Clinical and Translational Allergy最新文献_第9页

Requalification of patients with severe asthma for biological therapy—Practical ‘ReQuaBi’ rate decision scheme based on the analytical model 重度哮喘患者生物治疗的再认证——基于分析模型的实用“ReQuaBi”率决策方案

IF 4.6 2区医学 Q2 ALLERGY

Clinical and Translational Allergy

Pub Date : 2025-05-09 DOI: 10.1002/clt2.70059

Alicja Majos, Anna Ben Drissi, Maciej Kupczyk, Michał Panek

Background

Patients with severe asthma experience decreased quality of life due to fixed airway obstruction, hospitalisations and potential fatalities. However, to date, the requalification of severe asthma patients eligible for biological therapy in daily clinical practice remains unstudied.

Objective

The aim of the study was to prepare a universal decision-making algorithm for requalifying patients for biological therapy based on available clinical data obtained from a leading reference centre in Poland.

Methods

All severe asthma patients treated with biologics since 2013 at the Internal Medicine, Asthma and Allergy Department (Medical University of Lodz, Poland), were analysed. The analysis included demographic (age, sex), pre-treatment (reported at qualification: oral glucocorticosteroids use, total IgE serum level, peripheral blood eosinophilia, co-morbidities: atopic dermatitis, chronic allergic rhinitis or sinusitis) and treatment-related data (treatment time, current treatment status, reason for early termination of therapy, year of discontinuation, rediagnostics, requalification).

Results

Rediagnostics were performed in only 4.76% of all requalifications. The following additional data were used to requalify patients: blood eosinophilia (n = 63; 100.00% of requalifications), atopic comorbidities (n = 30; 47.62%) and total IgE serum level (n = 8; 12.70%). Kaplan–Meier curve analysis of all source data revealed the longevity of maintenance as follows: the highest for mepolizumab, then omalizumab, benralizumab, dupilumab and tezepelumab (p = 0.016). Based on the results, requalification model ‘ReQuaBi’, was constructed.

Conclusion

The most important criteria for selecting a biological agent in requalification are peripheral blood eosinophilia, followed by comorbidities and IgE levels. In most cases, extensive additional re-diagnosis may not be necessary.

背景：严重哮喘患者由于固定气道阻塞、住院和潜在的死亡而经历生活质量下降。然而，迄今为止，重症哮喘患者在日常临床实践中是否有资格接受生物治疗仍未得到研究。该研究的目的是根据波兰一家领先参考中心获得的现有临床数据，为重新确定患者接受生物治疗的资格准备一种通用决策算法。方法对2013年以来波兰罗兹医科大学（Lodz Medical University of Lodz）哮喘与过敏内科所有使用生物制剂治疗的重症哮喘患者进行分析。分析包括人口统计学（年龄、性别）、治疗前（确认时报告：口服糖皮质激素使用、血清总IgE水平、外周血嗜酸性粒细胞增加、合并症：特应性皮炎、慢性变应性鼻炎或鼻窦炎）和治疗相关数据（治疗时间、当前治疗状态、早期终止治疗的原因、停药年份、重新诊断、重新确认）。结果再诊断率仅为4.76%。以下附加数据用于重新评估患者：血嗜酸性粒细胞增多(n = 63；100.00%)，特应性合并症(n = 30；47.62%)和血清总IgE水平(n = 8；12.70%)。Kaplan-Meier曲线分析显示，mepolizumab的维持寿命最高，其次是omalizumab、benralizumab、dupilumab和tezepelumab （p = 0.016）。在此基础上，构建了再认证模型“ReQuaBi”。结论在再鉴定中选择生物制剂最重要的标准是外周血嗜酸性粒细胞增多，其次是合并症和IgE水平。在大多数情况下，可能不需要广泛的额外重新诊断。

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引用次数: 0

T cell immunophenotypes and IgE responses in patients with moderate-to-severe atopic dermatitis receiving dupilumab 接受dupilumab治疗的中重度特应性皮炎患者的T细胞免疫表型和IgE反应

IF 4.6 2区医学 Q2 ALLERGY

Clinical and Translational Allergy

Pub Date : 2025-05-08 DOI: 10.1002/clt2.70062

Davender Redhu, Wojciech Francuzik, Philipp Globig, Margitta Worm

Background

Targeting the interleukin-4 receptor alpha (IL-4Rα) subunit has proven clinical efficacy in atopic dermatitis (AD).

Objective

This study assessed the peripheral phenotype and function of T-cells, but also levels of total and sIgE and its receptors in AD patients receiving dupilumab.

Methods

AD patients were clinically assessed (n = 75) and peripheral blood samples were taken (n = 25). Multiparametric flow cytometry was performed to characterize T-cell subsets (before treatment and 6 months later). Total and specific IgE were measured by ImmunoCap, soluble CD23 and FcεR1 in serum by ELISA, and eosinophils by differential blood analysis.

