Clinical and Experimental Allergy最新文献

英文中文

Fatal Food Anaphylaxis in Children: A Statutory Review in England 儿童致死性食物过敏反应：英国的法定审查。

IF 6.3 2区医学 Q1 ALLERGY

Clinical and Experimental Allergy

Pub Date : 2025-01-07 DOI: 10.1111/cea.14614

Sylvia Stoianova, Vibha Sharma, Robert J. Boyle

Fatal anaphylaxis is a very rare, unpredictable tragedy. For children and young people, most fatal anaphylaxis is caused by food allergy, and thus, carers of children and young people with food allergy may become preoccupied about the possibility of sudden, unexpected fatal anaphylaxis. Other unexpected causes of death such as severe acute asthma are less rare than fatal anaphylaxis, but the rapidity of fatal food anaphylaxis and its propensity to affect adolescents and young adults generate continued concern and societal interest.The burden of avoiding known food allergens falls largely on people living with allergies and their families. Thus, an exposure leading to a fatal anaphylactic reaction may inspire fear and guilt in families and also in other carers, caterers and health professionals. Most anaphylactic reactions to food self-revert, with or without medical intervention [1]. In the past 30 years, several society-wide changes have been made to try to prevent fatal food anaphylaxis. In many countries such as the UK, these include widespread provision of adrenaline autoinjectors, new food allergen labelling laws, increased food allergy diagnostics and improved emergency service awareness of anaphylaxis and its management [2, 3]. Yet, fatal food anaphylaxis remains as common as it was 30 years ago, suggesting we need to go back a step and learn more about the condition [4]. Fatal food anaphylaxis is difficult to study prospectively, because it is very rare, unpredictable and usually occurs in the community. It is therefore important that we learn as much as we can from each tragic occurrence, and the recent statutory review of childhood fatal anaphylaxis and asthma provides an opportunity to do this (Figure 1, Table 1).England is one of very few countries with a national, statutory, multi-professional review of all child deaths [5]. Since 2019, the National Child Mortality Database (NCMD) collates and analyses information about child deaths. For all deaths under age 18, a comprehensive summary of the circumstances of death and background information from professionals is collated. A final record summarises conclusions of a multi-agency panel documenting contributory, modifiable factors and learning. The latest NCMD thematic report analysed child deaths in England because of asthma or anaphylaxis. It identified key findings and made recommendations for policy, practice and research [6].The report documents 54 child deaths from asthma and 19 from anaphylaxis in a 4-year period from 1 April 2019 to 31 March 2023. Many (54%) of the children who died from asthma also had a food allergy. However, the cause of death in these cases was thought to be asthma rather than food anaphylaxis. Fatal anaphylaxis was triggered by food allergy (n = 18) and in one case by anaesthesia, a rare cause of fatal anaphylaxis in childhood [7]. Just over half of

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引用次数: 0

Role of MicroRNAs in Allergy and Basophil Activation Test for IgE-Mediated Drug Allergy microrna在ige介导的药物过敏和嗜碱性粒细胞激活试验中的作用。

