DADOS: Busca de artigos originais e revisões indexados nas bases MEDLINE, Pubmed e Lilacs, publicados na última década, relacionando o tema de alergia a medicamentos com mecanismos imunológicos, epidemiologia, diagnóstico laboratorial, lesões cutâneas, manejo clínico e reexposição ao fármaco. SÍNTESE DOS DADOS: As reações alérgicas representam um terço das reações adversas a medicamentos. São consideradas eventos raros, mas com elevada morbimortalidade. Apesar da descrição de Gell & Coombs, útil para classificar reações alérgicas a fármacos, algumas permanecem sem classificação devido ao desconhecimento dos mecanismos imunológicos envolvidos. A existência de subpopulações de células T com características diversas daquelas comumente descritas revela a complexidade do tema e, ao mesmo tempo, elucida inúmeras questões inerentes ao mesmo. Recentemente, um novo conceito de apresentação de fármaco a linfócitos T surgiu, diante de evidências crescentes do seu envolvimento nas lesões cutâneas decorrentes de reações alérgicas a medicamentos. Na prática clínica, é muito difícil a correlação de sinais e sintomas das reações alérgicas a medicamentos com o mecanismo imunológico envolvido sem o auxílio de testes laboratoriais. Testes cutâneos in vivo e testes in vitro têm sido empregados nas suspeitas de reações alérgicas a medicamentos. No entanto, há poucos produtos comerciais adequados para sua execução. CONCLUSÕES: As reações alérgicas a fármacos constituem uma fração importante dos eventos adversos a medicamentos. É importante enfatizar a necessidade de notificação dessas reações pelos profissionais envolvidos no tratamento do paciente de forma sistematizada, por meio de ações de farmacovigilância, bem como a identificação dos possíveis mecanismos imunológicos envolvidos através de testes laboratoriais, história e avaliação clínica detalhadas.

Allergic diseases represent a major health problem in Europe. They are increasing in prevalence, severity and costs. The Global Allergy and Asthma European Network (GA 2 LEN), a Sixth EU Framework Program for Research and Technological Development (FP6) Network of Excellence, was created in 2005 as a vehicle to ensure excellence in research bringing together research and clinical institutions to combat fragmentation in the European research area and to tackle Allergy in its globality. The Global Allergy and Asthma European Network has benefited greatly from the voluntary efforts of researchers who are strongly committed to this model of pan-European collaboration. The network was organized in order to increase networking for scientific projects in allergy and asthma around Europe and to make GA 2 LEN the world leader in the field. Besides these activities, research has also been carried out and the first papers are being published. Achievements of the Global Allergy and Asthma European Network can be grouped as follows: (i) those for a durable infrastructure built up during the project phase, (ii) those which are project-related and based on these novel infrastructures, and (iii) the development and implementation of guidelines. The major achievements of GA 2 LEN are reported in this paper.

This historic review describes the people that were involved in studying some aspect of fish immunology and vaccination from as early as 1854. Between 1850 and 1940, most scientists were looking at fish from the angle of comparative anatomy, embryology, physiology, taxonomy and fish diseases. Most publications from this early period are describing the morphology of blood cells and hemopoietic or lymphoid organs. The first publications on specific immune responses and vaccination of fish were found in the period 1935e1938. However, the immune mechanisms behind protective immunization were largely unknown in those days. In the period after 1940, the first researchers can be found devoting their whole career to fish immunology. This paper has been organized largely by individuals and not so much by accomplishments. It is not the intent of this review to evaluate the scientific merit of the work discussed, but to provide the reader with information that was e at least in part e lost to the scientific community. Publications from before 1940 or in languages other than English (e.g. Russian) are usually not found by today's database searches on the Internet. ª

ABSTRAK Pendahuluan: Reaksi hipersensitivitas tipe I merupakan reaksi alergi yang dipicu oleh aktivitas IgE. Hipersensitivitas tipe I dapat berupa reaksi anafilaktik sistemik atau reaksi lokal yang ditandai oleh inflamasi dan kerusakan epitel mukosa. Udang dikenal sebagai makanan yang sering memicu alergi akibat kandungan protein di dalamnya merangsang reaksi system imun secara berlebihan pada pasien tertentu. Tujuan: Laporan kasus ini bertujuan membahas penatalaksanaan stomatitis alergika yang disebabkan alergi udang. Kasus: Seorang wanita berusia 36 tahun datang ke RSGM Trisakti dengan keluhan terasa gatal pada bibir atas dan bawah bagian dalam sejak 1 hari sebelum kedatangan. Keluhan tersebut dirasakan setelah memakan udang sehari sebelumnya.Tatalaksana: Pasien diberikan Aloclair gel 3x1 hari, dan kontrol dilakukan satu minggu setelah kunjungan pertama. Kata kunci :Alergi makanan, stomatitis alergika, alergi, hipersensitivitas tipe I

