International Archives of Allergy and Immunology最新文献

Introduction: Chronic spontaneous urticaria (CSU) is defined as urticaria lasting at least 6 weeks. Its symptoms (itching, redness, wheals, etc.) significantly impair quality of life and psychological well-being. This study aimed to assess the effect of omalizumab on anxiety, depression, and stress in CSU patients.

Method: This study prospectively evaluated patients diagnosed with CSU who were treated with six doses of omalizumab. A series of assessments were conducted prior to and following the administration of treatment. These included the Perceived Stress Scale (PSS), the Hospital Anxiety and Depression Scale (HADS: HADS-Anxiety [HADS-A] and HADS-Depression [HADS-D]), the Weekly Urticaria Activity Score (UAS7), and the Urticaria Control Test (UCT). The results for HADS-A and HADS-D were further classified as normal, borderline, or abnormal.

Results: A total of 34 patients (8 males, 26 females) with a mean age of 38.5 ± 9.9 years were included in the study. Following treatment, 31 of 34 patients (91%) achieved notable reduction in the UAS7 score, aligning with the minimal clinically important difference (9.5-10.5) criteria. A significant decrease was observed in HADS and PSS scores, while a significant increase was noted in UCT scores (p < 0.001 for all parameters). A significant decrease in the UAS7 score was observed in all subcategories of the HADS-A and HADS-D assessments at the 6-month evaluation period. However, no significant change was observed between subcategories.

Conclusion: The omalizumab treatment has positive impact on urticaria activity, psychological parameters, and stress condition in CSU patients. The presence of anxiety and depression at baseline does not impact the efficacy of the treatment. Nevertheless, patients exhibiting elevated psychological stress or anxiety/depression scores in the absence of urticaria control should be referred for further psychiatric evaluation.

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2 inflammatory disease associated with severe symptom burden and reduced quality of life. Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (NSAID-ERD) is a common coexisting condition, associated with more severe sinus disease and increased corticosteroid use.

Purpose: The aim of this study was to describe baseline characteristics and disease burden in patients with CRSwNP with coexisting NSAID-ERD enrolled in the AROMA registry.

Methods: AROMA is a prospective global registry study recruiting adult patients with severe CRSwNP. These patients are followed for up to 36 months after initiating dupilumab treatment. Baseline demographics and disease characteristics were assessed for all patients entering the registry.

Results: As of February 2023, the study had recruited 303 patients; 77 (25.4%) had coexisting NSAID-ERD. Of these patients, 11 (14.3%) had undergone a confirmatory aspirin challenge, and 11 (14.3%) had undergone an aspirin desensitization. The rate of previous sinonasal surgery was 64.9% in the coexisting NSAID-ERD group and 60.6% in the group without NSAID-ERD. The mean (SD) loss of smell score in patients with coexisting NSAID-ERD was 2.4 (0.85) versus 2.1 (1.16) in patients without (p = 0.0085). Leukotriene receptor antagonist use at baseline was 45.5% in patients with coexisting NSAID-ERD and 29.2% in patients without.

Conclusion: One-quarter of adults with CRSwNP in AROMA have coexisting NSAID-ERD, and most have not undergone a confirmatory aspirin challenge or desensitization. Patients with CRSwNP with coexisting NSAID-ERD report more severe smell loss at baseline and are more likely to have undergone sinonasal surgery.

Introduction: Perioperative hypersensitivity reactions (POHs) are rare occurrences, but they can lead to life-threatening complications. The culprits for POH vary between countries, and in about 25% of the cases, the causative agent of POH remains unknown. Data on POH and its causes in Switzerland are sparse. This study aimed to address this gap and provide insights into POH in Switzerland.

Methods: In this retrospective monocentric study, we analyzed data from 106 patients referred for POH evaluation to a tertiary allergology university center in Switzerland. We analyzed data about clinical characteristics, culprit drugs, and performed diagnostic tests (specific IgEs, basophil activation tests, skin tests, provocation tests).

