Current Opinion in Allergy and Clinical Immunology最新文献

Purpose of review: Chronic rhinosinusitis (CRS) is a diverse condition, including different underlying pathophysiologies. Tailoring the treatment for CRS depends on the individual's specific endotype and phenotype rather than using a universal approach. The emergence of biologics in recent years has raised questions about the role of antibiotics, particularly doxycycline, in CRS management. Insights from existing research on the mechanisms and appropriate use of doxycycline therapy may guide physicians in selecting the right treatment target.

Recent findings: CRS with nasal polyps (CRSwNP) is frequently associated with type 2 inflammation and characterized by tissue remodeling process that can result in recalcitrant condition. Doxycycline therapy (100 mg daily) improves CRSwNP by exerting antitissue remodeling effects through matrix metalloproteinase inhibition. Doxycycline seems to provide benefits when used alongside adequate medicine treatment.

Summary: Current evidence on the use of doxycycline therapy is limited to a small number of high-quality studies. Further research is needed to explore the duration and factors of success of doxycycline in treating CRS. Like other antibiotics, doxycycline has limitations related to side effects and the potential for antibiotic resistance. Therefore, treatment decisions should be made with caution, especially when doxycycline is used in combination with other pharmacologic therapies.

Purpose of review: The Nasal Allergen Provocation Test (NAPT) is a valuable diagnostic tool for allergic rhinitis, particularly in cases where conventional tests, such as the skin prick test (SPT) and serum-specific IgE (sIgE), yield inconclusive results. By replicating real-life allergen exposure in a controlled setting, NAPT enables the assessment of allergen-specific nasal reactivity. This article aims to review the current knowledge of NAPT.

Recent findings: Recent studies have reinforced NAPT as the gold standard for confirming nasal allergic responses. In the past, test protocols, allergen dosages, and outcome measurements varied widely. However, advancements in allergen standardization, the combination of objective and subjective measurements, and metered nasal allergen application have led to an improved and more reliable test method, with ongoing efforts to establish a universal protocol for clinical testing.

Summary: This review summarizes current knowledge on NAPT, including its clinical applications, indications, methodology, and recent advancements. Additionally, we compare NAPT with SPT and sIgE in terms of diagnostic accuracy. The protocols, allergen types and doses, test methodologies, and outcome measures of these studies were analyzed and compared.

Purpose of review: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder that demands lifelong management due to its potential to progress to fibrosis and esophageal strictures. This review synthesizes current strategies for evaluating EoE outcomes and highlights emerging approaches aimed at reconciling the often discordant relationship between clinical symptoms and histologic findings. An updated synthesis is crucial to guide evolving clinical practices.

Recent findings: Recent literature emphasizes the multifaceted nature of EoE, revealing limitations in traditional outcome measures. Advances in patient-reported outcomes (PROs), histologic scoring systems, and endoscopic assessments have enriched our understanding of disease activity. Furthermore, the integration of functional assessments through modalities such as high-resolution manometry and EndoFLIP, along with digital data integration, has refined disease monitoring and provided nuanced insights into treatment responses and long-term progression. Additionally, emerging evidence suggests that integrating novel biomarkers may further refine disease stratification and outcomes.

Summary: A multidimensional approach that combines clinical, histologic, endoscopic, and functional data is crucial for personalized management of EoE. These insights pave the way for improved therapeutic decision-making and highlight the need for standardized, comprehensive tools in both clinical practice and future research. These additional findings advocate for a shift towards precision medicine, emphasizing multidisciplinary and patient-centric approaches.

Purpose of review: Although biologics had been used to treat CRSwNP, not all patients respond favourably, necessitating the use of other biologics. As there are currently no guidelines available, the process and rationale for switching biologic therapy in the treatment of CRSwNP are examined in this review.

Recent findings: Due to the heterogeneity of diseases, biologic therapies may efficiently control CRSwNP but give inadequate control for asthma, or vice versa . Changing an ineffective first-line biologic to a second-line treatment or others is generally referred to as switching. The most common reasons for switching biologics are poor symptom management or ineffectiveness, and undesirable adverse effects. The ineffectiveness was largely due to the use of omalizumab or mepolizumab, whereas the adverse effects were due to dupilumab.

