European annals of allergy and clinical immunology最新文献

Summary: Background. Seed Storage Proteins (SSPs) associate with severe allergic reactions to tree nuts, peanuts, and seeds. This study aimed to characterize the molecular and clinical profiles of SSP sensitization, in patients allergic to peanuts, tree nuts, and/or seeds and sensitized to 2S Albumins (2S) or 7S and 11S Globulins (7S and 11S, respectively). Methods. A retrospective analysis from 2016 to 2024 of the characteristics of peanuts, and/or seeds allergic patients who were sensitized to SSPs (identified by ImmunoCAP™ ISAC) was performed. Reaction severity was graded using the oFASS scale. Results. Sixty-six patients (median age 10 years, range 1-67, IQR 15) were included. Walnut caused 41% of the reactions, followed by hazelnut and peanut (21%). Sensitization rates were 88% for 2S (Jug r 1 48%, Ana o 3 29%), 36% for 11S (Cor a 9 29%), and 23% for 7S. Co-sensitization occurred within and across protein families (p < 0.05). Jug r 1, Cor a 14, Ana o 3, Ara h 1, 2, and 6 were clinically relevant for walnut, hazelnut, cashew, and peanut allergies (p < 0.05). Severe reactions correlated with co-sensitization to non-specific lipid transfer proteins (nsLTPs) (p = 0.05). Conclusions. Jug r 1 (the main sensitizer), Cor a 9, Ana o 3, Ara h 1, 2, and 6 appear to be good markers of nut/peanut allergy. Co-sensitization to nsLTPs seems to exacerbate reaction severity. Identifying SSP sensitizations can improve diagnosis, management, and personalized recommendations for allergic patients.

Summary: Background. Small airway dysfunction (SAD) is increasingly recognized as a key feature in asthma, influencing control, exacerbations, and severity. Spirometry remains the gold standard for lung function assessment but mainly reflects large airways, whereas impulse oscillometry (IOS) offers complementary insights into peripheral airway function. Methods. A retrospective analysis was conducted on 218 patients referred for asthma-like symptoms or untreated mild asthma to the Allergy and Clinical Immunology Unit of L. Sacco Hospital (Milan). All underwent spirometry and IOS; 169 also completed bronchodilator testing. Concordance, discordance, and correlations were evaluated using chi-square tests, logistic regression, and Pearson's coefficient. Results. Among 218 patients (mean age 40 years, 62% female), SAD was detected in 24 by spirometry and 52 by IOS, with significant overall concordance (p < 0.001), particularly in patients with asthma-like symptoms. Discordance was associated with older age, female sex, and higher body mass index. Bronchodilator testing showed discordant responses, correlating with exertional symptoms and lower Asthma Control Test (ACT) scores. Conclusions. IOS and spirometry provide complementary insights into airway physiology. IOS is more sensitive to peripheral airway abnormalities and can detect distinct bronchodilator responses, whereas spirometry remains the standard assessment tool. Their combined use improves detection and monitoring of small airway dysfunction, especially in early or mild asthma, potentially guiding more personalized management strategies.

Background. Triple therapy with inhaled corticosteroids (ICS), long-acting β₂-agonists (LABA), and long-acting muscarinic antagonists (LAMA) is recommended for severe asthma patients with uncontrolled symptoms. Single-inhaler triple therapy (SITT) may offer additional clinical and practical benefits. This study analyzes the clinical profiles of patients receiving LAMA-containing regimens using real-world data from the Italian Registry on Severe Asthma (IRSA). Methods. We conducted a cross-sectional analysis of 2,155 patients with severe asthma enrolled in IRSA between 2018 and May 2025. Patients were stratified based on LAMA use ("LAMA Yes" vs. "LAMA No") and assessed across demographics, lung function, biomarkers, asthma control, healthcare utilization, and comorbidities. Results. Patients on triple therapy were older, had a greater smoking history, and worse lung function (FEV₁ and FVC, p<0.001). They also reported poorer asthma control (mean ACT 16 vs. 17.5, p<0.001), more exacerbations (3.6 vs. 2.8/year, p<0.001), higher systemic corticosteroid use, and more comorbidities, including obesity and bronchiectasis. Interestingly, no significant differences were observed in type 2 inflammation markers (eosinophils, FeNO). The odds of receiving a LAMA prescription increased with age and a higher number of exacerbations. Conclusions. Triple therapy, especially through SITT, identifies a clinically complex asthma phenotype with a high disease burden. Despite growing evidence supporting efficacy and adherence benefits, triple therapy remains relatively underutilized in clinical practice, albeit with a significant increase from 2023 to the present. These findings highlight the need for more careful prescribing and further real-world evidence to optimize SITT positioning before escalation to biologic treatments.

