Mojca Bizjak, Mitja Košnik, Riccardo Asero, Emek Kocatürk, Ana M. Giménez-Arnau, Marcus Maurer
<p>Circulating blood numbers of lymphocytes in chronic spontaneous urticaria (CSU) have not been given sufficient attention. Histopathological analysis of wheals in CSU has demonstrated an increased number of mast cells (MCs) and a perivascular infiltrate of T lymphocytes along with variable numbers of basophils, eosinophils, monocytes and neutrophils [<span>1</span>]. Grattan et al. reported lower blood lymphocyte counts in CSU patients than in healthy controls [<span>2</span>].</p><p>Autoimmune CSU (aiCSU), in which MCs and basophils are activated by immunoglobulin G (IgG) autoantibodies against the high-affinity receptor FcεRI for immunoglobulin E (IgE) or against IgE, is characterised by high disease activity and poor response to standard treatments [<span>3</span>]. An early attempt to define aiCSU using three criteria (i.e. a positive basophil activation test or histamine release, a positive autologous serum skin test [ASST] and a positive immunoassay for IgG anti-FcεRI or IgE), which are not usually available in clinical practice, did not incorporate clinical features now known to be important [<span>4</span>]. Several recently described features of aiCSU, such as blood basopenia and eosinopenia, high levels of IgG against thyroid peroxidase (anti-TPO) and low total serum IgE levels [<span>3, 4</span>], can assist in identifying patients with aiCSU, but there is still a need for additional parameters. We aimed to search for new routinely available markers of aiCSU in a substantial cohort of patients.</p><p>This study involved 300 CSU patients aged 17 years and older (68% female; mean age 45.0 years, SD 15.6 years), all assessed by the same dermatologist at Clinic Golnik. CSU was diagnosed clinically [<span>5</span>]. Exclusion criteria included prior omalizumab treatment, systemic glucocorticosteroid treatment within 7 days of venesection, predominant chronic inducible urticaria, wheals persisting more than 48 h and bradykinin-mediated angioedema. Data on demographics, patient history and laboratory tests were obtained at the initial visit as part of routine clinical care, based on the guidelines and clinical suspicion of comorbidities. The following laboratory tests were done at the Clinic Golnik laboratory: automated complete blood count (CBC) with differential (<i>n</i> = 300; Sysmex XN 3100, Sysmex), C-reactive protein (CRP; <i>n</i> = 292), total serum IgE (<i>n</i> = 149), anti-TPO (<i>n</i> = 184), antinuclear antibodies (ANA; <i>n</i> = 86) and IgG against complement component C1q (anti-C1q; <i>n</i> = 81). All patients were followed up for a minimum of 3 months, and responses to standard treatments were assessed. Uncontrolled CSU was defined as the Urticaria Control Test (UCT) score of 0–11 [<span>5</span>]. The study was approved by the Slovenian National Medical Ethics Committee (KME78/09/14). These data were systematically collected from patients' charts with their consent, in a retrospective manner, and analysed using IBM SPSS
{"title":"Lymphopenia in Chronic Spontaneous Urticaria is Linked to Basopenia and Eosinopenia","authors":"Mojca Bizjak, Mitja Košnik, Riccardo Asero, Emek Kocatürk, Ana M. Giménez-Arnau, Marcus Maurer","doi":"10.1111/cea.14538","DOIUrl":"10.1111/cea.14538","url":null,"abstract":"<p>Circulating blood numbers of lymphocytes in chronic spontaneous urticaria (CSU) have not been given sufficient attention. Histopathological analysis of wheals in CSU has demonstrated an increased number of mast cells (MCs) and a perivascular infiltrate of T lymphocytes along with variable numbers of basophils, eosinophils, monocytes and neutrophils [<span>1</span>]. Grattan et al. reported lower blood lymphocyte counts in CSU patients than in healthy controls [<span>2</span>].</p><p>Autoimmune CSU (aiCSU), in which MCs and basophils are activated by immunoglobulin G (IgG) autoantibodies against the high-affinity receptor FcεRI for immunoglobulin E (IgE) or against IgE, is characterised by high disease activity and poor response to standard treatments [<span>3</span>]. An early attempt to define aiCSU using three criteria (i.e. a positive basophil activation test or histamine release, a positive autologous serum skin test [ASST] and a positive immunoassay for IgG anti-FcεRI or IgE), which are not usually available in clinical practice, did not incorporate clinical features now known to be important [<span>4</span>]. Several recently described features of aiCSU, such as blood basopenia and eosinopenia, high levels of IgG against thyroid peroxidase (anti-TPO) and low total serum IgE levels [<span>3, 4</span>], can assist in identifying patients with aiCSU, but there is still a need for additional parameters. We aimed to search for new routinely available markers of aiCSU in a substantial cohort of patients.