International Archives of Allergy and Immunology最新文献

Introduction: Asthma is a complex chronic illness with significant morbidity and costs, but effective management can prevent these outcomes. The COVID-19 pandemic led to a shift from in-person to virtual healthcare, presenting an opportunity to explore telemedicine in asthma management.

Methods: We performed a scoping review guided by the Arksey and O'Malley framework. We used search terms including: asthma, telehealth, telemedicine, and virtual care, searching four databases (OVID Medline, CINAHL, Web of Science, Embase) from May to July 2023 for publications from 2010 onward, managed in Covidence. Inclusion criteria focused on articles addressing telemedicine accessibility for underserved or vulnerable groups. The selected articles were stratified into mutually exclusive categories: rural communities; lower income populations; lower income rural communities; black, indigenous, people of colour (BIPOC); and English as an additional language (EAL).

Results: Out of 811 articles identified in our searches, 171 remained following de-duplication and title/abstract screening. After full-text review, 11 articles remained, stratified into main categories: rural communities (n = 3), lower income (n = 1), lower income rural (n = 2), BIPOC (n = 4), and EAL (n = 1). Most articles (n = 9, 69%) reported a positive association with telehealth use, although barriers like the digital divide (n = 3, 21%) were also noted.

Conclusion: While telemedicine has a positive effect on asthma care, barriers like inaccessibility remain, thereby limiting full benefits.

Introduction: Atopic dermatitis (AD) is a common chronic inflammatory skin disorder associated with psychological burdens, including sadness and suicidality. Yet, little is known about long-term trends in these mental health outcomes among adolescents with AD. This study examined temporal trends in suicidal ideation and sadness in South Korean adolescents with and without AD.

Methods: Nationwide data from the Korean Youth Risk Behavior Web-based Survey, comprising middle and high school adolescents, were utilized, covering the period from 2007 to 2024. Weighted prevalence estimates were calculated to evaluate trends of questionnaire-based suicidal ideation and sadness by AD status. To examine the impacts of the COVID-19 pandemic, the study period was categorized into three periods, including pre-pandemic (2007-2019), intra-pandemic (2020-2022), and post-pandemic (2023-2024). For analyzing the β coefficients and β differences (β_diff) between three periods, binary logistic regression and linear regression were used. In addition, we utilized logistic regression models for calculating weighted odds ratio (wOR) with 95% confidence intervals (CIs).

Results: Among 1,140,402 adolescents (553,213 [48.51%] female), those with AD reported a higher prevalence of suicidal ideation (17.51% [95% CI: 17.32-17.70]) and sadness (33.11% [32.88-33.34]) compared to those without AD. Weighted prevalence rates showed an increase during the intra-pandemic period, both in suicidal ideation (β_diff, 3.67 [3.32-4.03]) and sadness (β_diff, 4.88 [4.45-5.32]). Statistically significant sex-specific differences were observed, with females displaying a higher risk of suicidal ideation (wOR, 1.69 [1.65-1.73]) and sadness (wOR, 1.61 [1.57-1.64]). Other risk factors associated with heightened prevalence included high levels of stress, smoking and drinking status, lower levels of education and economic status, and in-facility residential environments.

Conclusion: This is the first comprehensive study to display the association of AD with suicidal ideation and sadness in Korean adolescents. Our findings can provide insights into identifying vulnerable populations and seek to guide the public health strategies for minimizing disparities in the mental health burdens of AD.

Introduction: This study aimed to characterize the alterations in mitochondrial DNA (mtDNA) damage and inflammatory markers in bronchoalveolar lavage fluid (BALF) from patients with bronchiectasis during acute exacerbations (AEs) and to investigate their potential contribution to airway inflammation and disease mechanisms.

Methods: A retrospective case-control study was conducted, enrolling 45 patients with AEs and 84 patients with stable bronchiectasis (stable control [SC] group). BALF samples were collected via bronchoscopy. mtDNA damage was assessed using quantitative PCR, and inflammatory markers, including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), and interleukin-8 (IL-8), were quantified via enzyme-linked immunosorbent assay. Multivariate logistic regression was performed to identify independent predictors of AEs, and Spearman correlation analysis was used to evaluate the relationships between mtDNA damage and inflammatory markers.

