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Management and Research Progress of Severe Asthma in China 中国重症哮喘的管理与研究进展。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-10-25 DOI: 10.1111/cea.70166
Xiaoying Chen, Rui Feng, Xiaolong Ji, Bizhou Li, Tao Liu, Jing Li, Ruchong Chen

Asthma is one of the most common chronic respiratory diseases, persisting across the life course and affecting approximately 300 million people worldwide. Severe asthma, defined as asthma remaining uncontrolled despite adherence to optimised high-dose inhaled corticosteroids/long-acting β2-agonist therapy and management of contributory factors, worsens upon dose reduction. In China, 3.4%–8.3% of patients with asthma have severe asthma, characterised by heterogeneity, frequent exacerbations, and considerable medical and economic burdens. Recent advances in the understanding of its pathogenesis, especially the development of biologics, have enabled new treatment strategies. This review incorporates recent progress from China regarding the epidemiology, pathogenesis, and biologic therapy for severe asthma.

哮喘是最常见的慢性呼吸系统疾病之一,在整个生命过程中持续存在,影响全世界约3亿人。重度哮喘,定义为尽管坚持优化的高剂量吸入皮质类固醇/长效β2激动剂治疗和致病因素管理,哮喘仍未得到控制,但剂量减少后病情恶化。在中国,3.4%-8.3%的哮喘患者患有严重哮喘,其特点是异质性、频繁发作,以及相当大的医疗和经济负担。最近对其发病机制的理解取得了进展,特别是生物制剂的发展,使新的治疗策略成为可能。本文综述了中国在重症哮喘的流行病学、发病机制和生物治疗方面的最新进展。
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引用次数: 0
Managing Drug Hypersensitivities: Clinicians' Perceptions on an Optimised Documentation Tool With De-Labelling Feature. 管理药物超敏反应:临床医生对具有去标签功能的优化文档工具的看法。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-10-25 DOI: 10.1111/cea.70167
Veronique Shiwa, Sven Van Laere, Martine Grosber, Pieter Cornu
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引用次数: 0
Type-2 Biomarkers, Asthma Diagnosis and Lung Function Impairment in the General Population 普通人群中的2型生物标志物、哮喘诊断和肺功能损害。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-10-23 DOI: 10.1111/cea.70165
Sebastian Riemann, Andrei Malinovschi, Guy G. Brusselle
<p>The diagnosis of asthma is typically centred around the presence of four key hallmark features: variable respiratory symptoms, chronic airway inflammation, airway hyperresponsiveness and variable expiratory airflow limitation [<span>1-3</span>]. However, bronchodilator reversibility (BDR) is present in < 20% of (mild-to-moderate) asthma cases in primary care, limiting its diagnostic value [<span>4</span>]. Recent guidelines have shifted towards type-2 (T2) biomarkers. The 2022 ERS guideline supports FeNO > 50 ppb to confirm asthma when spirometry is normal or BDR absent, while recommending blood eosinophil counts (BEC) only for phenotyping [<span>1</span>]. The 2020 NAEPP guideline similarly endorses FeNO as an adjunct test, but not BEC [<span>5</span>]. In contrast, the 2024 BTS/SIGN/NICE guideline proposes FeNO (> 50 ppb) or elevated BEC as first-line diagnostic tests, removing the requirement for spirometry [<span>2</span>]. The Global Initiative for Asthma (GINA) recommends the use of FeNO and BEC mainly for asthma phenotyping [<span>3</span>].