Slovenian network of allergy and asthma: from epidemiology to genetics

In the integration part we will study the epidemiology of anaphylaxis and severe asthma in Slovenia. The research activities will be perform in five WPs. In WP 1 we will focus on airway remodeling in severe asthma (WP 1.1) and on the cellular and molecular changes in different asthma endotypes (WP 1.2). In large WP of IgE senzibilization and anaphylaxis (WP 2) we will study the link between specific IgEs, basophils and allergic disease. In this part we will in detail study the role of basophils in anaphylaxis (WP 2.1) and testing the correlation between basophil sensitivity and induction of tolerance during the specific immunotherapy (WP 2.2) and the correlation between basophil sensitivity and the severity of systemic allergic reaction (WP 2.3). In a third WP we will study the recombinant allergens (WP 3). In this part we will evaluate the biological activity of recombinant allergens (WP 3.1), especially those ones, which are important for the diagnosis of anaphylaxis (WP 3.2). The fourth WP is focused on biological therapies. In this WP we will monitor the molecular and cellular changes during anti-IgE (WP 4.1), anti IL-5 (WP 4.2) or anti TSLP (WP 4.3) therapy. Those data will be compared with the clinical response. The fifth large WP is focused on the genetics of the allergic diseases (WP 5). In WP 5.1 we will study the genetic background of anaphylaxis with the focus on tryptase gene TPSAB1 and somatic mutations related to mastocytosis. In the most complex genetic part we will perform whole transcriptomic analysis during the anaphylactic reaction in different clinical and experimental animal models (WP 5.2). We will also perform genotype – phenotype studies in different patients with the focus on the hereditary angioedema (WP 5.3).

Asthma and allergies are the most common chronic diseases in developed countries. Their prevalence is still increasing and is approaching 50% (patients suffering from any allergy anytime in their lifetime). Several hypotheses are discussed, such as the evolution of the »western lifestyle«, the hygiene hypothesis, and environmental changes. An important part in the development of allergies is genetics. We are currently facing two challenges. The first one is that we need to define the cause of the increasing prevalence which might lead to prevention. The second one is to define the exact mechanisms causing allergy symptoms which could result in a more efficient diagnostic approach and a more successful treatment. Only a half of those with allergen specific IgE actually develop symptoms. In case of anaphylaxis, as little as 10% of sensitized patients develop symptoms. Furthermore, it is unclear why some subjects with comparable specific IgE levels might develop only mild symptoms or a life-treating anaphylaxis. We still have not found biomarkers indicating which sensitized subjects are at risk for the development of life-threatening allergic reactions.                   Another important question is the exact mechanism behind specific immunotherapy, as it is still poorly understood. There are no in vitro tests to correctly predict treatment success. This research programme plans to study the above mentioned questions, causes for those differences as well as possible mechanisms in terms of recombinant allergens, by measuring the sensitivity of effector cells (basophils, mast cells), and in terms of genetics (incl. expression). Program group members are certain that the program will yield great results with an important effect on the development of science and improved visibility of Slovenia in this field.

The current research program titled “Slovenian Allergy and Asthma Network: from Epidemiology to Genetics« has brought together different health institutions and medicine areas in Slovenia (pneumology, immunology, otorhinolaryngology, epidemiology and family medicine). The result of this program is an effective national research platform that complies with the standards of excellence and already connects Slovenian and foreign researchers. The results of our research have achieved great international recognition. They have been published in the most influential allergy and clinical immunology journals. In addition to the promotion of Slovenian science, we have also achieved partnerships in joint projects with the leading research centers in Europe and USA. We are proud to be involved in the development of allergy and clinical immunology at the international level. The program has a direct impact on the development of society, as it accelerates the use of research results in clinical practice and provides assistance in the management of research development policy in Slovenia. It also promotes teaching, education and better integration in this field. The program is based on an integrated approach, and one of its most important goals is to improve the quality of patients’ lives by reducing the burden of allergic diseases in Slovenia.