Results: The AE group exhibited significantly lower mtDNA copy numbers and higher mtDNA deletion rates compared to the SC group (p < 0.001). Inflammatory markers, including IL-6, TNF-α, CRP, and IL-8, were markedly elevated in the AE group (p < 0.001). Spearman correlation analysis demonstrated a significant negative correlation between mtDNA copy number and all inflammatory markers, while mtDNA deletion rate was positively associated with inflammatory markers (p < 0.001). Moreover, multivariate logistic regression identified mtDNA copy number (odds ratio [OR] = 0.289, p = 0.026) and IL-6 (OR = 2.182, p = 0.038) as independent predictors of AEs.

Conclusion: mtDNA damage and elevated inflammatory marker levels in BALF are closely associated with AEs of bronchiectasis. These findings highlight their potential as biomarkers and therapeutic targets for future clinical application. Further studies are warranted to validate these observations and explore their role in the clinical management of bronchiectasis.

Introduction: Allergic rhinitis (AR) is an inflammatory disorder of the nasal mucosa in allergen-sensitized individuals. Beyond local inflammation, AR also promotes systemic inflammatory responses. This study aimed to evaluate biomarkers reflecting systemic inflammation like neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and serum SCUBE levels in the diagnosis and treatment monitoring of AR.

Methods: In this prospective, controlled study, 88 patients with AR and 50 healthy controls were enrolled. All AR patients received nasal corticosteroid (NCS) therapy; however, only 42 patients returned for follow-up. Symptom severity was assessed using the Visual Analogue Scale (VAS) and the Control of Allergic Rhinitis and Asthma Test (CARAT). Laboratory measurements included NLR, PLR, SII, PIV, and serum SCUBE1 and SCUBE2 levels. Intergroup and pre-posttreatment comparisons were performed.

Results: Compared with controls, AR patients exhibited significantly higher PLR, SII, and PIV values (p < 0.05 for all), whereas SCUBE1 or SCUBE2 levels showed no difference. Following treatment, significant clinical improvement was observed in VAS and CARAT scores (p < 0.001). In addition, NLR, PLR, and SII values significantly decreased compared with baseline (p < 0.05 for all). The area under the curve values were 0.655 (95% CI: 0.562-0.747) for PIV, 0.611 (95% CI: 0.512-0.711) for SII, and 0.607 (95% CI: 0.512-0.702) for PLR.

Conclusion: PLR, SII, and PIV were significantly elevated in patients with AR, while NLR, PLR, and SII improved following 1 month of NCS therapy. These findings highlight that the systemic inflammatory burden of AR should not be underestimated and suggest that novel, easily accessible biomarkers such as SII and PIV may provide additional value in the assessment and monitoring of inflammation in AR.

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disorder that may progress to asthma and/or allergic rhinitis (AR) in children, a progression known as the "atopic march."

Methods: This study aimed to evaluate the natural history of AD, its clinical phenotypes, and the risk of progression to atopic march over a 10-year period. A retrospective review of medical records was performed for children diagnosed with AD and those with respiratory allergies who had prior AD. Patients were categorized into early transient, early persistent, and late-onset phenotypes based on eczema onset age and disease course. Disease progression, atopic march development, and related risk factors were analyzed.

Results: The study included 894 children (375 females, 519 males) with a mean presentation age of 3.54 ± 3.31 years, mean follow-up of 3.65 ± 2.84 years. Based on clinical phenotypes, 61% (n = 545) were early transient, 15.2% (n = 136) early persistent, and 23.8% (n = 213) late-onset. Asthma and AR rates were 8.6-11.2% in early transient, 14.0-22.8% in early persistent, and 16.0-24.9% in late-onset phenotypes, respectively. Overall, 29.9% (n = 267) exhibited the atopic march; 56.3% (n = 503) were in remission; and 43.7% (n = 391) had persistent AD. Aeroallergen sensitization was significantly associated with persistent disease (p = 0.016) and atopic march progression (p = 0.001). Family history of atopy correlated with disease persistence (p = 0.033).

Conclusion: Nearly one-third of children with AD are at risk of developing additional allergic diseases constituting the atopic march. Children with AD who exhibit aeroallergen sensitization should be closely monitored for the development of respiratory allergies.