Results

SCORing Atopic Dermatitis scores and body surface area involvement decreased upon treatment after 6 months of treatment to 67% and 77% from baseline. At the T cell level, we observed a 0.55-fold reduction of Th2-cells and a mean 27% increase in regulatory T-cells from baseline, accompanied by shifts towards Th1 and Th17 phenotypes. Furthermore, circulating CD4⁺CXCR5⁺TFH17 and CD4⁺CXCR5⁺TFH17.1 positive cells (mean 40% and 42%) and T-cell-specific IL-2 (+0.96-fold) and IL-10 (+1.96-fold) secretion increased, whereas IL-4 (mean −55%) and IL-17A (mean −27%) were reduced. Eosinophil counts (mean −22%), total IgE (mean −47%) and House Dust Mite sIgE (mean −40%) decreased, whereas CD23 and FcεR1 remained unchanged.

Conclusions

The T-cell and cytokine profiles during anti-IL4-Ra treatment suggest that targeting this pathway promotes a systemic shift of the T-cell compartment by reducing the T helper type 2 and complementary IgE responses. The sustainability of these disease-modifying effects requires further investigation.

靶向白介素-4受体α (IL-4Rα)亚基治疗特应性皮炎（AD）的临床疗效已得到证实。目的本研究评估接受dupilumab治疗的AD患者外周血t细胞的表型和功能，以及total和sIgE及其受体的水平。方法对75例AD患者进行临床评估，并采集25例外周血标本。多参数流式细胞术检测t细胞亚群特征（治疗前和6个月后）。免疫帽法检测总IgE和特异性IgE， ELISA法检测血清可溶性CD23和FcεR1，鉴别血法检测嗜酸性粒细胞。结果：治疗6个月后，特应性皮炎评分和体表受累分别下降至67%和77%。在T细胞水平上，我们观察到th2细胞减少了0.55倍，调节性T细胞从基线平均增加了27%，同时向Th1和Th17表型转移。此外，循环CD4+CXCR5+TFH17和CD4+CXCR5+TFH17.1阳性细胞（平均40%和42%）和t细胞特异性IL-2（+0.96倍）和IL-10（+1.96倍）分泌增加，而IL-4（平均- 55%）和IL-17A（平均- 27%）减少。嗜酸性粒细胞计数（平均- 22%）、总IgE（平均- 47%）和屋尘螨sIgE（平均- 40%）下降，而CD23和FcεR1保持不变。结论：在抗il4 - ra治疗过程中，T细胞和细胞因子谱表明，靶向这一途径可通过减少辅助性T- 2型和辅助性IgE反应促进T细胞室的全身性转移。这些疾病修饰作用的可持续性需要进一步调查。

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引用次数: 0

Non-genetic factors associated with ACE-inhibitor and angiotensin receptor blocker-induced angioedema 与ace抑制剂和血管紧张素受体阻滞剂诱导的血管性水肿相关的非遗传因素

IF 4.6 2区医学 Q2 ALLERGY

Clinical and Translational Allergy

Pub Date : 2025-05-07 DOI: 10.1002/clt2.70058

Diana Dubrall, Nora L. Branding, Carina M. Mathey, Anna M. Weber, Michael Steffens, Maike Below, Matthias Schmid, Bettina Wedi, Dorothea Wieczorek, Philipp M. Amann, Harald Löffler, Lukas Koch, Clemens Schöffl, Heinrich Dickel, Nomun Ganjuur, Thorsten Hornung, Timo Buhl, Emel Aygören-Pürsün, Gerda Wurpts, Jens Greve, Markus M. Nöthen, Andreas J. Forstner, Bernhardt Sachs

Background

Angioedema (AE) rarely occurs as a potentially life-threatening adverse drug reaction (ADR) to angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB). The aim of the present study was to investigate non-genetic association factors with ACEi-/ARB-induced angioedema in the European ADR database EudraVigilance and the database of the vARIANCE study.

Methods

The cohort of the vARIANCE study comprised 114 patients who suffered from ACEi- or ARB-induced angioedema. In addition, 171 angioedema reports and 4650 reports on other ADRs of ACEi/ARB were identified in the ADR database EudraVigilance with the latter serving as a reference group. Odds ratios were calculated and a logistic regression analysis was performed using angioedema versus reference reports.

Results

Increased age, smoking, allergies and a history of previous angioedema were identified as associated factors for ACEi-/ARB-induced angioedema. In most patients, the swelling affected the face, lips and tongue. In the vARIANCE study, about 70% of angioedema occurred after 1 year of treatment. For one in two patients in the vARIANCE study (84.2% with ACEi treatment) and one in three patients from the EudraVigilance reports (59.6% with ARB treatment), the angioedema resulted in hospitalization.

Conclusions

We found small to moderate associations with certain individual patient-related factors in this pharmaco-epidemiological study. As a future perspective, combining non-genetic association factors with corresponding genetic data might provide an option to compose stronger and individual risk scores.

