International Archives of Allergy and Immunology最新文献

Background: House dust mites (HDM) are a primary trigger of allergic rhinoconjunctivitis (ARC), a common condition associated with substantial symptom burden and impaired quality of life. Although sublingual immunotherapy (SLIT) of HDM extracts has shown therapeutic potential, its overall efficacy and safety profile in adults and adolescents with ARC remains incompletely defined. We aimed to assess the efficacy and safety of HDM SLIT in adults and adolescents with ARC.

Methods: We conducted a systematic search of PubMed, Scopus, Web of Science (WOS), and Cochrane CENTRAL databases up to May 2025. We included studies comparing HDM SLIT to placebo or pharmacotherapy. The main efficacy outcomes were the combined symptom and medication score (CSMS), rhinitis symptom score (RSS), rhinitis medication score (RMS), and rhinoconjunctivitis quality of life questionnaire (RQLQ). Safety was assessed by analyzing treatment-related adverse events (AEs), serious, severe, and local AEs. A random-effects model was used to pool standardized mean differences (SMD) and risk ratios (RR).

Results: A total of 45 studies involving 30,288 participants were included in the systematic review, with 28 providing data for the meta-analysis. SLIT significantly improved multiple efficacy outcomes, including RSS and RMS, with a pooled SMD and 95% CI (-0.98, [-1.65, -0.31], p < 0.001) and (-1.00, [-1.80, -0.20], p = 0.01), respectively. SLIT was associated with a higher risk of treatment-related AEs with a pooled RR and 95% CI (1.16, [1.02, 1.33], p = 0.02), which were predominantly mild, local, and transient.

Conclusion: This study confirms that standardized HDM SLIT is an effective and safe disease-modifying therapy for adults and adolescents with ARC. It provides clinically meaningful reductions of symptoms and medication use and improves quality of life. The favorable safety profile supports its use as a foundational treatment in the management of HDM-induced ARC.

Introduction: Primary immunodeficiency diseases (PIDs) are a heterogeneous group of genetic disorders associated with recurrent infections, immune dysregulation, and increased morbidity and mortality when diagnosis is delayed. Primary care physicians (PCPs) play a critical role in early recognition; however, data on PCPs' knowledge and preparedness regarding PID remain limited. This study aimed to evaluate PCPs' knowledge, clinical approaches, and preparedness regarding PIDs across Türkiye.

Methods: This nationwide, cross-sectional study included 385 PCPs-general practitioners (GPs), family medicine residents (FMRs), and family medicine specialists (FMSs)- working in Family Health Centers in Türkiye. Participants completed a structured online questionnaire assessing sociodemographic characteristics, educational background, clinical experience, self-perceived PID knowledge, and performance on 15 PID-related multiple-choice questions based on international guidelines. Total knowledge scores (range: 0-15) were calculated. Correct response rates for individual items and total scores were compared across professional groups and according to educational and clinical variables. Multivariable logistic regression analyses were performed to identify factors independently associated with higher knowledge scores.

Results: The mean total knowledge score was 9.09 ± 2.46 (range 0-15). FMSs significantly higher total scores than FMRs and GPs (GPs 8.67 ± 2.47; FMRs 8.82 ± 2.63; FMSs 9.83 ± 2.03; p < 0.001). In multivariable analysis, being an FMS was independently associated with scoring above the mean (OR = 2.02, 95% CI: 1.26-3.23; p = 0.004). Regular participation in general medical educational activities was associated with significantly higher total scores (9.74 ± 2.31 vs. 8.23 ± 2.38; p < 0.001). PCPs who participated in PID-related educational activities within the past five years were also associated with higher total scores (9.43 ± 2.58 vs. 8.87 ± 2.47; p = 0.027). PCPs who reported requesting immunoglobulin testing or referring patients with recurrent lower respiratory tract infections achieved significantly higher total scores (9.18 ± 2.43 vs. 7.52 ± 2.42; p = 0.001). PCPs who self-perceived their PID knowledge as moderate or good had substantially higher total knowledge scores compared to those who self-perceived their knowledge as low (Low: 8.36 ± 2.55; Moderate: 9.41 ± 2.26; Good: 10.09 ± 2.50; p < 0.001).

Conclusion: PID-related knowledge scores among PCPs differed across professional groups, with GPs demonstrating lower scores. Higher knowledge scores were significantly associated with being an FMS and with participation in regular general medical education and past 5 year PID-related education. Strengthening targeted educational strategies, particularly for GPs in primary care settings, may improve early recognition and management of PIDs.