IF 6.3 2区医学 Q1 ALLERGY

Clinical and Experimental Allergy

Pub Date : 2025-01-07 DOI: 10.1111/cea.14616

Mohamed H. Shamji, Robert J. Boyle

In this month's editorial, the Editors of the journal have highlighted two fascinating studies that are included in this issue. The first article provides evidence that miR-107 is involved in the allergic response to house dust mites (HDM) in children with asthma [1]. Allergic asthma (AA) is a prevalent phenotype of asthma that presents atopic sensitisations in asthma patients exposed to allergens [2, 3]. Some, but not all, studies have suggested a possible increase in AA over time [4]. HDM are a significant trigger for AA in many regions, with HDM sensitisation potentially leading to severe, and in some instances, life-threatening asthma symptoms. In the study by Kim et al. [1], the relationship between microRNAs (miRNAs) and HDM sensitisation in children with asthma was investigated. The researchers examined serum samples from 1126 children in the Genetics of Asthma in Costa Rica Study (GACRS) and also replicated their findings in the Childhood Asthma Management Program (CAMP). Initially, the study revealed that 17 miRNAs were differentially expressed between HDM-sensitised and non-sensitised children in the GACRS group. Of the 17, miR-642a, let-7c-5p and miR-107 showed the strongest association with HDM sensitisation. Moreover, the CAMP cohort successfully replicated the elevated expression of miR-107 in HDM-sensitised children. Additional mediation analysis also presented significant effects of miR-107 on eosinophil count and total IgE after HDM sensitisation. These findings suggest new insights into the molecular mechanisms underlying HDM sensitisation in paediatric asthma and emphasise the potential of miRNAs, particularly, miR-107, which can be studied further for application as biomarkers or therapeutic targets for AA (Figure 1).This issue's second editor's choice article reports on the optimisation of the basophil activation assay for identifying IgE-mediated drug allergies [5]. Diagnosing drug allergies is a complex and nuanced process that presents several challenges. Allergic reactions can manifest with a broad spectrum of clinical symptoms, ranging from mild rashes to life-threatening anaphylaxis, making it difficult to establish consistent diagnostic criteria. Reactions may occur immediately or be delayed, sometimes appearing days after exposure [6]. This variability complicates the temporal connection between drug intake and allergic symptoms. Additionally, patients may experience allergic reactions to drug molecules with similar structures, further complicating the identification of the exact trigger, especially in cases involving structurally similar drugs. Unlike testing for environmental allergens, there are limited standardised and clinically validated laboratory tests available for many drug allergies. The reliability and availability of tests like the Basophil Activation Test (BAT) can vary for different drugs [7, 8]. While o

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引用次数: 0

Featured Cover

IF 6.3 2区医学 Q1 ALLERGY

Clinical and Experimental Allergy

Pub Date : 2025-01-07 DOI: 10.1111/cea.14621

Shican Zhou, Ju Lai, Na Che, Kai Fan, Chuanliang Zhao, Bojin Long, Chunyan Yao, Yu Zeng, Shaoqing Yu

The cover image is based on the article Emerging Role of SAMSN1⁺Mast Cells: Insights From Mendelian Randomisation and Transcriptomic Analyses on Chronic Sinusitis and Obesity by Shaoqing Yu et al.,https://doi.org/10.1111/cea.14529.

引用次数: 0

Anaphylaxis: Spotlight on Inflammation 过敏反应：聚焦炎症。

IF 6.3 2区医学 Q1 ALLERGY

Clinical and Experimental Allergy

Pub Date : 2025-01-07 DOI: 10.1111/cea.14610

Emilio Nuñez-Borque, Timothy E. Dribin, Pablo Rodriguez Del Rio, Carlos A. Camargo Jr, Vanesa Esteban, George du Toit, Rodrigo Jiménez-Saiz, Mattia Giovannini