血管水肿（AE）很少作为血管紧张素转换酶抑制剂（ACEi）或血管紧张素受体阻滞剂（ARB）的潜在危及生命的药物不良反应（ADR）发生。本研究的目的是在欧洲不良反应数据库EudraVigilance和方差研究数据库中调查与ACEi-/ arb诱导的血管性水肿相关的非遗传因素。方法方差研究的队列包括114例ACEi或arb诱导的血管性水肿患者。此外，在ADR数据库EudraVigilance中发现171例血管性水肿报告和4650例ACEi/ARB其他ADR报告，后者作为参照组。计算优势比，并将血管性水肿与参考报告进行logistic回归分析。结果年龄增加、吸烟、过敏和既往血管性水肿史被确定为ACEi-/ arb诱导血管性水肿的相关因素。在大多数患者中，肿胀影响到面部、嘴唇和舌头。在方差研究中，约70%的血管性水肿发生在治疗1年后。方差研究中有1 / 2的患者（ACEi治疗组为84.2%）和EudraVigilance报告中有1 / 3的患者（ARB治疗组为59.6%）因血管性水肿而住院。结论：在这项药物流行病学研究中，我们发现与某些个体患者相关因素有小到中等程度的关联。从未来的角度来看，将非遗传相关因素与相应的遗传数据相结合可能会提供一种选择，以组成更强的个体风险评分。

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引用次数: 0

Biological and target synthetic treatments for chronic spontaneous urticaria: A systematic review and network meta-analysis 慢性自发性荨麻疹的生物和靶向合成治疗：系统综述和网络荟萃分析

IF 4.6 2区医学 Q2 ALLERGY

Clinical and Translational Allergy

Pub Date : 2025-05-06 DOI: 10.1002/clt2.70052

Zuotao Zhao, Yaqi Zheng, Xiaoting Song, Chengyue Peng, Shuanglu Liao, Peixin Zhang, Yen Tan, Xiaojie Huang, Litao Zhang

Background

Most biological and synthetic target-specific drugs for antihistamine-refractory chronic spontaneous urticaria (CSU) have not been compared head-to-head. This systematic review and network meta-analysis evaluated their relative efficacy and safety.

Methods

Searches were conducted on PubMed, Embase, Web of Science and Cochrane library databases to March 25, 2024 for randomized trials. A random-effects model was used to calculate the network estimates reported as mean differences (MD) and odds ratios (OR) with corresponding 95% CIs. Main outcomes included the weekly urticaria activity score (UAS7), adverse events (AEs) and serious adverse events (SAEs).

Results

23 randomized clinical trials with 6933 participants that compared 26 different interventions or dosages and placebos were included. Omalizumab 300 mg [MD −10.07, 95% CI (−11.35; −8.82)] continues to demonstrate superior efficacy compared with placebo. Remibrutinib, at doses of 35 mg once daily [MD −7.80, 95% CI (−12.76; −2.51)], 25 mg twice daily [MD −7.69, 95% CI (−9.85; −5.76)], and 10 mg twice daily [MD −7.61, 95% CI (−12.59; −2.47)], had the best overall performance for efficacy and safety. Dupilumab, fenebrutinib, and rilzabrutinib also showed greater efficacy than placebo. The results were similar for the proportion of patients who achieved UAS7 ≤ 6 or UAS7 = 0. No significant differences were found among all treatment comparisons for AEs and SAEs.

Conclusion

The findings of this study indicate that the biological agent omalizumab 300 mg and the oral small molecule remibrutinib at doses of 35 mg, 25 mg, or 10 mg are recommended for patients with antihistamine-refractory CSU.

Trial Registration

PROSPERO: CRD42024516289

大多数生物和合成靶向性药物治疗抗组胺难治性慢性自发性荨麻疹（CSU）尚未进行比较。本系统综述和网络荟萃分析评估了它们的相对疗效和安全性。方法检索PubMed、Embase、Web of Science和Cochrane图书馆数据库至2024年3月25日进行随机试验。使用随机效应模型计算网络估计，报告为平均差异（MD）和比值比（OR），相应的ci为95%。主要结局包括每周荨麻疹活动度评分（UAS7）、不良事件（ae）和严重不良事件（sae）。结果纳入了23项随机临床试验，6933名参与者，比较了26种不同的干预措施或剂量和安慰剂。Omalizumab 300 mg [MD - 10.07, 95% CI (- 11.35；−8.82)]继续表现出优于安慰剂的疗效。Remibrutinib，剂量为35mg，每日1次[MD - 7.80, 95% CI (- 12.76；−2.51)],25 mg，每日2次[MD−7.69,95% CI(−9.85；−5.76)]，10 mg每日2次[MD−7.61,95% CI(−12.59；−2.47)]，在疗效和安全性方面的综合表现最佳。Dupilumab， fenebrutinib和rilzabrutinib也显示出比安慰剂更好的疗效。UAS7≤6或UAS7 = 0的患者比例结果相似。在ae和SAEs的所有治疗比较中没有发现显著差异。结论本研究结果表明，300mg生物制剂omalizumab和35mg、25mg或10mg口服小分子remibrutinib可推荐用于抗组胺难治性CSU患者。试验注册号：CRD42024516289

