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Eosinophil-Derived Neurotoxin Determinants and Reference Values in a Swedish Middle-Aged General Population 瑞典中年普通人群中的嗜酸性粒细胞衍生神经毒素决定因素和参考值。
IF 6.3 2区 医学 Q1 ALLERGY Pub Date : 2024-10-21 DOI: 10.1111/cea.14579
Suneela Zaigham, Nils Oskar Jõgi, Robert Movérare, Anders Sjölander, Niclas Rydell, Magnus Molin, Christer Janson, Andrei Malinovschi
<p>Eosinophilic inflammation in asthma is related to disease severity, lung function decline, disease control and response to corticosteroids during exacerbations [<span>1-3</span>]. Eosinophil activation leads to the release of cytokines, lipid mediators, chemotactic polypeptides and cytotoxic proteins that promote a pro-inflammatory host response and neutralises pathogens [<span>4</span>]. One of the cytotoxic granule proteins released during degranulation of activated eosinophils is the eosinophil-derived neurotoxin (EDN). Serum EDN is emerging as a novel marker of eosinophilic inflammation in patients with asthma [<span>4</span>]. In order to implement serum EDN as a marker in clinical practice, determinants and reference ranges for EDN need to be clearly established. Recently, EDN reference values were defined in early childhood [<span>5</span>]; however, further large studies defining values in older adults are needed. We aimed to study determinants of EDN using the Swedish CArdioPulmonary bioImage Study (SCAPIS), a general population study of middle-aged adults and propose reference values for EDN, including the lower (LLN) and upper limit of normal (ULN), in a healthy sub-population.</p><p>The Swedish CArdioPulmonary bioImage Study is a national, multicentred, population-based study of randomly selected men and women aged 50–64 years. Nationally, 30,154 men and women participated and from the Uppsala cohort 5036 subjects [<span>6</span>]. Serum EDN was an add-on measurement in the Uppsala cohort of SCAPIS (<i>n</i> = 4916) and was measured using an ImmunoCAP EDN research assay as described elsewhere [<span>7</span>]. EDN values were log-transformed for analysis. Univariate analyses were carried out to assess determinants of EDN, including age, sex, lifestyle, clinical conditions (assessed via questionnaire) and laboratory data. Independent sample <i>t</i>-tests were used to obtain mean values of EDN by each potential determining factor. The <i>p</i>-values were adjusted for false discovery rate (FDR) using the Benjamini–Hochberg method. Multiple linear regression models were used to assess the effect of determining factors on EDN. To define normal values of EDN, we selected a healthy population based on subjects free from EDN-modifying conditions. In this healthy sub-cohort, we used the 5<sup>th</sup> (LLN), 50<sup>th</sup> (median), 75<sup>th</sup>, 90<sup>th</sup> and 95<sup>th</sup> (ULN) percentiles to determine reference levels for serum EDN.</p><p>Male sex, body mass index (BMI) > 25, current smoking, presence of atopy, ever asthma, allergic rhinitis, angina pectoris, heart failure, hypertension, diabetes and impaired kidney function were all associated with higher mean EDN levels. Both pre-bronchodilatory FEV<sub>1</sub> < LLN and a post-bronchodilatory FEV<sub>1</sub>/FVC ratio < 0.70 were associated with higher mean EDN levels. After adjusting the <i>p</i>-values for FDR, these determining factors remained significantly
{"title":"Eosinophil-Derived Neurotoxin Determinants and Reference Values in a Swedish Middle-Aged General Population","authors":"Suneela Zaigham,&nbsp;Nils Oskar Jõgi,&nbsp;Robert Movérare,&nbsp;Anders Sjölander,&nbsp;Niclas Rydell,&nbsp;Magnus Molin,&nbsp;Christer Janson,&nbsp;Andrei Malinovschi","doi":"10.1111/cea.14579","DOIUrl":"10.1111/cea.14579","url":null,"abstract":"&lt;p&gt;Eosinophilic inflammation in asthma is related to disease severity, lung function decline, disease control and response to corticosteroids during exacerbations [&lt;span&gt;1-3&lt;/span&gt;]. Eosinophil activation leads to the release of cytokines, lipid mediators, chemotactic polypeptides and cytotoxic proteins that promote a pro-inflammatory host response and neutralises pathogens [&lt;span&gt;4&lt;/span&gt;]. One of the cytotoxic granule proteins released during