Results: The majority of POH patients were female (56.6%, n = 60). Allergic comorbidities were frequently present (68.9%, n = 73); a previous episode of POH was reported in 16.0% (n = 17). A trigger was diagnostically confirmed or strongly suspected in 76.4% (n = 81) of the cases. The most common confirmed or suspected triggers were neuromuscular blocking agents (NMBAs) and antibiotics (predominantly cephalosporins), each accounting for 26.5% (n = 27) of the reactions. This was followed by antiseptics (9.8%, n = 10) and opioids (9.8%, n = 10). Latex accounted for less than three percent of the reactions. For the confirmed triggers, identification primarily relied on positive skin test results (73.0%, n = 46), although different tests sometimes yielded varying results.

Conclusions: In Switzerland, antibiotics (mostly cephalosporins) and NMBA are among the most common triggers of POH. By combining skin tests and in vitro diagnostics, culprit drugs of POH could be identified in more than 75.0% of the cases.

Introduction: Artemisia pollen is a major aeroallergen source in Northern China that can cause multiple kinds of common allergic diseases. China's first Artemisia annua sublingual drops for Artemisia pollen-induced seasonal allergic rhinitis were launched in 2021. This study aimed to evaluate the efficacy and safety of a 2-year course of sublingual immunotherapy (SLIT) using A. annua allergen extract in patients with seasonal allergic rhinoconjunctivitis (SARC). Additionally, it sought to assess the sustained clinical efficacy of this therapy 1 year post-treatment.

Methods: Fifty patients (aged 4-60 years) with SARC and confirmed A. annua pollen allergy were enrolled in this study. In accordance with their preferences, the subjects were assigned to either the SLIT group (n = 25, receiving SLIT plus symptomatic treatment) or the control group (n = 25, receiving symptomatic treatment alone) at a ratio of 1:1. The entire study lasted for 3 years, initiating a 2-year treatment phase (2022 and 2023 pollen seasons) followed by a 1-year post-discontinuation follow-up period (2024 pollen season), with 2021 pollen season regarded as baseline. The total rhinoconjunctivitis symptom score (TRSS), total medication score (TMS), combined score of medication and rhinoconjunctivitis symptoms (CSMRS), and visual analogue scale (VAS) were compared between the two groups for clinical efficacy. In addition, the rhinoconjunctivitis quality of life questionnaire (RQLQ) was used to assess the impact of the A. annua SLIT on the quality of life of patients. Safety was evaluated based on adverse events.

Results: A total of 41 patients completed the study (SLIT: n = 21, control: n = 20). There were no significant differences between the two groups during 2021 pollen season (baseline). However, the scores of TRSS (all p < 0.001), CSMRS (all p < 0.001), VAS (2022: p < 0.01; 2023: p < 0.001; 2024: p < 0.001), and RQLQ scores (2022: p < 0.01; 2023: p < 0.001; 2024: p < 0.001) were significantly lower than the control group during the 2-year SLIT treatment period and 1-year follow-up period. For TMS scores, although no statistically significant differences were found in 2022 and 2023 pollen seasons (p > 0.05), the SLIT group showed a decreasing trend. And TMS of SLIT group was significantly lower than that of the control group during 2024 pollen season (p < 0.05). In addition, RQLQ scores correlated positively with CSMRS and VAS (all p < 0.001).

Conclusions: A 2-year course of SLIT with A. annua allergen extract significantly alleviated symptoms and reduced medication use in SARC patients, with clinical benefits persisting for at least 1-year post-treatment phase.

Introduction: This study aims to investigate the clinical and laboratory characteristics of patients with type IIb autoimmune chronic spontaneous urticaria (CSU) in a Vietnamese population and how this correlates with results of the Basophil Histamine Release Assay (BHRA).

Methods: A cross-sectional, single-center study was conducted with 388 CSU patients aged 16 years or older at the Vietnam National Dermatology and Venereology Hospital, from June 2023 to March 2024. Clinical data were collected, and laboratory tests were performed. Patients also underwent the Autologous Serum Skin Test (ASST) and BHRA. A multivariate logistic regression model was performed to identify factors associated with a positive BHRA.

Results: Of the 388 CSU patients, 60.3% had new onset symptoms, 34.0% had angioedema, and 12.6% had comorbid dermographism. Laboratory results indicated that 11.4%, 5.9%, and 1.8% of patients had elevated CRP levels, low total serum IgE levels, and basopenia, respectively. Additionally, elevated IgG anti-TPO levels, positive ANA, and positive ASST were found in 10.6%, 11.4%, and 57.2% of patients, respectively. There were 9.5% who tested positive for BHRA. Multivariate logistic regression identified UAS7 score (OR = 1.047, p = 0.017), low basophil levels (OR = 6.749, p = 0.027), and low total serum IgE (OR = 3.391, p = 0.039) as significant predictors of BHRA positivity.