{"title":"Biological and target synthetic treatments for chronic spontaneous urticaria: A systematic review and network meta-analysis","authors":"Zuotao Zhao, Yaqi Zheng, Xiaoting Song, Chengyue Peng, Shuanglu Liao, Peixin Zhang, Yen Tan, Xiaojie Huang, Litao Zhang","doi":"10.1002/clt2.70052","DOIUrl":"https://doi.org/10.1002/clt2.70052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Most biological and synthetic target-specific drugs for antihistamine-refractory chronic spontaneous urticaria (CSU) have not been compared head-to-head. This systematic review and network meta-analysis evaluated their relative efficacy and safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Searches were conducted on PubMed, Embase, Web of Science and Cochrane library databases to March 25, 2024 for randomized trials. A random-effects model was used to calculate the network estimates reported as mean differences (MD) and odds ratios (OR) with corresponding 95% CIs. Main outcomes included the weekly urticaria activity score (UAS7), adverse events (AEs) and serious adverse events (SAEs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>23 randomized clinical trials with 6933 participants that compared 26 different interventions or dosages and placebos were included. Omalizumab 300 mg [MD −10.07, 95% CI (−11.35; −8.82)] continues to demonstrate superior efficacy compared with placebo. Remibrutinib, at doses of 35 mg once daily [MD −7.80, 95% CI (−12.76; −2.51)], 25 mg twice daily [MD −7.69, 95% CI (−9.85; −5.76)], and 10 mg twice daily [MD −7.61, 95% CI (−12.59; −2.47)], had the best overall performance for efficacy and safety. Dupilumab, fenebrutinib, and rilzabrutinib also showed greater efficacy than placebo. The results were similar for the proportion of patients who achieved UAS7 ≤ 6 or UAS7 = 0. No significant differences were found among all treatment comparisons for AEs and SAEs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings of this study indicate that the biological agent omalizumab 300 mg and the oral small molecule remibrutinib at doses of 35 mg, 25 mg, or 10 mg are recommended for patients with antihistamine-refractory CSU.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>PROSPERO: CRD42024516289</p>\u0000 </section>\u0000 </div>","PeriodicalId":10334,"journal":{"name":"Clinical and Translational Allergy","volume":"15 5","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clt2.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143909212","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

Role of impulse oscillometry in chronic obstructive pulmonary disease and asthma-chronic obstructive pulmonary disease overlap 脉冲振荡测量法在慢性阻塞性肺病和哮喘-慢性阻塞性肺病重叠中的作用

IF 4.6 2区医学 Q2 ALLERGY

Clinical and Translational Allergy

Pub Date : 2025-04-22 DOI: 10.1002/clt2.70057

Yuning Huang, Xue Zhang, Jinwen Wang, Wuping Bao, Chengjian Lv, Yingying Zhang, Xue Tian, Yan Zhou, Min Zhang

Background

Small airway dysfunction (SAD) is critical in chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap (ACO), impacting disease severity, acute exacerbation (AE) risk, and prognosis. Traditional spirometry may miss SAD due to its reliance on forced vital capacity.

Objective

This study investigates the role of impulse oscillometry system (IOS) for early detection, disease monitoring, and AE prediction.

Methods

Pathological specimens from 64 patients with normal lung function were divided into small airway pathological abnormalities (PAs, n = 38) and normal pathology (PN, n = 26). Logistic regression and receiver operating characteristic (ROC) curve analysis evaluated IOS's predictive value for SAD. Additionally, 37 healthy volunteers, 125 COPD patients, and 128 ACO patients underwent spirometry, IOS, FeNO, CT scans, and blood tests. Correlations between IOS and spirometry indices were evaluated. One-year follow-up of 140 patients assessed IOS's predictive capability for AE.

Results

ROC analysis indicated that R5 − R20 combined with FEF₇₅%pred best predicted PAs (areas under the ROC curves [AUC] = 0.80). R5 − R20, with a cut-off of 0.09 kPa/[L/s], demonstrated 85.6% sensitivity and 72.9% specificity in distinguishing COPD from healthy individuals, and 89.1% sensitivity with 72.9% specificity for ACO. In COPD, R5 − R20 correlated strongly with spirometry indices (r = 0.60), while Fres correlated well in ACO (r = 0.48) for FEV₁%pred ≥ 50%, with slightly weaker correlations for FEV₁%pred < 50%. For predicting AE, a model combining R5 − R20, FEV₁%Pred and body mass index had an AUC of 0.860 in COPD, while a model with Fres, FEV₁%pred and fraction of exhaled nitric oxide achieved an AUC of 0.874 in ACO.

Conclusions

IOS is valuable for early detection, monitoring, and AE prediction in COPD and ACO, enhancing diagnostic precision.

