Junhai Chen, Linlu Wang, Xinyue Wang, Yana Zhang, Qintai Yang
Heterogeneity among CRSwNP patients in Western and Eastern countries leads to differences in management. Type 2 (T2) inflammation accounts for the majority of CRSwNP patients in Western countries, while non-T2 inflammation is the main endotype in CRSwNP patients in Eastern countries. Precise identification of T2 inflammation holds significant promise for optimising treatment outcomes. The treatment of T2 inflammation-biased CRSwNP primarily involves glucocorticoids, reboot surgery, and T2 biologics, while non-T2 inflammation-dominant CRSwNP is mainly treated with macrolide antibiotics.
{"title":"Treatment Approach to Chronic Rhinosinusitis Based on Endotype: Difference Between East and West","authors":"Junhai Chen, Linlu Wang, Xinyue Wang, Yana Zhang, Qintai Yang","doi":"10.1111/cea.70150","DOIUrl":"10.1111/cea.70150","url":null,"abstract":"<p>Heterogeneity among CRSwNP patients in Western and Eastern countries leads to differences in management. Type 2 (T2) inflammation accounts for the majority of CRSwNP patients in Western countries, while non-T2 inflammation is the main endotype in CRSwNP patients in Eastern countries. Precise identification of T2 inflammation holds significant promise for optimising treatment outcomes. The treatment of T2 inflammation-biased CRSwNP primarily involves glucocorticoids, reboot surgery, and T2 biologics, while non-T2 inflammation-dominant CRSwNP is mainly treated with macrolide antibiotics.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 11","pages":"1052-1056"},"PeriodicalIF":5.2,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.70150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205763","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}
Usmaan Ahmed, Yitong Shen, Robert L. Yellon, Jacqui Galloway, Priya Sellaturay, Shuaib Nasser, Padmalal Gurugama
{"title":"A Safe and Effective 7 Week Updosing Protocol for Bee and Wasp Venom Immunotherapy","authors":"Usmaan Ahmed, Yitong Shen, Robert L. Yellon, Jacqui Galloway, Priya Sellaturay, Shuaib Nasser, Padmalal Gurugama","doi":"10.1111/cea.70149","DOIUrl":"10.1111/cea.70149","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"56 1","pages":"106-108"},"PeriodicalIF":5.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191055","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 this month's editorial, the Editors of the journal have chosen two interesting studies that are included in this issue. The first article investigates the diversity of circulating food allergen-specific antibodies in eosinophilic esophagitis (EoE), extending the focus beyond IgG4 [<span>1</span>]. EoE is a food-triggered, Th2-mediated inflammatory disease of the oesophagus, characterised by high levels of IgG4 both in tissue and circulation, yet the role of additional antibody isotypes in disease activity has remained unclear. Previous work emphasised IgE or IgG4 alone; however, diet response and disease pathogenesis are not fully explained by these markers.</p><p>The study by Imam et al. [<span>1</span>] delivers key insights, profiling plasma for IgG and IgA subclasses specific to major food allergens in both active and inactive EoE versus non-EoE controls. The results indicate that, in addition to increased IgG4, EoE patients have significantly elevated levels of IgG2, IgA1 and IgA2 targeting allergens like casein, wheat and egg. These antibody signatures differ by disease activity and contrast sharply with non-EoE controls, which suggests a broader and more complex humoral immune landscape. Interestingly, the study found no circulating food-specific B cells, implying antibody production may be mainly tissue-localised in EoE—which aligns with previous research findings that showed the presence of B lymphocytes and plasma cells in the EoE tissue [<span>2-4</span>].</p><p>This study highlights how these diverse antibody responses could reflect sustained antigen exposure and ongoing mucosal inflammation, providing candidate biomarkers for improved dietary and therapeutic strategies. Future studies will need to continue exploring the longitudinal research of these antibodies and their clinical relevance in guiding individualised management and predicting response to diets. Figure 1 represents the graphical abstract illustrating the key findings of this paper.</p><p>This issue's second editor's choice article represents untargeted metabolomic analysis of exhaled breath condensate (EBC) to identify disease-specific metabolic signatures in adults with asthma [<span>5</span>]. There are many confounding factors that challenge definitive asthma diagnosis, which requires diagnostic tests with more accuracy and objectivity. Unlike genomic or proteomic markers, metabolites directly indicate cellular biochemical activity and disease states. Metabolomics also provide a highly sensitive approach to uncover small but clinically significant changes in biological pathways. Despite its potential, previous asthma metabolomics research has mostly focused on blood, urine or tissue, where relatively few studies have utilised the non-invasive EBC method to profile airway-derived metabolites [<span>6-8</span>].</p><p>In this study, Zhao et al. [<span>5</span>] utilised advanced mass spectrometry using ultra-performance liquid chromatography to perform untargeted