</p><p>This study involved 300 CSU patients aged 17 years and older (68% female; mean age 45.0 years, SD 15.6 years), all assessed by the same dermatologist at Clinic Golnik. CSU was diagnosed clinically [<span>5</span>]. Exclusion criteria included prior omalizumab treatment, systemic glucocorticosteroid treatment within 7 days of venesection, predominant chronic inducible urticaria, wheals persisting more than 48 h and bradykinin-mediated angioedema. Data on demographics, patient history and laboratory tests were obtained at the initial visit as part of routine clinical care, based on the guidelines and clinical suspicion of comorbidities. The following laboratory tests were done at the Clinic Golnik laboratory: automated complete blood count (CBC) with differential (<i>n</i> = 300; Sysmex XN 3100, Sysmex), C-reactive protein (CRP; <i>n</i> = 292), total serum IgE (<i>n</i> = 149), anti-TPO (<i>n</i> = 184), antinuclear antibodies (ANA; <i>n</i> = 86) and IgG against complement component C1q (anti-C1q; <i>n</i> = 81). All patients were followed up for a minimum of 3 months, and responses to standard treatments were assessed. Uncontrolled CSU was defined as the Urticaria Control Test (UCT) score of 0–11 [<span>5</span>]. The study was approved by the Slovenian National Medical Ethics Committee (KME78/09/14). These data were systematically collected from patients' charts with their consent, in a retrospective manner, and analysed using IBM SPSS","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 10","pages":"770-773"},"PeriodicalIF":6.3,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14538","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Simon Schneekloth, Mogens Krøigaard, Johannes K. Boysen, Holger Mosbech, Birgitte B. Melchiors, Lene H. Garvey
<p>Blue dyes are a common cause of perioperative hypersensitivity (POH) reactions, with studies reporting 1:300 patients having reactions ranging from localised urticaria to circulatory collapse [<span>1</span>].</p><p>Sentinel lymph node biopsy (SLNB) is the gold standard in early-stage breast cancer detection, using the combination of blue dye and isotope tracing with an identification rate of 98.8% [<span>2</span>]. The mode of sensitisation to patent blue V (PBV) is unknown as patients typically react on their first subcutaneous exposure. PBV is also used to colour products such as textiles, food and cosmetics, and exposure to PBV is almost inevitable in daily life. However, no information is available regarding potential risks of allergic reactions to PBV, through such exposure, after confirmed allergy to subcutaneous exposure. After a suspected POH reaction, it is important to refer patients for allergy investigation to identify the culprit drug and find a safe alternative [<span>3</span>].</p><p>The aims of this single-centre retrospective study were to identify patients investigated for suspected POH to PBV, characterise reactions, determine the proportion of patients with confirmed allergy to PBV and to evaluate the frequency of oral tolerance among patients with confirmed allergy to subcutaneously administered PBV.</p><p>Data were collected from the Danish Anaesthesia Allergy Centre (DAAC) database from 2004 to 2023 and included clinical history, symptoms from the POH reaction, results of skin tests, in-vitro tests and drug provocation in 843 patients.</p><p>In total, 843 patients had been investigated and 75 (8.9%) had been exposed to PBV prior to the suspected POH reaction and were included in the study. Included patients were predominantly women (<i>n</i> = 68, 91%, mean age: 56 years) with breast cancer. Of the 75 patients, 54 (72%) were diagnosed with PBV hypersensitivity. Symptoms occurred <30 min after injection in 30 cases (67%) and >30 min after injection in 15 cases (33%), unknown in 9 patients. Of the 21 patients testing negative to PBV, two tested positive to dicloxacillin and chlorhexidine, respectively. Of patients testing positive to PBV 28 (52%) suffered grade III reactions (modified Ring and Messmer classification [<span>3</span>]), meeting the criteria for anaphylaxis; 19 had grade I reactions, of which 6 had localised urticaria and 10 had generalised urticaria.</p><p>Diagnosis of allergy to PBV were made by skin prick test (SPT) in concentrations of 0.25, 2.5 and 25 mg/mL and intradermal test (IDT) in concentrations of 0.025 and 0.25 mg/mL. In total, 52 out of 54 patients with proven hypersensitivity to PBV underwent titrated sublingual and oral provocation up to 30 mg of PBV. This was tolerated by all patients. The protocol used for oral challenge with PBV is shown in Figure 1.</p><p>To our knowledge, this retrospective single-centre study presents the largest series of patients with PBV allergy so far and prov
