European annals of allergy and clinical immunology最新文献

Summary: Background. Local Allergic Rhinitis (LAR) is a phenotype defined by rhinitis symptoms with negative responses to systemic sensitization tests but with an exclusively nasal allergic inflammatory response. Data on the pediatric age group is scarce, and no Latin American data has been published so far. Methods. Nasal Allergen Challenge (NAC) was performed with Dermatophagoides pteronyssinus and Blomia tropicalis in six- to 18-year-old patients diagnosed with rhinitis and no systemic sensitization. NAC was monitored using subjective parameters and acoustic rhinometry. The study aimed to identify LAR in child and adolescent subjects previously diagnosed with non-allergic rhinitis (NAR) in a Brazilian specialty outpatient clinic (Allergy and Immunology). Results. During the study period, we analyzed 758 skin prick tests (SPT). Of those, 517 (68.2%) were diagnosed with rhinitis. Among those, 18.4% (95/517) had a negative SPT, meeting the criteria for inclusion in the study. Twenty-five patients underwent NAC, and 40% (10/25) of them, previously considered to have NAR, had a positive test and were reclassified as having LAR. Based on the analyzed characteristics, clinically differentiating LAR from NAR was impossible. Conclusions. This study represents the first investigation of LAR in child and adolescent subjects in Latin America, contributing significantly to the understanding of its prevalence and characteristics in this geographic area. Among a subgroup of patients lacking systemic sensitization submitted to NAC, 40% (10/25) demonstrated a positive NAC with Dermatophagoides pteronyssinus and Blomia tropicalis, warranting their reclassification to LAR. NAC with multiple allergens has been proven safe and viable in pediatric populations, affirming its critical role in the accurate diagnosis of LAR.

Summary: Background. Asthma is a major public health problem, with increasing prevalence in most countries, particularly among children. Poor dietary quality is also increasing in children, and evidence of the overall quality of children's food patterns effects on asthma is scarce. Methods. This cross-sectional analysis (660 children: 49.1% females, aged 7-12years) evaluated the association between diet quality and asthma (n = 56) and airway inflammation among school-aged children according to body mass index (BMI). Diet quality was assessed through the Healthy Eating Index (HEI)-2015, and categorized by tertiles. Higher scores represent a healthier diet. A questionnaire was used to enquire about self-reported medical diagnosis of asthma and asthma under medication. Lung function and airway reversibility were measured, and airway inflammation assessed measuring exhaled fractional nitric oxide (eNO). Two categories of BMI were considered: non-overweight/obese (p less than 85^th), (n = 491), and overweight/obese (p ≥ than 85^th), (n = 169). The associations between diet quality and asthma and airway inflammation were estimated using logistic regression models. Results. Non-overweight/obese children in 2^nd tertile of HEI-2015 score had decreased odds of having eNO ≥ 35ppb (OR 0.43, 95%CI 0.19-0.98), medical diagnosis of asthma (OR 0.18; 95%CI 0.04-0.84), and asthma treatment (OR 0.12; 95%CI 0.01-0.95), compared to children in the 1^st tertile. Conclusions. Our findings suggest that a higher diet quality associates with lower levels of airway inflammation and reduced prevalence of asthma among non-overweight/obese school-aged children.

Summary: Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus affecting mainly young individuals with a high burden of comorbid atopic diseases and is associated with increased morbidity. Proton pump inhibitors (PPIs) is often the first line of treatment by inducing clinical remission in 30-50% of patients. Recently new drugs, such as budesonide orodispersible tablets and a monoclonal antibody targeting interleukin-4 and 13, have been found to be effective in clinical trials and approved to treat this condition. A prompt diagnosis and correct management of these patients is of paramount importance to prevent fibrostenosis of the oesophagus and to improve the quality of life. The complex management of patients living with EoE requires the integrated cooperation of several specialists, including allergists, gastroenterologists, pathologists, dietitians, and psychologist.

Summary: Background. Allergy is a multifactorial disease in which variant genetic and environmental factors are involved. Pathophysiology of food allergy (FA) and its natural history are poorly understood till now. Novel biomarkers and curative treatment options are strongly required. We aimed to study the significance of serum sphingosine 1 phosphate (S1P) level in food allergy and assess its possible correlation with disease severity. Methods. Study conducted on fifty participants diagnosed to have food allergy and another fifty group matched individuals who served as a control group.  Results. The mean food allergy severity score of patients was 2.64±1.06, in which nearly two thirds (70%) are moderate, 18% are mild and about 12% of them are severe. A statistically significant increase in median value of S1P was found in patients with food allergies when compared to the control group. The best S1P cut-off level for the prediction of food allergy was (122.35 ng/L), with a sensitivity of 97.9% and a specificity of 95.7%, with a (97%) accuracy. Regarding Spearman's rho correlation analysis, a positive significant correlation was found between serum S1P level and Food allergy severity score. Conclusions. Sphingosine 1 phosphate (S1P) serum level can be a diagnostic marker for food allergy and its modulation could be a modality treatment for food allergies.

