Journal of Asthma and Allergy最新文献

Background: Cow's milk protein allergy (CMPA) is a prevalent food allergy in early childhood, significantly impacting the quality of life for affected children. Current palliative measures, such as specialized formula milk, offer temporary relief but are costly and fail to address the underlying issue. Thus, there is a critical need to better understand CMPA and explore new treatment options.

Methods: This study employed bibliometric methods to analyze global pediatric CMPA research and identify future directions for the first time. Visual analyses were conducted using VOS Viewer and CiteSpace software.

Results: A total of 2040 articles published between 2000 and 2023 showed increasing annual publications. In this field of research, the Icahn School of Medicine at Mount Sinai has made significant contributions, with the most influential articles published in the Journal of Allergy and Clinical Immunology. Current research emphasizes personalized therapy, probiotics, and gut microbiota in CMPA.

Conclusion: Future research will focus on microbiota-related personalized treatments, promising effective clinical interventions.

Background: The role of memory B cells and their subgroups in allergic rhinitis (AR) and allergen immunotherapy (AIT) remains unclear. This study aimed to investigate the characteristics of memory B cells in the circulation of patients with AR and those undergoing AIT, as well as their clinical significance.

Methods: This study involved a cohort comprising 32 healthy control subjects, 39 individuals diagnosed with AR, and 31 AR patients who had received AIT for over one year. Visual analog scale (VAS) scores were used for symptom assessment, and the serum concentrations of immunoglobulins and cytokines were quantified. This study evaluated alterations in the proportions of peripheral blood memory B cells and their subpopulations, plasma cells, and various T-cell subsets across the three participant groups.

Results: The proportion of IgA+CD27- class-switched memory B cells in the AR group significantly decreased compared to the control group, but significantly increased following AIT (P < 0.05). In AR patients, circulating IgA+CD27- class-switched memory B cells were significantly positively correlated with Treg cells, IL-10, and IL-4 and significantly negatively correlated with IFN-γ, total IgE, sIgE, and VAS scores (P < 0.05). After AIT, the number of circulating IgA+CD27- class-switched memory B cells in AR patients was significantly positively correlated with the number of Treg cells and IL-10 and significantly negatively correlated with the VAS score (P < 0.05).

Conclusion: The IgA+CD27- class-switched memory cell subset in human peripheral blood may serve as a potential biomarker for evaluating AR symptoms and treatment efficacy. Its mechanism may be associated with interactions between T and B cells.

Background: Non-pharmaceutical interventions (NPIs) were widely used during the coronavirus disease 2019 (COVID-19) pandemic, however their impact on acute asthma exacerbations (AEs) is not well studied.

Methods: We had retrospectively collected patients with asthma AEs between 2019 and 2020 and retrieved data from the Chang Gung Research Database, including clinical manifestations, medications, pulmonary function, clinic and emergency department visits and hospitalizations.

Results: A total of 39,108 adult patients with asthma were enrolled, of whom 1502 were eligible for analysis. The prevalence of acute AEs significantly decreased throughout 2020 compared with 2019 after implementation of the NPI policy. The patients were categorized into four groups: Group 1, acute AEs in 2019 with influenza infection (n=692); Group 2: acute AEs in 2019 without influenza infection (n=328); Group 3: acute AEs in 2020 with influenza infection (n=268); Group 4: acute AEs in 2020 without influenza infection (n=214). The patients in group 4 were significantly older (73.3±29.1 vs 65.5±29.2, 69.7±26.2 years, p<0.01) and had significantly worse forced expiratory volume in one second/forced vital capacity ratio (70.5±13.9 vs 79.6±15.5, 72.9±18.0, p<0.01) than those in group 1 and 2, and the highest rate of oral corticosteroid prescriptions (17%, p<0.01). The patients in group 3 and 4 had significantly lower rates of oxygen therapy, ventilator use and mortality at 3 and 12 months of follow-up than those in group 1 and 2.

Conclusion: The use of NPIs during the COVID-19 pandemic in Taiwan may reduce the frequency and severity of asthma AEs. This may provide some cost-effective strategies to attenuate acute asthma AEs.