Lesi Vesikobulosa merupakan lesi berisi cairan jernih dan berada pada lapisan epitel, ruptur serta menimbulkan ulserasi. Lesi vesikobulosa dalam rongga mulut memiliki gambaran klinis, sehingga dibutuhkan pemeriksaan penunjang dalam menentukan diferensial diagnosis untuk tatalaksana perawatan yang tepat.

Genome sequences from many organisms, including humans, have been completed, and high-throughput analyses have produced burgeoning volumes of 'omics' data. Bioinformatics is crucial for the management and analysis of such data and is increasingly used to accelerate progress in a wide variety of large-scale and object-specific functional analyses. Refined algorithms enable biotechnologists to follow 'computer-aided strategies' based on experiments driven by high-confidence predictions. In order to address compound problems, current efforts in immuno-informatics and reverse vaccinology are aimed at developing and tuning integrative approaches and user-friendly, automated bioinformatics environments. This will herald a move to 'computeraided biotechnology': smart projects in which timeconsuming and expensive large-scale experimental approaches are progressively replaced by predictiondriven investigations.

Paul Ehrlich (1854e1915) is nowadays considered a pioneer in a number of medical fields, and in the course of time his role in the establishment and development of disciplines such as histology, immunology, oncology and haematology has been acknowledged. Aim of this historical note is to illustrate, in the area of chemotherapy, the special importance of this brilliant scientist whose 150th anniversary of birth occurred in 2004.

Allergy describes a constellation of clinical diseases that affect up to 30% of the world's population. It is characterized by production of allergen specific IgE which bind to mast cells and initiate a cascade of molecular and cellular events that affect the respiratory tract (rhinitis and asthma) skin (dermatitis, urticaria) and multi systems (anaphylaxis) to a variety of allergens including pollens, mold spores, animal danders, insect stings, foods and drugs. The underlying pathophysiology involves immunoregulatory dysfunctions similar to those noted in highly stressed populations. The relationships in terms of potentials for intervention are discussed.

Disulfide bond isomerisation and the assembly of MHC class I-peptide complexes. Dick TP, Bangia N, Peaper DR, Cresswell P: Immunity 2002, 16:87-98. Significance: Newly synthesised MHC class I molecules assemble within the endoplasmic reticulum (ER) and load with optimal peptides while bound to the transporter associated with antigen processing (TAP), tapasin, the oxidoreductase ERp57 and calreticulin: collectively these are called the peptide-loading complex (PLC). This is the first study of the function of ERp57 in this complex. Findings: By trapping disulphide-bonded intermediates formed between ERp57 and other components of the PLC, using the sulphydryl blocker N-ethyl maleimide, the authors found that all ERp57 in the PLC was disulphide-bonded to tapasin, although only a fraction of tapasin was bound to ERp57. Formation of this ERp57-tapasin complex depended on the presence of class I heavy chain (HC). Site-directed mutagenesis identified cysteine 95 of tapasin and cysteine 57 of ERp57 as being required for forming the complex. Although no S-S intermediate was identified between ERp57 and HC, mutant tapasin molecules that did not bind to ERp57 restored MHC class I expression when introduced into tapasin-null cells. However, the class I molecules that were assembled in these cells were less stable, and loading with optimal peptides was impaired as a direct result of the failure of an intramolecular S-S (presumably in the α2 domain) to become fully oxidised upon assembly.

The next 'golden age' in vaccinology will be ushered in by the new science of vaccinomics. In turn, this will inform and allow the development of personalized vaccines, based on our increasing understanding of immune response phenotype: genotype information. Rapid advances in developing such data are already occurring for hepatitis B, influenza, measles, mumps, rubella, anthrax and smallpox vaccines. In addition, newly available data suggest that some vaccine-related adverse events may also be genetically determined and, therefore, predictable. This paper reviews the basis and logic of personalized vaccines, and describes recent advances in the field.