{"title":"Oral Tolerance in Patients With Allergy to Patent Blue V—A 20-Year Single Centre Experience","authors":"Simon Schneekloth, Mogens Krøigaard, Johannes K. Boysen, Holger Mosbech, Birgitte B. Melchiors, Lene H. Garvey","doi":"10.1111/cea.14534","DOIUrl":"10.1111/cea.14534","url":null,"abstract":"<p>Blue dyes are a common cause of perioperative hypersensitivity (POH) reactions, with studies reporting 1:300 patients having reactions ranging from localised urticaria to circulatory collapse [<span>1</span>].</p><p>Sentinel lymph node biopsy (SLNB) is the gold standard in early-stage breast cancer detection, using the combination of blue dye and isotope tracing with an identification rate of 98.8% [<span>2</span>]. The mode of sensitisation to patent blue V (PBV) is unknown as patients typically react on their first subcutaneous exposure. PBV is also used to colour products such as textiles, food and cosmetics, and exposure to PBV is almost inevitable in daily life. However, no information is available regarding potential risks of allergic reactions to PBV, through such exposure, after confirmed allergy to subcutaneous exposure. After a suspected POH reaction, it is important to refer patients for allergy investigation to identify the culprit drug and find a safe alternative [<span>3</span>].</p><p>The aims of this single-centre retrospective study were to identify patients investigated for suspected POH to PBV, characterise reactions, determine the proportion of patients with confirmed allergy to PBV and to evaluate the frequency of oral tolerance among patients with confirmed allergy to subcutaneously administered PBV.</p><p>Data were collected from the Danish Anaesthesia Allergy Centre (DAAC) database from 2004 to 2023 and included clinical history, symptoms from the POH reaction, results of skin tests, in-vitro tests and drug provocation in 843 patients.</p><p>In total, 843 patients had been investigated and 75 (8.9%) had been exposed to PBV prior to the suspected POH reaction and were included in the study. Included patients were predominantly women (<i>n</i> = 68, 91%, mean age: 56 years) with breast cancer. Of the 75 patients, 54 (72%) were diagnosed with PBV hypersensitivity. Symptoms occurred <30 min after injection in 30 cases (67%) and >30 min after injection in 15 cases (33%), unknown in 9 patients. Of the 21 patients testing negative to PBV, two tested positive to dicloxacillin and chlorhexidine, respectively. Of patients testing positive to PBV 28 (52%) suffered grade III reactions (modified Ring and Messmer classification [<span>3</span>]), meeting the criteria for anaphylaxis; 19 had grade I reactions, of which 6 had localised urticaria and 10 had generalised urticaria.</p><p>Diagnosis of allergy to PBV were made by skin prick test (SPT) in concentrations of 0.25, 2.5 and 25 mg/mL and intradermal test (IDT) in concentrations of 0.025 and 0.25 mg/mL. In total, 52 out of 54 patients with proven hypersensitivity to PBV underwent titrated sublingual and oral provocation up to 30 mg of PBV. This was tolerated by all patients. The protocol used for oral challenge with PBV is shown in Figure 1.</p><p>To our knowledge, this retrospective single-centre study presents the largest series of patients with PBV allergy so far and prov","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 10","pages":"763-765"},"PeriodicalIF":6.3,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14534","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Does Appropriate Timing for Early Introduction Differ Between Hen's Eggs and Nuts?","authors":"Sayaka Hamaguchi, Mayako Saito-Abe, Tatsuki Fukuie, Yukihiro Ohya, Kiwako Yamamoto-Hanada","doi":"10.1111/cea.14519","DOIUrl":"10.1111/cea.14519","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 9","pages":"700-702"},"PeriodicalIF":6.3,"publicationDate":"2024-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Weihong Shi, Ning Liu, Jin-Xian Huang, Hao Xiao, Juan Meng, Philip H Li
