European annals of allergy and clinical immunology最新文献

Summary: Long-lived plasma cells (LLPCs) constitute a specialized and durable arm of humoral memory. While their role in maintaining long-term IgG and IgA immunity is firmly established, their contribution to IgE-mediated allergic disease remains clinically unproven. Nevertheless, recent advances in LLPC biology-accelerated substantially since 2021-have shown that IgE⁺ LLPC-like cells do exist in human bone marrow and chronically inflamed tissues, providing an immunological basis for exploring their potential involvement in persistent sensitization. LLPCs arise through tightly orchestrated developmental programs and rely on survival niches shaped by stromal cells, cytokines and metabolic adaptations. These features allow continuous antibody secretion for years or decades, independently of antigen re-exposure. Their metabolic resilience and resistance to apoptosis make them among the most durable effector cells in adaptive immunity. In parallel, several mechanisms already known to support IgE persistence-early-life programming of type-2 responses, Treg/Tfr disequilibrium, sequential class switching from IgG1 memory, and rapid recall from non-IgE memory B cells-form a robust framework capable of sustaining long-term allergic sensitization irrespective of LLPC involvement. Within this architecture, the confirmed presence of IgE⁺ long-lived plasma cells offers a biologically plausible, though not yet clinically validated, explanation for the remarkable stability of IgE profiles observed in many allergic conditions. Considering LLPCs within the broader context of IgE persistence highlights an area of growing immunological relevance while underscoring that their precise contribution to allergic disease remains to be determined.

Summary: Background. The diagnosis of immediate drug allergy (DA) relies on a combination of skin tests (ST), drug provocation tests (DPT), specific IgE levels (sIgE) and/or basophil activation tests (BAT). We aimed to compare BAT results with those of other allergy tests in patients with suspected immediate DA to a heterogeneous group of drugs, aiming to assess its diagnostic value. Methods. Patients who underwent BAT for suspected immediate DA at our hospital from January 2018 to December 2023 were included. Each case (suspected drug) was classified based on diagnostic tests performed - probable vs. improbable allergy (assessed by ST and/or sIgE only) or confirmed vs. excluded allergy (assessed by DPT). Inter-method agreement was assessed with Cohen's kappa index (κ). Results. Eighty-five patients were included: 51 female (60.0%), median age 53.0 years [interquartile range (IQR) = 33.0, Q1-Q3=31.0-64.0]. Median time elapsed since index reaction was 1.0 year [IQR=3.0, Q1-Q3 = 1.0-3.0]. We identified 112 suspected drugs: out of 16 cases with positive BAT (14.3%), 6 were probable (37.5%) and 1 confirmed allergy (6.3%). From 89 drugs with negative BAT (79.5%), 41 were improbable (46.1%) and 5 excluded allergy (5.6%). Seven agents had an inconclusive BAT (6.3%). A slight agreement (κ = 0.201) between BAT and other studies was observed when combining probable/improbable and confirmed/excluded results (n = 76). When limiting these findings to confirmed/excluded results (n=6), we found a perfect agreement (κ = 1).  Conclusions. We assessed BAT performance in a larger sample than those from previous studies. Slight agreement between methods increased to a perfect agreement when limiting to confirmed cases. Larger studies are needed to establish BAT's diagnostic value.

Summary: NOT AVAILABLE.

Summary: Background. Hereditary angioedema (HAE) is a rare genetic disorder with variable prevalence, characterized by recurrent swelling in various parts of the body, including potential laryngeal attacks, significantly affecting patients' quality of life. Methods. A nationwide, cross-sectional survey study was conducted between December 2023 and June 2024, targeting adults (aged 18 and older). The patients filled out different HAE-related questionnaires. Descriptive statistics were used to analyze and summarize the data. Results. The prevalence of HAE in Croatia is estimated to be 3.10 per 100,000 people. The majority were females, patients with positive family history, and type 1 HAE. The median diagnostic delay was 13 years, with initial attacks typically occurring in adolescence, but diagnosis was often not established until young to middle adulthood. Regarding quality of life, approximately 51% reported a significant impact. Fatigue was prevalent, with 46.9% of patients experiencing mild to moderate levels, and 22.4% suffering from severe fatigue. Most patients reported minimal depression, and 37.7% presented with moderate to severe anxiety. Among employed individuals, a median presenteeism of 20% indicated productivity loss while at work, in contrast to generally minimal absenteeism. Conclusions. Recent more substantial diagnostic efforts and increased awareness are contributing factors to the higher observed prevalence of HAE in Croatia, mainly due to the sustained work of a dedicated patient organization and a well-developed network of national HAE experts. Patients still experience a high disease burden, impaired quality of life, and difficulties with daily activities, which trends also observed in other HAE cohorts worldwide.