degranulation of activated eosinophils is the eosinophil-derived neurotoxin (EDN). Serum EDN is emerging as a novel marker of eosinophilic inflammation in patients with asthma [&lt;span&gt;4&lt;/span&gt;]. In order to implement serum EDN as a marker in clinical practice, determinants and reference ranges for EDN need to be clearly established. Recently, EDN reference values were defined in early childhood [&lt;span&gt;5&lt;/span&gt;]; however, further large studies defining values in older adults are needed. We aimed to study determinants of EDN using the Swedish CArdioPulmonary bioImage Study (SCAPIS), a general population study of middle-aged adults and propose reference values for EDN, including the lower (LLN) and upper limit of normal (ULN), in a healthy sub-population.&lt;/p&gt;&lt;p&gt;The Swedish CArdioPulmonary bioImage Study is a national, multicentred, population-based study of randomly selected men and women aged 50–64 years. Nationally, 30,154 men and women participated and from the Uppsala cohort 5036 subjects [&lt;span&gt;6&lt;/span&gt;]. Serum EDN was an add-on measurement in the Uppsala cohort of SCAPIS (&lt;i&gt;n&lt;/i&gt; = 4916) and was measured using an ImmunoCAP EDN research assay as described elsewhere [&lt;span&gt;7&lt;/span&gt;]. EDN values were log-transformed for analysis. Univariate analyses were carried out to assess determinants of EDN, including age, sex, lifestyle, clinical conditions (assessed via questionnaire) and laboratory data. Independent sample &lt;i&gt;t&lt;/i&gt;-tests were used to obtain mean values of EDN by each potential determining factor. The &lt;i&gt;p&lt;/i&gt;-values were adjusted for false discovery rate (FDR) using the Benjamini–Hochberg method. Multiple linear regression models were used to assess the effect of determining factors on EDN. To define normal values of EDN, we selected a healthy population based on subjects free from EDN-modifying conditions. In this healthy sub-cohort, we used the 5&lt;sup&gt;th&lt;/sup&gt; (LLN), 50&lt;sup&gt;th&lt;/sup&gt; (median), 75&lt;sup&gt;th&lt;/sup&gt;, 90&lt;sup&gt;th&lt;/sup&gt; and 95&lt;sup&gt;th&lt;/sup&gt; (ULN) percentiles to determine reference levels for serum EDN.&lt;/p&gt;&lt;p&gt;Male sex, body mass index (BMI) &gt; 25, current smoking, presence of atopy, ever asthma, allergic rhinitis, angina pectoris, heart failure, hypertension, diabetes and impaired kidney function were all associated with higher mean EDN levels. Both pre-bronchodilatory FEV&lt;sub&gt;1&lt;/sub&gt; &lt; LLN and a post-bronchodilatory FEV&lt;sub&gt;1&lt;/sub&gt;/FVC ratio &lt; 0.70 were associated with higher mean EDN levels. After adjusting the &lt;i&gt;p&lt;/i&gt;-values for FDR, these determining factors remained significantly ","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 1","pages":"91-93"},"PeriodicalIF":6.3,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459404","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}
引用次数: 0
Pathomechanism of Adverse Reactions to Biological Treatment of Inflammatory Skin Conditions 炎症性皮肤病生物治疗不良反应的病理机制。
IF 6.3 2区 医学 Q1 ALLERGY Pub Date : 2024-10-20 DOI: 10.1111/cea.14583
Lichen Li, Dean J. Naisbitt, Yonghu Sun, Furen Zhang

Biological agents are widely used across medicine, including for immune-mediated skin conditions such as psoriasis and atopic dermatitis. When used to treat a relevant pathological process, they demonstrate impressive efficacy and credible safety, helping to achieve remission and improved function and quality of life. However, with their expanded use, awareness and understanding of adverse reactions to biologicals have also increased. Herein, we discuss the pathomechanism of adverse reactions to biological agents used to treat skin conditions and apply these to Pichler's classification system. This classification differentiates five distinct types, namely overstimulation (type α), hypersensitivity or immunogenicity (β), immunodeviation (γ), cross-reactivity (δ) and nonimmunologic adverse reactions (ε). This classification covers most types of adverse reactions associated with use of biological agents and could be used to better understand the reaction pathogenesis and manage the clinical features of biological adverse effects.

