Journal of Asthma and Allergy最新文献

Background: Reversal of methacholine induced bronchoconstriction (MIB) is routinely achieved by administering 200 mcg salbutamol via pressurized metered dose inhaler (pMDI). The propellant in the inhaler (hydrofluoroalkane-134a) contributes to greenhouse gas emissions, negatively impacting the environment. One alternative to delivering bronchodilator would be using the Aerogen^® Solo vibrating mesh nebulizer (VMN). Using the VMN to deliver methacholine during MCT as well as bronchodilator after MCT could reduce the carbon footprint of testing by eliminating pMDI inhaler use. The current study compared bronchodilator reversal of MIB via pMDI to that of VMN.

Methods: Sixteen individuals exhibiting airway hyperresponsiveness to methacholine completed a double blind, double dummy, placebo controlled, randomized, three-way crossover study. At each visit, participants underwent MCT followed by administration of placebo or salbutamol (200 mcg) via pMDI or VMN. Lung function and heart rate measurements were captured before and at 5, 10, 15, 30, 45 and 60 minutes after treatment administration.

Results: Pre MCT FEV₁ did not differ between the three treatment arms (RM ANOVA p = 0.741). When corrected for repeated measures, the reduction in FEV₁ after MCT (30.5%, 27.4% and 24.8% for placebo, pMDI and VMN, respectively) was similar across groups. Mean FEV₁ values after administration of salbutamol via pMDI or VMN were significantly greater than after placebo at all timepoints (RM ANOVA p < 0.001) with no significant difference between methods of salbutamol administration. Mean heartrate did not differ between treatments before or after treatment.

Conclusion: Use of the VMN for delivering salbutamol to reverse MIB is feasible. Doing so adds functionality to the use of this nebulizer for performing methacholine bronchoprovocation and reduces the negative environmental impact of pMDI inhalers.

Purpose: Biologic therapies have improved clinical outcomes and quality of life in patients with asthma, and treatment adherence is important for their effectiveness. This study evaluated 12-month adherence patterns for five asthma biologics approved in Japan and their impact on clinical and economic outcomes in patients with severe asthma.

Methods: This non-interventional, cross-sectional, retrospective cohort study used Japan's Medical Data Vision database (June 2009-September 2024). Adults with severe asthma, ≥30 days of continuous enrollment pre-biologic initiation and ≥12 months of follow-up were included. Adherence was assessed using medication possession ratio (MPR). Group-based trajectory modeling (GBTM) characterized distinct adherence trajectories over time, providing insights into heterogeneous adherence behaviors and subgroup patterns. Impact of biologic adherence on exacerbations (defined by hospital admissions, emergency department visits or requiring oral/intravenous corticosteroids), healthcare resource utilization (HCRU) and pharmacy costs were analyzed descriptively.

Results: Among 2904 eligible patients, average MPR was 62.6%-72.6% across the five biologics. Over 90% of patients received ≥1 follow-up dose of their biologic; with average MPR increased by 1%-6% among these patients versus the overall cohort. The GBTM analysis was conducted in 2531 patients without a biologic switch during follow-up, identifying seven distinct clusters with MPR ranging from 10.0% to 94.8%. Patients were also classified as adherent (41.1%), partially adherent (28.1%), minimally adherent (3.2%), or treatment discontinuation (27.6%), based on dosing frequency and intervals. Mean exacerbation rates defined by hospital admissions were low (0.02-0.08 events per patient/year). Exacerbations of any type typically increased with declining biologic adherence. Decreased adherence was generally associated with increased HCRU and higher asthma-related pharmacy costs, particularly when biologic costs were excluded.

Conclusion: Biologic adherence was consistently associated with fewer exacerbations, reduced HCRU and lower asthma-related pharmacy costs (excluding biologic costs), reinforcing the importance of optimizing adherence in patients with asthma.

Purpose: Egg oral immunotherapy (OIT) has demonstrated clinical efficacy; however, 10-35% of patients discontinue treatment due to severe adverse reactions, particularly during the build-up phase. To improve safety, we developed an incremental egg OIT protocol with gradual dose escalation and an extended build-up period. This study aimed to evaluate the safety and efficacy of this protocol in children with egg allergy.

Patients and methods: We retrospectively reviewed children aged 1-18 years with hen's egg allergy confirmed by oral food challenge (OFC) who initiated an incremental egg OIT protocol at Songklanagarind Hospital between August 2023 and March 2025. Demographic characteristics, serum specific immunoglobulin E (sIgE) levels to egg white, egg yolk, and ovomucoid, and adverse reactions during OIT were collected and analyzed.