We celebrate the centenary of the Nobel award to Elie Metchnikoff in 2008, shared with Paul Ehrlich, as respective pioneers of cellular and humoral immunology. Metchnikoff is rightly famous for his recognition of the biological significance of leukocyte recruitment and phagocytosis of microbes in host defence against infection, inflammation and immunity. As a comparative zoologist he utilised a broad range of model organisms for microscopic studies in vivo and in vitro. His work prefigures much of contemporary research in innate immunity. In this brief review, I cover some details of his Europe-wide life in Russia (mainly Odessa) and at the Pasteur Institute in Paris. He had a complex personality, yet his creative genius, imagination and insights justify the title of ''Father of natural immunity''.

These formalized expert guidelines were written by the French Society of Emergency Medicine (SFMU), in partnership with the French Allergology Society (SFA) and the French Speaking Group in Pediatric Intensive Care and Emergency (GFRUP). Their goal is to educate emergency physicians to early diagnosis of this potentially fatal reaction of severe hypersensitivity, the specific features associated with age, and risk factors identification. Anaphylaxis diagnosis is clinical and used Sampson’s clinical criteria. The authors offer helps sheets for emergency medical services dispatch and triage criteria for emergency department nurses. As underlined by the international guidelines, the main treatment is early administration of intramuscular epinephrine. If an epinephrine auto-injector is available, the emergency medical services dispatch center on-call physician (112-call) should encourage its immediate use. The second line of treatment is based on the eviction of the triggering factor, the appropriate waiting position, oxygen therapy, and depending on the symptoms, fluid therapy, bronchodilator and epinephrine nebulization. The severity of the prognosis and the unpredictability of developments justify the deployment of a mobile intensive care unit. A minimum six-hour hospital observation is indicated. Tryptase kinetics evaluation contributes to a posteriori diagnosis. At emergency department discharge, the patient must have a prescription of an emergency kit (containing two epinephrine
auto-injectors and β2-agonists), written instructions and a detailed written hospital report. A specialized consultation with an allergologist is essential after the emergency department discharge.

This article was initially published as a French version in Annales Françaises de Médecine d’Urgence (Gloaguen A, Poussel G, Cesareo E, et al. Ann Fr Med Urg 2016; 6: 342-64; erratum published in Ann Fr Med Urg, Erratum to: Prise en charge de l’anaphylaxie en médecine d’urgence. Recommandations de la Société française de médecine d’urgence (SFMU) en partenariat avec la Société française d’allergologie (SFA) et le Groupe
francophone de réanimation et d’urgences pédiatriques (GFRUP), et le soutien de la Société pédiatrique de pneumologie et d’allergologie (SP2A)

As Nature Reviews Immunology reaches its 10 th anniversary, we've asked the authors of one of the top-cited articles of each year to look back on the state of research at the time their Review was published, to consider why the article has had the impact it has and to discuss the future directions of their field. This Viewpoint article provides an interesting snapshot of some of the fundamental advances in the field of immunology over the past 10 years-including Toll-like receptor signalling, immune regulation mediated by regulatory T cells, indoleamine 2,3dioxygenase, myeloid-derived suppressor cells and interleukin-10, the development and heterogeneity of macrophages, dendritic cells and T helper cells, and the immune processes involved in diseases such as atherosclerosis-and looks forward to what the next 10 years may bring.

IgE to alpha-gal poses a significant threat to public health. While eating meat may seem innocuous to most, if IgE to alpha-gal is present in a human at the time of consumption it can cause urticaria to delayed-onset anaphylaxis resulting in death. The primary vector of transmission, the Lone star tick (Ambylomma americanum), is prevalent in central and eastern parts of Virginia, and will continue to increase in number of intensity burgeoning the entire eastern half of the state in the near future. Considering habitat and land use, modeling predictive bite forecasting will result in a thorough analysis of the distribution of the alpha-gal vector, A. americanum in Virginian counties. Combined with IRB-approved subject research on the alpha-gal allergy, the aim is to identify a categorical projection of potential incidence of tick bites and IgE allergy acquisition. Results indicate that location of tick bites in relation to tick distribution does not directly correlate. It appears people typically travel west of their home locations to
where the ticks are most populated. These factors suggest the ticks are more prevalent in the same areas people are settling due to climate and habitat rather than population of people.

J. Bousquet1, N. Khaltaev2, AA Cruz3, J. Denburg4, WJ Fokkens5, A. Togias6, T. Zuberbier7, CE Baena-Cagnani8, GW Canonica9, C. van Weel10, I. Agache11, N. Aït-Khaled12, C. Bachert13, MS Blaiss14, S. Bonini15, L.-P. Boulet16, P.-J. Bousquet17, ...