生物制剂广泛应用于医学领域,包括治疗免疫介导的皮肤病,如银屑病和特应性皮炎。当用于治疗相关病理过程时,生物制剂表现出令人印象深刻的疗效和可信的安全性,有助于实现缓解、改善功能和提高生活质量。然而,随着生物制剂使用范围的扩大,人们对其不良反应的认识和了解也在不断加深。在此,我们将讨论用于治疗皮肤病的生物制剂不良反应的病理机制,并将其应用于 Pichler 的分类系统。该分类法将不良反应分为五种不同类型,即过度刺激(α 型)、超敏反应或免疫原性(β 型)、免疫变异(γ 型)、交叉反应(δ 型)和非免疫性不良反应(ε 型)。这一分类涵盖了与使用生物制剂有关的大多数不良反应类型,可用于更好地了解反应的发病机理和管理生物不良反应的临床特征。
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引用次数: 0
Noninvasive Nasal Secretion Sampling for Assessing Inflammatory Phenotype of Adult Allergic Rhinitis Patients. 无创鼻分泌物采样用于评估成人过敏性鼻炎患者的炎症表型
IF 6.3 2区 医学 Q1 ALLERGY Pub Date : 2024-10-16 DOI: 10.1111/cea.14580
Liyue Li, Ziyi Long, Qianxue Hu, Pei Gao, Yue Zhou, Shan Chen, Tao Zhou, Liuqing Zhou, Qing Cheng, Hongjun Xiao, Jianjun Chen
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引用次数: 0
Whole Blood Transcriptomics Identifies Differences in Innate Immune Pathway Expression in Infants at Risk for Peanut Allergy 全血转录组学确定了有花生过敏风险的婴儿先天性免疫途径表达的差异。
IF 6.3 2区 医学 Q1 ALLERGY Pub Date : 2024-10-16 DOI: 10.1111/cea.14587
Abigail Lang, Samantha Gadd, Lauren Gunderman, Elizabeth Lippner, Ashley Devonshire, Matthew J. Schipma, Sergejs Berdnikovs, Rajesh Kumar
<p>Peanut allergy affects up to 2%–4% of children in the United States [<span>1</span>]. Despite advances in peanut allergy prevention through early introduction [<span>2</span>], there is limited understanding of molecular processes that drive development of peanut allergy. Similarly, differences between infants who tolerate peanut but demonstrate allergic sensitization and those with clinical reactivity to peanut are poorly understood. In a pilot study by our group, infants at high risk for peanut allergy demonstrated differential gene expression by clinical phenotype, but the magnitude of differences was not clinically significant given the variance of expression [<span>3</span>]. Further exploration of gene networks from differentially expressed gene (DEG) signatures may provide better targets for future studies. The primary objective of this study was to analyse the transcriptomic signature of a cohort of infants at risk for peanut allergy utilising whole blood RNA sequencing. We hypothesized that infants with peanut allergy would have differential expression of genes involved in immune pathways when compared to infants tolerant of peanut, with or without sensitization to peanut.</p><p>Infants aged 4–11 months (<i>n</i> = 70) with peanut allergy risk factors (egg allergy, moderate to severe atopic dermatitis, or both) were recruited from Ann and Robert H. Lurie Children's Hospital of Chicago between 2018 and 2021. Subjects were classified as either peanut non-allergic (PNA), peanut sensitised (PS), or peanut allergic (PA). PA subjects had a convincing clinical history of reaction to peanut and peanut skin prick (SPT) wheal ≥ 3 mm or peanut SPT wheal ≥ 8 mm without history of consumption. Subjects regularly consuming peanut without history of an adverse reaction to peanut or who had never consumed peanut and had peanut SPT wheal size of 0–2 mm were classified as PNA. Infants who had ingested peanut without clinical reaction or passed a peanut oral food challenge (OFC) and had a peanut SPT wheal size of 3–7 mm or positive peanut specific IgE (sIgE) were classified as PS.</p><p>RNA-seq was performed on whole blood. Deconvolution of gene expression by immune cell type showed no clinically significant differences between peanut allergy groups. Comparison of gene expression profiles by peanut allergy status was carried out using <i>DESeq2</i> [<span>4</span>]. DEGs were split into upregulated and downregulated groups and were analysed separately in pathway analyses performed using Metascape [<span>5</span>]. Significant differences in single gene expression between groups were reported if there was ≥ ± absolute log<sub>2</sub> fold change of 0.3 and FDR-corrected <i>p</i> ≤ 0.05.