Introduction: Relapse after omalizumab discontinuation in chronic spontaneous urticaria (CSU) is frequent, but predictors of recurrence remain unclear. This study aimed to identify clinical and laboratory factors associated with relapse within 12 months after treatment withdrawal.

Methods: We retrospectively analyzed 176 adult CSU patients who received omalizumab for ≥6 months and were followed for ≥12 months after discontinuation. Demographic, clinical, and laboratory variables were compared between relapse and non-relapse groups using logistic regression analyses.

Results: Relapse occurred in 118 patients (67.0%) within 12 months after omalizumab discontinuation. In multivariable analysis, three variables were independently associated with relapse: lower baseline Urticaria Control Test (UCT) score (odds ratio [OR] per 1-point increase = 0.60; 95% confidence interval [CI]: 0.47-0.77; p < 0.001), longer time to response after omalizumab initiation (OR per month = 2.64; 95% CI: 1.36-5.12; p = 0.004), and a history of prior relapse after treatment withdrawal (OR = 9.80; 95% CI: 1.52-63.14; p = 0.016). In univariate analysis, urticaria duration was significantly longer in relapsing patients (p < 0.001), but it was not an independent predictor. Additionally, no independent associations were found for age, sex, treatment duration, total immunoglobulin E, anti-thyroid peroxidase antibody, or comorbidities (all p > 0.05). The multivariable model showed excellent discrimination (area under the curve = 0.90; 95% CI: 0.84-0.95).

Conclusion: Lower baseline disease control, delayed clinical response, and prior relapse history were independent predictors of recurrence within 12 months after omalizumab discontinuation, whereas treatment duration and routine serologic markers were not. These findings highlight the need for individualized discontinuation strategies in CSU management.

Introduction: Fish is a potent allergen source that can induce both IgE-mediated and non-IgE-mediated reactions, particularly food protein-induced enterocolitis syndrome (FPIES). Prevalence and clinical course of fish allergy vary by age and geographic region, with limited data on tolerance development. This study aims to compare clinical and laboratory characteristics of IgE- and non-IgE-mediated fish allergy in children and to identify factors influencing tolerance.

Methods: This study included 47 children (6 months-18 years) diagnosed with fish allergy from 2010 to 2023 at a tertiary pediatric allergy clinic. Classification into IgE and non-IgE groups was based on clinical presentations, skin prick test (SPT), and specific IgE (sIgE). Tolerance was defined by negative oral food challenge (OFC) and dietary reintroduction.

Results: Among 47 patients (25 IgE-mediated, 22 non-IgE/FPIES), reactions included FPIES (46.8%), anaphylaxis (27.7%), and urticaria/angioedema (25.5%). Seven IgE and three non-IgE patients were excluded due to parental refusal of OFC. OFCs were not done in 9 IgE patients with high sIgE/SPT. OFCs confirmed tolerance in all tested IgE (9/9) and 7/17 non-IgE patients. Age at tolerance was similar between the groups. Severe reactions, inhalation-related symptoms, multiple fish allergies, and large SPT wheals predicted lower tolerance in IgE group (respectively, p = 0.028, p = 0.002, p = 0.046, p = 0.030), while older age at last reaction predicted persistence in non-IgE group (p = 0.017). Anchovy and salmon were most tolerated.

Conclusion: This first study evaluating IgE- and non-IgE-mediated fish allergies with OFCs shows substantial tolerance rates, highlighting the need for timely OFCs and personalized care addressing psychosocial factors like anxiety.

Introduction: Allergic asthma is a chronic inflammatory airway disease driven by the cytokine interleukin-13 (IL-13). Although IL-13 signals through the canonical JAK1/TYK2/STAT6 pathway, our understanding of the totality of IL-13-induced signaling intermediates is incomplete.

Methods: To address this, we performed a phospho-proteomic analysis of IL-13-stimulated A549 human airway epithelial cells. IL-13 stimulation led to differential phosphorylation at 145 unique serine/threonine residues across 92 proteins involved in diverse cellular processes. In silico analysis was used to predict kinases responsible for the observed changes, and therapeutics which may reduce IL-13-mediated pathology. The activation of these kinases and the ability of these therapeutics to limit IL-13 activity were tested in vitro using molecular techniques and in vivo in an IL-13-induced model of asthma.