Results: Fourteen patients were included; four underwent egg yolk OIT (EY-OIT) and ten underwent egg white OIT (EW-OIT). The median age was 44.5 months (IQR 31-63) in the EY-OIT group and 29.5 months (IQR 22.5-65.25) in the EW-OIT group. Mild adverse reactions occurred in 6 of 14 patients (43%). Reported reactions included active eczema and itchy throat in the EY-OIT group, and perioral erythema, active eczema, and acute urticaria in the EW-OIT group. No severe adverse reactions were observed during the OIT build-up and maintenance phases. Thirteen patients (92.9%) successfully escalated doses according to the protocol, and nine patients reached the target maintenance dose.

Conclusion: An incremental egg OIT protocol demonstrated a favorable safety profile in children with egg allergy. No severe adverse reactions occurred during the OIT build-up and maintenance phases, and most patients tolerated gradual dose escalation as planned, supporting the feasibility of this approach in real-world clinical practice.

Allergic rhinitis (AR) has traditionally been regarded as a localized inflammatory disorder of the nasal mucosa. However, accumulating evidence indicates that AR is associated with systemic immune dysregulation characterized by peripheral eosinophilia, altered T helper cell polarization, circulating cytokine imbalances, and widespread inflammatory signaling. This systemic immune disturbance contributes to the frequent coexistence of AR with asthma, atopic dermatitis, and other immune-mediated conditions. These associations support the concept of AR as part of a unified airway and systemic allergic disease spectrum. In this review, we summarize current insights into the immunopathogenesis of AR from both local and systemic perspectives. We focus on epithelial barrier dysfunction, type 2 immune responses, and immune cell trafficking between the upper and lower airways. We further discuss emerging systemic inflammatory biomarkers and their potential clinical relevance in disease stratification and management. Finally, we highlight recent advances in allergen immunotherapy and targeted biologic therapies, emphasizing their implications for precision treatment of AR and its comorbidities. Recognizing AR as a manifestation of systemic immune dysregulation may facilitate improved disease classification and support the development of more effective, individualized therapeutic strategies.

Purpose: Multiple allergen simultaneous tests (MASTs) are widely used for screening allergen-specific immunoglobulin E owing to their convenience and cost-effectiveness. Recently, several automated MAST analyzers with expanded allergen panels have become available in Korea; however, comparative evaluations remain limited.

Patients and methods: In this retrospective study, 200 residual serum samples from patients tested for suspected allergic diseases at a single tertiary hospital were analyzed. Each sample was tested using AdvanSure Alloscreen, AdvanSure Alloscreen Max108, SGTi-Allergy Screen, and PROTIA Allergy-Q. Semi-quantitative results (classes 0-6) were interpreted as positive at class ≥2. Concordance rates and Cohen's kappa coefficients were calculated.

Results: Overall agreement between the MAST systems was high (91-93%), with Cohen's kappa values indicating substantial to almost perfect agreement (κ = 0.67-0.76). The agreement between AdvanSure Alloscreen and its upgraded version, AdvanSure AlloScreen Max108, was the highest. For common allergens in the Korean population, Dermatophagoides pteronyssinus and Dermatophagoides farinae showed moderate agreement (κ = 0.47-0.82, respectively) between the MAST systems. Re-testing of discrepant samples (n = 78; 31 allergens) using ImmunoCAP-often considered the gold standard for allergy testing-demonstrated the highest concordance for the SGTi Allergy Screen (76.39%).

Conclusion: All four MAST systems demonstrated substantial to near-perfect qualitative agreement. The SGTi-Allergy Screen showed the best concordance with ImmunoCAP, whereas AdvanSure Alloscreen Max108 offered a balanced performance with broader allergen coverage. These findings indicate that laboratories should select a MAST system based on local needs, weighing analytical accuracy, allergen panel breadth, and overall testing efficiency.

Background: Asthma is a major global health issue, affecting over 260 million individuals and causing more than 450,000 deaths annually. A growing body of international and local research has investigated the link between Vitamin D levels and asthma outcomes. These studies suggest that Vitamin D may play a role in modulating immune responses, potentially influencing asthma control, the frequency of exacerbations, hospital visits, and overall disease severity. However, evidence remains contradictory, where other studies did not establish a direct link between vitamin D levels and asthma development given the limited real-world data from Saudi Arabia.

