European annals of allergy and clinical immunology最新文献

Summary: Asthma is a heterogeneous syndrome with a significant social and economic impact. While the knowledge of pheno-endotypes has advanced in severe asthma, little attention has been paid to the phenotypes of mild-moderate asthma. Along this line, a systematic review of the current literature on pollen-induced asthma was carried out, targeting the question whether it can be considered a specific phenotype of disease, with a focus on the role of pollen and its interplay with asthma. This article reports the first part of the review, which covered background information on the multiple atmospheric and environmental factors affecting pollen concentration, the molecular bases of pollen-induced allergenicity and the pathogenic effector circuits that sustain and amplify inflammatory signals in response to allergens in sensitized subjects.

Summary: Background. Clinical and laboratory features of wheat allergy dependent on augmentation factor (WALDA) are scarcely characterised as compared to wheat anaphylaxis dependent on augmentation factor (WANDA). In this study we assessed the pattern of comorbid atopic and gastrointestinal diseases and the sensitisation profile in patients with WALDA presenting with intermittent urticaria. Methods. We retrospectively assessed all patients with WALDA-urticaria in a tertiary referral center, with a combined gastrointestinal- allergy unit. WALDA diagnosis was based upon recognised clinical/serological criteria, Clinical, atopic features, allergy tests and gastrointestinal comorbidities were compared to a cohort of O5G negative patients sensitised/allergic to wheat and one of patients allergic to shrimp. Results. Overall, we recruited 11 patients with WALDA presenting with intermittent urticaria (median age 44 years, IQR 29-58, F:M ratio 1.7:1). Atopy was a frequent finding among patients (8/11, 72.7%), with food allergy (6/11, 54.5%) followed by respiratory allergies (5/11, 45.5%). Shrimp sensitisation was present in 8/11 patients (72.7%); half of them were also clinically reactive to shrimp. Irritable bowel syndrome (IBS) was present in 4/11 patients (36.3%). The prevalence of shrimp sensitization was 15.3%, (p=0.01), in a group (n=13) of O5G negative patients with wheat sensitisation/allergy (median age 31 years, IQR 27.7-52.0, F:M ratio 0.4:1), while IBS prevalence was 9% (p=0.12).  In the group of patients with shrimp allergy (n=13) with or without allergic rhinitis, the prevalence of O5G positivity was 0% and that of IBS 7.7%. Conclusions. Patients with WALDA-urticaria seems to present specific demographic features (female sex) and atopic (shrimp sensitisation/allergy).

Summary: HAE is a rare disease manifesting with recurrent attacks of disabling and potentially life-threatening angioedema for which early diagnosis and effective therapy are critical. Recent scientific progress and the development of novel therapeutic options has engendered multiple important changes in the diagnosis and management of the disease. In an attempt to encourage and facilitate the use of this progress for all patients, the Hellenic Society of Angioedema has undertaken the effort to develop consensus recommendations for the diagnosis, treatment and management of hereditary angioedema in special patients' groups. To this aim a panel of 11 experts was assembled and a modified Delphi method was used. After a comprehensive review of relevant literature from the last five years retrieved from Medline, the initial text of the recommendations was formulated and consensus was sought among the experts. The consensus included statements that were agreed by more than 80% of the experts. This article presents the 24 consensus recommendations that were finally formulated.

Summary: Background. Mixed rhinitis (MR) is a potential diagnosis for patients with allergic rhinitis (AR) who present symptoms following exposure to allergens yet also exhibit a significant burden of symptoms after exposure to non-specific irritants. MR is thought to be more prevalent than the isolated form of the disease (AR). However, there are still no established complementary tests or well-defined clinical criteria for diagnosing this phenotype in children and adolescents. This study aimed to propose and evaluate a questionnaire of triggers that could assist in clinically distinguishing patients with MR from those with AR and, through it, to estimate the prevalence of MR in a specialty center. Methods. This study focused on patients aged 8 to 18 years diagnosed with AR and under follow-up for at least six months. All patients completed the nasal irritant questionnaire (NIQ) with 18 items. The number of responses with a score ≥ 5 was used to define tertiles. The group from the 3^rd tertile onwards was described as "high irritant burden" (MR), while the others were defined as "low irritant burden" (AR). Additionally, symptom control scores, allergic sensitization, atopic comorbidities, and indoor exposure to aeroallergens were considered. Results. By using the diagnostic criterion of MR, defined as at least eight positive responses on the NIQ in a patient with AR, it was possible to determine that the prevalence of MR was 42.9% (54/126), with a predominance of males and adolescents (median 13 years) and a mean duration of 3 years since symptom onset. This group also exhibited poorer symptom control. Considering the other evaluated variables, no significant differences were observed between the groups. Conclusions. The prevalence of MR is significant among children with AR, and individuals with MR exhibit poorer symptom control. At least eight positive responses with a score ≥ 5 in the NIQ were a practical cut-off point for differentiating between AR and MR phenotypes.

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. Metamizole, a non-steroidal anti-inflammatory drug from the pyrazolone group, is a frequent cause of immediate hypersensitivity reactions and, more rarely, of delayed drug hypersensitivity reactions. Due to its favorable pharmacokinetic characteristics, metamizole is widely used in the postoperative period for pain control. Methods. Retrospective study of patients referred for allergological study between January 2012 and June2022 for postoperative hypersensitivity reactions. Clinical and diagnostic data were collected through review of patients' medical records. Twenty patients with postoperative hypersensitivity reactions were referred, of which 10 presented delayed reactions. We analyzed the results of skin prick, intradermal and patch tests performed with an intravenous metamizole solution as well as provocation tests performed with metamizole and acetylsalicylic acid. Cross-reactivity to non-steroidal anti-inflammatory drugs was excluded by confirmation of clinical tolerance to non-steroidal anti-inflammatory drugs or by acetylsalicylic acid provocation test. Results. In 7 of the 10 patients a delayed reaction to metamizole was diagnosed. These reactions were characterized as maculopapular exanthema, occurring in multiple postoperative settings. Skin tests were negative, except in one patient with late mild erythema in the ipsilateral upper limb and no reaction at the site of intradermal injection. Delayed hypersensitivity was demonstrated by late positive metamizole provocation tests. Conclusions. This study demonstrated that for a correct diagnosis a high degree of suspicion about possible delayed hypersensitivity drug reactions to metamizole in the postoperative setting is needed. In the investigation, provocation test with metamizole was decisive for diagnostic confirmation.