{"title":"Innovative Approaches to Allergic Disease Characterisation: Comprehensive Antibody Profiling and Non-Invasive Metabolomics","authors":"Mohamed H. Shamji, Robert J. Boyle","doi":"10.1111/cea.70152","DOIUrl":"10.1111/cea.70152","url":null,"abstract":"<p>In this month's editorial, the Editors of the journal have chosen two interesting studies that are included in this issue. The first article investigates the diversity of circulating food allergen-specific antibodies in eosinophilic esophagitis (EoE), extending the focus beyond IgG4 [<span>1</span>]. EoE is a food-triggered, Th2-mediated inflammatory disease of the oesophagus, characterised by high levels of IgG4 both in tissue and circulation, yet the role of additional antibody isotypes in disease activity has remained unclear. Previous work emphasised IgE or IgG4 alone; however, diet response and disease pathogenesis are not fully explained by these markers.</p><p>The study by Imam et al. [<span>1</span>] delivers key insights, profiling plasma for IgG and IgA subclasses specific to major food allergens in both active and inactive EoE versus non-EoE controls. The results indicate that, in addition to increased IgG4, EoE patients have significantly elevated levels of IgG2, IgA1 and IgA2 targeting allergens like casein, wheat and egg. These antibody signatures differ by disease activity and contrast sharply with non-EoE controls, which suggests a broader and more complex humoral immune landscape. Interestingly, the study found no circulating food-specific B cells, implying antibody production may be mainly tissue-localised in EoE—which aligns with previous research findings that showed the presence of B lymphocytes and plasma cells in the EoE tissue [<span>2-4</span>].</p><p>This study highlights how these diverse antibody responses could reflect sustained antigen exposure and ongoing mucosal inflammation, providing candidate biomarkers for improved dietary and therapeutic strategies. Future studies will need to continue exploring the longitudinal research of these antibodies and their clinical relevance in guiding individualised management and predicting response to diets. Figure 1 represents the graphical abstract illustrating the key findings of this paper.</p><p>This issue's second editor's choice article represents untargeted metabolomic analysis of exhaled breath condensate (EBC) to identify disease-specific metabolic signatures in adults with asthma [<span>5</span>]. There are many confounding factors that challenge definitive asthma diagnosis, which requires diagnostic tests with more accuracy and objectivity. Unlike genomic or proteomic markers, metabolites directly indicate cellular biochemical activity and disease states. Metabolomics also provide a highly sensitive approach to uncover small but clinically significant changes in biological pathways. Despite its potential, previous asthma metabolomics research has mostly focused on blood, urine or tissue, where relatively few studies have utilised the non-invasive EBC method to profile airway-derived metabolites [<span>6-8</span>].</p><p>In this study, Zhao et al. [<span>5</span>] utilised advanced mass spectrometry using ultra-performance liquid chromatography to perform untargeted","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 10","pages":"886-888"},"PeriodicalIF":5.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.70152","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191098","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}
Xinyu Shui, Yu Jiang, Cong Peng, Qiaozhi Cao, Jie Li
{"title":"The Incidence of Addiction and Its Risk Factors in Chinese Chronic Urticaria Patients.","authors":"Xinyu Shui, Yu Jiang, Cong Peng, Qiaozhi Cao, Jie Li","doi":"10.1111/cea.70151","DOIUrl":"https://doi.org/10.1111/cea.70151","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191145","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}
Allergic bronchopulmonary aspergillosis (ABPA) requires screening in adults with asthma using Aspergillus fumigatus-specific IgE (Af-IgE). The current Af-IgE threshold of 0.35 kUA/L has low specificity, leading to unnecessary downstream testing.
