European annals of allergy and clinical immunology最新文献

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.

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.