Penicillins are the most frequently prescribed class of medications worldwide and first-line antibiotic of choice for most bacterial infections. They are also commonly labelled as the culprit of drug 'allergy'; leading to obligatory use of second-line antibiotics, suboptimal antibiotic therapy and increased antimicrobial resistance. However, the majority of reported penicillin 'allergy' labels are found to be incorrect after allergy testing, emphasising the importance of proper drug allergy testing and evaluation. Penicillin skin testing (PST) remains an important component of drug allergy diagnosis; however, its practice and policies significantly differ across the world. Inappropriate and non-evidence-based PST practices can lead to consequences associated with allergy mislabelling. Even within different regions of China, with a population exceeding 1.4 billion, there are marked differences in the implementation, execution and interpretation of PST. This review aims to examine the differences in PST between Mainland China, Hong Kong and the rest of the world. We critically analyse the current practice of 'pre-emptive' PST in Mainland China, which has a significant false-positive rate leading to high levels of penicillin allergy mislabelling. Non-evidence-based practices further compound the high false-positive rates of indiscriminatory PST. We postulate that inappropriate PST policies and practices may exacerbate the mislabelling of penicillin allergy, leading to unnecessary overuse of inappropriate second-line antibiotics, increasing antimicrobial resistance and healthcare costs. We advocate for the importance of more collaborative research to improve the contemporary workflow of penicillin allergy diagnosis, reduce mislabelling and promote the dissemination of evidence-based methods for allergy diagnosis.
{"title":"Penicillin Allergy in China: Consequences of Inappropriate Skin Testing Practices and Policies.","authors":"Weihong Shi, Ning Liu, Jin-Xian Huang, Hao Xiao, Juan Meng, Philip H Li","doi":"10.1111/cea.14546","DOIUrl":"https://doi.org/10.1111/cea.14546","url":null,"abstract":"<p><p>Penicillins are the most frequently prescribed class of medications worldwide and first-line antibiotic of choice for most bacterial infections. They are also commonly labelled as the culprit of drug 'allergy'; leading to obligatory use of second-line antibiotics, suboptimal antibiotic therapy and increased antimicrobial resistance. However, the majority of reported penicillin 'allergy' labels are found to be incorrect after allergy testing, emphasising the importance of proper drug allergy testing and evaluation. Penicillin skin testing (PST) remains an important component of drug allergy diagnosis; however, its practice and policies significantly differ across the world. Inappropriate and non-evidence-based PST practices can lead to consequences associated with allergy mislabelling. Even within different regions of China, with a population exceeding 1.4 billion, there are marked differences in the implementation, execution and interpretation of PST. This review aims to examine the differences in PST between Mainland China, Hong Kong and the rest of the world. We critically analyse the current practice of 'pre-emptive' PST in Mainland China, which has a significant false-positive rate leading to high levels of penicillin allergy mislabelling. Non-evidence-based practices further compound the high false-positive rates of indiscriminatory PST. We postulate that inappropriate PST policies and practices may exacerbate the mislabelling of penicillin allergy, leading to unnecessary overuse of inappropriate second-line antibiotics, increasing antimicrobial resistance and healthcare costs. We advocate for the importance of more collaborative research to improve the contemporary workflow of penicillin allergy diagnosis, reduce mislabelling and promote the dissemination of evidence-based methods for allergy diagnosis.</p>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emma Genberg, Paula Kauppi, Johanna Sahlman, Anu Laulajainen-Hongisto, Markus Lilja, Sari Hammarén-Malmi, Lena Hafrén, Antti Mäkitie, Seija Vento, Sanna Toppila-Salmi, Paula Virkkula
<p>Most patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have type 2 inflammation, as do patients with eosinophilic asthma [<span>1-3</span>]. Asthma often accompanies CRSwNP [<span>4, 5</span>], and CRSwNP with comorbid asthma is associated with more severe sinonasal disease [<span>5-7</span>]. Furthermore, asthma is more prone to exacerbations when comorbid CRSwNP is present [<span>5, 8</span>]. The aim of this study was to describe the prevalence of asthma and evaluate asthma control in patients with uncontrolled CRSwNP undergoing endoscopic sinus surgery (ESS) at a tertiary centre. We also aimed to identify factors associated with asthma in this population.</p><p>This cross-sectional study was conducted as part of a prospective controlled multicentre trial (AirGOs Operative) investigating the benefits of complete and limited ESS in patients with uncontrolled CRSwNP. Patients suffering from uncontrolled CRSwNP, a Sinonasal Outcome Test-22 (SNOT-22) score ≥30, a nasal polyp (NP) score ≥4, a Lund–Mackay (LM) score ≥14 and at least one of the following: ≥1 previous surgery for CRSwNP, ≥1 oral corticosteroid course or ≥3 antibiotic courses during the past 2 years were included in this study.