</p><p>We evaluated this biomarker-first approach as a potential screening tool for asthma in the general population using U.S. NHANES 2007–2012 data from 18,319 participants (aged 6–80) with FeNO and BEC measurements and asthma status (self-reported physician-diagnosed current asthma). FeNO was measured with NIOX MINO (NIOX MINO, Aerocrine, Stockholm, Sweden). FeNO was defined as normal (< 20 ppb in children and adolescents aged 6–18/< 25 ppb in adults), intermediate (20–35/25–50 ppb) and high (≥ 35/≥ 50 ppb). Associations with asthma status were assessed using multivariable regression adjusted for demographic and clinical covariates. Associations between asthma status, high biomarkers and airflow obstruction were restricted to adults ≥ 18 years without emphysema (<i>N</i> = 12,575). Airflow obstruction was defined as prebronchodilator FEV<sub>1</sub>/FVC below the lower limit of normal using the GLI-2012 reference values.</p><p>The average age in the study group was 36 years. This study group included 1584 participants with current asthma (8.6%). Compared to controls, participants with current asthma were generally younger (32.7 years), had higher BMI (28.1 ± 8.7 kg/m<sup>2</sup>) and 56.2% were female. Reported use of oral and inhaled corticosteroids in asthmatics amounted to 3.6% and 21.8%, respectively (of which 12.8% reported use of ICS/LABA inhaler). Overall asthma prevalence increased from 5.9% in participants with normal FeNO and BEC < 150/μL to 31.7% in those with high FeNO and BEC > 500/μL (Figure 1A). In each of the three FeNO categories, asthma prevalence increased gradually according to increasing BEC levels (5.9% to 13% in the case of low FeNO, 8.8% to 23.6% in intermediate FeNO and 4.4% to 31.7% in participants with high FeNO).</p><p>Compared to individuals with low BEC and FeNO, moderate increases in BEC (150–300/μL) were associated with 1.3- to 3.2-fold higher o
哮喘的诊断通常以四个关键特征为中心:可变呼吸道症状、慢性气道炎症、气道高反应性和可变呼气气流限制[1-3]。然而,在初级保健中,支气管扩张剂可逆性(BDR)存在于20%的(轻度至中度)哮喘病例中,限制了其诊断价值。最近的指南已转向2型(T2)生物标志物。2022年ERS指南支持在肺活量测量正常或BDR缺失时,用50ppb的FeNO来确诊哮喘,而只推荐用血嗜酸性粒细胞计数(BEC)来诊断[1]表型。2020年NAEPP指南同样认可FeNO作为辅助测试,但不认可BEC[5]。相比之下,2024年BTS/SIGN/NICE指南建议将FeNO (50 ppb)或升高的BEC作为一线诊断检测,取消了肺量测定[2]的要求。全球哮喘倡议(GINA)建议使用FeNO和BEC主要用于哮喘表型[3]。我们使用美国NHANES 2007-2012数据,对这种生物标志物优先的方法作为普通人群哮喘的潜在筛查工具进行了评估,这些数据来自18319名参与者(6-80岁)的FeNO和BEC测量以及哮喘状态(自我报告的医生诊断的当前哮喘)。用NIOX MINO (NIOX MINO, Aerocrine, Stockholm, Sweden)测定FeNO。FeNO被定义为正常(6-18岁儿童和青少年20 ppb /成人25 ppb)、中等(20 - 35/25 - 50 ppb)和高(≥35/≥50 ppb)。使用多变量回归对人口统计学和临床协变量进行调整,评估与哮喘状态的关联。哮喘状态、高生物标志物和气流阻塞之间的关联仅限于≥18岁无肺气肿的成年人(N = 12575)。采用GLI-2012参考值将支气管扩张前FEV1/FVC低于正常下限定义为气流阻塞。研究小组的平均年龄为36岁。该研究组包括1584名哮喘患者(8.6%)。与对照组相比,目前患有哮喘的参与者通常更年轻(32.7岁),BMI更高(28.1±8.7 kg/m2), 56.2%为女性。报告使用口服和吸入皮质类固醇的哮喘患者分别占3.6%和21.8%(其中12.8%报告使用ICS/LABA吸入器)。总体哮喘患病率从FeNO和BEC 150/μL正常的5.9%增加到FeNO和BEC 500/μL高的31.7%(图1A)。在三种FeNO类别中,哮喘患病率随着BEC水平的增加而逐渐增加(低FeNO组为5.9%至13%,中等FeNO组为8.8%至23.6%,高FeNO组为4.4%至31.7%)。与低BEC和FeNO的个体相比,BEC中度升高(150-300 /μL)与当前哮喘的几率增加1.3- 3.2倍相关,这取决于FeNO水平。在BEC和FeNO最高的人群中,发现哮喘的几率高出3.7倍和7.1倍(在线补充)。使用FeNO 50 ppb和/或BEC 300 cells/μL的截断值,我们发现生物标志物阳性个体、哮喘诊断个体和气流阻塞个体之间存在异质性(图1B)。存在一个独特的亚组:没有正式哮喘诊断但生物标志物升高的个体,在某些情况下,并存气流阻塞。BEC≤300 ~ 500/μL、FeNO≤500/μL的非哮喘患者与FeNO≤300/μL的非哮喘患者相比,FEV1%的预测值明显低于FeNO≤300/μL的非哮喘患者。在这项基于人群的大型研究中,我们证明,在普通人群中,较高水平的FeNO和BEC始终与哮喘患病率增加有关。也许最引人注目的是,超过三分之二的FeNO高和BEC高于500/μL的人没有被诊断为哮喘,这可能表明(T2-)哮喘的诊断不足。为了支持这一假设,我们确定了一个没有哮喘诊断但T2生物标志物升高和气流阻塞的参与者亚组,发现没有哮喘和高T2生物标志物的参与者与没有哮喘但低T2生物标志物的参与者相比,FEV1显著降低。这些发现支持在普通人群中使用T2生物标志物FeNO和BEC筛查成人(T2高)哮喘。虽然T2生物标志物在初级保健中可能比用BDR进行肺活量测定更容易,但单独使用FeNO和/或BEC可能导致哮喘的过度诊断。在高测试前可能性人群中的诊断准确性研究先前表明,FeNO和BEC bbb的诊断准确性中等。因此,应建议临床医生将FeNO和BEC升高与客观肺功能检测(例如: (如BDR的肺活量测定或支气管挑战),并对可能不存在T2生物标志物升高的替代诊断或哮喘表型保持警惕[7,8]。NHANES研究的优势包括其大规模代表性设置,系统收集问卷,肺活量测定,FeNO测量和BEC。我们使用的NHANES数据是十多年前收集的,当时诊断哮喘算法尚未推荐FeNO或BEC测量,这为我们提供了在没有诊断偏差的情况下研究这些T2生物标志物的诊断效用的机会。本研究的局限性包括:医生诊断的哮喘的自我报告性质,这可能导致回忆性哮喘、错误分类和过度或不足诊断;缺乏过敏测试,以及临床相关结果(哮喘发作,因哮喘就诊)仅收集那些被诊断为哮喘的患者。