Journal of Asthma and Allergy最新文献

Objective: Allergic rhinitis (AR) is a highly prevalent allergic disorder with increasing global incidence, and gut microbiota dysbiosis has emerged as a key pathogenic factor. This review systematically synthesizes evidence on how traditional Chinese medicine (TCM)-including single herbs, herbal formulas, and auxiliary therapies-alleviates AR by targeting gut microbiota, aiming to clarify mechanistic pathways and provide evidence-based support for clinical practice.

Methods: A comprehensive literature search was conducted in PubMed, China National Knowledge Infrastructure (CNKI), and Embase databases. Keywords included ["Traditional Chinese Medicine" or "TCM" or "Chinese herbal medicine" or "herbal formula"], ["allergic rhinitis" or "AR"], ["gut microbiota" or "intestinal microbiota"], ["immune regulation"], ["intestinal barrier"], and ["inflammatory mediator"]. Only peer-reviewed studies (human or animal models) focusing on TCM-gut microbiota-AR interactions were included; non-relevant, non-peer-reviewed, or duplicate articles were excluded.

Results: A total of 210 relevant studies were initially identified from the three databases (PubMed: 67, Embase: 55, CNKI: 88); subsequently, 122 duplicate records, 44 irrelevant records (38 with title mismatch, 6 including meetings, case reports, and protocols), and 22 low-quality studies were excluded, and finally 24 studies were included in this review. TCM exerts anti-AR effects through multi-targeted modulation of the gut microbiota-intestinal barrier-immune axis. TCM (eg, Astragalus membranaceus, Xiaoqinglong Decoction) increases the abundance of beneficial bacteria (eg, Lactobacillus, Bifidobacterium) and reduces pathogenic taxa, while promoting the production of microbial metabolites like short-chain fatty acids (SCFAs). TCM components upregulate tight junction proteins (ZO-1, Occludin) and activate the PI3K/Akt pathway to enhance intestinal epithelial integrity, reducing barrier permeability. TCM balances Th1/Th2/Treg cell subsets, inhibits NLRP3 inflammasome-mediated pyroptosis, and reduces pro-inflammatory mediators (IL-4, IL-5, TNF-α) while elevating anti-inflammatory cytokines (IL-10, IFN-γ). Clinical trials confirm TCM alleviates AR symptoms (nasal congestion, rhinorrhea), lowers serum IgE levels, and reduces disease recurrence.

Conclusion: TCM ameliorates AR by integrating gut microbiota modulation, intestinal barrier repair, and immune regulation-highlighting its multi-pathway, multi-target advantages. Current limitations include insufficient large-scale randomized controlled trials and unclear TCM-microbiota crosstalk at the molecular level. Future research should leverage multi-omics technologies to decipher precise mechanisms and explore TCM-Western medicine combinations for optimized AR management.

Purpose: Alternaria alternata (AA) grows on decaying material. Spores occur on hot and dry days in the summer and can trigger asthma and allergic rhinitis. Skin prick test (SPT-AA) and Alternaria alternata-specific IgE (AA-IgE) are used for diagnostic purposes, but their predictive value is unclear.

Patients and methods: A retrospective analysis of electronic medical records to 2011-2021 was performed on symptoms, SPT-AA, AA-IgE, lung function, asthma therapy and bronchial provocation using Alternaria alternata extract (BP-AA).

Results: 149 children and adolescents (5-18 years) with Alternaria allergy were investigated. Between June and September, 86 Alternaria-sensitized patients had asthmatic symptoms and 113 had nasal symptoms (often outdoors or with mold exposure). SPT-AA and AA-IgE levels did not differ between the symptomatic and asymptomatic patients (SPT-AA, p= 0.23). A weak correlation was observed between the diagnostic tests in 49 patients with bronchial and/or nasal symptoms (r= 0.36, p= 0.01). Nineteen patients received provocation, 16 showed an early asthmatic response and 14 a late asthmatic response. Patients with BP-AA had a medium SPT-AA ≥7 mm or AA-IgE ≥16.8 kU/L. Both tests significantly correlate with PD20-AA (r= -0,49, p< 0.01 and r= 0.26, p< 0.01, respectively).