COMMENTARY www.nature.com/natureimmunology • may 2003 • volume 4 no 5 • nature immunology 425 Historical insight: Immunology's founding fathers argued fiercely about whether Metchnikoff 's phagocytes or Ehrlich's antibodies were the most important mediators of immunity. Antibodies won out, but even after lymphocytes re-established cellular immunology, the humoralist-cellularist divide persisted. The trans-immunologists [immunochemists] start at the end, with the structure of antibody molecules, hoping to work their way backwards, and the cis-immunologists [immunobiologists] start at the beginning, with the effect of antigenic exposure, hoping to work their way forwards ....a cis-immunologist will sometimes speak to a transimmunologist; but the latter rarely answers. Niels Jerne, 1967 1

In 2009, the Global Asthma and Allergy European Network (GA 2 LEN) proposed a pan-European standardized allergen battery for clinical practice and research [1]. While Parietaria species sensitization is an unquestionable cause of seasonal allergy in Mediterranean countries [2], and as such is included in this battery, Plantago lanceolata is widely considered to be a rare, isolated cause of hay fever and/or allergic asthma. This weed tolerates a wide variety of climatic conditions, and thrives in dry environments with low fertility. The Portuguese city of Porto and its surroundings belong, in biogeographic terms, to the Euro-Siberian region, the Cantabrian-Atlantic province, the Galician-Asturian subprovince, and the Galician-Portuguese sector; the climate is Mediterranean (Köppen climate classifi cation, Csb) with a cool summer and substantial winter rainfall. Since a higher-than-expected prevalence of this pollen has been described in climatically similar regions of Spain [3-5], and since not infrequently, we have obtained signifi cant levels of in vitro and in vivo specifi c immunoglobulin (Ig) E to this allergen, we launched a project designed to estimate the rate of P lanceolata sensitization in a sample of inhabitants of Porto and to compare it to the rate of Parietaria judaica sensitization. Furthermore, because Ole e 1 and Pla l 1 allergens share common epitopes [6], as a secondary outcome, we decided to investigate whether or not concomitant sensitization might be a consequence of crossreactivity between these allergen sources. To accomplish this, we reviewed skin prick test (SPT) results performed with a standardized set of aeroallergens by our university hospital allergy department over 2 consecutive years. Patients with positive SPTs to P Judaica and/or P lanceolata living near Porto were selected. The largest and perpendicular wheal diameter for each allergen was measured and the following value calculated: largest + perpendicular diameter/2; the test was considered positive when this mean value was ≥3 mm and controls showed adequate reactions [1]. Measurements were performed by 2 independent observers and the average of both observations was used. Pollen grains were collected in a Burckhardt trap and counted by a specialized botanist. All data analyses were performed using the SPSS statistical package version 18.0 for Windows (SPSS, Chicago, Illinois, USA).The χ 2 test was used to analyze differences between categorical variables, and independent sample tests were used for continuous variables (the t test for normally distributed variables and the Mann-Whitney U test for asymmetrically distributed variables). A P value of less than .05 was considered statistically signifi cant.

Allergic diseases represent a major health problem in Europe. They are increasing in prevalence, severity and costs. GA2LEN (Global Allergy and Asthma European Network), an FP6 Network of Excellence, was created in 2005 as a vehicle to ensure excellence in research bringing together research and clinical institutions to combat fragmentation in the European research area and to tackle Allergy in its globality. GA2LEN benefited greatly from the voluntary efforts of researchers who are strongly committed to this model of pan-European collaboration. The network was organized in order to increase networking for scientific projects in allergy and asthma around Europe and to make GA2LEN the world leader in the field. Besides these activities, research has been jointly made and the first papers are being published. GA2LEN achievements in general can be grouped as those for a durable infrastructure built up during the project phase those which are project-related work based on these novel in...