总之,我们的分析强调了T2生物标志物FeNO和BEC作为普通人群中T2哮喘的首选筛查工具的潜力,可以更快地发现未确诊的哮喘患者。然而,在诊断途径中孤立地预先使用这些生物标志物可能导致哮喘的过度诊断,并且无法识别所有哮喘病例(例如,t2 -低哮喘)。研究概念与设计:g.g.b., A.M.;数据管理:s.r., A.M.;数据分析:S.R.;数据解释:s.r., a.m., G.G.B.;原稿:S.R.;审稿编辑:a.m., G.G.B.;srb声明:NHANES已获得NCHS研究伦理审查委员会(https://wwwn.cdc.gov/Nchs/Nhanes/)的批准,NCHS ERB协议号为2007-2008和2009-2010的NHANES编号为# 2005-06,NHANES 2011-2012的协议号为# 2011-17。所有参与者均获得了书面知情同意。报告阿斯利康、葛兰素史克和赛诺菲在提交的工作之外的会议支持;A.M.报告了Chiesi的顾问委员会费用、勃林格殷格翰的酬金以及NIOX和赛默飞世尔科学公司对研究者发起的研究的支持;G.G.B.报道了来自阿斯利康、勃林格殷格翰、奇耶西、葛兰素史克、默克夏普、诺华和赛诺菲再生龙的荣誉。除敏感数据类型外,NHANES数据可在https://wwwn.cdc.gov/Nchs/Nhanes/上公开获取。在Zenodo上可以在以下存储库中获得额外的在线补充:https://doi.org/10.5281/zenodo.17276627。
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引用次数: 0
Reassessing the Relationship Between Exhaled Nitric Oxide and Acute Bronchodilation in Asthma Patients 哮喘患者呼出一氧化氮与急性支气管扩张关系的再评估。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-10-21 DOI: 10.1111/cea.70156
Martin Färdig, Alain Michils, Renaud Louis, Mare Sabbe, Alain Van Muylem, Florence Schleich, Andrei Malinovschi
<p>Fractional exhaled nitric oxide (Fe<sub>NO</sub>) is an established marker of type-2 airway inflammation valuable in asthma management [<span>1</span>]. However, non-inflammatory factors, such as changes in airway calibre, may also influence Fe<sub>NO</sub> levels. Airway narrowing reduces Fe<sub>NO</sub> levels, likely due to reduced epithelial surface area limiting the NO diffusion from the airway lining into the lumen [<span>2</span>]. This effect may even be more pronounced when peripheral airways are involved, as the majority of NO is produced in the conductive airways [<span>3</span>]. By studying the dynamics of Fe<sub>NO</sub> from pre-bronchodilator (BD) to post-BD, Michils et al. previously identified three distinct post-BD Fe<sub>NO</sub> profiles in asthma: a change ≤ ±10% (Fe<sub>NO</sub> =), an increase > +10% (Fe<sub>NO</sub>+) and a decrease exceeding > −10% (Fe<sub>NO</sub>–), suggesting that Fe<sub>NO</sub> may help locate the site of airway obstruction [<span>4</span>].</p><p>Therefore, in a larger population of unselected asthmatics with stricter BD-withhold, we studied whether the post-BD Fe<sub>NO</sub> =, Fe<sub>NO</sub>+ and Fe<sub>NO</sub>– profiles could be confirmed, and secondly, if they could be associated with clinical features.</p><p>This cross-sectional analysis included 236 asthmatics (63% females), aged 14–83 years, from the asthma clinic of Liège University Hospital (Belgium). Fe<sub>NO</sub> and dynamic spirometry were performed according to current international guidelines, measured sequentially, both before and 15 min after the inhalation of BD (400 μg of salbutamol), using the NIOX Vero equipment. Only patients scheduled for bronchial provocation tests were instructed to discontinue short-acting (SABA) and long-acting β2-agonists (LABA) for 8–24 h. Informed written consent was collected from all participants at enrolment.</p><p>Continuous and dichotomized variables were compared across the Fe<sub>NO</sub> profiles using the Kruskal–Wallis and the Chi<sup>2</sup> tests (Stata/IC 16.1). Statistical significance level was set at a <i>p</i>-value < 0.05.</p><p>The median (Q1, Q3) pre- and post-BD Fe<sub>NO</sub> levels (parts per billion) were 20.0 (13.0, 36.5) and 20.5 (12.0, 36.5) (<i>n</i> = 236), respectively (<i>p</i> = 0.079) (Online Repository 1). While only 107 (63.1%) withheld BD use prior to the test, pre- (19.0 [14.0, 34.0] vs. 22.0 [13.0, 40.0], <i>p</i> = 0.545) and post-BD Fe<sub>NO</sub> levels (19.0 [13.0, 34.0] vs. 21.0 [12.0, 41.0], <i>p</i> = 0.686) were similar across participants with and without prior BD use. In relation to pre- and post-BD Fe<sub>NO</sub> levels, 96 (40.7%) had a change ≤ −10% and ≤ +10% (Fe<sub>NO</sub> =) (22.0 [15.0, 42.0] vs. 21.0 [14.5, 41.5], <i>p</i> = 0.470), 73 (30.9%) an increase > +10% (Fe<sub>NO</sub>+) (19.0 [11.0, 43.0] vs. 28.0 [16.0, 50.0], <i>p</i> < 0.001) and 67 (28.4%) a decrease > −10% (Fe<sub>NO</sub>–) (18.0 [13.0, 27.0] vs. 14.0