Results: Analysis of IL-13-induced differentially phosphorylated proteins revealed activation of several pathways including RNA splicing, cytoskeletal remodeling, GTPase activity, and focal adhesion complex formation. Network analysis identified SRC family kinases (SFKs), a family of non-receptor tyrosine kinases, as potential regulators of IL-13-induced changes in phosphorylation, and dasatinib, a pan-SFK inhibitor, as a potential inhibitor of IL-13 signaling. In both human and mouse lung fibroblasts, molecular approaches demonstrated activation of SFKs following IL-13 stimulation. In vitro, dasatinib reduced IL-13-induced STAT6 phosphorylation and downstream gene expression. In vivo, dasatinib attenuated IL-13-induced airway hyperresponsiveness without significantly affecting inflammatory cell infiltration or gene expression in bronchoalveolar lavage fluid.

Conclusion: These findings support a potential therapeutic role for dasatinib in inhibition of IL-13-driven responses such as those observed in allergic asthma.

Introduction: Several biological treatments are available for patients with asthma who are not well controlled with inhaled corticosteroids (ICS) and bronchodilators. Real-life studies comparing the effectiveness of add-on biological treatments are lacking.

Methods: In this retrospective study, the population included adult patients with asthma who were treated with omalizumab and mepolizumab. The number of systemic corticosteroids (injectable and oral) and the number of ICS purchases were compared between 12 months before the first biological treatment and 12 months after.

Results: Of 173 patients, 122 were treated with omalizumab and 51 with mepolizumab. A higher proportion of females received mepolizumab than omalizumab (87% vs. 48%, respectively, p = 0.034). Omalizumab significantly reduced the number of patients who purchased corticosteroid injections from 34% to 21% (p < 0.001) but not mepolizumab. A trend toward reduction in the number of patients who purchased corticosteroid tablets was demonstrated during the year of mepolizumab treatment (from 84% to 63%, p = 0.07). For both drugs, no significant differences were found in the mean number of corticosteroid injections, tablets, and inhaler purchases between the year before and during the biological treatments.

Conclusion: Omalizumab was superior to mepolizumab in reducing the number of patients who were treated with corticosteroid injections.

Introduction: The aim of this study was to conduct a network meta-analysis (NMA) of randomized controlled trials (RCTs) to compare the efficacy of various biologics for treating moderate-to-severe allergic asthma.

Methods: This study conducted a comprehensive and systematic literature search in Cochrane Library, Embase, PubMed, and Web of Science databases from the inception to December 31, 2024. The data extracted from eligible literature were analyzed using the Cochrane Randomized Trials Risk of Bias 2 tool and Stata 18.0 program.

Results: A total of 19 RCTs, involving 7,449 patients with moderate-to-severe allergic asthma, were included in this NMA. In terms of reducing exacerbations, benralizumab (mean difference (MD) = -0.47, 95% confidence interval (CI) [-0.82, -0.12]), dupilumab (MD = -0.47, 95% CI [-0.72, -0.21]), omalizumab (MD = -0.30, 95% CI [-0.42, -0.17]), and tezepelumab (MD = -0.81, 95% CI [-1.09, -0.54]) all demonstrated superior efficacy compared to placebo. Additionally, tezepelumab was markedly more advanced than omalizumab (MD = -0.52, 95% CI [-0.80, -0.23]). With regard to lung function improvement, dupilumab (MD = 0.16, 95% CI [0.07, 0.24]) and tezepelumab (MD = 0.08, 95% CI [0.03, 0.14]) both exceeded placebo. Regarding asthma control, dupilumab (MD = -0.40, 95% CI [-0.77, -0.04]) and omalizumab (MD = -0.49, 95% CI [-0.89, -0.08]) both effectively lowered scores on the asthma control questionnaire (ACQ) compared to placebo. For enhancing quality of life, omalizumab (MD = 0.62, 95% CI [0.21, 1.03]) significantly raised scores on the standardized asthma quality of life questionnaire (AQLQ [S]+12) relative to placebo.

Conclusion: Considering its significant clinical advantages in reducing exacerbations and improving lung function, tezepelumab should be prioritized as a treatment option for moderate-to-severe allergic asthma.