Objectives
To determine an optimal Af-IgE threshold that maintains high sensitivity while improving specificity for ABPA screening in adults with asthma.
Methods
We performed a diagnostic accuracy study of prospectively collected data using distinct derivation and validation cohorts in a tertiary care setting. The index test was ImmunoCAP Af-IgE at thresholds of 0.35, 0.70 and 0.90 kUA/L. The reference standard was the 2024 ISHAM-ABPA criteria applied by investigators aware of all test results.
Results
We included 543 consecutive asthmatic subjects investigated for possible ABPA in the derivation cohort (July 2017–September 2018) and 375 subjects with established asthma and ABPA in the validation dataset (January 2020–December 2023). ABPA prevalence was 19.5% (106/543) in derivation and 69.6% (261/375) in validation cohorts. Bayesian latent class analysis estimated a 0.3 kUA/L cut-off but did not improve specificity; frequentist analysis showed model misfit. In the validation cohort, increasing the threshold from 0.35 to 0.70 kUA/L improved specificity from 66.7% (95% CI, 57.6–74.7) to 72.8% (95% CI, 64.0–80.1; p = 0.016) without significant sensitivity reduction (100% to 98.9%; 95% CI, 96.7–99.6; p = 0.25). No patients with bronchiectasis were missed. At 0.90 kUA/L, sensitivity significantly decreased (97.7%; 95% CI, 95.1–98.9; p = 0.031).
Conclusions
ImmunoCAP Af-IgE threshold of 0.70 kUA/L optimised diagnostic performance for ABPA screening in adults with asthma, potentially reducing unnecessary confirmatory testing.
背景：过敏性支气管肺曲霉病（ABPA）需要使用烟曲霉特异性IgE （Af-IgE）筛查成人哮喘患者。目前的Af-IgE阈值为0.35 kUA/L，特异性较低，导致不必要的下游检测。目的：确定一个最佳的Af-IgE阈值，在保持高敏感性的同时提高成人哮喘ABPA筛查的特异性。方法：我们在三级医疗机构中使用不同的推导和验证队列对前瞻性收集的数据进行了诊断准确性研究。指标检测为ImmunoCAP Af-IgE，阈值分别为0.35、0.70和0.90 kUA/L。参考标准是2024 ISHAM-ABPA标准，由了解所有测试结果的研究人员应用。结果：我们在衍生队列（2017年7月至2018年9月）中纳入了543名连续哮喘受试者，以调查可能的ABPA，并在验证数据集（2020年1月至2023年12月）中纳入了375名已确诊哮喘和ABPA的受试者。衍生组ABPA患病率为19.5%(106/543)，验证组为69.6%（261/375）。贝叶斯潜类分析估计的截止值为0.3 kUA/L，但没有提高特异性；频率分析显示模型不匹配。在验证队列中，将阈值从0.35提高到0.70 kUA/L，特异性从66.7% （95% CI, 57.6-74.7）提高到72.8% (95% CI, 64.0-80.1; p = 0.016)，而敏感性没有显著降低（100%至98.9%;95% CI, 96.7-99.6; p = 0.25）。无遗漏支气管扩张患者。在0.90 kUA/L时，敏感性显著降低（97.7%;95% CI, 95.1-98.9; p = 0.031）。结论：0.70 kUA/L的免疫cap Af-IgE阈值优化了成人哮喘ABPA筛查的诊断性能，可能减少不必要的确认性检测。
{"title":"Optimal ImmunoCAP Aspergillus fumigatus-Specific IgE Threshold for Detecting Allergic Bronchopulmonary Aspergillosis in Adults With Asthma: A Diagnostic Accuracy Study","authors":"Ritesh Agarwal, Puneet Saxena, Valliappan Muthu, Inderpaul Singh Sehgal, Kuruswamy Thurai Prasad, Sahajal Dhooria, Mani Singh, Mandeep Garg, Ashutosh N. Aggarwal, Shivaprakash M. Rudramurthy, Arunaloke Chakrabarti","doi":"10.1111/cea.70148","DOIUrl":"10.1111/cea.70148","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Allergic bronchopulmonary aspergillosis (ABPA) requires screening in adults with asthma using <i>Aspergillus fumigatus</i>-specific IgE (Af-IgE). The current Af-IgE threshold of 0.35 kUA/L has low specificity, leading to unnecessary downstream testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To determine an optimal Af-IgE threshold that maintains high sensitivity while improving specificity for ABPA screening in adults with asthma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a diagnostic accuracy study of prospectively collected data using distinct derivation and validation cohorts in a tertiary care setting. The index test was ImmunoCAP Af-IgE at thresholds of 0.35, 0.70 and 0.90 kUA/L. The reference standard was the 2024 