呼气一氧化氮分数(FeNO)是2型气道炎症的一种确定的标志物,在哮喘管理中具有重要价值。然而,非炎症因素,如气道口径的改变,也可能影响FeNO水平。气道狭窄降低了一氧化氮水平,可能是由于上皮表面积的减少限制了一氧化氮从气道内壁扩散到管腔[2]。当周围气道受到影响时,这种影响甚至可能更加明显,因为大多数一氧化氮是在导电气道中产生的。Michils等通过研究支气管扩张剂(BD)前至BD后FeNO的动态变化,先前确定了哮喘患者在BD后FeNO的三种不同特征:变化≤±10% (FeNO =),增加+10% (FeNO+)和减少超过+ gt; - 10% (FeNO -),提示FeNO可能有助于定位气道阻塞部位[4]。因此,在更大的未选择的bd -保留更严格的哮喘人群中,我们研究了bd后FeNO =、FeNO+和FeNO -谱是否可以被证实,其次,它们是否与临床特征相关。横断面分析包括236例哮喘患者(63%为女性),年龄14-83岁,来自比利时li<e:1>大学医院哮喘门诊。采用NIOX Vero仪器,在吸入BD (400 μg沙丁胺醇)前和吸入15 min后,按照现行国际指南进行FeNO和动态肺活量测定。只有计划进行支气管激发试验的患者被指示停用短效(SABA)和长效β2激动剂(LABA) 8-24小时。在入组时收集所有参与者的知情书面同意。使用Kruskal-Wallis和Chi2检验(Stata/IC 16.1)比较连续变量和二分类变量在FeNO剖面上的差异。p值为&lt; 0.05。bd前后FeNO水平(十亿分之一)的中位数(Q1, Q3)分别为20.0(13.0,36.5)和20.5 (12.0,36.5)(n = 236) (p = 0.079) (Online Repository 1)。虽然只有107人(63.1%)在测试前拒绝使用BD,但在有和没有使用BD的参与者中,术前(19.0 [14.0,34.0]vs. 22.0 [13.0, 40.0], p = 0.545)和术后FeNO水平(19.0 [13.0,34.0]vs. 21.0 [12.0, 41.0], p = 0.686)相似。与bd前后的FeNO水平相比,96例(40.7%)FeNO变化≤- 10%和≤+10% (FeNO =) (22.0 [15.0, 42.0] vs. 21.0 [14.5, 41.5], p = 0.470), 73例(30.9%)FeNO增加&gt; +10% (FeNO+) (19.0 [11.0, 43.0] vs. 28.0 [16.0, 50.0], p &lt; 0.001), 67例(28.4%)FeNO - (18.0 [13.0, 27.0] vs. 14.0 [9.00, 22.0], p &lt; 0.001) (Online Repository 2)。当比较FeNO =、FeNO+和FeNO -谱时,既往使用BD的患者比例相似。在肺活量方面,三组间第一秒用力呼气量(FEV1)和FEV1/用力肺活量(FVC)均无差异。相应地,背景特征、疾病控制、生物标志物水平和药物使用相似。然而,与FeNO=和FeNO+型相比,FeNO -型的SABA处理程度较低。同样,LABA和吸入性皮质类固醇(ICS)在相同的FeNO患者中也不常见;但无统计学意义(表1)。同样,在既往使用BD的参与者(n = 129)中,BD前FEV1预测值为80% (n = 126), BD后FEV1阳性变化为5% (n = 115),目前不吸烟者(n = 200), SABA, LABA和/或长效毒碱激动剂(LAMA)治疗在FeNO - profile中较少见(Online Repository 3-9)。我们的第一个发现是证实了双相障碍后哮喘患者的FeNO =、FeNO+和FeNO -谱,并且这些模式与先前是否使用双相障碍无关。其次,FeNO -型患者较少接受哮喘药物治疗。我们的研究结果与先前的研究一致,即BD前后的FeNO没有显著差异,BD对FeNO的影响较小或没有影响[4-6]。然而,发现了三种不同的bd后FeNO谱,与Michils等人(n = 67)和Demey等人(n = 30)的论文一致。然而,我们的研究人群更大,总体上表现出更好的疾病控制,保留了肺功能,阻塞较少,对BD的反应较小,从而贡献了新的知识。基于通气分布试验和理论模型,Michils等人认为这些特征可能可以通过阻塞缓解部位来解释:分别是中央(FeNO =)、腺泡前(FeNO+)和腺泡内(FeNO -)气道。由于没有这样的测量,我们只能在这方面进行推测。尽管FeNO患者的临床特征总体上是相似的,但在FeNO -患者中,SABA的使用并不常见。在同一档案中,LABA和ICS的使用往往不太常见,但没有统计学意义。 这可能表明该组症状较少,因此用药较少,或者较低的治疗程度可能与更多的腺泡内气道阻塞有关。依赖于bd后正常受试者的可变性,用于定义FeNO谱的潜在任意阈值(±10%)可能是一个限制。然而,在一次重新测试中,Michils等人报告了可接受的可重复性,一个独立的研究小组最近证实了这些截断值与成人哮喘(n = 92)小气道功能障碍的关系。没有进行通风分布试验,这是主要的限制。然而,本研究的主要目的不是验证不同的FeNO行为的意义,因为我们已经在其他三个研究中这样做了;COPD和哮喘患者[4,7,9]。在一个相对较小的、均匀的、单中心的、控制良好的哮喘患者样本中,只有63.1%的人在测试前拒绝使用双相激素,我们的研究结果的普遍性仅限于相似的人群,总体上影响了我们研究结果的可靠性。基于一个更大且完全独立的哮喘患者队列,本研究证实了先前描述的三种不同的双相障碍后FeNO特征。这些特征似乎与先前的BD使用无关,可能反映气道阻塞的程度和/或阻塞缓解的部位。虽然这些模式的临床特征没有明显差异,但我们首先描述了FeNO -谱与支气管扩张剂使用频率低有关,表明哮喘表型较轻或治疗不足。因此,评估双相障碍前后的FeNO可能有助于了解哮喘疾病负担,并在理论上有助于确定气道阻塞的位置。因此,FeNO可能在哮喘控制和/或治疗评估的临床评估中被证明是有用的。然而,目前的研究还很有限,需要进一步的研究来确定其临床意义和临床应用潜力。马丁Färdig对研究的概念和设计、数据管理、数据分析和解释、手稿写作和编辑做出了贡献。Alain Michils, Renaud Louis, Mare Sabbe, Alain Van Muylem和Florence Schleich对研究的构思和设计,数据收集,数据解释和批判性地修改手稿做出了贡献。Andrei Malinovschi对研究的构思和设计、数据管理、数据解释做出了贡献,并对手稿进行了严格的修改。所有列出的作者在提交前都批准了手稿的最终版本,并同意对工作的各个方面负责。该研究是根据《赫尔辛基宣言》的指导方针进行的,并于2018年12月12日获得了Erasme大学医院伦理委员会(P2018/481)的多中心批准,并于2018年12月4日获得了lifranchge大学医院伦理委员
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引用次数: 0
