European annals of allergy and clinical immunology最新文献

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.

Summary: Evidence supports the hypothesis of pollen-induced asthma as a specific asthma phenotype, with defined clinical features and tailored pathways for its clinical management. The probability of diagnosis varies significantly in the pollen season, in which allergic patients are symptomatic, as compared to asymptomatic periods outside the pollen season. In this context, a novel diagnostic scheme for pollen-induced asthma has been developed. Pollen exposure is the key risk factor for symptoms and exacerbations. Therefore, we proposed a therapeutic algorithm for pollen-induced asthma based on a risk stratification model that considers the medical history of the patients and the measurement of objective markers, allowing a tailored therapeutic approach.

Summary: Background. In diagnosing insect venom allergy and making immunotherapy decisions, clinical history, skin tests, and specific serum IgE levels are commonly utilized. This study aims to emphasize the clinical significance of using the basophil activation test in accurately identifying sensitivities in individuals with insect venom allergy and to compare its effectiveness with other testing methods. Methods. This study included a total of 43 patients, who experienced at least one systemic allergic reaction following insect stings and were deemed suitable for immunotherapy.Basophil activation test, specific serum IgE levels, and skin prick test results utilized in making immunotherapy treatment decisions were recorded. Results. Our study determined that the overall clinical sensitivities of the basophil activation test (BAT), specific serum IgE (spIgE), and skin prick test (SPT) for apis mellifera were 95.5%, 95.7%, and 48.4% respectively, while for vespula vulgaris, they were 83.3%, 100%, and 33.3%. Based on these results, the prediction of systemic reactions to bee stings is ordered as spIgE > BAT > SPT. Additionally, early-stage skin prick tests showed a sensitivity of 67% and specificity of 50% at a cut-off value of 1.5 mm, and 33% sensitivity and 83% specificity at 2.5 mm. Conclusions. This study demonstrates that the basophil activation test (BAT) can provide a high positive predictive value in immunotherapy treatment decisions and offer significant insights in clinical practices.

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.