Publications

Purpose of review There is an unmet need for better immunological tests in cases of suspected occupational asthma to many workplace chemicals; here we consider the basophil activation test (BAT), a potential alternative to the detection of specific IgE antibodies.

Recent findings BAT is fairly widely used in general allergy services; and there is increasing experience of its use in the diagnosis of occupational allergy to low molecular weight agents and chemicals including wood dusts, persulphates, antibiotics and latex.

We are delighted to introduce an issue of FHJ in which we have focused our minds, and hopefully those of our readers, on the ever-present activity of all clinicians (and humans) – learning. This is such a wide topic, so we have considered a number of different dimensions with the confidence that these will stimulate interest, debate and discussion. Firstly, we have considered the important issue of learning to speak up in our workplaces.

Rationale

There is an aspiration to retain increasing numbers of older workers in employment, and strategies to achieve this need to make provision for the increasing prevalence of chronic diseases with age. There is a consistent body of cross-sectional evidence that suggests that patients with chronic obstructive pulmonary disease are more likely to have adverse employment outcomes.

Objectives

We report the findings of the first longitudinal study of this issue.

Methods

IgG4 and its role in immune tolerance has been investigated widely. Symptom reduction and improved clinical outcomes in immunotherapy trials are associated with significant increases in allergen-specific IgG4 antibodies. Natural immune tolerance observed in beekeepers and cat owners has also been associated with elevated levels of bee venom and cat allergen-specific IgG4, respectively. Functionally, allergen-specific IgG4 has been shown to reduce the binding of IgE-allergen complexes to B cells, a key step in the initiation of the type 1 hypersensitivity allergic response.

Rationale: Asthma is heterogeneous and knowledge on exacerbation patterns is lacking. Previous studies have had a relatively short follow-up or focused on severe disease.

Objectives: To describe exacerbation patterns over a prolonged follow-up in a population that includes patients of all disease severity.

Transient paradoxical closure of the larynx, occurring in the absence of any underlying structural or neurological defect, is a recognized cause of paroxysmal breathlessness and wheeze. This phenomenon, most commonly termed vocal cord dysfunction and more recently termed inducible laryngeal obstruction (ILO),1 is often misdiagnosed and mistreated as asthma.2, 3 This may be explained by the lack of a robust, accepted diagnostic methodology.4, 5