Background: The epithelial cells of the airway mucosa, as the initiating factors of airway inflammation, regulate the occurrence of innate and acquired immune responses. According to the same airway theory and the latest research results on pericytes in the lower respiratory tract, there may also be interactions or information transmission between the epithelial cells and pericytes of the airway mucosa in the upper respiratory tract.

Methods: In this study, primary mucosal epithelial cells of nasal polyps(NP) were first isolated and cultured to establish a stimulation system of house dust mite (HDM) extract. Then, a co-culture system of primary mucosal epithelial cells of NP and human microvascular pericytes was established using Transwell chambers. The migration of pericytes in each group after co-culture was determined by using the plate scratch test. Transcriptomics was applied to study the differences in gene expression of pericytes in each group after co-culture. The expression of cytokines and chemokines in the culture supernatants of each group was detected by ELISA. Finally, the protein expression of the related pathways after co-culture was detected by the WB method.

Results: The results of this study show that the pericytes migration in the eosinophilic co-culture group is significantly higher than that in the other groups. Compared with the model group, the co-culture group increased the cell viability of human nasal mucosal epithelial cells stimulated by HDM. The migration ability of human nasal mucosal epithelial cells decreased after HDM stimulation, and the migration ability was restored after co-culture. The results indicated that in the co-culture group, POSTN, VCAM-1 and CCL-5 expressed by pericytes were the most numerous. The WB detection results revealed that the PDGF pathway in pericytes was activated, and the expressions of related proteins all changed accordingly.

Conclusions: This study indicates that in the co-culture model of mucosal epithelial cells of NP and pericytes, the stimulated epithelial cells can upregulate the expression of factors such as POSTN, VCAM-1 and CCL-5 in pericytes. There exists a PDGF/PI3K/AKT/NF-κB signaling pathway between mucosal epithelial cells of NP and pericytes.

Objective: This study aimed to characterize the allergen among children with atopic dermatitis (AD) in Hangzhou, China, and to investigate the impact of COVID-19 restriction measures on these patterns.

Methods: In this retrospective study of 8,797 children with AD, we analyzed specific immunoglobulin E (sIgE) results. We assessed sensitization prevalence, intensity, and used multivariable logistic regression to evaluate independent associations, including restriction phase (pre-, during-, post-), while adjusting for age, gender, and season.

Results: The overall sensitization prevalence was 73.2%. House dust mite was the dominant sensitizer (45.6%), with the highest median sIgE level (19.05 IU/mL) and proportion of high-level sensitization (73.65%). Restriction measures were independently associated with a sharp decline in risk for most inhalant allergens during the restriction phase (OR=0.40, 95%CI:0.36-0.45), followed by significant post-restriction recovery (OR=0.81, 95%CI:0.73-0.90). In contrast, house dust mite sensitization risk increased post-restriction (OR=1.33, 95%CI:1.21-1.47). Food allergen sensitization showed a delayed, pronounced decline post-restriction (OR=0.49, 95%CI:0.44-0.54). Male gender and increasing age were confirmed as independent risk factors. Furthermore, distinct seasonal fluctuations were observed, with a higher risk of sensitization to various inhalant allergens during autumn and winter.

Conclusion: The allergen sensitization profile in Hangzhou is distinct and heavily dominated by house dust mite. COVID-19 restriction measures were independently associated with divergent, allergen-specific shifts, highlighting the profound influence of environmental and behavioral factors. These findings advocate for dynamic, region-specific management and inform public health planning for allergic diseases.

Introduction: Vitamin- and iron-containing medicinal preparations are widely perceived as safe; however, hypersensitivity reactions may pose diagnostic challenges. Standardized diagnostic pathways for suspected hypersensitivity are limited. This study aimed to compare pharmacovigilance-based causality assessment tools with allergist-defined clinical outcomes in patients evaluated for suspected hypersensitivity to vitamin- and iron-containing preparations.

Methods: A retrospective review was performed in 40 patients referred to a tertiary allergy center for suspected adverse reactions to vitamin- or iron-containing medicinal preparations. Demographic characteristics, index reaction features, diagnostic testing results, and clinical outcomes were collected. Causality classifications using the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) system and the Naranjo algorithm were compared with allergist-defined final evaluations.

Results: The cohort was predominantly female (97.5%) and atopic. Iron-containing products were most commonly implicated (40%), followed by B-complex vitamins (27.5%) and combined formulations (12.5%). Most reactions reflected Type B hypersensitivity (67.5% immediate; 10% delayed). Diagnostic testing was feasible in 82.5% of patients, and confirmed hypersensitivity was uncommon (10%), with most reactions classified as probable or non-allergic. WHO-UMC and Naranjo showed significant correlation (χ² = 74.7, p < 0.001), with fair categorical agreement (κ = 0.28) and strong rank correlation (ρ = 0.78). Concordance with allergist-defined clinical outcomes was weak (WHO-UMC κ = 0.09; Naranjo κ = 0.18).