ISHAM-ABPA criteria applied by investigators aware of all test results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 543 consecutive asthmatic subjects investigated for possible ABPA in the derivation cohort (July 2017–September 2018) and 375 subjects with established asthma and ABPA in the validation dataset (January 2020–December 2023). ABPA prevalence was 19.5% (106/543) in derivation and 69.6% (261/375) in validation cohorts. Bayesian latent class analysis estimated a 0.3 kUA/L cut-off but did not improve specificity; frequentist analysis showed model misfit. In the validation cohort, increasing the threshold from 0.35 to 0.70 kUA/L improved specificity from 66.7% (95% CI, 57.6–74.7) to 72.8% (95% CI, 64.0–80.1; <i>p</i> = 0.016) without significant sensitivity reduction (100% to 98.9%; 95% CI, 96.7–99.6; <i>p</i> = 0.25). No patients with bronchiectasis were missed. At 0.90 kUA/L, sensitivity significantly decreased (97.7%; 95% CI, 95.1–98.9; <i>p</i> = 0.031).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ImmunoCAP Af-IgE threshold of 0.70 kUA/L optimised diagnostic performance for ABPA screening in adults with asthma, potentially reducing unnecessary confirmatory testing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"56 1","pages":"61-67"},"PeriodicalIF":5.2,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.70148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148145","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}
Nicole L. Messina, Laure F. Pittet, Emily K. Forbes, Kaya Gardiner, Katie L. Flanagan, Anne-Louise Ponsonby, Roy Robins-Browne, Frank Shann, Mike South, Peter Vuillermin, Susan Donath, Dan Casalaz, Nigel Curtis, the Melbourne Infant Study: BCG for Allergy and Infection Reduction (MIS BAIR) Group
<p>Vaccination with BacilleCalmette-Guérin (BCG) has off-target effects on the immune system which may influence the risk of developing allergic disease in later life. The Melbourne Infant Study: BCG for Allergy and Infection Reduction (MIS BAIR) randomised controlled trial (NCT01906853) investigated whether neonatal BCG vaccination reduces the incidence of allergy, eczema and infections at 1 and 5 years of age, and asthma at 5 years of age [<span>1</span>]. In the trial, neonatal BCG vaccination reduced the incidence of eczema at 1 year [<span>2</span>], particularly in children of parents with a history of eczema, but did not significantly reduce lower respiratory tract infections [<span>3</span>] or food allergy [<span>4</span>] at 1 year of age. At 5 years of age, neonatal BCG vaccination reduced the risk of more severe forms of asthma but had minimal effect on the overall incidence of asthma [<span>5</span>].</p><p>The MIS BAIR trial also aimed to investigate atopic sensitisation to a range of common allergens at 5 years of age. This required participants to attend a clinic visit for skin prick testing (SPT) at 5 years of age [<span>1, 4</span>]. In March 2020, COVID-19 pandemic ‘lockdown’ measures in Melbourne (which included stay-at-home orders [<span>6, 7</span>]) prevented 5-year SPT clinic visits being done for the following 12 months. During this period, 1124 (88%) of participants were eligible for their SPT clinic visit, with 62.7% (798/1272) only eligible after March 2020. To provide an opportunity for these participants to attend their SPT clinic visit after lockdown restrictions had eased, the age of eligibility for the SPT clinic visit was extended to 7 years of age. However, participants' families remained reluctant to visit a hospital setting during the pandemic and consequently, overall, only 34.2% (435/1272) attended a school-age (5–7 years of age) SPT clinic visit (Figure 1A).