Conclusion: Our results identified key clinical and laboratory characteristics associated with type IIb autoimmune CSU in Vietnamese patients. Higher UAS7 scores, basopenia, and low IgE levels were significant predictors of BHRA positivity.

Introduction: Peanut allergy is a common and potentially life-threatening condition affecting up to 2% of children in Western countries. Management traditionally relied on avoidance, but in 2020, the FDA-approved peanut oral immunotherapy (pOIT) to induce desensitization. This meta-analysis evaluated the efficacy and safety of pOIT versus placebo by incorporating newly published trials to inform clinical decision-making.

Methods: This systematic review and meta-analysis followed PRISMA guidelines and Cochrane methodology, with registration number. Randomized controlled trials (RCTs) comparing pOIT to placebo in IgE-mediated peanut allergy were included. Primary outcomes were gastrointestinal disorders and wheezing. Data were pooled using a random-effects model in RevMan 5.4.1, and evidence certainty was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

Results: This meta-analysis included 15 RCTs with 1,530 patients (1,014 pOIT, 516 placebo). pOIT significantly increased gastrointestinal disorders (risk ratio [RR] = 1.90; 95% confidence interval [CI]: 1.25-2.89; p = 0.003) and epinephrine use (RR = 2.29; 95% CI: 1.43-3.67; p = 0.0006). No significant differences were observed in wheezing, eczema, respiratory disorders, respiratory symptoms, or vomiting. Heterogeneity ranged from low to high across outcomes. Certainty of evidence was rated high for gastrointestinal disorders, epinephrine use, and respiratory symptoms and moderate for wheezing, eczema, and vomiting. Heterogeneity was primarily driven by specific outlier studies, as identified through sensitivity analyses.

Conclusion: OIT increases desensitization in patients with peanut allergy but is associated with a significantly higher risk of gastrointestinal side effects and epinephrine use, reflecting an increased rate of systemic allergic reactions. While outcomes such as wheezing, eczema, and respiratory symptoms showed no significant differences, variability in study design and adverse event reporting limits broad generalizability. These findings emphasize the need for careful patient selection, pre-treatment counseling, and close monitoring. Future research should focus on protocol standardization, long-term outcomes, and strategies to minimize adverse effects while maintaining efficacy.

Introduction: The latest international joint guideline supports the use of second-generation H1 antihistamines (sgAHs) as the first-line treatment for chronic spontaneous urticaria (CSU).

Methods: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials of various types of sgAHs in the treatment of CSU up to March 2025. For efficacy, the primary outcome was the change from baseline in the total symptom score, while the secondary outcomes were pruritus score and wheal score. For safety, the total numbers of all withdrawals due to adverse events and common adverse effects were extracted for each treatment, which included central nervous system side effects and anticholinergic side effects.

Results: We identified and included 24 randomized clinical trials (RCTs) involving 5,172 patients. Ebastine ranked first in the total symptom score (standardized mean difference [SMD) -2.80 [95% confidence interval (CI):-5.12 to -0.47]) and pruritus score (SMD -1.10 [95% CI: -2.06 to -0.13]), while olopatadine ranked first in the wheal score (SMD -0.84 [95% CI: -1.37 to -0.32]). Bepotastine besilate had a significantly lower incidence of somnolence in adverse events (odds ratio 0.15 [95% CI: 0.03-0.69]) than other sgAHs.

Conclusion: Both ebastine and olopatadine showed promising efficacy, and no significant differences were found in acceptability and safety compared with placebo. There are no meaningful differences in safety risks between different second-generation antihistamines.

Introduction: Tree nut/peanut (TN/PN) allergies are among the most common pediatric food allergies, often persisting into later life and posing significant clinical risks. The likelihood of tolerance acquisition varies, and predictive factors remain inadequately defined in clinical practice. This study was conducted to evaluate clinical and laboratory features associated with anaphylaxis risk and tolerance development in pediatric patients with TN/PN allergy, while also examining the potential influence of aeroallergen sensitization, coexisting atopic diseases, and skin test reactivity on these outcomes.