Conclusion: The Diagnosis of Alternaria allergy is still a challenge. The weak to moderate correlation between SPT-AA and AA-IgE seems to be allergen-specific. Typical medical history is a key diagnostic criterion. Allergy profiles and climate may play a role in the manifestation of symptoms. BP-AA help to establish threshold values for SPT-AA and AA-IgE. In unclear cases, nasal or bronchial provocation should be performed before immunotherapy.

Background and objectives: Comorbidities are common in severe asthma and can influence disease burden, and treatment outcomes. This study aimed to compare the prevalence and distribution of comorbidities potentially related to T2 inflammation and oral corticosteroid (OCS) use in severe asthma patients from Gulf countries using International Severe Asthma Registry (ISAR) data, and to assess their association with age, sex, and smoking status.

Methods: Data from severe asthma patients in Kuwait (n=494), Saudi Arabia (n=398), and the UAE (n=257) were extracted from ISAR (n=16,269). Comorbidities were categorized as T2-related or OCS-related. Comparative and subgroup analyses evaluated the prevalence and distribution of these comorbidities and their associations with age, sex, and smoking status.

Results: Gulf patients with severe asthma were significantly younger and had earlier disease onset compared to ISAR. T2-related comorbidities, especially allergic rhinitis and nasal polyposis were more prevalent in the Gulf, while OCS-related comorbidities such as osteoporosis, anxiety, and cardiovascular disease were markedly lower. Obesity was highly prevalent across all countries and subgroups. Significant associations were found between comorbidity types and age, sex, and smoking status, with T2 burden increasing in younger and male patients, and OCS burden remaining consistently low.

Conclusion: Severe asthma patients in the Gulf showed a high prevalence of T2-related comorbidities and obesity, with fewer OCS-related conditions. These patterns vary by age, sex, and smoking, highlighting the need for personalized management in this region.

Background: Asthma-associated eosinophilic pneumonia (EP) is a relatively uncommon clinical condition characterized by abnormal accumulation of eosinophils in the lung parenchyma or alveolar spaces. Computed tomography (CT)-guided percutaneous lung biopsy, a minimally invasive diagnostic technique, demonstrates a high diagnostic yield for pulmonary diseases. This method offers several advantages, including minimal tissue trauma, procedural simplicity, high positive rate, and an acceptable risk profile for complications, establishing it as a reliable tool for diagnosing both infectious and neoplastic pulmonary conditions. However, the diagnosis of EP remains challenging due to its non-specific clinical presentation and atypical imaging features, often leading to clinical misdiagnosis as pulmonary infection, tuberculosis, or lung cancer. Elevated eosinophil counts in peripheral blood and bronchoalveolar lavage fluid (BALF) provide crucial diagnostic clues. A BALF eosinophil proportion ≥25% is considered highly suggestive of the diagnosis. Nevertheless, when the BALF eosinophil count falls below the diagnostic threshold for EP, lung biopsy serves as a valuable alternative for achieving a definitive diagnosis and facilitating differential diagnosis.

Case: We report a 18-year-old female patient with a history of asthma who was initially diagnosed with pulmonary infection at another hospital. Despite empirical treatment with multiple antimicrobial agents, her condition progressed. Bronchoalveolar lavage revealed an eosinophil percentage of 20% in BALF, which was slightly below the standard diagnostic threshold of 25%. Given the strong clinical suspicion and the subthreshold BALF result, a CT-guided percutaneous lung biopsy was performed at our institution, which confirmed the diagnosis of chronic eosinophilic pneumonia (CEP).

Results: Following the diagnosis of chronic eosinophilic pneumonia, glucocorticoid therapy was initiated. A follow-up chest CT scan at 7 months revealed complete resolution of the pulmonary infiltrates, which was accompanied by the normalization of peripheral blood eosinophil counts. The patient remained disease-free without recurrence until the last follow-up in May 2025.