</p><p>In addition to basic characteristics and comorbidities, the data in this study comprised preoperative nasoendoscopy, NP and LM scores, exhaled nitric oxide (eNO), blood eosinophil count (B-eos), serum immunoglobulin E concentration (S-IgE), serum allergen-specific IgE measurements, Sniffin’ Sticks Screening 12 Test (SST-12) and Health-Related Quality of Life (HRQoL) of the upper and lower airways (SNOT-22, Asthma Control Test [ACT] and 15D).</p><p>Asthma was assessed and diagnosed systematically. Previous asthma diagnosis was based on medical record information for physician-diagnosed asthma. The prevalence of previous physician-diagnosed asthma (AB), asthma diagnosed in the preoperative tests (preAB), and no asthma were calculated. All the patients underwent spirometry and a bronchodilator test and peak expiratory flow (PEF) recording preoperatively [<span>9</span>]. Methacholine challenge test was performed for patients with asthma symptoms (prolonged or night-time cough, wheezing or shortness of breath with or without auscultatory wheezing) but without AB and with undiagnostic results in spirometry and PEF recording. In spirometry, improvement with a bronchodilator in forced expiratory volume in the first second (FEV1) or forced vital capacity of at least 12% and 200 mL was considered diagnostic for asthma [<span>9</span>]. In PEF recording, diurnal variability (≥20% and 60 L/min at least three times) or bronchodilator responsiveness (≥15% and 60 L/min at least three times) was considered diagnostic for asthma. In the methacholine challenge test, moderate or severe hyperreactivity (a cumulative dose of ≤600 μg inhaled methacholine causes a 20% reduction in FEV1) was considered diagnostic for asthma. Uncontrolled asthma in AB and preAB p
{"title":"Asthma is Underdiagnosed and Often Uncontrolled in Preoperative Patients With Chronic Rhinosinusitis With Nasal Polyps","authors":"Emma Genberg, Paula Kauppi, Johanna Sahlman, Anu Laulajainen-Hongisto, Markus Lilja, Sari Hammarén-Malmi, Lena Hafrén, Antti Mäkitie, Seija Vento, Sanna Toppila-Salmi, Paula Virkkula","doi":"10.1111/cea.14548","DOIUrl":"10.1111/cea.14548","url":null,"abstract":"<p>Most patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have type 2 inflammation, as do patients with eosinophilic asthma [<span>1-3</span>]. Asthma often accompanies CRSwNP [<span>4, 5</span>], and CRSwNP with comorbid asthma is associated with more severe sinonasal disease [<span>5-7</span>]. Furthermore, asthma is more prone to exacerbations when comorbid CRSwNP is present [<span>5, 8</span>]. The aim of this study was to describe the prevalence of asthma and evaluate asthma control in patients with uncontrolled CRSwNP undergoing endoscopic sinus surgery (ESS) at a tertiary centre. We also aimed to identify factors associated with asthma in this population.</p><p>This cross-sectional study was conducted as part of a prospective controlled multicentre trial (AirGOs Operative) investigating the benefits of complete and limited ESS in patients with uncontrolled CRSwNP. Patients suffering from uncontrolled CRSwNP, a Sinonasal Outcome Test-22 (SNOT-22) score ≥30, a nasal polyp (NP) score ≥4, a Lund–Mackay (LM) score ≥14 and at least one of the following: ≥1 previous surgery for CRSwNP, ≥1 oral corticosteroid course or ≥3 antibiotic courses during the past 2 years were included in this study.</p><p>In addition to basic characteristics and comorbidities, the data in this study comprised preoperative nasoendoscopy, NP and LM scores, exhaled nitric oxide (eNO), blood eosinophil count (B-eos), serum immunoglobulin E concentration (S-IgE), serum allergen-specific IgE measurements, Sniffin’ Sticks Screening 12 Test (SST-12) and Health-Related Quality of Life (HRQoL) of the upper and lower airways (SNOT-22, Asthma Control Test [ACT] and 15D).</p><p>Asthma was assessed and diagnosed systematically. Previous asthma diagnosis was based on medical record information for physician-diagnosed asthma. The prevalence of previous physician-diagnosed asthma (AB), asthma diagnosed in the preoperative tests (preAB), and no asthma were calculated. All the patients underwent spirometry and a bronchodilator test and peak expiratory flow (PEF) recording preoperatively [<span>9</span>]. Methacholine challenge test was performed for patients with asthma symptoms (prolonged or night-time cough, wheezing or shortness of breath with or without auscultatory wheezing) but without AB and with undiagnostic results in spirometry and PEF recording. In spirometry, improvement with a bronchodilator in forced expiratory volume in the first second (FEV1) or forced vital capacity of at least 12% and 200 mL was considered diagnostic for asthma [<span>9</span>]. In PEF recording, diurnal variability (≥20% and 60 L/min at least three times) or bronchodilator responsiveness (≥15% and 60 L/min at least three times) was considered diagnostic for asthma. In the methacholine challenge test, moderate or severe hyperreactivity (a cumulative dose of ≤600 μg inhaled methacholine causes a 20% reduction in FEV1) was considered diagnostic for asthma. Uncontrolled asthma in AB and preAB p","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 12","pages":"999-1002"},"PeriodicalIF":6.3,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mutong Zhao, Yi Zhuang, Yuan Liang, Lin Ma, Chunping Shen