Unsupervised Machine Learning Identifies Asthma Phenotypes in the Population-Based West Sweden Asthma Study 在基于人群的西瑞典哮喘研究中,无监督机器学习识别哮喘表型。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-10-15 DOI: 10.1111/cea.70161
Muwada Bashir Awad Bashir, Daniil Lisik, Saliha Selin Ozuygur Ermis, Rani Basna, Reshed Abohalaka, Selin Ercan, Helena Backman, Teet Pullerits, Roxana Mincheva, Göran Wennergren, Madeleine Rådinger, Jan Lötvall, Linda Ekerljung, Hannu Kankaanranta, Bright I. Nwaru
<p>Asthma is a heterogeneous disease, and a clear-cut characterisation of its phenotypes has historically been daunting for both clinical practice and research purposes [<span>1</span>]. Asthma phenotypes have been defined primarily based on clinical experience [<span>2</span>]. Computational science is helping to elucidate biological processes, with ongoing applications in asthma phenotyping [<span>3</span>]. In this context, clustering algorithms can learn from unlabeled data to produce distinct subgroups. This data-driven approach is believed to be less subjective and, with relevant input data, can produce clinically meaningful phenotypes [<span>4</span>]. Characterising asthma at a more granular level aligns with efforts towards precision medicine, potentially enabling improved and tailored management. By including a broad range of clinical, biological, and epidemiological parameters, we employed a machine learning approach to identify and describe asthma phenotypes in adults.</p><p>The study sample was derived from the West Sweden Asthma Study (WSAS), a longitudinal cohort study investigating different aspects of airway diseases among a representative sample of adults, which started in 2008 [<span>5</span>]. A total of 3101 individuals underwent clinical investigations, of which 1895 subjects who had ever had asthma were included in the current study. Asthma was defined as self-reported ever asthma. Age at onset was determined through the follow-up question “at what age did your asthma start?”. In total, 44 variables were selected, based on clinical experience and previous studies (see details at https://osf.io/ucrnt).</p><p>Missing data were imputed using multiple imputation with random forest. The phenotypes were derived using Deep Embedded Clustering, a novel approach that combines deep learning with clustering to discover patterns in complex data [<span>6</span>]. The R packages NbClust, Monte Carlo reference-based consensus clustering (M3C), and Adjusted Rand Index (ARI) were used to decide the optimal number of clusters based on consensus of 30 internal validation indices. The proposed numbers were evaluated in conjunction with clinical experience to determine the final optimal number of clusters (details at https://osf.io/ucrnt/). Continuous data were expressed as means and standard deviations (SD). Group comparisons were performed by one-way analysis of variance with the Tukey post hoc test or Kruskal–Wallis test, as appropriate, for continuous variables and the Chi-square for categorical variables (details at https://osf.io/ucrnt/).</p><p>Cluster 1 had the oldest average age at asthma onset (35 years), while cluster 4 had the youngest average age (13 years) (Figure 1). Cluster 1 also had the oldest average chronological age (65 years), highest average BMI (28.5 kg/m<sup>2</sup>), highest proportion of smokers and average pack-year history, most respiratory symptoms, but the lowest proportion of allergic sensitization and family hist