Summary: Switching biologics is a nuanced process influenced by a variety of patient-specific and clinical factors. Biologics that effectively treat upper and lower airway diseases are recommended for optimal control in CRSwNP patients with concurrent asthma. There was no difference in outcomes between switching biologics with and without a washout period. Switching between biologics in the same class is generally not recommended. Dupilumab serves as an effective treatment option for refractory cases particularly aspirin-exacerbated respiratory disease.

Purpose of review: Local allergic rhinitis (LAR) is increasingly recognized as a distinct phenotype of chronic rhinitis, yet its prevalence and characteristics in Asia remain underexplored. Given the variability in reported LAR prevalence across regions, this review re-evaluates the allergy landscape in Asia, considering environmental and immunological factors, as well as study methodology that may contribute to differences from Western populations.

Recent findings: There were more Asian studies which reported lower prevalence (0-20%), in contrast to higher rates in Europe, particularly Mediterranean countries. Urbanization, air pollution, and high dust mite exposure may be important factors of nonatopic rhinitis in Asia. Diagnostic approaches, including nasal-specific IgE and provocation tests, vary across studies, impacting prevalence estimates.

Summary: The lower reported LAR prevalence in Asia suggests potential differences in underlying mechanisms or diagnostic limitations. Further research is needed to refine diagnostic criteria, explore environmental triggers, and assess the clinical relevance of LAR in Asian populations. A better understanding of LAR in Asia could guide targeted management strategies and improve recognition of this condition in clinical practice.

Purpose of review: Food allergy represents a major public health issue, affecting about 8% of children and 11% of adults in the United States. Research in the field has rapidly expanded but is limited by a lack of standardized data fields or common data elements (CDEs) to record food allergy data. The present review focuses on the need for developing CDEs for food allergy, and their anticipated impact, as well as describes the central tenets of CDEs.

Recent findings: Standardization of data definitions and consistency in data collection within a study and across multiple studies is a fundamental principle of clinical research. Several NIH centers have been collaborating to support the development of CDEs, thereby promoting the FAIR principles for clinical research.

Summary: The population health burden of food allergies continues to rise in the absence of a standardized language for documenting food allergy clinical research data. Development and implementation of food allergy CDEs is needed both nationally and globally, to better understand and reduce the burden of this immune-mediated disease. When adopted, these CDEs will not only improve data consistency and interoperability but also speed up and improve the quality of future food allergy clinical trials.

Purpose of review: To explore the potential applicability in clinical trials of the groundbreaking international consensus named DEFASE (DEfinition of Food Allergy SEverity) as the unique grading system for IgE-mediated food allergy (FA) severity embracing the different aspects of the disease in a holistic approach. Herein, we discuss its relevance in clinical trials and potential applications in research and clinical settings through a few clinical scenarios.

Recent findings: The DEFASE score has been developed to be used in research settings as a comprehensive scoring system. Researchers are currently focusing on internal and external validation of the scoring system, targeting these models to various food allergenic sources, populations, and settings.

Summary: Implementing the DEFASE score in clinical trials could improve patient stratification, guide therapeutic decisions, and support regulatory assessments. Future research will focus on its external validation and integration with biomarker data to refine its predictive accuracy and make this tool applicable in the near future.

Purpose of review: Allergen immunotherapy (AIT) is increasingly popular as a treatment strategy for food allergy. Unfortunately, there is significant heterogeneity in reported outcomes, specifically in the dose-thresholds selected for evaluation and the symptoms used to define a "tolerated dose". These considerations are often investigator-driven and do not consider patient perspectives.

Recent findings: A systematic review by the EAACI CO-FAITH taskforce recently flagged the need to better standardize and harmonize outcomes used in clinical trials of food-AIT. Using less objective symptoms to define dose-limiting symptoms can underestimate the reaction threshold determined at baseline food challenge. As a consequence, this can overestimate the efficacy of food-AIT by 15%. In this review, we perform an individual patient data (IPD) meta-analysis using data from three randomized-controlled trials and one real-world registry, to evaluate how the definition of dose "tolerance" impacts upon reported desensitization rates.

Summary: This analysis provides insight into how clinical efficacy rates for food-AIT are impacted by using different dose thresholds and definitions for when a dose might be consider tolerated. Using more patient-centric outcomes may be a more useful metric to harmonize reporting of outcomes and inform clinical practice, paving the way towards reaching a consensus on outcome reporting in trials of food-AIT.