{"title":"Upadacitinib for Refractory Paediatric Atopic Dermatitis: A Real-World Study on Effectiveness and Safety in Dupilumab Nonresponders","authors":"Mutong Zhao, Yi Zhuang, Yuan Liang, Lin Ma, Chunping Shen","doi":"10.1111/cea.14518","DOIUrl":"10.1111/cea.14518","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 9","pages":"694-696"},"PeriodicalIF":6.3,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evaluation of Commercial Early Introduction Products in Infants: Protein Content of Early Introduction Products","authors":"Sayaka Hamaguchi, Daisuke Harama, Mayako Saito-Abe, Fumi Ishikawa, Miori Sato, Tatsuki Fukuie, Yukihiro Ohya, Kiwako Yamamoto-Hanada","doi":"10.1111/cea.14539","DOIUrl":"10.1111/cea.14539","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 11","pages":"939-942"},"PeriodicalIF":6.3,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In Europe, North America and China, most infants are wholly or partially fed with a commercial milk formula during their first year despite consistent public health recommendations promoting breastfeeding. For some nonbreastfed babies, a standard first infant formula may not meet their nutritional needs, because of cows' milk allergy, an inherited metabolic condition, illness or prematurity. These infants may need ‘specialised’ infant formulas, which are classified by the World Health Organization and Food and Agriculture Organization Codex Alimentarius as Foods for Special Medical Purposes (FSMP) [<span>1</span>]. FSMP include low-allergy formulas such as soya formula, extensively hydrolysed formula and amino-acid formula, used for formula-fed infants with cows' milk allergy.</p><p>Legal definitions and regulatory requirements for FSMP are that they should be used under medical supervision and there should be scientific evidence that they are safe and meet the nutritional requirements of the intended target population. In Europe, there is also guidance on how to assess products against these requirements [<span>2</span>]. However, there is a lack of regulatory oversight for FSMP, and they are frequently used without medical supervision. Commercial milk formula companies are often able to choose whether to market a product as FSMP or as a standard infant formula. Thus, in the United Kingdom, antireflux and comfort milks are marketed as FSMP, despite the lack of evidence that comfort milks alleviate colic or constipation, whereas soya formula and lactose-free formula are not marketed as FSMP despite falling under the international definition of FSMP set by Codex. All four product types can be purchased over the counter in pharmacies, and in shops and supermarkets. In the United States, a comprehensive national survey found that almost 60% of formula purchased in stores had reduced or absent lactose [<span>3</span>]. Low-allergy formulas are also lactose-free or lactose-reduced, posing health risks above standard infant formulas because nonlactose carbohydrate sources such as maltodextrin and glucose syrup are associated with dental caries and early childhood obesity [<span>4</span>].</p><p>Other health risks associated with infant FSMP include increased risk of bacterial contamination due to the addition of probiotics, making proper sterilisation impossible, and potential adverse effects from components such as phyto-oestrogens in soya formula and thickeners in antireflux formula. In general, the health risks associated with FSMP are not clearly communicated to consumers through product labelling.</p><p>Infant FSMP not only carry health risks but also are more expensive than their brand-equivalent first infant formulas (Table 1). The record high prices of first infant formula in the current cost of living crisis are a concern for parents and carers, and high prices may lead to unsafe feeding practices [<span>5</span>]. This concern is exacerbat