Anaphylaxis is a medical condition for which several definitions have been proposed (Table 1 is available in the repository information at https://osf.io/sc2ey/?view_only=f66e841be31b42418eecf639caa0b24d). Charles Richet and Paul Portier coined the term ‘anaphylaxis’ in 1902. If discovered earlier, it might have invigorated the ongoing scientific debate in the late 19th century between Rudolf Virchow and Iliá Méchnikov on the detrimental versus beneficial nature of inflammation [1]. While inflammation typically serves as a response to tissue damage or infection, to restore homeostasis, anaphylaxis is a classic example of an immunopathological reaction in which an exaggerated and inappropriate response can lead, although rarely, to potentially fatal outcomes. Precisely, the role of inflammation has been underlined as central in several atopic diseases, but, surprisingly, not in anaphylaxis.The most common triggers of anaphylaxis are foods, insect stings and medications, but the aetiology may be unknown in some cases (idiopathic). This reaction is a multisystem condition that may involve different findings from the skin/mucosal, respiratory, cardiovascular and/or gastrointestinal systems. However, patients may rarely present isolated respiratory or cardiovascular involvement, and skin/mucosal participation may be absent. In addition, anxiety about the possibility of a new episode of anaphylaxis significantly impairs the quality of life of patients and their relatives, restricting daily activities and increasing the state of constant alertness [2]. The foundations of acute anaphylaxis management are removing the trigger, proper patient positioning, immediate administration of adrenaline and repeat adrenaline injections if severe clinical manifestations do not resolve. Moreover, this treatment can be supplemented with the use of second-line medications (e.g., β2-adrenergic agonists), as well as with the administration of supportive treatments (e.g., oxygen) [2, 3]. Most patients treated with adrenaline experience prompt resolution of symptoms and signs. However, a minority of patients may require three or more doses of adrenaline (refractory anaphylaxis) or have recurrence after an asymptomatic period (biphasic anaphylaxis) [4, 5].Different signalling pathways can mediate anaphylaxis (Figure 1). Among them, the classical one is mediated by immunoglobulin (Ig)E. In sensitised individuals, secreted IgE binds to its high-affinity receptor (FcεRI) on effector cells (mainly mast cells and basophils), which store preformed pro-inflammatory granules. Then, allergen binding by cell-bound IgE triggers effector cell activation, leading to the immediate release of potent pro-inflammatory mediators, such as histamine, tryptase, platelet-activating factor (PAF), prostaglandins, leukotrienes and TNF-α, which are responsible for the rapid clinical manifestations of anaphylaxis [6]. Ho

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引用次数: 0

Hospitalisation Trends of Severe Paediatric Asthma in Tokyo 2015-2019. 东京2015-2019年严重儿科哮喘住院趋势

IF 6.3 2区医学 Q1 ALLERGY

Clinical and Experimental Allergy

Pub Date : 2025-01-05 DOI: 10.1111/cea.14620

Kazu Ishikawa, Kiwako Yamamoto-Hanada, Tatsuki Fukuie, Akira Ishiguro, Yukihiro Ohya

引用次数: 0

Correction to “Prize-Winning Abstracts From BSACI 2024 Meeting”

IF 6.3 2区医学 Q1 ALLERGY

Clinical and Experimental Allergy

Pub Date : 2025-01-03 DOI: 10.1111/cea.14617

Mohamed H. Shamji and Robert J. Boyle, Prize-Winning Abstracts From BSACI 2024 Meeting. Clinical & Experimental Allergy, 54 (2024): 953–955. https://doi.org/10.1111/cea.14599

Some text was missing from the article. The extra text is below, and should be added at the end of the article:

7. Allied Health Category Winner: Odette Rodda, University Hospital Dorset, UK

Assessing the need for an allergy service for Adolescents and Young Adults—a pilot study.

Timely, appropriate diagnosis and treatment are imperative in food allergy. This service evaluation aimed to explore the need for a dedicated allergy clinic for adolescents and young adults (AYA).

AYA aged 12–20 years with food allergies and other allergic conditions were approached during routine clinic appointments over 6 months. Fifty questionnaires were collected. Most (86%) knew how to recognise an allergic reaction and most (81.6%) had an adrenaline auto-injectors. However, only 12.8% rated their allergies as potentially causing anaphylaxis. Most (62%) AYA used antihistamines as rescue medications (62%) and most (59%) did not carry their autoinjector. Only 18.4% of respondents would tell friends about their allergies. Most (62%) would like to attend clinic with other AYA and 81% would prefer clinics in the afternoon or evening. Thematic analysis identified three themes ‘I have to take responsibility’, ‘I need peer support’ and ‘what happens next’. This pilot study identified AYA understanding and behaviours about their allergies and transition to adult services.

We apologize for this error.