另一方面,早发轻度特应性哮喘表型(第4簇)可能代表了传统的儿童期哮喘,其特点是过敏致敏性高,哮喘控制较好,症状负担低。我们的数据表明,这种表型也可能具有最高的缓解率,因为根据最近的症状和药物使用定义,这种表型在患有当前哮喘的患者中所占比例最低,这表明尽管这种表型在儿童时期发展,但可能是短暂的。总之,在一个有代表性的哮喘成人样本中发现了四种临床相关的哮喘表型,通过哮喘发病年龄、严重程度、肺功能、症状模式和炎症来区分。这些表型为催化重要的哮喘研究提供了一个新的环境,包括免疫途径的详细分析,假设的危险因素建模,合并症/多病概况的特征,以及评估未来的临床结果。构思了这个研究的想法。M.B.A.B.在B.I.N. l.e.、g.w.、h.k.和R.B.的指导下处理数据、进行分析、起草手稿并设计图表。M.B.A.B.参与了数据处理和分析的实施。BN为研究和数据收集的设计和实施做出了贡献。所有作者都讨论了结果,并为最终稿件做出了贡献。本研究由B.I.N.和h.k.监督,并由瑞典哥德堡地区伦理审查委员会批准。伦理批准号034-08 906-16 593-08和052-16。所有参与者在参与研究前均给予书面同意。报告了来自阿斯利康、勃林格殷格翰、基耶西、科维斯制药、葛兰素史克、Medscape、默沙明、诺华、Orion制药和赛诺菲的讲座和咨询的个人费用。所有其他作者声明与当前工作没有利益冲突。由于与研究参与者的协议和治理限制,研究数据不能公开共享。
{"title":"Unsupervised Machine Learning Identifies Asthma Phenotypes in the Population-Based West Sweden Asthma Study","authors":"Muwada Bashir Awad Bashir,&nbsp;Daniil Lisik,&nbsp;Saliha Selin Ozuygur Ermis,&nbsp;Rani Basna,&nbsp;Reshed Abohalaka,&nbsp;Selin Ercan,&nbsp;Helena Backman,&nbsp;Teet Pullerits,&nbsp;Roxana Mincheva,&nbsp;Göran Wennergren,&nbsp;Madeleine Rådinger,&nbsp;Jan Lötvall,&nbsp;Linda Ekerljung,&nbsp;Hannu Kankaanranta,&nbsp;Bright I. Nwaru","doi":"10.1111/cea.70161","DOIUrl":"10.1111/cea.70161","url":null,"abstract":"&lt;p&gt;Asthma is a heterogeneous disease, and a clear-cut characterisation of its phenotypes has historically been daunting for both clinical practice and research purposes [&lt;span&gt;1&lt;/span&gt;]. Asthma phenotypes have been defined primarily based on clinical experience [&lt;span&gt;2&lt;/span&gt;]. Computational science is helping to elucidate biological processes, with ongoing applications in asthma phenotyping [&lt;span&gt;3&lt;/span&gt;]. In this context, clustering algorithms can learn from unlabeled data to produce distinct subgroups. This data-driven approach is believed to be less subjective and, with relevant input data, can produce clinically meaningful phenotypes [&lt;span&gt;4&lt;/span&gt;]. Characterising asthma at a more granular level aligns with efforts towards precision medicine, potentially enabling improved and tailored management. By including a broad range of clinical, biological, and epidemiological parameters, we employed a machine learning approach to identify and describe asthma phenotypes in adults.&lt;/p&gt;&lt;p&gt;The study sample was derived from the West Sweden Asthma Study (WSAS), a longitudinal cohort study investigating different aspects of airway diseases among a representative sample of adults, which started in 2008 [&lt;span&gt;5&lt;/span&gt;]. A total of 3101 individuals underwent clinical investigations, of which 1895 subjects who had ever had asthma were included in the current study. Asthma was defined as self-reported ever asthma. Age at onset was determined through the follow-up question “at what age did your asthma start?”. In total, 44 variables were selected, based on clinical experience and previous studies (see details at https://osf.io/ucrnt).&lt;/p&gt;&lt;p&gt;Missing data were imputed using multiple imputation with random forest. The phenotypes were derived using Deep Embedded Clustering, a novel approach that combines deep learning with clustering to discover patterns in complex data [&lt;span&gt;6&lt;/span&gt;]. The R packages NbClust, Monte Carlo reference-based consensus clustering (M3C), and Adjusted Rand Index (ARI) were used to decide the optimal number of clusters based on consensus of 30 internal validation indices. The proposed numbers were evaluated in conjunction with clinical experience to determine the final optimal number of clusters (details at https://osf.io/ucrnt/). Continuous data were expressed as means and standard deviations (SD). Group comparisons were performed by one-way analysis of variance with the Tukey post hoc test or Kruskal–Wallis test, as appropriate, for continuous variables and the Chi-square for categorical variables (details at https://osf.io/ucrnt/).