La alergia se define como una reacción inflamatoria sintomática de hipersensibilidad inmediata a un antígeno medio ambiental normalmente inocuo . Este proceso es mediado por anticuerpos de tipo Inmunoglobulina E (IgE) dirigidos contra un antígeno denominado alergeno . Estos anticuerpos de tipo IgE formados por células plasmáticas derivadas de células B, se denominan anticuerpos homocitotrópicos, porque se depositan en la membrana de mastocitos autólogos. Así una re-exposición al alergeno producirá la degranulación del mastocito y la liberación de factores mediadores de la reacción alérgica . La IgE se encuentra ligada a la membrana del mastocito por un receptor de alta afinidad para la IgE el receptor FceRI (1,2) , y además se ha identificado el receptor FceRII o CD23 que es el receptor de baja afinídad para IgE el cual tiene dos isoformas, una el Fce Rlla que está presente sólo en células B y el Fce Rllb que se expresa en células T, monocitos, macrófagos, células de Langerhans, células dendríticas, eosinófilos, y plaquetas (2,3) y que estaría implicado en la regulación de las respuestas mediadas por IgE por parte de las células T (4) . Todos estos mecanismos determinan la aparición de la reacción alérgica, que sustenta a diversas patologías de piel como la dermatitis atópica, la urticaria, el eczema, el angioedema alérgico, la hipersensibilidad por picaduras de insectos, y otras patologías no cutáneas como el asma bronquial alérgica, la rinitis alérgica, la migraña histamínica, la diarrea alérgica, el shock anafiláctíco, etc (5) . Sin embargo, a pesar del avance suscitado en este campo, los mecanismos implicados en la alergia son sumamente complejos he involucran a muchos factores como el medio ambiente, los factores inmunogenéticos, las subpoblaciones de células T (Th1/Th2) y los perfiles de citoquinas que producen, existiendo muchos otros mecanismos moleculares subyacentes de reciente identificación.

The hematopoietic and the immune systems in all their com-ponents are characterized by a multifrequency time structure with prominent rhythms in cell proliferation and cell function in the circadian, infradian, and circannual frequency ranges. The circulating formed ...

Ocular allergy (OA) includes a group of common and less frequent hypersensitivity disorders frequently misdiagnosed and not properly managed. The diagnosis of OA is usually based on clinical history and signs and symptoms, with the support of in vivo and in vitro tests when identification of the specific allergen is required. To date, no specific test is available for the diagnosis of the whole spectrum of the different forms of OA. The lack of recommendations on diagnosis of OA is considered a medical need not only for allergists but also for ophthalmologists. This position paper aims to provide a comprehensive overview of the currently available tools for diagnosing OA to promote a common nomenclature and procedures to be used by different specialists. Questionnaires, sign and symptom grading scales, tests, and potential biomarkers for OA are reviewed. We also identified several unmet needs in the diagnostic tools to generate interest, increase understanding, and inspire further investigations. Tools, recommendations, and algorithms for the diagnosis of OA are proposed for use by both allergists and ophthalmologists. Several unmet needs in the diagnostic tools should be further improved by specific clinical research in OA.

Introduction: PubMed is the most important of the non-specialized databases on biomedical literature. International and quickly updated is elaborated by the American Government and contains only information about papers published in scientific journal/s. Although it can be used as an unique Data Base, as a matter of fact is the addition of several subgroups (among them MEDLINE) that can be searched simultaneously.

Contemporary immunology has established its fundamental theory as a biological expression of personal identity, wherein the "immune self" is defended by the immune system. Protection of this agent putatively requires a cognitive capacity by which the self and the foreign are perceived and thereby discriminated; from such information, discernment of the environment is achieved and activation of pathways leading to an immune response may be initiated. This so-called cognitive paradigm embeds such functions as "perception," "recognition," "learning," and "memory" to characterize immune processes, but the conceptual character of such functions has meanings that vary with the particular theory adopted. When different formulations of cognition are considered, immunology's conceptual infrastructure shifts: Extensions of conventional psychological understanding of representational cognition based on a subject-object dichotomy support notions of immune agency; alternatively, formulations of perception that dispense with representations and attendant notions of agency reconfigure the predicate epistemology dominating current immune theory. Reviewing immunological literature of the past five decades, these two understandings of perception-representational and non-representational (considered here from ecological, enactivist, and autopoietic perspectives)-offer competing views of immune cognitive functions. These, in turn, provide competing philosophical understandings of immunology's conceptual foundations, which reflect parallel controversies dominating current debates in philosophy of mind and attendant discussions about personal identity.

Background: The Allergic Rhinitis and Its Impact on Asthma (ARIA) workshop proposes a classification of allergic rhinitis severity. It does not take into account impairment in quality of life and treatment should be adapted accordingly. Methods: Two cross-sectional surveys were designed:a spring survey, for which 1,321 practitioners enrolled 3,026 patients consulting for seasonal allergic rhinitis and an autumn-winter survey, for