</p><p>In addition to the low follow-up rate, there was a difference between the randomisation groups in the proportion of participants who did not attend an SPT clinic visit (58.6% (373/637) in the BCG group vs. 73.1% (464/635) in the Control group) (Figure 1A). This might be attributable to disappointment in being randomised to the Control group [<span>8</span>] as participants' families were not blinded to the randomisation group due to BCG vaccination site scarring. Despite the large proportion of missing data, the available SPT results and longitudinal testing provide valuable information in relation to the progression of atopic sensitisation in early life.</p><p>Among the 435 participants who attended, the median age at the SPT clinic visit was 64 months (IQR 61–68 months; range 60–87 months). Of these, 99.1% (431/435) had a valid SPT, and 90.6% (394/435) were tested against all the pre-specified food (peanut, cashew nuts, hazelnut, walnut, raw egg, cow's milk, sesame and shellfish) and aero (dog, cat, house dust mite, rye grass and <i>Alternaria t
接种卡介苗（BCG）对免疫系统有脱靶作用，可能影响日后患过敏性疾病的风险。墨尔本婴儿研究：减少卡介苗过敏和感染（MIS BAIR）随机对照试验（NCT01906853）调查了新生儿接种卡介苗是否能降低1岁和5岁时过敏、湿疹和感染的发生率，以及5岁时哮喘的发生率。在试验中，新生儿接种卡介苗降低了1岁时湿疹的发病率，特别是在父母有湿疹史的儿童中，但没有显著降低1岁时下呼吸道感染[3]或食物过敏[4]。在5岁时，新生儿接种卡介苗降低了更严重哮喘形式的风险，但对哮喘bbb的总体发病率影响甚微。MIS BAIR试验还旨在调查5岁儿童对一系列常见过敏原的特应性致敏。这要求参与者在5岁时去诊所进行皮肤点刺试验（SPT）[1,4]。2020年3月，墨尔本的COVID-19大流行“封锁”措施（包括居家令[6,7]）阻止了接下来12个月的5年SPT诊所就诊。在此期间，1124（88%）的参与者有资格参加他们的SPT诊所就诊，62.7%（798/1272）的参与者只有在2020年3月之后才有资格。为了让这些参与者有机会在封锁限制放松后参加防范小组委员会诊所就诊，防范小组委员会诊所就诊的资格年龄延长至7岁。然而，在大流行期间，参与者的家庭仍然不愿意去医院就诊，因此，总体而言，只有34.2%（435/1272）参加了学龄（5-7岁）SPT诊所就诊（图1A）。除了低随访率外，随机分组之间未参加SPT门诊就诊的参与者比例也存在差异(BCG组为58.6%(373/637)，对照组为73.1%(464/635))（图1A）。这可能是由于被随机分配到对照组[8]的失望，因为参与者的家庭没有因为卡介苗接种部位疤痕而对随机分组视而不见。尽管有很大比例的数据缺失，但现有的SPT结果和纵向测试提供了与生命早期特应性致敏的进展有关的有价值的信息。在参加的435名参与者中，SPT诊所就诊时的中位年龄为64个月（IQR为61-68个月；范围为60-87个月）。其中，99.1%（431/435）具有有效的SPT， 90.6%（394/435）针对所有预先指定的食物（花生、腰果、榛子、核桃、生鸡蛋、牛奶、芝麻和贝类）和空气（狗、猫、屋螨、黑麦草和狐猸子）过敏原进行了测试。在有效SPT的参与者中，37.4%（161/431）对至少一种过敏原有特应性致敏（比阴性对照≥2mm）。这些参与者中的大多数对黑麦草（62.1%,100/161）和/或屋尘螨（52.8%,85/161）敏感（图1B）。对多种过敏原有有效SPT的参与者中有19.0%（81/426）发现对一种以上过敏原敏感，其中48名参与者对2,16至3,10至4和7至5种或更多过敏原敏感，主要是草（7/7），屋尘螨（6/7），花生（5/7）和鸡蛋（5/7）。与先前的研究一致，对食物过敏原的致敏性随着时间的推移从1岁时的18.2%（198/1089）下降到5-7岁（学龄）时的10.9%（47/431）。这是由于先前食物致敏的减少和解决（图1B）。一岁和学龄儿童的食物过敏原致敏持续时间因食物而异。卵子致敏从1年的9.9%下降到5-7年的2.3%，只有13.3%的参与者持续致敏。同样，榛子过敏只持续了6.3%的参与者。对于其他食物过敏原，在一年和学龄期间，23%-37%的参与者持续致敏（牛奶23.1%，腰果29.2%，芝麻33.3%，贝类33.3%和花生37.1%）。相比之下，对空气过敏原（黑麦草、室内尘螨、狗和猫）的致敏率从1岁时的5.0%（54/1089）增加到5-7岁时的34.8%(150/431)（图1B）。BCG组对任何核心过敏原的特应性致敏率为38.8%(95/245)，对照组为42.0%(66/157)（图1C）。由于数据缺失的比例较大，且干预组之间的不平衡，统计比较卡介苗接种对5-7岁儿童特应性致敏的影响是不可行的。我们调查了与未参加学龄儿童访视相关的因素，如预期的那样，发现未参加学龄儿童访视与2020年3月1日后的访视有关(χ2 p < 0。 001)并随机分配到对照组（χ2 p < 0.001）。它还与母亲受教育程度较低（χ2 p < 0.001）、出生后第一年接受托儿服务（χ2 p = 0.005）以及居住地距离诊所超过30公里（χ2 p = 0.02）有关。未参加学龄访问与测试的其他变量无关，包括1岁时的特应性致敏或湿疹、过敏性疾病家族史（过敏、湿疹、花粉热或哮喘）或父母出生在海外（数据未显示）。这些数据为墨尔本儿童早期对食物和空气过敏原的致敏演变提供了有价值的见解，这是一个过敏性疾病高发的环境。担任首席研究员，负责研究构思、设计和获得资金。北卡罗来纳和sd制定了最终的科学方案和伦理申请，所有其他作者都提供了关键的评估和修改。K.G.负责协调，n.c.、d.c.、P.V.和N.L.M.参与实施。E.K.F.和N.L.M.参与了研究，n.c.、s.d.、L.F.P.和M.S.参与了分析计划。E.K.F.领导，N.L.M.监督，L.F.P.负责数据的清理和准备。N.L.M.起草了手稿，并协调了手稿的准备和修改。所有作者都对稿件进行了批判性的评价和修改。作者声明无利益冲突。支持本研究结果的数据可根据通讯作者的合理要求提供。
