From the President

From left to right: Benjamin Marsland, PhD; Donald Y. M. Leung, MD, PhD, FAAAAI; EAACI President Antonella M. Muraro, MD, PhD; AAAAI President Thomas A. Fleisher, MD, FAAAAI; Yvonne Huang, MD; Supinda Bunyavanich, MD, PhD, FAAAAI; Liam O’Mahony, PhD.

Dear Colleagues,

As summer transitioned into fall, our nation’s capital was the site for another PRACTALL (Practical Allergy) meeting between the AAAAI and the European Academy of Allergy and Clinical Immunology (EAACI). PRACTALL is an initiative of the AAAAI and EAACI that aims to harmonize European and American approaches to best allergy practices and science.

Holding face-to-face PRACTALL meetings provides an opportunity for allergy/immunology practitioners and researchers, as selected by the AAAAI and EAACI based on their subject matter expertise, to discuss diverse perspectives on important clinical issues in allergy/immunology and to recommend action on these issues. The end product is a PRACTALL consensus report that is published in our organizations’ respective journals.

Allow me to provide some history for you. AAAAI and EAACI have been holding PRACTALL meetings since 2005. This year’s was held over Labor Day weekend in Washington, DC, and has the distinction of being the fourteenth meeting; the focus was on the role of the microbiome in the development of allergic disease. If you are curious what past PRACTALL reports have focused on, here are recent topics:

• Precision medicine in patients with allergic diseases
• Sublingual grass and ragweed immunotherapy
• Endotypes and phenotypes of chronic rhinosinusitis
• Immune response modifiers
• Asthma phenotypes
• Oral food challenges

As briefly mentioned earlier, both AAAAI and EAACI select participants who are subject matter experts to attend the face-to-face meeting and help write the PRACTALL consensus document. I was honored to be joined by the following individuals chosen by the AAAAI: Supinda Bunyavanich, MD, PhD, FAAAAI, Yvonne Huang, MD, and Donald Y. M. Leung, MD, PhD, FAAAAI. In addition, it is also always a pleasure to be joined by our European colleagues. EAACI’s participants included President Antonella M. Muraro, MD, PhD, Benjamin Marsland, PhD, and Liam O’Mahony, PhD.

To provide some perspective on why the role of the microbiome in the development of allergic disease is an important topic to focus on for a PRACTALL, I invited Professor Muraro to share her thoughts:

“Since 2005 AAAAI and EAACI have initiated an ongoing collaboration developing PRACTALL consensus documents highlighting the alignment of the two societies in providing evidence-based recommendations for clinicians to fight global allergy epidemics. Discoveries from basic science research in the last decade have brought significant progress in the knowledge of pathophysiologic processes of allergic diseases. Crucial determining factors for complex immune regulation and barrier function in allergic diseases include respiratory infections, nutrition and the microbiome.

In order to clarify the compelling role played by the microbiome in allergies and asthma development and severity, a new PRACTALL has been finalized focusing on the mechanisms and strategies that potentially improve allergy preventive effects of the microbiome and enable future evidence-based implementation.

Alteration of the gut microbial population appears to increase the risk for both food and respiratory allergy, while manipulation of the gut microbiota with a diet rich in fiber has the potential to decrease lung inflammation in allergic asthma. Race, mode of delivery, breastfeeding and cord blood vitamin D levels, are all strong influencers of the infant gut microbiome composition. Like the internal gut microbiome, which is increasingly recognized as an important instructor of immune maturation, the external environmental microbiome might shape immune responses on the skin, airway mucosal surfaces, and potentially also at the gut early in life. In environments rich in microbial exposures the incidence of allergic diseases and asthma is very low. A potential explanation is that the diversity of the external microbes and their compounds and metabolites targets many facets of innate immunity and potentially counterbalances the many maladapted pathways leading to allergy development. However the current, great heterogeneity between studies prevents specific and practical advice to consumers on the most effective strategies.

Better understanding of the complexity of the interactions between the external and individual microbiome would ultimately foster a precision medicine approach to prevention and management of allergic diseases. Both EAACI and AAAAI are hugely committed to continuing working together to make this goal a reality.”

My sincere thanks go to Professor Muraro for her contribution to this message and for sharing Co-Chair duties for this particular PRACTALL. If you are planning to attend the 2017 EAACI Congress in Helsinki, Finland, consider adding the EAACI-AAAAI PRACTALL Symposium on Monday, June 19 from 10:45 am to 12:15 pm to your schedule. Several of our PRACTALL participants will be speaking during this special session.

During the time we spent together at the PRACTALL meeting in Washington, DC, the group focused on the role of the microbiome in relation to asthma, atopic dermatitis and food allergy. Our PRACTALL participants were each asked to deliver a presentation on a specific topic. Dr. Huang tackled the microbiome and asthma from the angle of looking at clinical studies, challenges and needs, while Dr. O’Mahony discussed novel opportunities for intervention and Dr. Marsland covered mechanistic insights. From there we moved onto how the microbiome relates to the other two diseases, with Dr. Leung tackling atopic dermatitis and Dr. Bunyavanich delivering the final presentation on food allergy.

After each presentation, there was healthy discussion and exchange regarding what we do know based on the published literature, where gaps in knowledge exist and where additional research could be valuable in addressing those gaps. I want to thank all of the PRACTALL participants once again for their time, expertise and collegiality. It was a very rewarding experience and I look forward to seeing the final PRACTALL consensus report in its published form.

On a final note, the U.S. presidential election has come and gone, but there is another election that needs your attention—the AAAAI Board of Directors election. While voting will begin December 6, we are currently collecting questions for the two Secretary-Treasurer candidates. As in prior elections, you do have the opportunity to ask the future AAAAI President a question. Click here for more details on how to submit your question for consideration by November 14.

Sincerely,

Thomas A. Fleisher, MD, FAAAAI

AAAAI President

Last updated: November 11, 2016