&lt;/p&gt;&lt;p&gt;Cluster 1 had the oldest average age at asthma onset (35 years), while cluster 4 had the youngest average age (13 years) (Figure 1). Cluster 1 also had the oldest average chronological age (65 years), highest average BMI (28.5 kg/m&lt;sup&gt;2&lt;/sup&gt;), highest proportion of smokers and average pack-year history, most respiratory symptoms, but the lowest proportion of allergic sensitization and family hist","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"56 2","pages":"170-172"},"PeriodicalIF":5.2,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12879267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291368","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
Longitudinal Blood Transcriptome Analysis Reveals Dynamic Gene Expression Patterns in Patients With Allergic Rhinitis Following House Dust Mite Subcutaneous Immunotherapy. 纵向血液转录组分析揭示了屋尘螨皮下免疫治疗后变应性鼻炎患者的动态基因表达模式。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-10-14 DOI: 10.1111/cea.70158
Chang Liu, Shikun He, Jinxiu Zhang, Jincai Zhu, Jianxia Rao, Kanghua Wang, Yunping Fan, Yueqi Sun

Introduction: Subcutaneous immunotherapy (SCIT) is a well-established treatment for inducing immune tolerance in patients with allergic rhinitis (AR). However, the precise molecular mechanisms by which SCIT induces immune tolerance, particularly at the transcriptomic level over the treatment course, have not been fully elucidated. This study aimed to investigate the molecular mechanisms of SCIT by analysing changes in peripheral blood gene expression profiles in AR patients over time.

Methods: Whole blood samples were prospectively collected from 30 AR patients (16 paediatric, 14 adult) and 10 healthy controls. RNA sequencing was performed at baseline and at 3, 6 and 12 months of SCIT. Differentially expressed genes (DEGs) were identified, and pathway enrichment, immune cell deconvolution and weighted gene co-expression network analysis were conducted to explore immune regulation and tolerance mechanisms.

Results: AR patients showed 1180 DEGs compared to healthy controls, with upregulated genes related to B-cell activation and downregulated genes linked to Th1 differentiation. Both paediatric and adult cohorts exhibited consistent transcriptomic changes, characterised by progressive normalisation of gene expression, with the number of DEGs decreasing over time and significant convergence towards healthy control profiles by 12 months. SCIT enhanced type I interferon responses and antiviral pathways while reducing B-cell activation and inflammatory responses. Immune cell analysis revealed increased regulatory T cells and dendritic cells by 6 months and reduced Th2 cells and eosinophils by 12 months. Key immune-related hub genes, including CD19, CD79A, CD79B, CD22, IFIH1, STAT1, DHX58, TLR4, IL1B and TLR1, were identified as central to SCIT efficacy.

Conclusion: SCIT dynamically modulates blood gene expression profiles in AR patients, inducing immune tolerance and reducing inflammatory responses. These findings enhance understanding of the molecular mechanisms of SCIT and highlight potential biomarkers for predicting and monitoring treatment efficacy.