{"title":"Changes in Atopic Sensitisation From 1 to 5 Years of Age: Longitudinal Data From the MIS BAIR Trial","authors":"Nicole L. Messina, Laure F. Pittet, Emily K. Forbes, Kaya Gardiner, Katie L. Flanagan, Anne-Louise Ponsonby, Roy Robins-Browne, Frank Shann, Mike South, Peter Vuillermin, Susan Donath, Dan Casalaz, Nigel Curtis, the Melbourne Infant Study: BCG for Allergy and Infection Reduction (MIS BAIR) Group","doi":"10.1111/cea.70144","DOIUrl":"10.1111/cea.70144","url":null,"abstract":"<p>Vaccination with BacilleCalmette-Guérin (BCG) has off-target effects on the immune system which may influence the risk of developing allergic disease in later life. The Melbourne Infant Study: BCG for Allergy and Infection Reduction (MIS BAIR) randomised controlled trial (NCT01906853) investigated whether neonatal BCG vaccination reduces the incidence of allergy, eczema and infections at 1 and 5 years of age, and asthma at 5 years of age [<span>1</span>]. In the trial, neonatal BCG vaccination reduced the incidence of eczema at 1 year [<span>2</span>], particularly in children of parents with a history of eczema, but did not significantly reduce lower respiratory tract infections [<span>3</span>] or food allergy [<span>4</span>] at 1 year of age. At 5 years of age, neonatal BCG vaccination reduced the risk of more severe forms of asthma but had minimal effect on the overall incidence of asthma [<span>5</span>].</p><p>The MIS BAIR trial also aimed to investigate atopic sensitisation to a range of common allergens at 5 years of age. This required participants to attend a clinic visit for skin prick testing (SPT) at 5 years of age [<span>1, 4</span>]. In March 2020, COVID-19 pandemic ‘lockdown’ measures in Melbourne (which included stay-at-home orders [<span>6, 7</span>]) prevented 5-year SPT clinic visits being done for the following 12 months. During this period, 1124 (88%) of participants were eligible for their SPT clinic visit, with 62.7% (798/1272) only eligible after March 2020. To provide an opportunity for these participants to attend their SPT clinic visit after lockdown restrictions had eased, the age of eligibility for the SPT clinic visit was extended to 7 years of age. However, participants' families remained reluctant to visit a hospital setting during the pandemic and consequently, overall, only 34.2% (435/1272) attended a school-age (5–7 years of age) SPT clinic visit (Figure 1A).</p><p>In addition to the low follow-up rate, there was a difference between the randomisation groups in the proportion of participants who did not attend an SPT clinic visit (58.6% (373/637) in the BCG group vs. 73.1% (464/635) in the Control group) (Figure 1A). This might be attributable to disappointment in being randomised to the Control group [<span>8</span>] as participants' families were not blinded to the randomisation group due to BCG vaccination site scarring. Despite the large proportion of missing data, the available SPT results and longitudinal testing provide valuable information in relation to the progression of atopic sensitisation in early life.</p><p>Among the 435 participants who attended, the median age at the SPT clinic visit was 64 months (IQR 61–68 months; range 60–87 months). Of these, 99.1% (431/435) had a valid SPT, and 90.6% (394/435) were tested against all the pre-specified food (peanut, cashew nuts, hazelnut, walnut, raw egg, cow's milk, sesame and shellfish) and aero (dog, cat, house dust mite, rye grass and <i>Alternaria t","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"56 1","pages":"79-81"},"PeriodicalIF":5.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.70144","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124311","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}