{"title":"Specialised Infant Formulas: Overused, Overpriced and Obesogenic","authors":"Victoria L. Sibson, Susan Westland","doi":"10.1111/cea.14532","DOIUrl":"10.1111/cea.14532","url":null,"abstract":"<p>In Europe, North America and China, most infants are wholly or partially fed with a commercial milk formula during their first year despite consistent public health recommendations promoting breastfeeding. For some nonbreastfed babies, a standard first infant formula may not meet their nutritional needs, because of cows' milk allergy, an inherited metabolic condition, illness or prematurity. These infants may need ‘specialised’ infant formulas, which are classified by the World Health Organization and Food and Agriculture Organization Codex Alimentarius as Foods for Special Medical Purposes (FSMP) [<span>1</span>]. FSMP include low-allergy formulas such as soya formula, extensively hydrolysed formula and amino-acid formula, used for formula-fed infants with cows' milk allergy.</p><p>Legal definitions and regulatory requirements for FSMP are that they should be used under medical supervision and there should be scientific evidence that they are safe and meet the nutritional requirements of the intended target population. In Europe, there is also guidance on how to assess products against these requirements [<span>2</span>]. However, there is a lack of regulatory oversight for FSMP, and they are frequently used without medical supervision. Commercial milk formula companies are often able to choose whether to market a product as FSMP or as a standard infant formula. Thus, in the United Kingdom, antireflux and comfort milks are marketed as FSMP, despite the lack of evidence that comfort milks alleviate colic or constipation, whereas soya formula and lactose-free formula are not marketed as FSMP despite falling under the international definition of FSMP set by Codex. All four product types can be purchased over the counter in pharmacies, and in shops and supermarkets. In the United States, a comprehensive national survey found that almost 60% of formula purchased in stores had reduced or absent lactose [<span>3</span>]. Low-allergy formulas are also lactose-free or lactose-reduced, posing health risks above standard infant formulas because nonlactose carbohydrate sources such as maltodextrin and glucose syrup are associated with dental caries and early childhood obesity [<span>4</span>].</p><p>Other health risks associated with infant FSMP include increased risk of bacterial contamination due to the addition of probiotics, making proper sterilisation impossible, and potential adverse effects from components such as phyto-oestrogens in soya formula and thickeners in antireflux formula. In general, the health risks associated with FSMP are not clearly communicated to consumers through product labelling.</p><p>Infant FSMP not only carry health risks but also are more expensive than their brand-equivalent first infant formulas (Table 1). The record high prices of first infant formula in the current cost of living crisis are a concern for parents and carers, and high prices may lead to unsafe feeding practices [<span>5</span>]. This concern is exacerbat","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 7","pages":"452-454"},"PeriodicalIF":6.3,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14532","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>There is a mounting body of evidence that grandmaternal smoking increases the risk of asthma not only in their children but also in nonexposed grandchildren [<span>1</span>]. Effects of in utero exposure to tobacco smoke might be transmitted over generations via epigenetic modification of the foetal germ cells suggesting that the effects could be sex specific [<span>2</span>].</p><p>Using prospectively collected data over three generations from Swedish national registries, we have demonstrated that maternal [<span>3</span>] but not paternal [<span>4</span>] grandmother's smoking during pregnancy was related to an increased risk of grandchild asthma. We have now set up a much bigger registry-based cohort also comprising data on paternal smoking from the Swedish conscript registry. Our aim was to assess whether potential effects of grandmaternal and parental smoking were sex specific and whether paternal smoking affected the associations.</p><p>We have used dispensed prescriptions of leukotriene antagonists (Anatomic Therapeutic Chemical (ATC) code R03) and/or inhaled steroids (ATC codes R03AK06, R03AK07, R03AK08, R03AK11, R03BA) as a proxy for asthma. We have defined three phenotypes of asthma during the first 6 years of life as suggested by Martinez et al [<span>5</span>]:</p><p>Early transient asthma was defined as purchase of at least two prescriptions of asthma medication before 3 years of age and no or less than two purchases after 3 years of age, early persistent as at least two purchases also after 3 years of age and late onset as at least two prescriptions after 3 years of age but no or less than two before.