European annals of allergy and clinical immunology最新文献

Summary: Epithelial barriers are crucial defenses against pathogens and allergens, and recent theories suggest that environmental factors may compromise them, leading to type 2 inflammation and conditions such as asthma, atopic dermatitis, food allergy, and rhinitis. While skin and respiratory barriers show clear dysfunctions in allergies, the role of the gut epithelium is less defined, particularly in view of its ability to absorb nutrients and maintain immune tolerance under normal conditions. Research indicates that gastrointestinal barrier integrity typically remains preserved in food allergies, allowing for the development of immune tolerance to ingested food antigens through mechanisms like Treg cells and IgA. Allergies to cow's milk or hen's egg proteins most often resolve with age, highlighting the gut's evolving role in allergen sensitization. Studies like the LEAP (Learning Early About Peanut Allergy) trial demonstrate the preventive benefits of early allergen exposure against peanut allergy, supporting the dual allergen exposure hypothesis. New allergens such as alpha-Gal and gibberellin-regulated proteins (GRP) reveal distinct sensitization pathways beyond traditional ingestion routes, implicating non-dietary sources in allergen introduction. Altogether, there is lack of evidence suggesting that the intestinal epithelium is disrupted in food allergy.

Summary: Background. Childhood asthma, a chronic inflammatory disease, is linked to sleep-breathing disorders (SBD). The vulnerability of asthmatic children to SBDs is well-established, yet limited research focuses on adolescents. This study addresses the research gap, exploring the frequency and risk factors of SBD in adolescents with asthma. Methods. A cross-sectional study was conducted among 98 adolescents (12-17 years) with asthma at a Lisbon healthcare facility. Comprehensive assessments, including sociodemographic data, medical history, lung function variables, and validated questionnaires for SBD risk (Pediatric Sleep Questionnaire), rhinitis control, and asthma control (Control of Allergic Rhinitis and Asthma Test and Asthma Control Test), were employed. Results. The study revealed a substantial frequency of SBD symptoms, with 25.5% of adolescents classified as high-risk based on the Pediatric Sleep Questionnaire. Significant associations were identified between high SBD risk and elevated body mass index (BMI), uncontrolled rhinitis, and uncontrolled asthma. Logistic regression analysis confirmed elevated BMI as a robust predictor of SBD risk, indicating a 5.9-fold increase compared to normal-weight counterparts. Conclusions. This study contributes valuable insights into the interplay between asthma and SBD in adolescents. The high prevalence of SBD symptoms, particularly among those with excess weight and uncontrolled respiratory symptoms, underscores the need for targeted preventive strategies. The identified risk factors, notably elevated BMI, provide clinicians with actionable information for intervention, emphasizing the importance of addressing modifiable factors associated with asthma and SBD in this specific population.

Summary: Airways hyperresponsiveness (AHR) is a pathognomonic event of asthma in which the airways are reactive to various bronchoconstrictor stimuli at 'doses' that normally have no bronchoconstrictor effect in non-asthmatics. AHR is an objective measure of clinical efficacy, and the introduction of biologics revived interest as a marker of disease and its pathophysiologic mechanism. This article aims to discuss the mechanisms of AHR, focusing on the role of epithelial damage and TSLP production, and promote its correct assessment for the evaluation of patients with severe asthma, to predict the risk of exacerbations and outcomes, and the eligibility for treatment with an anti-TSLP agent. AHR is a complex trait of asthma, induced by the concurrence of many pathophysiological factors and related to different clinical manifestations. Recent evidence demonstrates the important role of airway epithelial damage and TSLP production in many of these events. A therapeutic response based on AHR control could be considered as a condition of disease remission and seems a promising new goal for the management of patients with severe asthma.

Summary: Background. Chronic spontaneous urticaria (CSU) response to anti-IgE treatment can be rapid, late or absent. Recently, potential mechanisms of activation of mast cells alternative to FceRI, including mas-related G protein-coupled receptor X2 (MRGPRX2), activation of coagulation cascade, and activation of eosinophils have been described. We measured several potential in-vitro markers, including well-known MRGPRX2 activators, in sera of patients CSU both responding and not responding to omalizumab. Methods. D-dimer, substance P (SP), eosinophil cationic protein (ECP), soluble MRGPRX2, IgE anti-FceRI, IgE anti-FceRII, IgG anti-FceRI and IgG anti-FceRII were measured in 32 patients with severe CSU at baseline and one week after the start of omalizumab therapy, and in 20 healthy controls. Results. At baseline CSU patients showed significantly higher levels of D-dimer, IgE anti-FceRI, IgG anti-FceRI, and ECP (p < 0.001 in all cases), and significantly lower levels of soluble MRGPRX2 (p = 0.009) than controls. The two groups showed similar levels of IgG and IgE to FceRII and SP. One week after the first omalizumab administration there was a significant drop of IgE anti-FceRI (p < 0.001) and D-dimer (p = 0.028), in early responders. SP increased in all CSU patients (p < 0.001) irrespective of the final response to omalizumab. IgE anti-FceRI response at one week was associated with the final response to omalizumab (OR:0.12 [95%CI 0.01-1.06]). Conclusions. Severe CSU is associated with high plasma levels of several biomarkers including D-dimer, IgE anti-FceRI, IgG anti-FceRI and ECP and low levels of soluble MRGPRX2. IgE anti-FceRI response at one week may predict the final response to omalizumab.