Summary: Background. Drug hypersensitivity reactions (DHRs) include allergic, exaggerated pharmacologic, and pseudoallergic reactions to medications. The basophil activation test (BAT) using CD63 expression is a sensitive and specific complementary tool in the diagnosis of immediate DHRs. Methods. In this study we analysed retrospectively 1160 patients with history of DHRs categorized into several subgroups of diagnoses. BAT using CD63 expression was performed in the whole blood and results were analysed by flow cytometry. Results. The mean value of CD63 expression was significantly higher for positive patients than negative/borderline findings (P ˂ 0.001). The highest frequencies of positive BAT were in categories of diagnosis codes D89 (Other disorders involving the immune mechanism, not elsewhere classified) and L50 (Urticaria). The percentage values were the higher in the group of antibiotics and anticoagulants. Comparing individual drugs in vitro, we observed the highest prevalence of positive reactions by local anaesthetics (Mepivastesin, Mesocain, Lidocaine), antibiotics (Amoxiclav, Megamox duo), antirheumatics, antiphlogistics and antiuratics (Ibuprofen, Ibalgin). The BAT positivity decreases with age, there were significant differences in the CD63 activation between old age and children, younger adults, and older adults (P ˂ 0,001, P ˂ 0,05 and P ˂ 0,01, respectively). No significant differences have been found between men and women. Conclusions. BAT is a useful complementary tool to support the diagnosis of drug hypersensitivity conditions, especially in cases with severe reaction where drug challenge is contraindicated. The implementation of BAT in clinical practice is valuable in the workup of DHRs and extremely useful in the case of life-threatening drug allergies.

Summary: Background. Eosinophilic ascites (EA) is characterised by a high eosinophil count in the ascitic fluid and, although very rare, is mainly caused by eosinophilic gastrointestinal diseases (EGIDs), parasitic infections, and hypereosinophilic syndrome (HES). Symptoms caused by EGIDs are varied and depend on the gastrointestinal tract affected as well as the layer(s) involved; typically, EA implies a serosal involvement. Herein, we report our single Centre experience of three cases of EA in patients suffering from EGIDs together with a systematic review of all the other cases described in the literature. Methods. Patients selection was performed by querying the database containing patients suffering from EGIDs referred to our hospital and extracting all cases with eosinophilic ascites. In order to describe the reported cases of eosinophilic ascites, a literature review was carried out on Pubmed. Results. We identified three patients with EA suffering from EGIDs at our Centre. In the systematic literature review, a total of 105 patients suffering from EA due to EGIDs were identified from 81 literature articles. For both groups, we described: demographic characteristics, other immunological diseases, gastrointestinal symptoms, how ascites was diagnosed, ascitic fluid characteristics, peripheral eosinophils, gastrointestinal tract affected, therapy, and relapses. Conclusions. EA is a rare presentation of EGIDs and proper evaluations should be performed to make a proper diagnosis; it is crucial to exclude clonal and secondary causes of hypereosinophilia, but differential diagnosis with single organ-HES is often unclear. Steroid therapy is effective and monoclonal antibodies directed against IL-5 could be as well, but further studies are needed.

Summary: Background. Chronic spontaneous urticaria (CSU) is a common disorder characterized by the recurrence of wheals and/or angioedema for more than 6 weeks. About 35% of patients experience wheals and angioedema (AE-CSU) and around 6% of patients only present angioedema, also known as chronic histaminergic angioedema (CHA). As few data comparing CHA and AE-CSU are published, we analyzed the differences between demographic and clinical characteristics of these populations. Methods. A multicenter, observational, retrospective study, involving eight Allergology Centers in Lombardy, Italy, including 44 CHA and 34 AE-CSU pediatric and adult patients was performed. Data about sex, age, comorbidities, inflammatory markers, complement fractions, blood count, use of ACE inhibitors or angiotensin receptor blockers, site of angioedema attacks, therapy used to treat attacks, frequency of attacks at diagnosis, after 6 months of therapy and after 12 months of therapy were collected and analyzed. Results. A higher rate of atopy was found in AE-CSU than in CHA (58.8% vs 29.5%, p = 0.01). Hypothyroidism and antithyroid antibodies were more frequently detected in AE-CSU (p < 0.05). Face was the site majorly involved in both populations. Tongue angioedema was more reported in CHA than AE-CSU (22.7% vs 2.9%, p = 0.019). In CHA patients, upper airway involvement was reported mainly in male patients (p = 0.02). Monthly frequency of angioedema attacks at diagnosis was higher in AE-CSU than in CHA (2.1 vs 1.45, p = 0.045). Conclusions. Some characteristics may differentiate CHA from AE-CSU, as the latter experience higher rates of atopy, hypothyroidism and anti-thyroid antibodies positivity, as well as higher frequency of attacks and less tongue involvement.