Viljami E. Salmi, Annina Lyly, Mikko Neuvonen, Elmo Saarentaus, Mikko Niemi, Sanna Toppila-Salmi
<p>Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) is a common chronic airway inflammatory disease characterised by asthma, chronic rhinosinusitis with nasal polyps (CRSwNP) and hypersensitivity to NSAIDs, including acetylsalicylic acid (ASA, aspirin), posing a significant burden on respiratory health [<span>1</span>]. N-ERD currently lacks reliable clinical laboratory tests, yet early diagnosis and management are essential to prevent disease progression [<span>2</span>]. The pathogenesis of N-ERD has been linked to dysregulation of arachidonic acid (AA) metabolism, which affects levels of pro-inflammatory lipid mediators such as leukotrienes and prostaglandins [<span>1, 3</span>]. ASA alters AA metabolism by inhibiting cyclooxygenase (COX) enzymes and redirecting lipid synthesis towards pro-inflammatory leukotrienes [<span>1</span>]. Despite extensive research into eicosanoids in N-ERD, the full spectrum of lipid mediators involved remains incompletely understood. In this study, we investigated the effect of a low dose of ASA (25 mg) on plasma and urine lipid mediator concentrations in N-ERD patients compared with healthy controls, aiming to identify novel biomarkers and deepen understanding of disease mechanisms.</p><p>This study included eight consecutively recruited N-ERD patients and seven age-matched healthy controls (25–62 years). All subjects were Finnish females, selected to minimise demographic variability. N-ERD was diagnosed based on typical symptoms after NSAID intake and confirmed with ASA challenge, lung function testing and clinical examination [<span>1</span>]. All patients had asthma and CRSwNP. Ethics approval and informed consent were obtained as part of the AirGOs-Medical clinical trial (NCT03825757) [<span>4</span>].</p><p>Blood plasma and urine samples were collected after overnight fasting at baseline and 2 h after ingestion of 25 mg ASA (Primaspan, 50 mg tablet, Orion, Espoo, Finland). Although this initial dose did not provoke symptoms in all patients, it was part of a broader challenge that ultimately confirmed N-ERD in each case (Figure 1A). Our aim was to detect metabolic changes while minimising the risk of severe respiratory reactions. Lipid mediators were quantified using liquid chromatography–tandem mass spectrometry, targeting 158 eicosanoids and related compounds, with 30 analytes quantified. Urine concentrations were normalised to creatinine levels.</p><p>Linear mixed-effects models were used to evaluate the effects of group (N-ERD vs. control), ASA intake (before vs. after) and their interaction (different ASA effects between groups) on individual lipid concentrations. Lipids with a significant <i>p</i> value (<i>p</i> < 0.05) in the group comparison were considered main findings and are presented in this letter.</p><p>Reduced plasma concentrations of the endocannabinoid-related lipids arachidonoylethanolamide (AEA) and oleoylethanolamide (OEA) were associated with N-ERD