Methods: In this retrospective, cross-sectional study, 121 children (0-18 years) diagnosed with TN/PN allergy at a tertiary allergy centre between 2016 and 2024 were analyzed. Data included allergic reaction history, comorbidities, total IgE, eosinophil counts, and prick-to-prick (PTP) test wheal sizes. Tolerance acquisition was defined based on oral food challenge, absence of reactions upon re-exposure, and clinical follow-up.

Results: Multiple nut allergy was present in 81% of patients, with hazelnut (67%) and pistachio (62%) being the most common. IgE-mediated reactions were predominant (91%), including urticaria (79%) and anaphylaxis (36%). During follow-up, 25% of patients developed tolerance, while 13% continued to experience anaphylaxis. Aeroallergen sensitization, particularly to pollens, was significantly associated with reduced tolerance in almond and walnut allergy (p < 0.05). Persistent multi-nut allergy correlated with higher anaphylaxis risk (p < 0.01). Strong co-sensitization was observed between pistachio-cashew (r = 0.686) and almond-walnut (r = 0.579). Notably, smaller PTP wheal sizes predicted tolerance acquisition (p < 0.05).

Conclusion: Pediatric TN/PN allergy is frequently severe and persistent. Multiple nut allergy, aeroallergen sensitization, and larger PTP wheal sizes are significant risk factors for prolonged allergy and anaphylaxis. Early identification of these markers may improve risk stratification and guide individualized follow-up strategies.

Introduction: Anaphylaxis is a life-threatening, systemic allergic reaction. This study aimed to compare anaphylactic triggers, clinical presentation, and management between elderly (≥65 years old) and non-elderly adults.

Methods: Data from the Cross-Canada Anaphylaxis Registry (C-CARE) from April 2011 to May 2024 were collected, spanning five emergency departments and one emergency medical service across three Canadian provinces. Demographics, trigger, symptom severity, comorbidities, and medication use were assessed. Chi-square tests were used to compare categorical variables between elderly and non-elderly adults, whereas non-parametric t tests were used for numerical variables.

Results: Among 1,135 anaphylaxis cases, 90 (7.9%) involved elderly patients. Drug and venom anaphylaxis triggers were more prevalent (p < 0.01) in elderly adults compared to non-elderly adults, while food allergies were less common. Elderly patients were more likely to experience anaphylaxis at home (p < 0.01) and had a higher intensive care unit admission rate (p = 0.04). Use of epinephrine was less frequent in elderly patients (30.0%).

Conclusion: Compared to younger adults, elderly patients exhibit distinct anaphylactic triggers and have increased ICU admission and lower epinephrine use. Our findings highlight the need for improved recognition, treatment adherence, and tailored management strategies in this vulnerable population.

Introduction: Chronic spontaneous urticaria (CSU) is a burdensome condition marked by recurrent wheals and/or angioedema lasting over 6 weeks. Despite current treatments, many patients remain symptomatic. Remibrutinib, a selective Bruton's tyrosine kinase inhibitor, is a promising therapy targeting mast cell degranulation.

Methods: A systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. PubMed, Cochrane CENTRAL, and Google Scholar were searched for randomized controlled trials (RCTs) comparing remibrutinib to placebo. The primary outcome was change in Urticaria Activity Score over 7 days (UAS7). Safety outcomes included adverse events (AEs) and serious adverse events (SAEs). Analyses were performed using Review Manager (RevMan 5.4).

Results: Three RCTs were included. Remibrutinib significantly reduced UAS7 scores compared to placebo (MD = -7.78, 95% confidence interval (CI): -10.24 to -5.32, p < 0.01) and improved disease control (RR = 2.16, 95% CI: 1.73-2.71, p < 0.00001) and absence of hives/itch (RR = 3.41, 95% CI: 2.32-5.03, p < 0.00001). No significant differences were found in overall AEs (RR = 1.05, p = 0.59) or SAEs (RR = 1.85, p = 0.37). However, infection risk was higher with remibrutinib, particularly for total infections (RR = 1.59, p < 0.00001) and upper respiratory infections (RR = 2.89, p = 0.009).

Conclusion: Remibrutinib significantly improves CSU symptoms and disease control. While generally safe, it may increase infection risk, notably upper respiratory tract infections. Further long-term studies are needed to confirm these findings.