Summary: Spice allergies are often under-recognized and under-researched, leading to delays in diagnosis and treatment. Cross-reactivity with other plant allergens further complicates accurate diagnosis. This literature review seeks to systematize and analyze current data on hypersensitivity to spices, including pepper, cumin, oregano, anise, mustard, and other seasonings. The review covers research published from 2010 to 2023 in peer-reviewed journals, books, and conference proceedings, sourced from databases such as PubMed, Scopus, Web of Science, and Google Scholar. The main pepper allergens are PR-10 proteins, profilins and defensins. They can cause cross-allergic reactions with pollen and other plant allergens. Cumin allergens belong to the PR-10 family and can provoke allergic reactions. Cross-reactivity between cumin and other umbelliferae is common. Oregano contains Bet v 1 allergens and profilins, often leading to cross-allergies with other spices and plants. Allergies to anise are less common but can be a serious problem due to cross-reactivity with birch pollen. Mustard is one of the most allergenic spices. These proteins can cause severe reactions even in small amounts. Diagnosis is carried out using skin prick tests and blood tests for specific IgE antibodies. Cross-reactivity among spices and other allergens complicates the diagnosis and management of spice allergies. This review will be useful for the development of personalized dietary recommendations for patients, accounting for cross-reactivity and individual sensitization profiles.

Summary: Background. Pediatric cutaneous mastocytosis patients diagnosed and followed up by our specialist were enrolled in this study, and clinical and laboratory evaluations were retrospectively analyzed from patients' archived files. Methods. Patients, who applied to the Division of Pediatric Allergy And Immunology Unit of a University Training and Research Hospital between 01.01.2010 and 28.04.2021, were enrolled in this study. Results. Of the 33 patients included in the study, 11 (33.3%) were female and 22 (67.7%) were male. The median age of onset of the patient's complaints was 7 (0-60) months. The median age at diagnosis was 11 (2-64) months. Their complaints' median regression age was 54 (6-192) months. Resistant clinical findings were followed in 13 (39.4%) patients. Itching, redness, gastrointestinal symptoms, and maculopapular eruption were the most common complaints. The rashes were mostly polymorphic and larger than 1 cm. Heat was the most common trigger. Darier's sign was positive in 97% of the patients. Antihistamines were the most commonly used drug for prophylaxis and treatment. The autoinjector prescription rate was 24.2%. Conclusions. Quality of life was mildly affected in 48,5% of the patients based on the CDLQI scores. Thus, patients should be followed up through adolescence for the development of systemic signs and symptoms.

Summary: Background. Lipid transfer proteins (LTP) allergy is often a challenge for clinicians. We evaluated a multiplex diagnostic approach with diverse cofactors to stratify LTP syndrome risk. Methods. Of the 1,831 participants screened with 'Allergy Explorer-ALEX-2', 426 had reactions to at least one LTP. Data was gathered and recorded via an electronic database. Results. Reactivity to peach Pru p 3 was found in 77% of individuals with LTP allergy. Higher levels of specific IgE and concurrent sensitization to more than 5 molecules (50% of all LTP-sensitised participants, 62% of symptomatic cases) were significantly associated with an increased risk of severe reactions (p = 0.001). Several cofactors, either alone or in combination, also influenced patients' clinical outcomes. Some cofactors increased the risk of severe reactions, such as mono reactivity to LTP in 44.6% of cases (p = 0.001), Food-Dependent Exercise-Induced Anaphylaxis (FDEIA) in 10.8% of patients (p = 0.001), and Food-dependent NSAID-induced hypersensitivity (FDNIH) in 11.5% (p = 0.005). On the other hand, reactivity to PR10 (24.2%; p = 0.001), profilin hypersensitivity (10.3%; p = 0.001), and/or atopic dermatitis (16.7%; p = 0.001) had a mitigating effect on symptom severity. Conclusions. Clinical severity of LTP syndrome is associated with an expanded IgE repertoire in terms of the number of LTP components recognized and increased IgE levels in individual molecules. Ara h 9, Cor a 8, and Mal d 3 showed the strongest association with clinical severity. In addition, several cofactors may either exacerbate (FDEIA, FDHIH, and LTP monoreactivity) or ameliorate (atopic dermatitis and co-sensitization to profilin and/or PR10) individual patient outcomes. These factors may be utilized for the daily clinical management of LTP syndrome.