{"title":"Systemic N-Acylethanolamines and Other Lipid Mediators Are Associated With NSAID-Exacerbated Respiratory Disease","authors":"Viljami E. Salmi, Annina Lyly, Mikko Neuvonen, Elmo Saarentaus, Mikko Niemi, Sanna Toppila-Salmi","doi":"10.1111/cea.70145","DOIUrl":"10.1111/cea.70145","url":null,"abstract":"<p>Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) is a common chronic airway inflammatory disease characterised by asthma, chronic rhinosinusitis with nasal polyps (CRSwNP) and hypersensitivity to NSAIDs, including acetylsalicylic acid (ASA, aspirin), posing a significant burden on respiratory health [<span>1</span>]. N-ERD currently lacks reliable clinical laboratory tests, yet early diagnosis and management are essential to prevent disease progression [<span>2</span>]. The pathogenesis of N-ERD has been linked to dysregulation of arachidonic acid (AA) metabolism, which affects levels of pro-inflammatory lipid mediators such as leukotrienes and prostaglandins [<span>1, 3</span>]. ASA alters AA metabolism by inhibiting cyclooxygenase (COX) enzymes and redirecting lipid synthesis towards pro-inflammatory leukotrienes [<span>1</span>]. Despite extensive research into eicosanoids in N-ERD, the full spectrum of lipid mediators involved remains incompletely understood. In this study, we investigated the effect of a low dose of ASA (25 mg) on plasma and urine lipid mediator concentrations in N-ERD patients compared with healthy controls, aiming to identify novel biomarkers and deepen understanding of disease mechanisms.</p><p>This study included eight consecutively recruited N-ERD patients and seven age-matched healthy controls (25–62 years). All subjects were Finnish females, selected to minimise demographic variability. N-ERD was diagnosed based on typical symptoms after NSAID intake and confirmed with ASA challenge, lung function testing and clinical examination [<span>1</span>]. All patients had asthma and CRSwNP. Ethics approval and informed consent were obtained as part of the AirGOs-Medical clinical trial (NCT03825757) [<span>4</span>].</p><p>Blood plasma and urine samples were collected after overnight fasting at baseline and 2 h after ingestion of 25 mg ASA (Primaspan, 50 mg tablet, Orion, Espoo, Finland). Although this initial dose did not provoke symptoms in all patients, it was part of a broader challenge that ultimately confirmed N-ERD in each case (Figure 1A). Our aim was to detect metabolic changes while minimising the risk of severe respiratory reactions. Lipid mediators were quantified using liquid chromatography–tandem mass spectrometry, targeting 158 eicosanoids and related compounds, with 30 analytes quantified. Urine concentrations were normalised to creatinine levels.</p><p>Linear mixed-effects models were used to evaluate the effects of group (N-ERD vs. control), ASA intake (before vs. after) and their interaction (different ASA effects between groups) on individual lipid concentrations. Lipids with a significant <i>p</i> value (<i>p</i> < 0.05) in the group comparison were considered main findings and are presented in this letter.</p><p>Reduced plasma concentrations of the endocannabinoid-related lipids arachidonoylethanolamide (AEA) and oleoylethanolamide (OEA) were associated with N-ERD ","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"56 1","pages":"95-98"},"PeriodicalIF":5.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.70145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084904","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":"British Society for Allergy and Immunology Abstracts From the 2025 Annual Conference","authors":"","doi":"10.1111/cea.70139","DOIUrl":"10.1111/cea.70139","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 10","pages":"976-1048"},"PeriodicalIF":5.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022956","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}
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