Clinical Trial Registration

No. ChiCTR2400089625, www.chictr.org.cn.

背景小气道功能障碍（SAD）在慢性阻塞性肺疾病（COPD）和哮喘-慢性阻塞性肺疾病重叠症（ACO）中至关重要，会影响疾病的严重程度、急性加重（AE）风险和预后。传统的肺活量测定法由于依赖于用力肺活量，可能会漏诊 SAD。本研究探讨了脉冲振荡测量系统（IOS）在早期检测、疾病监测和 AE 预测中的作用。方法将 64 例肺功能正常患者的病理标本分为小气道病理异常（PA，38 例）和正常病理（PN，26 例）。逻辑回归和接收器操作特征（ROC）曲线分析评估了 IOS 对 SAD 的预测价值。此外，37 名健康志愿者、125 名慢性阻塞性肺病患者和 128 名 ACO 患者接受了肺活量测定、IOS、FeNO、CT 扫描和血液检查。评估了 IOS 和肺活量指数之间的相关性。对 140 名患者进行的一年随访评估了 IOS 对 AE 的预测能力。结果 ROC 分析表明，R5 - R20 与 FEF75%pred 结合对 PA 的预测效果最佳（ROC 曲线下面积 [AUC] = 0.80）。R5 - R20 的临界值为 0.09 kPa/[L/s]，在区分慢性阻塞性肺病和健康人方面的灵敏度为 85.6%，特异度为 72.9%；在区分 ACO 方面的灵敏度为 89.1%，特异度为 72.9%。在慢性阻塞性肺病中，R5 - R20 与肺活量指数的相关性很强（r = 0.60），而在 ACO 中，Fres 与 FEV1%pred ≥ 50% 的相关性很好（r = 0.48），与 FEV1%pred < 50% 的相关性稍弱。在预测 AE 方面，结合 R5 - R20、FEV1%pred 和体重指数的模型在 COPD 患者中的 AUC 为 0.860，而结合 Fres、FEV1%pred 和呼出一氧化氮分数的模型在 ACO 患者中的 AUC 为 0.874。结论 IOS 对慢性阻塞性肺病和 ACO 的早期检测、监测和 AE 预测很有价值，可提高诊断的精确性。临床试验注册号：ChiCTR2400089625，www.chictr.org.cn。

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引用次数: 0

Clinical characteristics and risk factors for escalation to anaphylaxis from non-severe drug hypersensitivity reaction 非严重药物超敏反应升级为过敏反应的临床特征和危险因素

IF 4.6 2区医学 Q2 ALLERGY

Clinical and Translational Allergy

Pub Date : 2025-04-22 DOI: 10.1002/clt2.70047

Hyo-In Rhyou, Sung-Ryeol Kim, Jae-Woo Jung, Sae-Hoon Kim, Ji-Hyang Lee, Hye Jung Park, Kyung-Hee Park, Hee-Sun Park, Eun-Hee Chung, Gil-Soon Choi, Sujeong Kim, Min-Suk Yang, Jung-Yeon Shim, Young-Il Koh, Da-Woon Sim, Jae-Hyun Lee, Young-Hee Nam, Hye-Ryun Kang

Background

Drug hypersensitivity reaction (DHR) poses significant challenges in clinical practice, with some patients experiencing more severe reactions upon re-exposure. Understanding the factors contributing to escalation into more severe reactions is crucial for improving patient safety. This study aimed to investigate the clinical characteristics and risk factors associated with the progression from non-severe DHR to anaphylaxis.

Methods

A multicenter retrospective study was conducted using data from a drug-induced anaphylaxis registry across 10 university hospitals in Korea. Clinical data, including information on culprit drugs, DHR history, and the severity of reactions, were assessed.

Results

Among 494 cases of drug-induced anaphylaxis, 417 cases (84.4%) occurred without prior DHR, while 77 cases (15.6%) had a history of non-severe DHR. Of these, 43 cases had a previous DHR to a drug of the same class, and 34 cases involved DHR to drugs of different classes. In the group with prior DHR to a drug of the same class, anaphylaxis occurring in daily life was significantly more common compared to those reacting to a different class of drug or those with no prior DHR (48.8% vs. 23.5% or 22.5%, p = 0.008 and < 0.001, respectively). Non-steroidal anti-inflammatory drugs (NSAIDs), H2 blockers, and penicillins were identified as risk factors for anaphylaxis evolving from non-severe DHR.

Conclusion

Enhanced vigilance is required for patients with a history of non-severe DHR to NSAIDs, H2 blockers, and penicillins as re-exposure may lead to the progress to anaphylaxis.

