European annals of allergy and clinical immunology最新文献

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.

Summary: Background. Little is known about the relationship between allergic diseases and seizure disorders including epilepsy. It is hypothesized that inflammation from allergic diseases may predispose children to seizures. The aim of this study is to investigate the frequency of seizure disorder in children with asthma and allergy. Methods. This is a cross-sectional survey study of parents of 1,300 children and adolescents under 20 years of age referred to the Allergy and Asthma Clinic of Imam Ali Hospital (Karaj) who were asked to complete a screening questionnaire for seizures in their children. Parents who reported any history of seizures in their children were contacted to answer a second in-depth questionnaire to determine more detail of type, triggers, and treatment of seizures. Results. A total of 705 males (62%) and 433 females (38%) participated in this study, with a mean and standard age of 6.62 ± 4.57 years. Among them, 70.6% had asthma, 15.2% had allergic rhinitis, 5.6% had atopic dermatitis, 3.5% had urticaria, 2.7% had food allergies, 1% had drug allergies, and 1.4% had other allergic diseases. Additionally, 88 patients (7.7%) had a history of doctor-diagnosed seizures, 57 patients (5%) had febrile convulsions, and 15 patients (1.31%) had idiopathic epilepsy. There was no significant relationship found between febrile convulsions, seizures, and epilepsy with the type of allergic diseases. However, a significant association was observed between the number of comorbid allergic diseases in patients with febrile convulsions (OR 1.4, 95%CI 1.07-1.83, p = 0.013). There was also an association between the epilepsy and comorbid allergic diseases number with an odds ratio OR 1.84, 95%CI 0.28-12, however the risk of epilepsy was increased by 0.84% but this increase was not significant. Regarding the relation between the number of allergic diseases in parents and idiopathic epilepsy in their children, a significant association was found only for mothers (OR 1.28, 95%CI 1.04-2.23, p = 0.024), but not for fathers (p > 0.05). Conclusions. Febrile convulsion is associated with the number of comorbid allergic diseases in children and the mother's number of allergic diseases is more related to idiopathic epilepsy in children than the father's.

Summary: Background.Patients with autoimmune forms of chronic spontaneous ur-ticaria (aiCSU) exhibit autoantibodies against the high-affinity IgE recep-tor (FcεRI) and IgE. As the presence of these autoantibodies does not cor-relate with disease activity, the functional affinity/avidity may be relevant in aiCSU. This exploratory study aimed to characterize the quantity and avidity of autoantibodies against IgE and FcεRI over 6 months. Methods. The serum of 49 patients with CSU and 30 healthy control subjects was obtained at baseline and 6 months. Serum was analyzed by ELISA, to determine the quantity and avidity of anti-IgE and anti-FcεRI autoan-tibodies, and by basophil activation test (CU-BAT). Results. An increase in the quantity of anti-FcεRI and anti-IgE antibodies and a simultaneous decrease in avidity was found in all patients with CSU after 6 months: median anti-IgE increased from 6.7 ng/mL (IQR 5.1-12.5) to 23.8 ng/mL (IQR 12.3-121.5), p < 0.001, median anti-FcεRI from 52.4 ng/mL (IQR 26.3-111.4) to 129.5 ng/mL (IQR 73.7-253.7), p < 0.001. Me-dian anti-IgE avidity decreased from 75.8% (IQR 55.3-90.8) to 56.4% (IQR 30.6-76.2), p = 0.019 and median anti-FcεRI avidity from 75.1% (IQR 49.8-90.0) to 52.2 (IQR 38.2-60.1), p < 0.001. In contrast, the frequency of activated basophils did not change significantly over time. Surprisingly, autoantibody avidity did not correlate with basophil acti-vation. Conclusions. Both the quantity and avidity of anti-FcεRI and anti-IgE antibodies change over time, demonstrating that the CU-BAT is more suitable to diagnose aiCSU. In addition, the avidity of anti-FcεRI and anti-IgE antibodies do not correlate with CU-BAT and disease activ-ity, suggesting that further factors independent of anti-FcεRI and anti-IgE autoantibodies contribute to aiCSU.