</p><p>Half of the population was PNA (<i>n =</i> 35, 50%), 12 subjects (17%) were PS, and 23 subjects were PA (33%). Most subjects in each sub-group were male and had eczema. When adjusted for multiple comparisons, there were no statistically significant DEGs between PA a
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引用次数: 0
Nutrition Industry Sponsorship of Healthcare Professional Associations 营养行业赞助医疗保健专业协会
IF 6.3 2区 医学 Q1 ALLERGY Pub Date : 2024-10-16 DOI: 10.1111/cea.14581
Robert J. Boyle, Victoria L. Sibson, Christoffer van Tulleken
<p>Last month, the World Health Organisation (WHO) published new resources to support Healthcare Professional Associations (HCPA) wishing to avoid conflicts of interest in relation to nutrition companies marketing foods for infants and young children. The new WHO resources include a model policy, suggestions for alternative funding sources and case studies of good practice [<span>1</span>]. The case studies include the Indian Academy of Paediatrics and examples from Africa, which are especially important given the harms associated with formula marketing in these regions [<span>2</span>]. The new resources underscore a long-standing WHO recommendation, made more explicit since 2016—that HCPA (and health workers) should not accept funding from companies that market foods for infants and young children, for either the general running of the HCPA or for supporting HCPA educational or scientific meetings such as an annual congress [<span>3</span>]. The scope of ‘foods’ that relevant companies might market is quite broad, including formula, ‘growing up’ drinks, specialised low-allergy formula, non-liquid foods and even bottles and teats sold for formula feeding. The scope of ‘infants and young children’ is from birth through to age 36 months, the period of time covered by the International Code of Marketing of Breastmilk Substitutes.</p><p>This WHO recommendation has met with significant resistance from HCPAs, including some allergy HCPAs [<span>4</span>]. Two key reasons cited for continuing to accept nutrition industry funding are access to scientific information about nutrition products, and difficulty funding educational and scientific activities without nutrition industry support [<span>5</span>]. Access to scientific information about nutrition products does not require a financial relationship, since companies already provide product information in the public domain and on request, without any exchange of funding. Finding alternative resources for educational and scientific activities is more challenging. So these new WHO resources aim to support HCPAs to address this challenge.</p><p>This month, the British Society for Allergy and Clinical Immunology (BSACI) hosted its first annual conference without sponsorship from any company that markets foods for infants and young children. It is 5 years since the society's announcement that it will no longer accept funding from commercial formula milk companies for its conference and educational activities. Culture change takes time, and reducing income sources is not something which organisations find easy. This is recognised by the WHO, hence the inclusion of case studies to help HCPAs understand that they are not alone in finding this difficult, and a journey is often required to transition away from nutrition industry funding. There are a number of other allergy societies which take a similar approach to BSACI of avoiding formula industry sponsorship. However, these are dwarfed by the major allergy HC