Summary: Background. Anaphylaxis is the most severe form of acute systemic allergic reactions. Several recommendations have been proposed to guide and standardize anaphylaxis approach and management. The objective of this study is to characterize a cohort of patients referred through an anaphylaxis fast-track system, to enhance and standardize anaphylaxis patient care. Methods. Observational study including patients with anaphylaxis admitted in the emergency department (ED) and/or referred through the fast-track system (June 2022 - June 2025). Collected data included demographics, clinical presentation, aetiology, treatment, adrenaline autoinjector (AAI) prescription, request for serum tryptase testing, biphasic reactions, diagnosis and follow-up care. Results. Over the 399 patients referred through the fast-track system for specialist evaluation, anaphylaxis was confirmed in 120 patients. Drug-induced anaphylaxis was the most prevalent, with nonsteroidal anti-inflammatory drugs the most reported (46.3%). Food-induced anaphylaxis was the second cause, with shellfish accounting for most cases (63.5%). The most common association of symptoms was mucocutaneous and respiratory symptoms (49.5%). Among the 120 confirmed cases, intramuscular adrenaline was administered in 68.4% (67/98) of patients admitted to ED and AAI in only 18.4% (18/98). Biphasic reactions were only reported in three patients. No fatalities or recurrent episodes were documented. Conclusions. These findings highlight the importance of standardized protocols or fast-track systems for anaphylaxis diagnosis and management, allowing for a rapid recognition, treatment and management of patients. Nevertheless, the need to continually improve medical education and training remains. This study is limited by its selected cohort, the exclusion of primary-care emergency department data owing to coding limitations, and its inherently descriptive design.

Summary: Background. Flaxseed allergy is a rare and potentially underdiagnosed condition. In recent years, sensitization to flaxseed has increased due to its growing presence in the human diet. This study presents three distinct cases of flaxseed allergy and discusses the strengths and limitations of current diagnostic tools in identifying this emerging allergy. Methods. Each case underwent a detailed clinical history followed by an allergological evaluation using in vivo testing (skin prick-to-prick) and in vitro methods (serum specific IgE testing with singleplex and multiplex immunoassays) for flaxseed and other suspected seeds or tree nuts. Results. Case 1: A male patient, previously diagnosed with pumpkin seed allergy, experienced multiple episodes of urticaria and angioedema following ingestion of bread containing unspecified dark seeds. Testing revealed sensitization to flaxseed, pumpkin, sunflower, sesame seeds and storage proteins from soy, walnut, and hazelnut. Case 2: A male patient developed cutaneous symptoms after ingesting an energy bar. Testing showed positivity only to flaxseed, while results for other seeds and tree nuts were negative. Case 3: A female patient with repeated episodes of labial angioedema and anaphylaxis, initially misdiagnosed with sesame allergy, was found to be allergic to flaxseed. Conclusions. Flaxseed allergy remains a rare but emerging condition that is difficult to diagnose, partly due to its frequent omission from ingredient labels and the absence of specific allergenic molecules in commercial diagnostic tests. Future regulatory consideration should evaluate the inclusion of flaxseed among priority food allergens.

Summary: Background. Oral immunotherapy (OIT) is a promising strategy for severe and persistent cow's milk (CM) allergy. However, clinical experience concerning long-term follow-up is scarce. The objective is to assess long-term efficacy and safety of maintenance phase of OIT in real-life. Methods. Prospective study of children with severe IgE-mediated CM allergy that underwent CM-OIT, and were followed-up by the authors, up to 15 years. Complete desensitisation was defined when maintenance dose of 200 mL daily was achieved. Characterization (clinical and laboratory) was performed before and after OIT during follow-up.  Results. Thirty-three patients enrolled: 58% male, 70% asthmatics and 67% with previous history of CM-anaphylaxis. Mean age at onset of CM-OIT was 7±2.8 years. Complete desensitisation was ensured in 94% (free diet with dairy 200mL of CM or equivalent). During maintenance phase 79% developed allergic reactions, with anaphylaxis in 33%, including exercise-induced anaphylaxis in 15% and with cheese intake in 15%. We stress that eosinophilic esophagitis appeared in 12%. Specific IgE levels and skin prick tests (SPT) to CM and casein have significantly decreased, and in most patients (61%) SPT became negative. When available, specific IgG4 levels have significantly increased. Conclusions. This real-life study supports long-term efficacy and safety of CM-OIT. CM-OIT had a high success rate, allowing diet without restrictions with persistence of the effect up to 15 years. However, one-third of patients experienced anaphylaxis during maintenance phase. CM-OIT should always be performed by allergy experts and only motivated families should be enrolled, since long-term follow-up is required, and daily intake of CM is needed to ensure desensitization.

Summary: Background.Soy allergy represents a diagnostic challenge, particularly when mediated by Gly m 4, a PR-10 protein known for its cross-reactivity with birch pollen allergens. Traditional diagnostic methods, including skin prick tests (SPTs) and specific IgE assays, often lack sensitivity or specificity, especially for Gly m 4-mediated allergies. Methods. In this study, the basophil activation test (BAT) was evaluated as a tool to distinguish true allergy from mere sensitization to Gly m 4. Results.A total of four patients sensitized to Gly m 4 and Bet v 1 (PR-10 of soy and birch) were included in this study. Two patients were confirmed allergic to soy based on positive BAT results with Gly m 4 and soy total extract, correlating with clinical symptoms of allergy. Conversely, two other patients were determined to be sensitized but clinically tolerant, as BAT results were negative, consistent with their symptom-free status during oral food challenges. Conclusions. The study highlights the limitations of traditional diagnostic methods, which often yielded false-negative or inconclusive results, and underscores the BAT's ability to provide functional evidence of allergen reactivity. We demonstrate the utility of BAT in identifying clinically relevant Gly m 4-mediated soy allergies. By enabling precise differentiation between allergy and sensitization, the BAT emerges as a valuable diagnostic tool, complementing molecular allergen-specific IgE assays and offering a safer and more specific alternative to oral food challenges.