药物超敏反应（DHR）在临床实践中是一个重大挑战，一些患者在再次接触后会出现更严重的反应。了解导致病情升级为更严重反应的因素对于提高患者安全至关重要。本研究旨在探讨从非严重DHR发展为过敏反应的临床特征和危险因素。方法采用韩国10所大学医院的药物性过敏反应登记数据进行多中心回顾性研究。评估临床数据，包括罪魁祸首药物信息、DHR史和反应严重程度。结果494例药物性过敏反应中，417例（84.4%）无DHR史，77例（15.6%）有非严重DHR史。其中，43例既往对同类药物有DHR， 34例对不同类别药物有DHR。在既往对同类药物有DHR的组中，日常生活中发生过敏反应的发生率明显高于对不同类别药物有反应的组或既往无DHR的组(48.8%比23.5%或22.5%,p = 0.008和<；分别为0.001)。非甾体抗炎药（NSAIDs）、H2阻滞剂和青霉素类药物被确定为非严重DHR演变为过敏反应的危险因素。结论有非严重DHR史的患者应提高对非甾体抗炎药、H2阻滞剂和青霉素类药物的警惕，再次暴露可能导致过敏反应的进展。

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引用次数: 0

Prediction of hereditary angioedema during attacks in patients with recurrent angioedema: Awareness at a glance with the hereditary angioedema prediction score 复发性血管性水肿患者发作期间遗传性血管性水肿的预测：遗传性血管性水肿预测评分的一瞥

IF 4.6 2区医学 Q2 ALLERGY

Clinical and Translational Allergy

Pub Date : 2025-04-16 DOI: 10.1002/clt2.70040

Semra Demir, Müge Olgaç, Osman Ozan Yeğit, İlkim Deniz Toprak, Mehmet Erdem Çakmak, Merve İğde Hormet, Nida Öztop, Pelin Korkmaz, Şule Kamacı Çelik, Deniz Eyice Karabacak, Nevzat Kahveci, Işıl Göğem İmren, Bircan Erden, Raif Coşkun, Pelin Karadağ, Derya Ünal, Aslı Gelincik

Background/Aim

Misdiagnosis of hereditary angioedema (HAE) leads to inappropriate management of the attacks. A scoring system that anticipates diagnosis can be beneficial for clinicians who are unfamiliar with angioedema. This study aims to develop a practical scoring system for use during acute attacks to predict HAE in patients with recurrent angioedema (RAE).

Method

To predict HAE, nine HAE experts unanimously identified five predictive items (PIs); absence of urticaria, presence of abdominal pain episodes, family history, early onset of attacks and previous unresponsiveness to anti-histaminergic treatments. The researchers questioned 106 patients with HAE and 155 patients with mast cell-mediated angioedema (MMAE) about PIs. A score was attributed to each significant PI based on OR values obtained through logistic regression analysis. The cut-off point for the prediction of HAE and its sensitivity and specificity were determined by ROC curve analysis.

Results

In a univariate analysis, all items showed significant differences between HAE and MMAE patients. Regression analysis attributed scores as follows: 23 points for the absence of urticaria, 11 points for the abdominal pain episodes, 9 points for family history, and 53 points for unresponsiveness to antihistaminergic treatments. No score was attributed to early onset of age (p > 0.05). The ROC analysis revealed an area under the curve of 0.990, with a total score of ≥38 demonstrating the best sensitivity (96.4%) and specificity (96.1%).

Conclusions

HAEps is a valuable tool for diagnosing HAE in patients with RAE. A score of 38 or more indicates the possible presence of HAE with substantial sensitivity and specificity.

背景/目的遗传性血管性水肿（HAE）的误诊会导致治疗不当。预测诊断的评分系统对不熟悉血管性水肿的临床医生是有益的。本研究旨在开发一种实用的评分系统，用于急性发作期间预测复发性血管性水肿（RAE）患者的HAE。方法预测HAE， 9名HAE专家一致确定5个预测项目（pi）；无荨麻疹，腹痛发作，家族史，早发性发作，既往对抗组胺能治疗无反应。研究人员询问了106例HAE患者和155例肥大细胞介导的血管性水肿（MMAE）患者关于pi的问题。根据逻辑回归分析得到的OR值，对每一个显著PI进行评分。预测HAE的分界点及其敏感性和特异性通过ROC曲线分析确定。结果在单变量分析中，所有项目均显示HAE和MMAE患者之间存在显著差异。回归分析将得分归为如下：无荨麻疹23分，腹痛发作11分，家族史9分，抗组胺药治疗无反应53分。没有得分归因于早发年龄(p >；0.05)。ROC分析显示曲线下面积为0.990，总分≥38时灵敏度为96.4%，特异度为96.1%。结论HAEps是诊断RAE患者HAE的有效工具。38分及以上提示可能存在HAE，具有相当的敏感性和特异性。