Conclusion: Immunologically mediated hypersensitivity to vitamin and iron preparations appears uncommon in this tertiary allergy cohort. Pharmacovigilance-based causality assessment tools and allergist-led diagnostic evaluation demonstrate complementary but non-interchangeable roles, highlighting the importance of clinical verification in hypersensitivity reactions.

Introduction: An international treat-to-target (T2T) consensus for atopic dermatitis (AD), encompassing clinical and patient-reported outcomes, was proposed in 2021. A revised framework of systemic drug therapy for moderate-to-severe AD was proposed by Zhao and Gao in 2022. This study aimed to evaluate the efficacy of abrocitinib and dupilumab in patients with moderate-to-severe AD in the context of the clinical and patient-reported T2T goals for AD proposed by Zhao and Gao.

Methods: Data were evaluated from adults with moderate-to-severe AD who received abrocitinib (200 mg/day) or dupilumab (300 mg biweekly after a 600 mg loading dose) for 16 weeks in JADE COMPARE and 26 weeks in DARE. Data from patients who received abrocitinib 100 mg/day in JADE COMPARE were also included in this analysis. Assessments included the proportions of patients attaining 1-year T2T goals proposed by Zhao and Gao (Peak Pruritus Numerical Rating Scale score of ≤4, ≥75% improvement in Eczema Area and Severity Index [EASI] or EASI≤7, ≥75% improvement in SCORing Atopic Dermatitis [SCORAD] or SCORAD≤24, Patient-Oriented Eczema Measure score of ≤7, and Dermatology Life Quality Index score of ≤5 at Week 16 of JADE COMPARE and Week 26 of DARE.

Results: In JADE COMPARE, 226, 238, and 242 patients received abrocitinib 200 mg, 100 mg and dupilumab, respectively. In JADE DARE, 362 received abrocitinib 200 mg and 365 received dupilumab. The proportions of patients attaining the 1-year T2T goals at Week 16 of JADE COMPARE were 41.2% (200 mg), 29.5% (100 mg) and 29.0% (dupilumab); these proportions were 49.5% (200 mg) and 38.3% (dupilumab) at Week 26 of DARE.

Conclusions: Greater proportions of patients attained the 1-year T2T improvements proposed by Zhao and Gao with abrocitinib 200 mg than with dupilumab. Early achievement of 1-year targets in many patients treated with abrocitinib suggest that target domains may necessitate re-evaluation.

Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare severe cutaneous adverse reaction (AR), which can be life threatening [J Am Acad Dermatol. 2013;68(5):693.e1-14]. The reporting of DRESS in Australian electronic medical records (EMRs) has not been studied.

Methods: A dual ascertainment strategy was employed in this multi-centre, retrospective study. Part 1 involved data collection from a 2.5-year cohort of consecutive inpatient admissions. Patients with an AR label of DRESS, eosinophilia or severe rash were identified, along with the causative agents. Part 2 involved evaluating the AR label documentation for patients from an independently derived list of confirmed DRESS cases from an immunology department register. Case note review was undertaken for all possible cases of DRESS that were identified, and RegiSCAR scores were calculated.

Results: Of the 135,080 inpatients from Part 1, there were 17 patients (prevalence 12.59 per 100,000) with at least possible DRESS (RegiSCAR >2). The prevalence of patients with a RegiSCAR score consistent with probable or definite DRESS was 6.66 per 100,000 individuals. Among the 135,080 patients, 12 individuals had a DRESS AR label on the EMR (prevalence 8.88 per 100,000). In Part 2 of the study, 16 confirmed DRESS cases were identified from an Immunology department register over a period of 8 years. The mean age of this group was 49.3 at diagnosis (SD 21.58) and 50% were female (n = 8). Of the 16 cases, 14 (87.5%) were correctly labelled as "DRESS syndrome" in the EMR. In total, there were 31 patients with at least possible DRESS identified, with two cases (6.45%) of false negative AR documentation, and one case (3.23%) of false positive AR documentation. The most common drug culprits were vancomycin (n = 11, 29.7%), penicillin-based antibiotics (n = 9, 24.3%), and carbamazepine (n = 3, 8.1%).

Conclusion: The prevalence of EMR-documented DRESS syndrome in South Australia is higher than seen in other studies. Most DRESS was caused by antibiotics. The majority of patients were documented correctly in the EMR as far as can be determined.

İntroduction: To evaluate the clinical, laboratory, and follow-up characteristics of pediatric patients diagnosed with food allergy (FA) in a tertiary pediatric immunology and allergy clinic.