Conclusion: In asthmatic patients presenting with elevated peripheral blood eosinophils and pulmonary opacities with a predominant peripheral distribution on imaging, secondary eosinophilic pneumonia should be considered. When the bronchoalveolar lavage (BAL) fluid eosinophil count falls slightly below the diagnostic threshold (eg, 20% as in our case), Lung biopsy should be considered to establish a definitive diagnosis, which is critical for guiding subsequent patient management and improving outcomes.

Background: The influence of intestinal microorganisms on the development and course of allergic diseases has recently been the subject of intensive research, but studies describing changes in the intestinal microbiome of asthma patients in response to altering factors are still scarce.

Objective: (1) the analysis of eating habits composition of intestinal microbiota and BMI in asthma patients compared to the control group, (2) the comparison of the results of the analyzed parameters in asthma patients and in the control group, (3) the analysis of asthma treatment results depending on the composition of intestinal microbiota.

Methods: Clinical stool isolates were cultured and genetic material was sequenced. The study included 49 subjects with asthma and a control group of 18 healthy volunteers. Clinical data was collected through questionnaires on the most frequently reported symptoms and the FFQ questionnaire. The composition of intestinal microbiota was determined using the traditional breeding method (the serial dilution method was used) followed by 16S rRNA sequencing.

Results: Patients with asthma reported the greatest severity of clinical symptoms in all the body systems examined.The most common cause of the aberrant stool test results was E. coli, with titers <10⁶. The was no difference in the dietary habits between the asthma patients and the control group. Alpha and beta diversity, was significantly lower in asthma patients compared to the control group. Asthma patients had lower abundance of Faecalibacterium vs healthy volunteers. Statistically significant depletion of Oscilospirales, Anaerovoracaceea, was demonstrated in patients with uncontrolled asthma compared to controlled and partially controlled asthma. In patients taking glucocorticoids (oral and inhaled) enriched intestinal microbiota in Anaerovoracaceae and Christensenellaceae and depleted Faecalibacterium were observed.

Conclusion: Patients with asthma showed less richness and diversity in the composition of their intestinal microbiota compared to the control group.

Rational: The incidence of pediatric respiratory allergic diseases is rising annually. However, no study has systematically investigated the spectrum of inhalant allergens in children from Fuzhou, China, using ImmunoCAP assay technology and cohort analysis. This study aimed to characterize the distribution of allergen-specific IgE (sIgE) in children aged 0-14 years with respiratory allergies in Fuzhou, providing theoretical support for etiological diagnosis, treatment, and prevention.

Methods: A total of 196 children underwent allergen screening: 116 diagnosed with allergic rhinitis (AR) and 80 with asthma (AS). Serum sIgE antibodies against inhalant allergens were detected using the ImmunoCAP system.

Results: In the AR group, Dermatophagoides pteronyssinus (d1) showed the highest sensitization rate (112/116), followed by Dermatophagoides farinae (d2) (110/116). In the AS group, d1 and d2 had equally high positivity rates (both 78/80), while Blattella germanica (i6) sensitization was significantly higher in AS than in AR. Sensitization to the animal epithelium panel (ex1) differed significantly between diseases in the 4-6-year age group. Correlation analysis revealed a strong positive correlation between tree pollen mix (tx5) and weed pollen mix (wx5) in both groups, and a significant correlation between d2 and d1.

Conclusion: Dermatophagoides pteronyssinus (d1) and D. farinae (d2) are the predominant allergens in pediatric respiratory allergies in Fuzhou. This study offers valuable insights for preventing and treating these conditions.