上个月,世界卫生组织(WHO)发布了新资源,以支持希望避免与销售婴幼儿食品的营养公司发生利益冲突的医疗保健专业协会(HCPA)。世卫组织的新资源包括政策范本、替代资金来源建议和良好实践案例研究[1]。案例研究包括印度儿科学会和非洲的实例,鉴于配方奶粉营销在这些地区造成的危害,这些案例研究尤为重要[2]。新资源强调了世卫组织的一项长期建议,该建议自2016年以来更加明确,即婴幼儿保健协会(和卫生工作者)不得接受销售婴幼儿食品的公司提供的资金,用于婴幼儿保健协会的一般运作或支持婴幼儿保健协会的教育或科学会议,如年度大会[3]。相关公司可能销售的 "食品 "范围相当广泛,包括配方奶粉、"成长 "饮料、专用低过敏配方奶粉、非液体食品,甚至包括用于配方奶粉喂养的奶瓶和奶嘴。婴幼儿 "的范围是从出生到 36 个月大,也就是《国际母乳代用品销售守则》所涵盖的时间段。世卫组织的这一建议遭到了 HCPAs 的强烈抵制,包括一些过敏 HCPAs [4]。继续接受营养行业资助的两个主要原因是:获取有关营养产品的科学信息,以及在没有营养行业支持的情况下难以资助教育和科学活动[5]。获取营养产品的科学信息并不需要经济关系,因为公司已经在公共领域提供了产品信息,而且是应要求提供的,没有任何资金交换。为教育和科学活动寻找替代资源更具挑战性。本月,英国过敏与临床免疫学会(BSACI)首次在没有任何婴幼儿食品销售公司赞助的情况下举办了年会。自该学会宣布不再接受商业配方奶粉公司对其会议和教育活动的资助以来,已经过去了 5 年。文化的改变需要时间,而减少收入来源对各组织来说并非易事。世卫组织认识到了这一点,因此纳入了案例研究,以帮助过敏协会认识到,并非只有他们发现了这一困难,摆脱营养行业的资助往往需要一个过程。其他一些过敏协会也采取了与 BSACI 类似的方法,即避免配方奶粉行业的赞助。然而,与欧洲、亚洲和美洲的主要过敏 HCPA 相比,这些协会就相形见绌了。过敏是营养行业的一个重要增长领域,而营养行业的赞助往往占 HCPA 总收入的很大一部分。尽管世界卫生组织的指南和这些新资源主要针对 HCPA 和营养行业,但各种营利性公司与 HCPA、慈善机构、监管机构和主要舆论领袖之间的关系也存在问题。这些都会对公众健康、医疗保健和科学产生负面影响。2009 年,美国国家科学院发布了一份具有里程碑意义的报告,其中一个知名小组指出,商业影响可能会损害 "科学调查的完整性、医学教育的客观性、患者护理的质量以及公众对医学的信任"[6]。婴幼儿营养行业的利益冲突在这个故事中占有特殊的地位--这既是因为从 20 世纪初开始,配方奶粉行业的营销对公众健康造成了破坏性影响,从而引发了《世界卫生组织守则》的制定;也是因为当前的全球儿童肥胖症危机。组织经常质疑,是否真的有必要通过避免他人认为有问题的利益冲突来做出重大的经济牺牲。HCPA 质疑利益冲突会在其特定医疗保健领域造成伤害或正在造成伤害的概念。就过敏症而言,有证据表明,利益冲突会导致过度诊断和不必要地使用具有健康和营养风险的特殊配方产品(表 1)[7]。正是这类来自医疗保健、公共卫生和生物医学等多个领域的证据,促使政府和政府间组织提出建议,如世界卫生组织的建议。
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引用次数: 0
Cochrane Corner: Pharmacological Treatment of Gastro-Oesophageal Reflux in Children 科克伦角:儿童胃食管反流的药物治疗。
IF 6.3 2区 医学 Q1 ALLERGY Pub Date : 2024-10-10 DOI: 10.1111/cea.14577
Aahil Damani, Nabeela Bhaloo
<p>Reflux is commonly cited as the cause of common issues in babies, such as vomiting and crying. Though it is often self-limiting, in many cases, anti-reflux medications and feed thickeners are prescribed to infants and young children. Their use is controversial, and it is not clear whether they are effective. Data shown are trends in community prescribing for total quantity of thickener (Gaviscon infant and Instant Carobel) sachets/live births in England in the previous year (Figure 1); total items of infant anti-reflux medications prescribed/live birth in England in the previous year (Figure 2) [<span>1</span>].</p><p>This Cochrane Corner aims to assess the evidence for pharmacological agents in treating GORD in infants and children.</p><p>GOR is common [<span>2</span>], and GORD incidence in children is estimated at 0.84 per 1000 person years [<span>3</span>]. Several pharmacological treatments are available to treat reflux, including PPIs and H2 receptor antagonists, and they are being prescribed more frequently in recent years [<span>4</span>]. This Cochrane review aimed to establish which were beneficial in children split into subgroups of infants and older children. In addition to the cost of prescribing these medications, it is important to consider the potential side effects, which include infection risk, electrolyte abnormalities and fractures [<span>5</span>]. Similarly, whilst prokinetics such as domperidone, cisapride and erythromycin are effective in managing reflux, they have been associated with the very rare but serious risks of drug-induced long-QT syndrome, Torsades de Pointes and sudden cardiac death, due to a combination of non-modifiable (age, family history of arrhythmias, genetic conditions and co-morbidities) and modifiable risk factors (electrolyte imbalances, concurrent use of other medications). Thus, use of these prokinetics is cautioned against, though cardiac complications of domperidone have not been noted in children [<span>6</span>].