</p><p>The study cohort comprised 28,723 children together with their parents and grandmothers. The prevalence of asthma was 7.8%. Grandchild asthma was almost twice as common in boys as in girls. Smoking during pregnancy has declined over the years, and maternal and grandmaternal smoking habits in early pregnancy were closely associated with maternal age. Additional information: https://zenodo.org/doi/10.5281/zenodo.12610766.</p><p>The effects of smoking variables on asthma risk were studied using multinomial logistic regression, with crude, adjusted and interaction models defined in Table 1.</p><p>In the final model with all adjustments allowing interaction between sex and smoking variables, the associations with maternal grandmother's smoking on late onset and early persistent asthma were statistically significantly larger in girls than in boys. Paternal grandmother's smoking had no association with grandchild asthma. However, paternal smoking increased early transient asthma and late-onset asthma in boys, with statistically significantly lower odds ratio (OR) in girls.</p><p>We have also assessed the outcome with a wider definition of asthma based on any asthma medication also including an inhaled beta<sub>2</sub>-agonist (ATC codes R03AC and R03AL). When this asthma definition was considered, maternal grandmother's smoking was a
{"title":"Sex Disparities in Asthma Related to Parental and Grandmaternal Smoking Habits—A Population-Based Register Study","authors":"Lennart Bråbäck, Shyamali Chandrika Dharmage, Caroline Lodge, Kadri Meister, Bertil Forsberg","doi":"10.1111/cea.14541","DOIUrl":"10.1111/cea.14541","url":null,"abstract":"<p>There is a mounting body of evidence that grandmaternal smoking increases the risk of asthma not only in their children but also in nonexposed grandchildren [<span>1</span>]. Effects of in utero exposure to tobacco smoke might be transmitted over generations via epigenetic modification of the foetal germ cells suggesting that the effects could be sex specific [<span>2</span>].</p><p>Using prospectively collected data over three generations from Swedish national registries, we have demonstrated that maternal [<span>3</span>] but not paternal [<span>4</span>] grandmother's smoking during pregnancy was related to an increased risk of grandchild asthma. We have now set up a much bigger registry-based cohort also comprising data on paternal smoking from the Swedish conscript registry. Our aim was to assess whether potential effects of grandmaternal and parental smoking were sex specific and whether paternal smoking affected the associations.</p><p>We have used dispensed prescriptions of leukotriene antagonists (Anatomic Therapeutic Chemical (ATC) code R03) and/or inhaled steroids (ATC codes R03AK06, R03AK07, R03AK08, R03AK11, R03BA) as a proxy for asthma. We have defined three phenotypes of asthma during the first 6 years of life as suggested by Martinez et al [<span>5</span>]:</p><p>Early transient asthma was defined as purchase of at least two prescriptions of asthma medication before 3 years of age and no or less than two purchases after 3 years of age, early persistent as at least two purchases also after 3 years of age and late onset as at least two prescriptions after 3 years of age but no or less than two before.</p><p>The study cohort comprised 28,723 children together with their parents and grandmothers. The prevalence of asthma was 7.8%. Grandchild asthma was almost twice as common in boys as in girls. Smoking during pregnancy has declined over the years, and maternal and grandmaternal smoking habits in early pregnancy were closely associated with maternal age. Additional information: https://zenodo.org/doi/10.5281/zenodo.12610766.</p><p>The effects of smoking variables on asthma risk were studied using multinomial logistic regression, with crude, adjusted and interaction models defined in Table 1.</p><p>In the final model with all adjustments allowing interaction between sex and smoking variables, the associations with maternal grandmother's smoking on late onset and early persistent asthma were statistically significantly larger in girls than in boys. Paternal grandmother's smoking had no association with grandchild asthma. However, paternal smoking increased early transient asthma and late-onset asthma in boys, with statistically significantly lower odds ratio (OR) in girls.</p><p>We have also assessed the outcome with a wider definition of asthma based on any asthma medication also including an inhaled beta<sub>2</sub>-agonist (ATC codes R03AC and R03AL). When this asthma definition was considered, maternal grandmother's smoking was a","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 12","pages":"1003-1005"},"PeriodicalIF":6.3,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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