Allergic cross-reactivity among different fungal species appears to be widely existing. Fungus-related foods, such as edible mushrooms, mycoprotein, and fermented foods by fungi, can often induce to fungus food allergy syndrome (FFAS) by allergic cross-reactivity with airborne fungi. This article presents a case study of an individual with mold allergy who experienced anaphylaxis after consuming seafood mushrooms. This study indicated that Alt a 1 mediating cross-allergy between Alternaria alternata and Hypsizygus marmoreus, which has not been documented in the literature concerning the FFAS. Mushrooms tend to induce anaphylaxis in patients with mold-allergy and warrants clinicians' attention.

Background: Fractional exhaled nitric oxide has been widely used as a biomarker of airway inflammation. By measuring nitric oxide concentrations at different exhalation flow rates, it is possible to assess inflammation in various segments of the respiratory tract. This study hypothesized that FeNO could serve as a valuable tool for evaluating airway inflammation in children with different types of allergic asthma.

Methods: This retrospective single-center study included 487 children with asthma, categorized as inhalant-sensitized (n=238), food-sensitized (n=36), mixed-sensitized (n=181), and non-sensitized controls (n=32). Fractional exhaled nitric oxide was measured following ERS/ATS protocols, including FeNO₅₀ (flow rate 50 mL/s), FeNO₂₀₀ (200 mL/s), and CaNO (alveolar or peripheral airway NO concentration). Multivariable median regression was used to assess group differences after adjusting for age, sex, BMI, inhaled corticosteroid (ICS) use, rhinitis, and recent respiratory infection.

Results: FeNO₅₀ and FeNO₂₀₀ levels were significantly higher in both the inhalation allergen and mixed allergen groups compared to the control and food allergen groups (all adjusted P < 0.01). For instance, FeNO₅₀ showed an adjusted median difference of -5.00 ppb (95% CI: -8.50, -2.00; P =0.003) between the control group and inhalations. CaNO levels did not differ significantly across groups (P = 0.133).

Conclusion: FeNO₅₀ and FeNO₂₀₀ levels were significantly higher in inhalant- and mixed-sensitized children compared with food-sensitized or non-sensitized controls, indicating stronger type-2 inflammatory features. CaNO showed no significant difference across groups after adjustment. These findings highlight FeNO as a potential biomarker associated with airway inflammation in sensitized asthma; however, further prospective studies are warranted for confirmation.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease often accompanied by comorbidities such as allergic rhinitis (AR) and asthma. Dupilumab, a monoclonal antibody targeting IL-4Rα, has demonstrated significant efficacy and safety in the treatment of AD. However, its effectiveness in patients with comorbidities remains underexplored. We aimed to evaluate the impact of Dupilumab on the severity of dermatitis, comorbidity control, medication safety, and treatment adherence in Chinese AD patients in real-world settings.

Methods: This is a single-center retrospective-prospective real-world cohort study that included 376 patients with AD who received Dupilumab treatment from February 2021 to February 2024. Among them, 270 patients had AD, and 106 had AD with comorbidities, including 106 cases of AR and 20 cases of asthma. Baseline clinical data and laboratory parameters were collected. The severity of AD, quality of life, and comorbidity control were assessed at week 0, 4, 8, 12, and 16. Efficacy indicators and related predictive factors were evaluated, and drug continuation rates at week 52 were assessed.

Results: After 16 weeks of Dupilumab treatment, the median improvement in EASI score was 95.3% (from 8.5 to 0.40), with an EASI75 response rate of 78.9%. AD efficacy-related scores and comorbidity-related scores showed significant improvement compared to baseline (all P<0.05). There was no statistical difference in efficacy between the AD group and AD with comorbidities group. Drug survival analysis showed similar drug continuation rates at 52 weeks for both groups (P>0.05). Adverse events were mainly eye-related events (8.51%, 32/376), followed by localized symptom worsening (2.13%), hair loss (1.60%), and facial erythema (1.33%). Patients with higher baseline EASI scores were more likely to achieve 90-100% improvement (P = 0.024).

Conclusion: Dupilumab effectively improves AD symptoms and comorbidities, with consistent efficacy across comorbid status and good safety profile. Higher baseline disease severity associates with better treatment response.