简介:皮下免疫治疗(SCIT)是一种成熟的治疗方法,用于诱导过敏性鼻炎(AR)患者的免疫耐受。然而,SCIT诱导免疫耐受的精确分子机制,特别是在治疗过程中的转录组水平,尚未完全阐明。本研究旨在通过分析AR患者外周血基因表达谱随时间的变化来探讨SCIT的分子机制。方法:前瞻性采集30例AR患者(16例儿童,14例成人)和10例健康对照者的全血样本。RNA测序在基线和3、6、12个月时进行。鉴定差异表达基因(differential expression genes, DEGs),通过途径富集、免疫细胞反褶积和加权基因共表达网络分析,探索免疫调控和耐受机制。结果:与健康对照组相比,AR患者的温度为1180度,与b细胞活化相关的基因上调,与Th1分化相关的基因下调。儿童和成人队列均表现出一致的转录组变化,其特征是基因表达逐渐正常化,deg数量随着时间的推移而减少,并在12个月时向健康对照特征显著趋同。sciit增强I型干扰素反应和抗病毒途径,同时减少b细胞活化和炎症反应。免疫细胞分析显示调节性T细胞和树突状细胞增加了6个月,Th2细胞和嗜酸性粒细胞减少了12个月。关键的免疫相关中枢基因,包括CD19、CD79A、CD79B、CD22、IFIH1、STAT1、DHX58、TLR4、IL1B和TLR1,被确定为SCIT疗效的核心。结论:SCIT动态调节AR患者血液基因表达谱,诱导免疫耐受,减少炎症反应。这些发现加强了对SCIT分子机制的理解,并突出了预测和监测治疗效果的潜在生物标志物。
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引用次数: 0
Adherence to Grass Pollen Allergen Immunotherapy and Allergy Medication Use in Patients With Allergic Rhinitis 草花粉过敏原免疫治疗和过敏药物在变应性鼻炎患者中的应用。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-10-13 DOI: 10.1111/cea.70159
Morten Borg, Ole Hilberg, Rikke Ibsen, Anders Løkke
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引用次数: 0
Direct and Indirect Pathways Between Patient, Health System and Socioeconomic Factors and Medication Adherence in Asthma 哮喘患者、卫生系统和社会经济因素与药物依从性之间的直接和间接途径。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-10-13 DOI: 10.1111/cea.70160
Tunn Ren Tay, Mon Hnin Tun, Sudev Suthendran, Nicole Yu-Fang Sieow, Yan Cao, Soyah Binti Mohamed Noor, Hui Ye, Haijuan Chen, Xiao Ling Li, Norlidah Binte Mohd Noor, Nuraini Binte Mohamed Razali, Chee Wei Tan, Choon How How
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引用次数: 0
Intestinal Fibroblasts Orchestrate IL-4-Driven Th2 Polarisation in Food Allergy via Paracrine Signalling and Nanotherapeutic Targeting 肠道成纤维细胞通过旁分泌信号和纳米靶向治疗介导食物过敏中il -4驱动的Th2极化。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-10-13 DOI: 10.1111/cea.70157
Botang Guo, Hanqing Zhang, Yong Yu, Yang Mi, Pengyuan Zheng, Ping Tang, Pingchang Yang, Minyao Li
{"title":"Intestinal Fibroblasts Orchestrate IL-4-Driven Th2 Polarisation in Food Allergy via Paracrine Signalling and Nanotherapeutic Targeting","authors":"Botang Guo,&nbsp;Hanqing Zhang,&nbsp;Yong Yu,&nbsp;Yang Mi,&nbsp;Pengyuan Zheng,&nbsp;Ping Tang,&nbsp;Pingchang Yang,&nbsp;Minyao Li","doi":"10.1111/cea.70157","DOIUrl":"10.1111/cea.70157","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 12","pages":"1272-1275"},"PeriodicalIF":5.2,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279037","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}
引用次数: 0
Featured Cover 了封面
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-10-12 DOI: 10.1111/cea.70147
T. T. Ma, C. E. Fan, X. Tong, C. Y. An, H. J. Cai, L. Y. Ai, Y. F. Li, D. Y. Wang, X. D. Wang, G. L. Shang, Y. D. Hu, Y. F. Bai, Y. L. Chen, H. T. Wang, H. Y. Ning, L. Zhang, J. J. Zhang, X. Y. Wang

The cover image is based on the article Epidemiology, Diagnosis and Prevention of Allergic Rhinitis in High-Pollen Areas of Northern China by T. T. Ma et al., https://doi.org/10.1111/cea.70087.

封面图片基于t.t. Ma et al., https://doi.org/10.1111/cea.70087的文章《中国北方高花粉地区变应性鼻炎的流行病学、诊断和预防》。
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引用次数: 0
期刊
Clinical and Experimental Allergy
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