{"title":"Prediction of hereditary angioedema during attacks in patients with recurrent angioedema: Awareness at a glance with the hereditary angioedema prediction score","authors":"Semra Demir, Müge Olgaç, Osman Ozan Yeğit, İlkim Deniz Toprak, Mehmet Erdem Çakmak, Merve İğde Hormet, Nida Öztop, Pelin Korkmaz, Şule Kamacı Çelik, Deniz Eyice Karabacak, Nevzat Kahveci, Işıl Göğem İmren, Bircan Erden, Raif Coşkun, Pelin Karadağ, Derya Ünal, Aslı Gelincik","doi":"10.1002/clt2.70040","DOIUrl":"https://doi.org/10.1002/clt2.70040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Aim</h3>\u0000 \u0000 <p>Misdiagnosis of hereditary angioedema (HAE) leads to inappropriate management of the attacks. A scoring system that anticipates diagnosis can be beneficial for clinicians who are unfamiliar with angioedema. This study aims to develop a practical scoring system for use during acute attacks to predict HAE in patients with recurrent angioedema (RAE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>To predict HAE, nine HAE experts unanimously identified five predictive items (PIs); absence of urticaria, presence of abdominal pain episodes, family history, early onset of attacks and previous unresponsiveness to anti-histaminergic treatments. The researchers questioned 106 patients with HAE and 155 patients with mast cell-mediated angioedema (MMAE) about PIs. A score was attributed to each significant PI based on OR values obtained through logistic regression analysis. The cut-off point for the prediction of HAE and its sensitivity and specificity were determined by ROC curve analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In a univariate analysis, all items showed significant differences between HAE and MMAE patients. Regression analysis attributed scores as follows: 23 points for the absence of urticaria, 11 points for the abdominal pain episodes, 9 points for family history, and 53 points for unresponsiveness to antihistaminergic treatments. No score was attributed to early onset of age (<i>p</i> > 0.05). The ROC analysis revealed an area under the curve of 0.990, with a total score of ≥38 demonstrating the best sensitivity (96.4%) and specificity (96.1%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HAEps is a valuable tool for diagnosing HAE in patients with RAE. A score of 38 or more indicates the possible presence of HAE with substantial sensitivity and specificity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10334,"journal":{"name":"Clinical and Translational Allergy","volume":"15 4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clt2.70040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836335","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

Factors that influence user adherence of the Mask-air® application 影响用户坚持使用 Mask-air® 应用的因素

IF 4.6 2区医学 Q2 ALLERGY

Clinical and Translational Allergy

Pub Date : 2025-04-14 DOI: 10.1002/clt2.70054

Anna Szylling, Boleslaw Samoliński, Filip Raciborski, Konrad Furmańczyk, Mariola Chrzanowska, Oksana Wojas, Edyta Krzych-Fałta, Emilia Gawińska-Drużba, Krzysztof Samoliński, Jean Bousquet, Piotr Samel-Kowalik

Background

Monitoring adherence in chronic diseases remains a significant challenge. Allergic rhinitis (AR), one of the most common chronic conditions, serves as an excellent model for studying determinants of app use in monitoring adherence and health assessment during treatment. The Mask-air® app supports clinical decision-making by involving patients in symptom observation and promoting adherence to therapy. This study aimed to identify the defining characteristics of Mask-air® users, describe their disease phenotype and satisfaction with the app, and explore reasons for discontinuation.

Materials and Methods

Adult patients 20–44 years old suffering from AR (n = 198) receiving care at an allergy outpatient clinic were invited to participate in a trial using the Mask-air® app. Investigators collected data on symptoms, administered treatments, and clinical evaluation results through questionnaires. At a follow-up visit (n = 163), these were compared, and patients were questioned about their satisfaction with the app. Patients presented their app records, and those who declined or stopped using the app were asked to provide reasons in a questionnaire.

Results

No distinguishing characteristics of Mask-air® users (n = 131) were identified compared with those who declined the app (n = 67). App readiness was analyzed according to age, socioeconomic status, disease severity, comorbidities, and therapeutic modality. Respondents were categorized into: those who did not install the app (17.7%), those who installed but did not use it (16.2%), and those who installed and evaluated it (66.2%), with 15.6% failing to produce symptom monitoring records. Overall, satisfaction ratings were high though patients were critical of the app's therapeutic aspect.

Conclusions

The study found no specific features distinguishing Mask-air® users, suggesting that it can be recommended to all patients regardless of gender, socioeconomic or educational status, or disease phenotype. However, with a dropout rate of nearly 50%, it is essential for clinicians to emphasize the app's benefits to improve adherence and engagement.