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引用次数: 0

Food Allergy Prevalence in Two Population-Based UK Cohorts Born 12 Years Apart 相隔12年出生的两个英国人群的食物过敏患病率

IF 6.3 2区医学 Q1 ALLERGY

Clinical and Experimental Allergy

Pub Date : 2025-01-02 DOI: 10.1111/cea.14605

William Fong, Kaci Pickett-Nairne, Manzi Venter, Veeresh Patil, Syed Hasan Arshad, Graham C. Roberts, Tara Dean, Ramesh J. Kurukulaaratchy, Carina Venter

Background

Adverse food reactions include food allergy (FA; immune-mediated) and food intolerances (non-immune-mediated). FA are classified into IgE- and non-IgE-mediated FA. There is limited information available about changes in FA prevalence over time.

Methods

Two cohorts of children were evaluated, born on the Isle of Wight (IOW) 12 years apart, the IOW birth cohort (IOWBC; 1989–1990) and the FA and Intolerance Research birth cohort (FAIRBC; 2001–2002). We compared the prevalence of parental reported reactions to foods (adverse food reactions), allergic sensitisation to foods and FA between the IOWBC and FAIRBC, at ages 1, 2, 3–4 and 10 years. FA included both IgE- and non-IgE-mediated FA.

Results

Reported adverse reactions to food and sensitisation rates remained stable between the two cohorts. For example, FA at age 3–4 years was reported in 9.1% (95% CI: 7.5, 10.7) in IOWBC and 8.3% (95% CI: 6.5, 10.1) in FAIRBC (p = 0.57) and food sensitisation by skin prick test at age 3–4 years was found in 3.2% (95% CI: 2.1, 4.3) in IOWBC and 4.5% (95% CI: 2.9, 6.1) in FAIRBC (p = 0.20). Confirmed FA prevalence was lower in FAIRBC than IOWBC at ages 1, 2 and 3–4, but these differences were not significant after adjustment for multiple comparisons. For example, FA at age 3–4 years was confirmed in 5.0% (95% CI: 3.8, 6.2) in IOWBC and 3.0% (95% CI: 1.9, 4.2) in FAIRBC (p = 0.03, significance threshold after Bonferroni correction p < 0.004). Confirmed cow's milk allergy rate was higher in IOWBC than FAIRBC at 3 years (< 0.001) but not at other time points.

Conclusion

Our data show no evidence of changes in rates of adverse reactions to foods, food sensitisation or food allergy during the first 10 years of life between two cohorts born in England in 1989–1990 and 2001–2002.

背景：食物不良反应包括食物过敏(FA；免疫介导的)和食物不耐受（非免疫介导的）。FA分为IgE介导FA和非IgE介导FA。关于FA患病率随时间变化的信息有限。方法：对相隔12年出生在怀特岛（IOW）的两组儿童进行评估，IOW出生队列(IOWBC；1989-1990)和FA和不耐受研究出生队列(FAIRBC；2001 - 2002)。我们比较了IOWBC和FAIRBC在1岁、2岁、3-4岁和10岁时父母报告的食物反应（食物不良反应）、食物过敏和FA的患病率。FA包括IgE介导和非IgE介导的FA。结果：报告的食物不良反应和致敏率在两个队列之间保持稳定。例如，IOWBC中3-4岁的FA发生率为9.1% (95% CI: 7.5, 10.7)， FAIRBC中为8.3% (95% CI: 6.5, 10.1) (p = 0.57)， IOWBC中3-4岁皮肤点刺试验的食物致敏率为3.2% (95% CI: 2.1, 4.3)， FAIRBC中为4.5% (95% CI: 2.9, 6.1) （p = 0.20）。在1岁、2岁和3-4岁时，FAIRBC确诊的FA患病率低于IOWBC，但经过多次比较调整后，这些差异并不显著。例如，在IOWBC中，3-4岁的FA发生率为5.0% (95% CI: 3.8, 6.2)，在FAIRBC中为3.0% (95% CI: 1.9, 4.2) （p = 0.03，经Bonferroni校正后的显著性阈值）。结论：我们的数据显示，1989-1990年和2001-2002年在英格兰出生的两个队列中，没有证据表明在生命的前10年期间食物不良反应、食物致敏或食物过敏发生率发生变化。

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