Summary: Anaphylaxis is a severe, rapidly developing, and life-threatening systemic hypersensitivity reaction. The diagnosis of anaphylaxis is primarily clinical. Numerous studies on the mechanisms and the biomarkers of the disease are initiated every year. The biomarkers of anaphylaxis may become an important tool for the diagnosis, prevention, repeated risk assessment, severity stratification, and new therapeutic strategies for treatment of the disease. Various immune and non-immune mediators produced and released by effector cell populations are currently considered as biomarkers of anaphylaxis. Here, we review the current data on potential biomarkers of anaphylaxis and the possibilities and perspectives for their use in future clinical practice.

Summary: Background. Subcutaneous immunotherapy is an effective treatment of respiratory allergy and allergoids offer a treatment option characterized by reduced IgE-binding properties to improve the safety profile. Purpose of this study was to investigate the efficacy and the safety of an injective monomeric allergoid in patients with moderate to severe persistent allergic rhinitis due to house dust mites. Methods. in a perspective, controlled, observational study a suspension of 0.70 mL at 10 BU/mL containing a mixture of carbamylated extract of Dermatophagoides was injected monthly for 12 months, following a 5-weeks build-up phase (0.10-0.20-0.30-0.50-0.70 mL weekly), to 58 patients (mean age 25.1 ± 12.7). A matching group of 60 patients (mean age 34.0 ± 14.2) was observed as control, and both groups were allowed to assume standard pharmacotherapy. After one year, changes from baseline in visual analogue scale for symptoms and drugs intake were compared; satisfaction rate was based on patients' and physicians' judgements. Results. In respect to baseline both groups showed an improvement in symptoms with a significant difference in favor of immunotherapy. Drugs intake was significantly lower in patients receiving injections. High level of agreement was found between doctors and patients on their rate of satisfaction. No serious reactions occurred, and at least a mild episodic local or systemic reaction was reported by a limited number of patients. Conclusions. In routine practice injective monomeric allergoid of house dust mites was safe and associated with a perceived significant clinical benefit in persistent rhinitis shown by objective and subjective outcomes.

Summary: Background. Allergies represent a substantial health concern affecting individuals across all age groups. Diagnostic screenings, such as phadiatop and phadiatop infant, are employed to identify specific IgE antibodies associated with allergic reactions. This study delves into the relationship between total IgE levels and screening test outcomes, with the objective of establishing a total IgE threshold capable of predicting the likelihood of negative results in these screenings. Methods. This retrospective observational study included adults and children under 15 years old who underwent total IgE tests in addition to phadiatop and phadiatop infant screenings from January 2018 to December 2022. Exclusion criteria were applied to patients with insufficient serum samples or those whose IgE determinations or screening tests had been invalidated according to standard laboratory protocols. Results. Data analysis uncovered a robust correlation between total IgE levels and screening test outcomes. Additionally, thresholds of 20 UI/mL and 28 UI/mL were pinpointed for total IgE levels, below which the likelihood of obtaining a positive result in phadiatop or phadiatop infant, respectively, significantly decreased. Conclusions. These findings present cost-effective strategies for healthcare practitioners by recommending the initial use of total IgE testing. Subsequently, reflex testing with phadiatop or phadiatop infant, depending on the IgE value, could be considered.

Summary: Many food allergens not actually included in the European priority list of allergenic foods have the potential to cause severe allergic reactions and could escape correct identification and behave as "hidden allergens". Moreover, the adoption in recent years of novel diets based on plant products and new sustainable foods or the use of specific food additives have contributed to the onset of new emerging allergens of public health importance. The knowledge of hidden allergens is important both for physicians and for patients to improve the prevention, diagnosis and treatment of food allergies, in order to decrease eventual improper diagnosis of idiopathic anaphylaxis. In this review, the characteristics of the most frequent hidden allergens and their diagnostic tools are described. A detailed history with a careful review of the ingredient lists, an understanding of possible cross-reactions or contaminations with other foods, together with an allergological evaluation consisting of in vivo or in vitro tests and, where necessary, an oral food challenge, are recommended for the successful identification of the culprit allergen. In future, it will be very important to implement these diagnostic tools, especially in the field of molecular allergology, and reporting allergens on labels should become mandatory.