</p><p>This Cochrane Review analysed 36 randomised control trials involving 2251 infants and children, out of which 22 trials were excluded due to insufficient data for extraction. The sample sizes of the studies included were small (range = 10–268), and due to methodological differences between the studies, a meta-analysis could not be performed. The trials often used subjective questionnaires, and blinding the trials was a challenge. Although blinding is less of an issue for trials using objective data such as 24-h pH impedance studies and endoscopic findings, the subjective outcome assessments used in these trials are vulnerable to detection bias in the absence of blinding. Such questionnaires do have the benefit of aiding clinicians with decision-making as they are patient-centred.</p><p>Though one trial [<span>7</span>] performed endoscopic studies at baseline, they did not repeat them after the intervention; therefore, no comparisons could be made. In another case, pH indices w
反流通常被认为是婴儿常见问题的原因,如呕吐和哭泣。虽然它通常是自限性的,但在许多情况下,抗反流药物和饲料增稠剂被开给婴儿和幼儿。它们的使用是有争议的,也不清楚它们是否有效。数据显示的是前一年英格兰社区处方增稠剂(加夫iscon婴儿和速溶胡萝卜素)小袋/活产总量的趋势(图1);前一年英国婴儿抗反流药物处方/活产总项目数(图2)。Cochrane Corner旨在评估婴儿和儿童GORD药物治疗的证据。GOR很常见,儿童GORD发病率估计为每1000人年0.84例。有几种药物治疗可用于治疗反流,包括PPIs和H2受体拮抗剂,近年来这些药物的处方越来越频繁。这篇Cochrane综述旨在确定哪些是对儿童有益的,这些儿童被分成婴儿和大一点的儿童亚组。除了处方这些药物的费用外,重要的是要考虑潜在的副作用,包括感染风险、电解质异常和骨折。同样,虽然多潘立酮、西沙比利和红霉素等促动力学药物对控制反流有效,但由于不可改变的(年龄、心律失常家族史、遗传条件和合并症)和可改变的危险因素(电解质失衡、同时使用其他药物)的组合,它们与非常罕见但严重的药物性长qt综合征、角性扭转和心源性猝死的风险相关。因此,尽管在儿童中尚未发现多潘立酮的心脏并发症,但应谨慎使用这些促原药物。本Cochrane综述分析了36项随机对照试验,涉及2251名婴儿和儿童,其中22项试验因数据不足而被排除。纳入的研究样本量较小(范围= 10-268),由于研究之间的方法学差异,无法进行荟萃分析。这些试验通常使用主观问卷,对试验进行盲测是一项挑战。虽然对于使用客观数据(如24小时pH阻抗研究和内窥镜检查结果)的试验来说,盲法不是一个问题,但在没有盲法的情况下,这些试验中使用的主观结果评估容易受到检测偏差的影响。这样的问卷确实有帮助临床医生决策的好处,因为他们是病人为中心。尽管一项试验在基线时进行了内窥镜研究,但在干预后他们没有重复这些研究;因此,无法进行比较。在另一种情况下,pH指数使用[8];然而,结果没有足够详细的报告,无法提取汇总统计数据来评估疗效和对实践的影响。对未来研究的建议包括改进试验设计,以确保有足够的细节,以便提取汇总统计数据,并使用可测量的结果,如内镜检查结果和pH指数的改善,这些结果可以在干预前后进行评估,以便进行直接比较。根据GRADE标准对研究进行评价也是有益的。尽管如此,使用酸阻滞剂的理由将保持不变,因为婴儿胃内容物的pH值并不那么酸,因为牛奶中的酸度很低,因此,使用阻滞剂的理由是有限的。然而,由于大多数研究现在是阻抗研究,他们也可以报道非酸性反流。还有一个利益冲突,因为许多研究在手稿写作过程中涉及制药。未来的研究应该在不受药物影响的情况下进行。许多研究还评估了雷尼替丁的功效,雷尼替丁在2019年因含有一种名为NMDA[9]的杂质而被暂停在欧盟(EU)销售。因此,建议未来的研究重点放在欧盟现有的药物干预措施上,如PPIs.A.D。和N.B.对这份手稿的撰写也做出了同样的贡献。作者声明无利益冲突。
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引用次数: 0
Cluster Analysis Identifies Patients With Severe Eosinophilic Asthma Who Achieve Super-Response and Remission With Mepolizumab 聚类分析确定了哪些严重嗜酸性粒细胞哮喘患者对美泊利珠单抗产生了超强反应并获得缓解
IF 6.3 2区 医学 Q1 ALLERGY Pub Date : 2024-10-10 DOI: 10.1111/cea.14584
Danilo Di Bona, Massimo Bilancia, Claudia Crimi, Michelina Daddato, Alida Benfante, Maria Filomena Caiaffa, Cecilia Calabrese, Raffaele Campisi, Santi Nolasco, Giovanna Elisiana Carpagnano, Maria D'Amato, Corrado Pelaia, Girolamo Pelaia, Angelantonio Maglio, Nicola Scichilone, Giulia Scioscia, Giuseppe Spadaro, Massimo Triggiani, Isabella Carrieri, Giuseppe Valenti, Alessandro Vatrella, Luigi Macchia, Nunzio Crimi

This study identifies two distinct subgroups of patients with severe eosinophilic asthma who respond differently to mepolizumab. Cluster analysis reveals that patients with a family history of asthma, positive skin prick tests and higher baseline lung function have better treatment outcomes, highlighting the value of personalised treatment strategies.