Summary: Cannabis is the most widely used drug worldwide sought for recreational and medicinal purposes. Cannabis allergy was first described 50 years ago but has become more frequently reported over the past decade due to a larger industrial and domestic cultivation, and an evolving legal status. However, it remains an infrequent cause of allergy in the Mediterranean European countries. We describe three clinical cases with primary sensitization to cannabis characterized by anaphylactic reactions. We hypothesize that in all three case reports, sensitization to Can s 3 nsLTP played a crucial role in the development of anaphylaxis, either directly following ingestion of hemp-containing food, or even indirectly through primary sensitization via involuntary exposure or occupation exposure to cannabis sativa.

Summary: Background.Omega-3 fatty acids are involved in many processes in the human body. Their beneficial effects were documented mainly in relation to cardiovascular and immune systems. Patients with immunodeficiencies with predominantly antibody defects due to their reduced immunoglobulin levels should have factors adversely affecting the course of the disease eliminated. Methods. Nineteen primary immunodeficient patients with predominant antibody defects (out of which fourteen with CVID) and eighteen immunocompetent participants had their blood tested in order to determine the concentration of EPA, DHA and omega-3 index values. The Mann-Whitney U tests were used to determine statistical significance. Results. Immunodeficient participants, especially with CVID, overall tend to have a slightly lower mean concentration of omega-3 fatty acids such as DHA and in particular EPA (CVID: 0.86% ± 0.28% vs 1.06% ± 0.31%, p = 0.095) as compared with the control group and the differences were most evident among patients aged 30-39 (0.67 ± 0.16% vs 1.12 ± 0.12%, p = 0.025). 63% of patients with immunodeficiency had an omega-3 index value between 4-8, compared to 39% in the control group. 37% of participants with predominantly antibody defects had an omega-3 index value > 8% (29% of all CVID group) compared with 61% of the control group. None of the participants achieved a result of 4% or lower. People without immunodeficiency consumed products rich in omega-3 acids more often. Conclusions. These findings suggest that primary immunodeficient patients with predominantly antibody defects tend to have lower omega-3 index values, albeit not significantly and seem to have higher cardiovascular risk than the control group. Research has also shown that education is needed regarding the effects and necessity of consuming products rich in omega-3 fatty acids, especially in patients with immunodeficiency.

Summary: The aim of this contribution was to highlight the "favorable" and "unfavorable" roles of domestic and non-domestic animals on airway sensitization processes and on the type/severity of the clinical symptoms induced by their exposure. We performed a literature research in MEDLINE for allergic manifestations and animals. Pets can be "allergy friends" through mechanisms related to hygiene hypothesis and translational aspects, the dual role of IgG4 antibodies for pets, and their promising role as healthcare service animals (dogs). On the contrary, animals can be "allergy enemies" when inducing allergic sensitization and  respiratory symptoms (sometimes leading to severe reactions), and also due to cross reactivity with other pets allergens, indirect exposure and ubiquity of their allergens, cross reactivity between Can f 5 and human prostate-specific antigen (PSA). Moreover, in some cases they can trigger anaphylaxis, induce occupational asthma, and act as pests. Finally, we must outline the modest efficacy of allergen immunotherapy (AIT) for their allergens. From a strictly allergological perspective, it is evident that the "negative" aspects resulting from exposure to domestic / non-domestic animals outweigh the "positive" aspects. As a consequence, it is up to humans to seek new ways to balance the pros and cons by exploring research areas that can allow the best possible coexistence with subjects at risk of allergy with domestic and non-domestic animals.

Summary: Background. Eosinophilic esophagitis (EoE) is an immune-mediated chronic esophageal disease, with frequent association with atopy. A vali-dated non/minimally invasive biomarker of disease severity has not been identified. We aimed to determine if sensitization to airborne and food allergens correlates with disease severity, and to evaluate the association between clinical and laboratory characteristics with the severity of EoE. Methods. Retrospective study of EoE patients observed in a differentiated center, 2009-2021. The association between patients' diagnosis age, disease duration before diagnosis, sensitization to airborne/food allergens, serum total IgE and peripheral blood eosinophil values and severe clinical disease (presence of symptoms with a significant impact on quality of life and/or ≥ 1 hospital admission due to EoE complications, namely severe dysphagia, food impaction or esophageal perforation) and histological severe disease (≥ 55 eos/hpf and/or microabscesses in esophageal biopsies) was evaluated. Results. 92 patients were observed, 83% male, 87% atopic. There was a mean delay in diagnosis of 4 years (range 0-31). 84% had aeroallergen sensitization and 71% food sensitization. Food impaction and dysphagia were the most frequent symptoms, and severe clinical disease was observed in 55%. Histologically, 37% had severity criteria. Patients with severe clinical disease had a significantly longer mean disease duration before diagnosis than patients without severe clinical disease (79 vs 15 months; p = 0.021). Patients who described food impaction were significantly older at time of diagnosis than those who have never had impaction (18 vs 9 years; p < 0.001). There was no significant association (p < 0.05) between sensitization, serum total IgE and peripheral blood eosinophil values and clinical or histological severity. Conclusions. An older age at diagnosis and a longer disease duration before diagnosis appear to be useful for pre-dicting EoE clinical severity. Despite having been demonstrated a high prevalence of allergic disease, the presence of sensitization to airborne and/ or food allergens do not seem to be useful for predicting clinical or histo-logical severity.