Summary: Background. We aimed to describe the clinical heterogeneity (infectious and noninfectious manifestations) and the impact of immunoglobulin replacement therapy on the reduction of infections in patients given a diagnosis of common variable immunodeficiency. Methods. This was a descriptive case series study. Medical charts were retrospectively reviewed based on demographics, clinical presentation, immunoglobulin replacement therapy and laboratory findings at diagnosis. Results. Thirty six common variable immunodeficiency patients were enrolled. Nineteen of them were male (53%). The median age at onset of symptoms was 8 years and at common variable immunodeficiency diagnosis was 19 years. Family history for immunodeficiency was observed in 2 patients (5%). Recurrent infections were present in 35 patients (97%) and they were the first clinical manifestations in 31 patients (86%). Respiratory infections were the most frequent, followed by gastrointestinal infections. Noninfectious manifestations were present in 32 patients (89%), including bronchopulmonary disease, allergy, autoimmunity, lymphoproliferation, gastrointestinal disorders and malignancy. Chronic pulmonary disease and lymphoproliferation were the most common. There was an important reduction of infections 1 year after begining immunoglobulin replacement therapy, mainly pneumonia and sinusitis. Conclusions. Although the diagnosis of common variable immunodeficiency has improved over the last decade, many patients are still being referred and diagnosed late. Physicians must recognize that both infectious and noninfectious manifestations can be the initial signs of common variable immunodeficiency and are very common in these patients. Immunoglobulin replacement therapy significantly reduces respiratory infections.

Summary: Background. Mites are responsible for allergic diseases, such as asthma and rhinitis, in nearly 1.5% of the world population. It is known that nowadays, besides House Dust Mites (HDM), Storage Mites (SM) are important sensitisers in urban non-occupational dwellings, predominantly in the Mediterranean area. The main objective of our study was to analyse the clinical relevance of the most prevalent SM, Lepidoglyphus destructor, by assessing the relationship between sensitisation to the major molecular allergen Lep d 2 and allergic respiratory disease phenotype in an urban population monosensitised to this molecular allergen. Methods. Cross-sectional study which included consecutive patients evaluated in our Allergy Department between 2012 and 2018, from urban non-occupational setting, with rhinitis and/or asthma, perennial symptoms and proven sensitisation to SM Lep d 2, tested using ImmunoCAP Immuno Solid-phase Allergen Chip (ISAC) technology, which detects 112 allergens. Results. A total of 37 allergic patients were included (23 female), aged 20.1 ± 12.8, min-max 5-58 years-old. The molecular sensitisation profile showed 18.9% of L. destructor mite monosensitised patients, having only sIgE to Lep d 2. This subset of patients mainly had allergic rhinitis, with 28.6% also being asthmatic. Regarding severity, most patients showed a persistent moderate phenotype of respiratory disease. The mean value of Lep d 2 sIgE was 8.3 ± 9.8 ISU-E, lower than in mite polysensitised patients (21.7 ± 21.5, p = 0.049). Conclusions. Our proof-of-concept study focused on Lep d 2 monosensitisation, showed that SM may have clinical relevance in perennial allergic asthma and rhinitis, and should be taken into account when assessing and treating allergic respiratory disease. Conclusions. The present survey demonstrated that Italian primary care pediatricians accomplish ARIA guidelines and adapt treatment on the basis of the intensity of symptoms. Corticosteroids and antihistamines are the most common prescribed medications. Nasal lavages are also popular.

Summary: Background. Allergic rhinitis (AR) is a widespread condition. The Italian Society of Pediatric Allergology and Immunology (SIAIP) promoted an initiative to update the knowledge on AR in children and adolescents. The present survey directly addressed primary care pediatricians, thus reflecting the real-world management of AR in children and adolescents. The aim was to investigate common practice in managing AR children. Methods. A panel of experts drafted a series of questions concerning the practical management of children with AR in clinical practice. The questionnaire was administered to a large sample of primary care pediatricians (864). Results. 864 primary care pediatricians participated to the survey. Each pediatrician on average follows 94 children with AR; globally 81,231 children. More than 70% of participants follow ARIA guidelines. Accordingly, 42% of children have mild AR and 58% moderate/severe. Asthma, conjunctivitis and adenoid hypertrophy are the most common comorbidity. Most pediatricians autonomously follow their patients. The intensity of treatment (use of medication) is directly proportional to the symptom severity.  Intranasal corticosteroids are the most common medication used followed by oral antihistamines and nasal lavages (with hypertonic or isotonic solution). Up to 20% of participants prescribe the fixed association topical corticosteroids plus antihistamine. Conclusions. The present survey demonstrated that Italian primary care pediatricians accomplish ARIA guidelines and adapt treatment on the basis of the intensity of symptoms. Corticosteroids and antihistamines are the most common prescribed medications. Nasal lavages are also popular.