European annals of allergy and clinical immunology最新文献

Summary: The aim of this contribution was to highlight the "favorable" and "unfavorable" roles of domestic and non-domestic animals on airway sensitization processes and on the type/severity of the clinical symptoms induced by their exposure. We performed a literature research in MEDLINE for allergic manifestations and animals. Pets can be "allergy friends" through mechanisms related to hygiene hypothesis and translational aspects, the dual role of IgG4 antibodies for pets, and their promising role as healthcare service animals (dogs). On the contrary, animals can be "allergy enemies" when inducing allergic sensitization and  respiratory symptoms (sometimes leading to severe reactions), and also due to cross reactivity with other pets allergens, indirect exposure and ubiquity of their allergens, cross reactivity between Can f 5 and human prostate-specific antigen (PSA). Moreover, in some cases they can trigger anaphylaxis, induce occupational asthma, and act as pests. Finally, we must outline the modest efficacy of allergen immunotherapy (AIT) for their allergens. From a strictly allergological perspective, it is evident that the "negative" aspects resulting from exposure to domestic / non-domestic animals outweigh the "positive" aspects. As a consequence, it is up to humans to seek new ways to balance the pros and cons by exploring research areas that can allow the best possible coexistence with subjects at risk of allergy with domestic and non-domestic animals.

Summary: Background. Data on epidemiology of anaphylaxis are difficult to record. During the lockdown in 2020-2021 due to Coronavirus disease 2019 (COVID-19), referrals to Emergency Department (E.D.) reduced. The aims of the study are to determine anaphylaxis frequency before and during COVID-19 pandemic and risk factors for severity. Methods. Clinical records from a general E.D. of Milan in Italy were retrospectively evaluated before (2018-2019) and during the COVID-19 pandemic (2020-2021) analyzing demographic data, comorbidities, chronic therapies, causes, severity and adrenaline use. Results. The frequency of anaphylaxis remained stable (120/104129 = 0.12% in 2018-2019; 72/66720 = 0.11% in 2020-2021). No differences in the occurrence of anaphylaxis were found in sex and mean age. The main causes of anaphylaxis were food (2018-2019: 53% vs 2020-2021: 51%) and drugs (2018-2019: 27% vs 2020-2021: 33%). Hymenoptera stings had a low occurrence and unidentified trigger was about 15% in each period. The severity of anaphylaxis had a similar distribution in the two periods. Gender and cardiovascular diseases did not influence the severity, instead a positive correlation was found in age over 50 yo (p<0.001). Angiotensin II receptors blockers, β-blockers, diuretics and proton pump inhibitors were associated with increasing severity (p<0.01). Adrenaline administration was similar in the two periods. Conclusions. Anaphylaxis frequency was not affected by the COVID-19 pandemic. Food anaphylaxis remained the most important cause in the urban area. The severity of anaphylaxis was affected by ageing and some chronic therapies, which indirectly point out the role of chronic diseases in the clinical presentation.

Summary: Background. Diagnostic criteria for hypereosinophilia (HE) have been revised. Accordingly, the minimum interval between the two results with an absolute eosinophil count (AEC) ≥ 1500 cells/µL has been reduced from 4 to 2 weeks. The aims of this study were to identify patients with HE according to the new diagnostic criteria in children and demonstrate the effects of the revised time interval criterion on patient characteristics and disease spectrum. Methods. Individuals aged ≤ 18 years admitted to a tertiary university hospital were identified using an algorithm based on old and new diagnostic criteria for HE. While patients diagnosed with HE according to old diagnostic criteria were included in group 1, patients who were diagnosed with HE according to the new diagnostic criteria but did not meet the old criteria were included in group 2. Results. Patients in group 1 were significantly older than patients in group 2 at the time of diagnosis of HE (p = 0.004). While the number of patients diagnosed with HE aged 1-5 years was higher in group 1 (p = 0.01), the number of patients diagnosed with HE under the age of one year was higher in group 2 (p = 0.002). The most common cause of HE in group 1 was allergic disorders (10/40, 25%), while non-parasitic infections (17/36, 47%) were the most common diagnosis in group 2. Conclusions. The new diagnostic criteria may change the characteristics of pediatric patients with HE and the spectrum of associated diseases.

Summary: Background. Understanding the reason for the decrease in atopic dermatitis risk in preterm patients may be crucial for the development of prophylaxis and therapeutic measures. The hypotheses include a change in T-helper1/T-helper2/T-helper17 balance, thymus development, and intestinal colonization. This study was designed to compare these parameters between preterm and term patients.  Methods. The investigated population comprised 28 preterm and 19 term-born patients. On the 7^th day of life, T-helper1/T-helper2/T-helper17 cytokine concentrations were assessed, thymus ultrasonographic examination was performed, and the stool was examined for the presence of pathogenic bacteria. The last two procedures were repeated at 37 weeks of post-menstrual age in the preterm group. Results. There were no significant differences in the concentrations of interferon-γ, tumour necrosis factor-a (TNFa), interleukin (IL)-2, IL-6, or IL-10 after mitogen stimulation between the preterm and term groups. A negative correlation was found between IL-2 and the week of gestation at birth (r_s= -0.466, p=0.038) and thymus/weight ratio and week of gestation at birth (r_s= -0.592, p=0.006). IL-6 was negatively correlated with birth weight in preterm group (r_s -0.694, p=0.008), whereas IL-10 positively with birth weight in term group (r_s 0.775, p=0.041). Correlations of other investigated cytokines were statistically insignificant. The levels of IL-2 and interferon-γ after phytohemagglutinin stimulation were greater in the subgroup with pathogenic bacteria in the stool at birth (381.38 (148.7-727.4) vs. 13.23 (7.98-197.8) pg/ml; p=0.049; 17.49 (6.53-30.54) vs. 3.37 (1.03-9.82) pg/ml; p=0.037), whereas no significant differences were found between the levels of IL-6, IL-10 or TNFa. Conclusions. The observed associations may indicate an altered pattern of immunological development in preterm and term children.

Summary: Background. Many physicians believe delivering medications for asthma exacerbation via nebulizers is more efficacious than using a metered dose inhaler (MDI) with spacer. This study aimed to evaluate pediatricians and allergists' chosen method in children under 5 years: MDI with spacer or nebulizer. Methods. A brief survey was sent via electronic mail to a randomly selected group of pediatricians and allergists. There was a 15.8% (430/2718) total response rate. We divided respondents into 2 groups. Group A comprised 289 primary care pediatricians, and Group B included 141 practicing allergists. Results. In Group A, 68.5% (196/286) respondents indicated an MDI with spacer as their method of choice to deliver bronchodilator therapy during an asthma exacerbation; 64.7% (187/289) reported an MDI with spacer is an effective method; and 48% (135/281) believe delivering medication through a nebulizer will produce increased adverse effects than MDIs with spacers. In Group B, 55% (77/140) of respondents indicated MDI with spacer as their method of choice; 48.9% (69/141) reported a nebulizer is an effective method; and 65.7% (90/137) believe delivering medication through a nebulizer will produce increased adverse effects. Conclusions. Contrary to evidence-based recommendations, most allergists, compared to pediatricians, are not only prescribing nebulizers as their first choice for delivering bronchodilator therapy, but also half of these asthma specialists consider nebulizers to be an effective mode of delivery. As far as safety is concerned, ironically, almost two-thirds of allergists believe more side effects are associated with delivering bronchodilator therapy through a nebulizer.