这项研究确定了严重嗜酸性粒细胞性哮喘患者的两个不同亚群,他们对美泊利珠单抗的反应各不相同。聚类分析显示,有哮喘家族史、皮肤点刺试验阳性和基线肺功能较高的患者治疗效果更好,这凸显了个性化治疗策略的价值。
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引用次数: 0
Anaphylaxis Management in Paediatric Patients Undergoing Milk Oral Immunotherapy 接受牛奶口服免疫疗法的儿科患者的过敏性休克处理。
IF 6.3 2区 医学 Q1 ALLERGY Pub Date : 2024-10-09 DOI: 10.1111/cea.14582
Dimitry Buyansky, Roy Khalaf, Sofianne Gabrielli, Julia Upton, Eyal Grunebaum, Edmond S. Chan, Ingrid Baerg, Liane Beaudette, Danbing Ke, Bruce Mazer, Christine McCusker, Duncan Lejtenyi, Moshe Ben-Shoshan
<p>Following anaphylaxis, previous guidelines mandate the transfer of the affected individual to the emergency department (ED) for further assessment. The Canadian Paediatric Society (CPS) suggests a minimum period of observation in the ED of 4–6 h following onset of allergic symptoms to evaluate the need for additional interventions and manage potential biphasic reactions. Translating Emergency Knowledge for Kids (TREKK) has similar recommendations depending on the severity of the reaction and patient-specific risk factors, ranging from a 2-h observation to an overnight stay if deemed necessary [<span>1, 2</span>]. More recent US guidelines call against routine transfer to ED of all anaphylaxis cases following epinephrine use, advising case-by-case evaluation based on patient factors and relation circumstances [<span>3, 4</span>]. This paper aims to examine the differences in anaphylaxis management and associated characteristics among two groups: those who presented to the ED after an anaphylactic episode and those who did not in a cohort of children who have challenge-confirmed diagnoses of milk allergy and are currently undergoing oral immunotherapy to cow's milk (OIT).</p><p>In this retrospective cohort study, we analysed data from the year 2014 to 2023 inclusively. Participants selected were paediatric patients undergoing milk OIT at three children's hospitals across Canada: the Montreal Children's Hospital (Montreal), the British Columbia Children's Hospital (Vancouver) and the Hospital for Sick Children (Toronto). Only adverse reactions meeting the definition of anaphylaxis according to the National Institute of Allergy and Infectious Disease classification were included in the analysis [<span>5</span>]. The Muraro et al. [<span>6</span>] grading system was used to categorise the severity of anaphylactic reactions. Participants were grouped into two categories based on their response post-reaction: those who visited the ED and those who managed the reaction entirely at home. Descriptive statistics were used to present demographic, clinical management characteristics and levels of biomarkers. All statistical data were analysed using R 4.2.3 binary for macOs 10.3 (R Foundation for Statistical Computing, Vienna, Austria). Categorical data were presented as percentages, and continuous data as a median (interquartile range [IQR]). Fisher's test was used to compare categorical variables and Mann–Whitney test was used to compare continuous variables. This study was approved by participating centres ethics committees.</p><p>The study included 27 paediatric patients undergoing cow's milk OIT. The median age of patients at the start of OIT was 12.0 years (9.5–14.0) and 51.9% were males. Out of the 27 patients included in the study, 92.6% had asthma. A total of 60 anaphylactic reactions were reported from 2014 to 2023. Notably, 63.3% resulted in a visit to the ED. The updosing phase was identified as a particularly vulnerable period, with most anaphy
