Clinical and Experimental Allergy最新文献

Background: Previous studies demonstrated the heterogeneity of the nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) phenotype. Patients with severe asthma and aspirin hypersensitivity may exhibit differences in sputum mRNA gene expression. The aim of the study was to identify distinct transcriptional subtypes of severe asthma with aspirin hypersensitivity using unsupervised cluster analysis.

Methods: Sputum induction was performed in 27 patients with severe asthma and aspirin hypersensitivity who met 2022 Global Initiative for Asthma criteria for type 2 (T2) severe asthma. Using the transcriptional signatures of 87 genes, along with clinical characteristics and biomarker measurements, 2 distinct subtypes were identified and compared between study participants.

Results: Two clusters were identified: cluster 1 (n = 10) and cluster 2 (n = 17). In cluster 1, low GATA3 expression was observed, along with several activated inflammatory genes, while cluster 2 was characterised by high GATA3 expression. Cluster 1 was characterised by increased sputum eosinophil count (p = 0.04) and percentage (p = 0.035), and decreased sputum macrophage count (p = 0.003) and percentage (p = 0.003). Patients in cluster 1 had increased sputum supernatant prostaglandin D₂ levels (p = 0.031). Patients in cluster 1 tended to have a higher Lund-Mackay score (p = 0.074) and elevated peripheral blood eosinophilia (p = 0.059).

Conclusion: Patients in cluster 1 exhibited T2 inflammation with low GATA3 expression, while those in cluster 2 showed T2 inflammation with high GATA3 expression. Sputum GATA3 expression may serve as a useful biomarker for differentiating distinct severe asthma subtypes in patients with N-ERD.

Background and objectives: Dysfunctional breathing (DB) is common and impairs quality of life. Various non-pharmacological interventions have been identified, but there is a lack of agreement regarding essential treatment components and delivery methods. This study aimed to gain consensus from experts and people with DB regarding the critical components, optimal format and delivery methods of non-pharmacological DB interventions.

Methods: A two-round Delphi process was conducted involving international experts, with each round followed by a consumer focus group. Online surveys were distributed using the Qualtrics platform. Components were defined as essential (median ≥ 4 on a 5-point Likert scale, interquartile range [IQR] = 0), desirable (median = 5, IQR > 0), or optional (median = 4, IQR > 0). In the 2nd round, components with a median score ≤ 3 and IQR = 0 were eliminated, and components without consensus (IQR > 0) were rescored.

Results: Participants in Round 1 included 46 experts and 5 focus group patients with DB, and in Round 2, 44 experts and 4 patients. Essential components for treating DB were a comprehensive assessment, breathing retraining with or without biofeedback, education, manual therapy, psychological therapy, and home practice of techniques. Desirable components were individualised home programs and information materials, and re-assessment. Optional components were individualised modes of treatment delivery and exercise therapy.

Conclusion: This study identified five essential interventions for treating DB, with assessment and home practice essential for treatment delivery. Individualisation of interventions and treatment format is suggested. The findings provide a basis for the development of treatment options for people with DB.

Food allergy is an emerging public health concern in India, driven by rapid urbanisation, changing dietary patterns, environmental influences, and increasing recognition of allergic diseases. Despite the growing burden, food allergy care in India is challenged by limited epidemiological data, variable diagnostic practices, and inadequate access to specialised services. These gaps underscore the need for standardised, context-specific guidance tailored to the diverse sociocultural and dietary landscape of the country. This consensus document was developed by a multidisciplinary panel of allergy experts using a structured Delphi methodology to ensure methodological rigour and expert agreement. It provides a comprehensive overview of evidence-based approaches to the diagnosis and management of food allergy, adapted to Indian clinical practice. The consensus recommends adoption of a standardised diagnostic framework incorporating detailed clinical history, skin prick testing, serum-specific IgE estimation, and supervised oral food challenges, where appropriate. Recognition of region-specific allergens-including milk, wheat, egg, peanut, fish, chickpea, lentils, and sesame-is emphasised to improve diagnostic accuracy and culturally relevant patient counselling. The document highlights the importance of comprehensive management strategies that integrate strict allergen avoidance with balanced, culturally appropriate nutritional planning and psychosocial support. Standardisation of clinical practice is advocated to reduce heterogeneity in care, facilitate early diagnosis, and improve patient outcomes. At a broader level, the consensus emphasises strengthening public health policies through clear food labelling, enhanced allergy education, and school-based preparedness programs. Preventive strategies, including early supervised introduction of allergenic foods, are encouraged in appropriate settings. Advanced therapeutic options such as biologic agents and oral immunotherapy are recommended only for selected patients with severe disease and under specialist supervision. Finally, the consensus underscores the urgent need for robust epidemiological studies, improved diagnostic infrastructure, and enhanced professional training to address existing knowledge gaps. Collectively, these recommendations aim to improve quality of care, reduce disease burden, and support the development of effective, evidence-based food allergy management in India.