Methods: This retrospective study included 300 children diagnosed with FA between January 2018 and January 2022. Patients were classified into IgE-mediated, mixed-type, and non-IgE-mediated FA. Demographic features, clinical symptoms, diagnostic tests (skin prick test-SPT, specific IgE), nutritional patterns, and tolerance outcomes were analyzed.

Results: IgE-mediated FA was observed in 43.7%, mixed-type in 30.6%, and non-IgE-mediated in 25.7%. Cow's milk (67.3%) and egg white (50.6%) were the most frequent allergens. Anaphylaxis occurred in 6.3% of patients. Complementary feeding patterns varied across groups; dairy products were more common in the IgE-mediated group (40.6%), while vegetables were more frequently introduced in the non-IgE (65.7%) and mixed (37.5%) groups. Tolerance was most often achieved for cow's milk (80.1%), egg white (80.0%), and egg yolk (78.4%), with a median age of 3 years. In contrast, tolerance did not develop in 77% for walnut, 76.9% for hazelnut, and 71.4% for peanut. Primary immunodeficiency (PID) was identified in 21% of patients, predominantly transient hypogammaglobulinemia of infancy (79.0%). Multiple food allergies were significantly more frequent in patients with PID (42.8% vs. 35.8%, p=0.004).

Conclusion: FA subtypes display distinct clinical and nutritional features. Routine immunologic evaluation may aid in the early identification of underlying PIDs in children with FA.

Background: Fatal anaphylaxis is a rare but devastating outcome of severe allergic reactions. Identifying predictors of fatal anaphylaxis is essential to guide prevention, early intervention, education and management strategies.

Methods: A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive health sciences librarian -assisted search of MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science identified studies published from inception to December 2024. Inclusion criteria encompassed observational studies and randomized controlled trials investigating fatal anaphylaxis in adults and children. Risk of bias was evaluated using the Newcastle-Ottawa Scale.

Results: A total of 3,006 studies were identified through five databases. After removing 1,038 duplicates, 1,968 unique records were screened. Of these, 136 full-text articles were assessed for eligibility, and 28 met the inclusion criteria. The included studies were conducted across 20 countries. Of the 28 included studies, 27 were retrospective cohort designs and one was a case-control study. This predominance of retrospective designs is expected given the rare and unpredictable nature of fatal anaphylaxis. Food allergens (particularly peanuts and cow's milk), medications (e.g., antibiotics, contrast media, and neuromuscular blockers), and insect stings were the most common triggers of fatal anaphylaxis. Asthma, cardiovascular comorbidities, and older age (≥65 years) were frequently reported predictors of mortality. Delayed epinephrine administration defined as more than 30 minutes after symptom onset or failure to administer in the pre-hospital setting was also associated with fatal outcomes. Subgroup analyses identified higher risk among patients with multiple comorbidities and those exposed to high-risk allergens, including peanuts and cow's milk in children (<18 years) and perioperative medications in older adults (≥65 years). Risk of bias analysis indicated moderate study quality, with limitations largely due to retrospective designs and inconsistent reporting.

Conclusions: Asthma, cardiovascular comorbidities, older age, and delayed epinephrine administration were key predictors of fatal anaphylaxis. These findings highlight the need for timely intervention and targeted strategies, while emphasizing the importance of improved global data and standardized methodologies.

Perioperative drug allergy (PDA) is a significant problem in surgical practice, but few studies in the literature fully address this problem. In our pilot study, which included 569 patients treated in the surgical department, 44 patients (7.7%), with an average age of 52.52±1.87 years, met the inclusion criteria; 26 (59.1%) of them were female. Drug hypersensitivity reactions (DHRs) were initially reported in 34 patients (5.98%), and DHRs developed during the hospital stay in 13 patients (2.3%). The most common reactions were to antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and local anaesthetics. A total of 26.5% of patients with a history could not name the specific medicines that caused certain reactions in the past but indicated the drug groups. This suggests that the level of inaccuracy in DHR recordings upon hospital admission is relatively high. A total of 23.1% of patients with hospital reactions did not initially report past reactions but remembered them after the reaction occurred. Obviously, the number of patients with reactions during anamnesis is significantly greater than previously reported. To prevent severe complications, a medical history should be carefully collected, polypharmacy should be avoided, drug cross-reactivity should be considered, and drug tests should be conducted in patients at increased risk. In emergencies, when testing is impossible, one should rely on the patient's history and use alternative drugs. The pilot study confirmed the necessity of a multicenter study and a national electronic registry. This will enhance the diagnosis, prevention, and treatment of DHRs in surgical practice, ultimately improving the quality of medical care.