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引用次数: 0
Adrenaline Auto-Injectors for Preventing Fatal Anaphylaxis 用于预防致命性过敏性休克的肾上腺素自动注射器。
IF 6.3 2区 医学 Q1 ALLERGY Pub Date : 2024-10-09 DOI: 10.1111/cea.14565
Marcus Sim, Vibha Sharma, Karen Li, Mary Hazel Gowland, Tomaz Garcez, Cassandra Shilladay, Richard Pumphrey, Nandinee Patel, Paul J. Turner, Robert J. Boyle

Anaphylaxis affects up to 5% of people during their lifetime. Although anaphylaxis usually resolves without long-term physical consequences, it can result in anxiety and quality of life impairment. Rarely and unpredictably, community anaphylaxis can cause rapid physiological decompensation and death. Adrenaline (epinephrine) is the cornerstone of anaphylaxis treatment, and provision of adrenaline autoinjectors (AAI) has become a standard of care for people at risk of anaphylaxis in the community. In this article, we explore the effectiveness of AAIs for preventing fatal outcomes in anaphylaxis, using information drawn from animal and human in vivo studies and epidemiology. We find that data support the effectiveness of intravenous adrenaline infusions for reversing physiological features of anaphylaxis, typically at doses from 0.05 to 0.5 μg/kg/min for 1–2 h, or ~ 10 μg/kg total dose. Intramuscular injection of doses approximating 10 μg/kg in humans can result in similar peak plasma adrenaline levels to intravenous infusions, at 100–500 pg/mL. However, these levels are typically short-lived following intramuscular adrenaline, and pharmacokinetic and pharmacodynamic outcomes can be unpredictable. Epidemiological data do not support an association between increasing AAI prescriptions and reduced fatal anaphylaxis, although carriage and activation rates remain low. Taken together, these data suggest that current AAIs have little impact on rates of fatal anaphylaxis, perhaps due to a lack of sustained and sufficient plasma adrenaline concentration. Effects of AAI prescription on quality of life may be variable. There is a need to consider alternatives, which can safely deliver a sustained adrenaline infusion via an appropriate route.

在人的一生中,过敏性休克的发病率高达 5%。虽然过敏性休克通常不会对身体造成长期影响,但会导致焦虑和生活质量下降。罕见且不可预测的是,社区性过敏性休克可导致迅速的生理失调和死亡。肾上腺素(肾上腺素)是治疗过敏性休克的基石,提供肾上腺素自动注射器(AAI)已成为社区过敏性休克高危人群的标准护理方法。在本文中,我们利用从动物和人体体内研究以及流行病学中获得的信息,探讨了 AAI 在预防过敏性休克致命后果方面的有效性。我们发现,数据支持静脉注射肾上腺素可有效逆转过敏性休克的生理特征,通常剂量为 0.05 至 0.5 μg/kg/min,持续 1-2 小时,或总剂量约为 10 μg/kg。人体肌肉注射剂量接近 10 μg/kg,可产生与静脉注射相似的峰值血浆肾上腺素水平(100-500 pg/mL)。不过,肌肉注射肾上腺素后,这些水平通常持续时间较短,药代动力学和药效学结果可能无法预测。流行病学数据不支持增加 AAI 处方与减少致命性过敏性休克之间存在关联,尽管携带率和激活率仍然很低。总之,这些数据表明,目前的 AAI 对致命性过敏性休克的发生率影响不大,这可能是由于缺乏持续和足够的血浆肾上腺素浓度所致。AAI处方对生活质量的影响可能各不相同。有必要考虑可通过适当途径安全输注持续肾上腺素的替代品。
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引用次数: 0
Diagnostic Accuracy of Skin Prick Test, Food-Specific IgE and Component Testing for IgE-Mediated Peanut, Egg, Milk and Wheat Allergy 皮肤点刺试验、食物特异性 IgE 和成分检测对 IgE 导致的花生、鸡蛋、牛奶和小麦过敏的诊断准确性。
IF 6.3 2区 医学 Q1 ALLERGY Pub Date : 2024-10-07 DOI: 10.1111/cea.14578
Kok Wee Chong, R. Sultana, May Ping Lee, Lynette Liling Tan, Anne Goh, Si Hui Goh, Wenyin Loh
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引用次数: 0
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Clinical and Experimental Allergy
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