监测慢性病患者的依从性仍然是一个重大挑战。过敏性鼻炎（AR）是最常见的慢性疾病之一，可以作为研究应用程序使用决定因素的一个很好的模型，用于监测治疗期间的依从性和健康评估。Mask-air®应用程序通过让患者参与症状观察和促进治疗依从性来支持临床决策。本研究旨在确定Mask-air®用户的定义特征，描述他们的疾病表型和对应用程序的满意度，并探讨停止使用的原因。材料与方法邀请在过敏门诊接受治疗的20-44岁AR成年患者（n = 198）使用Mask-air®应用程序参与试验。研究人员通过问卷调查收集症状、给予治疗和临床评估结果的数据。在随访中（n = 163），对这些进行比较，并询问患者对应用程序的满意度。患者提供了他们的应用程序记录，那些拒绝或停止使用应用程序的人被要求在问卷中提供原因。结果Mask-air®用户（n = 131）与拒绝使用该应用程序的用户（n = 67）相比，未发现显著特征。根据年龄、社会经济地位、疾病严重程度、合并症和治疗方式分析应用程序准备情况。受访者分为：未安装（17.7%）、安装但未使用（16.2%）、安装后评估（66.2%），其中15.6%的人没有产生症状监测记录。总体而言，尽管患者对该应用的治疗方面持批评态度，但满意度仍然很高。结论：本研究未发现区分Mask-air®使用者的特定特征，提示可以推荐给所有患者，无论性别、社会经济或教育状况或疾病表型。然而，由于近50%的辍学率，临床医生必须强调该应用程序的好处，以提高依从性和参与度。

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引用次数: 0

Correction to “Eosinophils and COVID-19: Insights into immune complexity and vaccine safety” 更正“嗜酸性粒细胞与COVID-19：对免疫复杂性和疫苗安全性的见解”

IF 4.6 2区医学 Q2 ALLERGY

Clinical and Translational Allergy

Pub Date : 2025-04-14 DOI: 10.1002/clt2.70056

Sahli W, Vitte J, Desnues B. Eosinophils and COVID-19: insights into immune complexity and vaccine safety. Clin Transl Allergy. 2025;e70050.

In Figure 1, the icons of monocyte and T cell and some labels were missing. This should have appeared as the following Figure 1.

We apologize for this error.

王晓东，王晓东，王晓东，等。嗜酸性粒细胞与新冠肺炎：免疫复杂性和疫苗安全性的研究进展。临床变态反应。2025;e70050。在图1中，单核细胞和T细胞的图标以及部分标签缺失。这应该显示如下图1所示。我们为这个错误道歉。

引用次数: 0

Benralizumab and the integrated management of co-morbid severe eosinophilic asthma with chronic rhinosinusitis with nasal polyps 贝那利珠单抗与合并严重嗜酸性粒细胞哮喘合并慢性鼻窦炎合并鼻息肉的综合治疗

IF 4.6 2区医学 Q2 ALLERGY

Clinical and Translational Allergy

Pub Date : 2025-04-08 DOI: 10.1002/clt2.70051

Joaquim Mullol, Maria D'Amato, Eugenio de Corso, Joseph K. Han, Jody Tversky

Background

Type 2 (T2) inflammation, characterized by blood and airway eosinophilia, underlies severe eosinophilic asthma (SEA) and chronic rhinosinusitis with nasal polyps (CRSwNP). In line with the Global Airways theory, SEA and CRSwNP frequently co-occur, creating a multimorbid phenotype. Separately, SEA and CRSwNP are burdensome: when concomitant, they compound each other, creating a more difficult-to-treat disease with increased complications.

Body

Current management approaches rarely control disease and are associated with substantial side-effects. Several recently developed anti-IL-5 monoclonal antibodies have shown efficacy in treating co-morbid SEA with CRSwNP by targeting T2 inflammation with systemic therapies. Of these, only benralizumab directly targets the IL-5 receptor-α, leading to rapid, sustained, near-complete eosinophil depletion. Analyses in patients with co-morbid SEA with CRSwNP are limited, although data from the ANDHI, XALOC-1, and RANS studies suggest benralizumab can effectively target inflammation underlying co-morbid disease.

Conclusion

Despite progress toward more effective therapies, treatment approaches remain siloed, with SEA and CRSwNP often managed separately. There is a need for the development of multidisciplinary approaches for treating patients with comorbid SEA with CRSwNP.

背景2型（T2）炎症以血液和气道嗜酸性粒细胞增多为特征，是严重嗜酸性粒细胞哮喘（SEA）和慢性鼻窦炎伴鼻息肉（CRSwNP）的基础。与Global Airways理论一致，SEA和CRSwNP经常同时发生，形成多病表型。单独来说，SEA和CRSwNP都是负担沉重的：当它们同时出现时，它们会相互复合，产生一种更难以治疗的疾病，并发症也会增加。目前的治疗方法很少能控制疾病，而且有很大的副作用。最近开发的几种抗il -5单克隆抗体已显示出通过靶向T2炎症和全身治疗治疗CRSwNP合并症SEA的疗效。其中，只有benralizumab直接靶向IL-5受体-α，导致快速、持续、近乎完全的嗜酸性粒细胞耗竭。虽然来自ANDHI、XALOC-1和RANS研究的数据表明，benralizumab可以有效靶向合并症下的炎症，但对合并SEA和CRSwNP患者的分析有限。结论：尽管在更有效的治疗方面取得了进展，但治疗方法仍然是孤立的，SEA和CRSwNP通常是分开处理的。有必要开发多学科方法来治疗合并SEA和CRSwNP的患者。

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引用次数: 0