Objective: This study aims to investigate the effect of serum Vitamin D levels and asthma exacerbations among adults, adolescents, and children within a Saudi population.

Methods: A single-center retrospective cohort study was conducted at the National Guard Hospital in Riyadh, Saudi Arabia, involving 379 asthma patients with documented Vitamin D deficiency within the past 6 to 12 months. The primary outcome was the effect of serum Vitamin D levels and asthma exacerbations. The secondary outcome is defining the correlation between Vitamin D levels and asthma severity.

Results: A significant difference in asthma exacerbation frequency was observed between the Vitamin D-deficient and adequate groups during both the 6- and 12-month periods, with the adequate group experiencing more frequent exacerbations (p = 0.030). Furthermore, significant associations were found between Vitamin D levels and emergency room visits (p < 0.001), as well as the need for rescue medication (p = 0.004).

Conclusion: Interestingly, the results revealed that individuals with adequate vitamin D had a significantly higher frequency of exacerbations compared to those in the deficient group. These findings could be due to several confounding factors. Although vitamin D may contribute to overall respiratory health, its impact on severe asthma events may be overshadowed by other critical factors, such as Age and BMI, comorbidities, adherence to controller medications, and exposure to environmental triggers.

Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis characterized by eosinophilic inflammation and involvement of small- to medium-sized vessels. Given its heterogeneous clinical presentation, early diagnosis and appropriate management are critical. Although systemic corticosteroids remain the mainstay of therapy, concerns regarding their long-term adverse effects underscore the growing need for alternative treatment strategies.

Case presentation: A 70-year-old man with a medical history of sinusitis, eosinophilic pneumonia, and bronchial asthma was referred for assessment of pleural effusion, which resolved spontaneously at the time of presentation. The patient was observed without intervention, while continuing asthma management. Approximately 6 months later, the patient experienced exacerbation of asthma and recurrence of pleural effusion. Thoracentesis was performed for symptom relief and benralizumab (30 mg) was initiated, resulting in temporary clinical improvement. However, after the third dose, the patient developed abdominal pain, peripheral neuropathy, and a skin rash. Laboratory studies revealed peripheral eosinophilia and elevated levels of rheumatoid factor (RF), myeloperoxidase-anti-neutrophil cytoplasmic antibody (MPO-ANCA), and total immunoglobulin E (IgE). A second skin biopsy revealed granulomatous inflammation, confirming the diagnosis of EGPA. Mepolizumab treatment (300 mg) was initiated, resulting in clinical resolution.

Conclusion: This case highlights that EGPA may develop during anti-IL-5 therapy. Close monitoring of clinical signs, along with biomarkers such as eosinophil count, RF, MPO-ANCA, and IgE, is essential for timely diagnosis. Furthermore, successful disease control by switching to mepolizumab monotherapy suggests the potential for managing EGPA using appropriate biologic regimens to minimize corticosteroid-related adverse effects. Further accumulation of similar cases and larger studies is warranted to inform future clinical practice.

Background: The prevalence and clinical characteristics of asthma phenotypes are less studied in mild asthma than in severe asthma. This study aims to assess the prevalence and clinical features of different phenotypes in patients with asthma with different severity.

Methods: A cross-sectional study was conducted in Hong Kong. Adult patients with mild, moderate and severe asthma based on GINA steps (1 to 5) were included. The prevalence of eosinophil phenotype, elevated IgE, overlapping eosinophil phenotype with elevated IgE levels and type 2 phenotype in mild and moderate/severe asthma were compared. The clinical features of different phenotypes in patients with mild or moderate/severe asthma were also compared.

Results: A total of 152 patients were recruited. The mild asthma group had significantly fewer patients with type 2 phenotype (49.0% vs 69.3%, p = 0.015), eosinophilic phenotype (25.5% vs 43.6%, p = 0.030), elevated IgE (41.2% vs 59.4%, p = 0.033), and overlapping eosinophilic phenotype with elevated IgE (17.6% vs 33.7%, p = 0.038). Those with mild eosinophilic phenotype had better lung function than their non-eosinophilic counterparts (2.67 ± 0.75 L vs 2.18 ± 0.62 L, p = 0.045), in contrast to the comparatively poorer lung function of those with eosinophilic moderate/severe asthma (87.87 ± 19.54% vs 98.10 ± 19.77%, p = 0.018). The eosinophilic phenotype and a higher blood eosinophil count were only associated with an increased risk of exacerbation in moderate/severe asthma.

Conclusion: The prevalence of the type 2 phenotype is lower in patients with mild asthma than in patients with moderate/severe asthma. Eosinophilic phenotype in the mild and moderate/severe asthma group showed differences in spirometry findings and exacerbation risks. The heterogeneity in the phenotype across asthma of different severity suggests that risk stratification based on blood-based biomarkers alone may be inadequate and other clinical factors should also be considered.

Background: Cough variant asthma (CVA) is a clinically significant asthma phenotype and a major cause of chronic cough, with a substantial risk of progressing to classic asthma. Acupuncture has shown potential in alleviating cough, modulating airway inflammation, and improving quality of life, though high-quality evidence in CVA remains limited. This multicenter pilot trial aims to evaluate the feasibility and preliminary efficacy of acupuncture as adjunctive therapy for CVA.

Methods and analysis: This multicenter, randomized, sham-controlled pilot trial is designed to assess the feasibility, safety, and preliminary efficacy of acupuncture as adjunctive therapy for CVA. Eighty-eight participants will be randomized 1:1 to receive real acupuncture (RA) or sham acupuncture (SA), in addition to inhaled corticosteroid (ICS)-based standard care. The intervention comprises 16 sessions over 8 weeks, with an additional 8-week follow-up. The primary outcome is the effective response rate at week 8, defined as a ≥50% reduction in cough severity on the visual analogue scale (VAS). Secondary outcomes include patient-reported measures such as the Cough Severity Diary (CSD), Cough Hypersensitivity Questionnaire (CHQ), Cough Evaluation Test (CET), and Leicester Cough Questionnaire (LCQ); psychological and sleep assessments using the Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and Pittsburgh Sleep Quality Index (PSQI); and objective biomarkers including fractional exhaled nitric oxide (FeNO) and peripheral blood eosinophil counts.

Ethics and dissemination: Ethical approval was obtained from the Medical Ethics Committee of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (No. 2024KL-208). The results of this study will be distributed through peer-reviewed journals.

Clinical trial registration: https://itmctr.ccebtcm.org.cn, identifier ITMCTR2025000435. Registered on 27 February 2025.

Introduction: It has been proposed that patients with asthma on monoclonal antibodies (mAb) targeting Interleukin-5 (IL-5), IL-4/IL-13 pathways or IgE may demonstrate insufficient defense against viral infections requiring strong T-helper-cell-type-1-(Th1) for neutralizing antibody production and cytotoxic CD8+ T-cell responses for efficient clearance of the viral pathogens. It is a matter of debate whether those mAb may impair the immune response against SARS-CoV-2-spike-protein by interacting with cytokines critical for B-cell differentiation and antibody maturation. This controlled cross-sectional cohort study aimed to characterize the mucosal and serum humoral immune response as well as the cellular reactivity against spike-protein in asthma patients on mAb or on conventional treatment (conv).

Materials and methods: Nasal and serum anti-spike-IgG and -IgA concentrations, avidity, neutralizing IgG and cytokine profiles were assessed using serological and neutralization assays and bead-based cytokine detection in nine patients on mAb matched to nine patients on conv who had received COVID-19-mRNA-vaccination. Proportions of spike-induced subpopulations of T- and B-cells were investigated by flow cytometry.

Results: Blockade of IL-5 and IL-5 receptor showed higher serum and nasal concentrations of anti-spike-IgA against recombinant-binding-domain-(RBD) and spike-protein-1-(S1) and similar concentrations of anti-spike-IgG compared to mAb or conv therapy. A spike-specific CD8+ T-cell-driven immune response with increased cytotoxic markers was seen in anti-IL-5 treatments. Baseline Th1 responses correlated with IFNγ- and TNFα-production in supernatants of spike-protein-stimulated cultures in all patients.

Conclusion: The findings indicate a significant specific adaptive immune response to SARS-CoV-2-spike-protein exposures by Th1- and Th2-driven responses with a significant response by serum and mucosal anti-S1 and anti-RBD-IgA in anti-IL-5-treated patients compared to IL-4/IL-13-targeting, anti-IgE or conventional therapies. Thus, based on the results it may be expected that immunogenicity of COVID-19-mRNA-vaccines or infection-induced spike-exposures is equivalent between asthma patients on monoclonal antibodies compared to those treated with conventional therapy.