Airway inflammation, a hallmark feature of asthma, drives many canonical features of the disease, including airflow limitation, mucus plugging, airway remodeling, and hyperresponsiveness. The T2 inflammatory paradigm is firmly established as the dominant mechanism of asthma pathogenesis, largely due to the success of inhaled corticosteroids and biologic therapies targeting components of the T2 pathway, including IL-4, IL-5, IL-13, and thymic stromal lymphopoietin (TSLP). However, up to 30% of patients may lack signatures of meaningful T2 inflammation (ie, T2 low). In T2-low asthma patients, T2 inflammation may be masked due to anti-inflammatory treatments or may be highly variable depending on exposure to common asthma triggers such as allergens, respiratory infections, and smoke or pollution. The epithelium and epithelial cytokines (TSLP, IL-33) are increasingly recognized as upstream drivers of canonical T2 pathways and as modulators of various effector cells, including mast cells, eosinophils, and neutrophils, which impact the pathological manifestations of airway smooth muscle hypertrophy, hypercontractility, and airway hyperresponsiveness. Approved biologics for severe asthma target several distinct mechanisms of action, leading to differential effects on the spectrum of T2 inflammation, inflammatory biomarkers, and treatment efficacy (reducing asthma exacerbations, improving lung function, and diminishing symptoms). The approved anti-asthma biologics primarily target T2 immune pathways, with little evidence suggesting a benefit of targeting non-T2 asthma-associated mediators. Indeed, many negative results challenge current assumptions about the etiology of non-T2 asthma and raise doubts about the viability of targeting popular alternative inflammatory pathways, such as T17. Novel data have emerged from the use of biologics to treat various inflammatory mediators and have furthered our understanding of pathogenic mechanisms that drive asthma. This review discusses inflammatory pathways that contribute to asthma, quantitatively outlines effects of available biologics on biomarkers, and summarizes data and challenges from clinical trials that address non-T2 mechanisms of asthma.

Background: Extranodal NK/T-cell lymphoma, nasal type (ENKTCL-NT) is a rare, highly invasive Epstein-Barr virus associated hematological malignant tumor with an unfavorable prognosis. Although ENKTCL-NT has been previously reported, no relevant article has provided an intuitive, progressive series of schematic illustrations of the rapid progression of facial ulcers.

Objective: This article reports a serious case of ENKTCL-NT that involved the entire process from onset to death.

Case summary: A 67-year-old man suffered a facial lesion started at the right ala nasi. The wound continued to spread uncontrollably to the nasion and the nasolabial groove. Subsequently, he used an unauthorized external application of herbal medicine, which unfortunately resulted in further expansion of the wound, encompassing the area from the right eyelid to the left inner canthus, extending up to the eyebrow arch, down to the right ala nasi, and deep into the nasal bone over six months. Histopathological analysis of the two biopsies revealed inflammatory necrotic granulation tissue.

Conclusion: Nasal extranodal NK/T-cell lymphoma presenting with non-specific symptoms could easily lead to misdiagnosis. It progresses quickly, while adequate, repeated, and multiple spot biopsies for histopathologic examination help confirm the diagnosis.

Background: The increasing global prevalence of asthma necessitates effective disease management, with patients and their families playing a central role. Enhancing health literacy (HL) among caregivers is critical to improving asthma outcomes.

Purpose: This study aimed to validate the Arabic version of the Asthma Numeracy Questionnaire (Ar-ANQ) to address the gap in HL assessment tools for Arabic-speaking populations.

Patients and methods: A total of 400 parents of children with asthma completed the Ar-ANQ at an outpatient respiratory clinic. Confirmatory factor analysis (CFA) and Rasch analysis were employed to evaluate the psychometric properties of the instrument.

Results: CFA supported the unidimensional structure of the Ar-ANQ, with excellent model fit indices (χ²/df = 4.6, SRMR = 0.02, CFI = 0.99, GFI = 0.99, TLI = 0.96) and high internal consistency (Cronbach's α = 0.82). Rasch analysis further demonstrated psychometric robustness, with high person and item separation reliabilities (0.74 and 0.99, respectively) and acceptable infit and outfit statistics.

Conclusion: The Arabic version of the Asthma Numeracy Questionnaire (Ar-ANQ) is a reliable and valid instrument for assessing health literacy among parents of children with asthma.

Purpose: Although periostin has recently emerged as a new mediator in chronic allergic diseases, particularly in upper airway disease, its significance as a biomarker for allergic rhinitis (AR) is still unclear. Therefore, we aimed to assess the potential of periostin as a novel candidate biomarker for diagnosing and assessing the severity of AR.

Patients and methods: A total of 40 patients with AR and 22 healthy controls, all aged over 18 years, were recruited for the study. Participants underwent examinations to assess serum levels of total IgE (tIgE), specific IgE (sIgE), periostin, and remodeling-related factors, as well as fractional exhaled nitric oxide (FeNO) and fractional nasal nitric oxide (FnNO). Additionally, clinical characteristics questionnaire and nasal function assessments were completed by AR patients.

Results: The levels of serum periostin were significantly higher in patients with AR compared to healthy controls (Z=-3.605, p<0.001). There was a notable positive correlation between serum periostin and FeNO (r=0.398, p=0.012), FnNO (r=0.379, p=0.017), as well as the visual analogue scale (VAS) score for ocular tearing (r=0.351, p=0.026) in AR patients. Furthermore, the serum periostin levels were higher in moderate-to-severe AR compared to mild AR cases (Z=-2.007, p=0.045). The level of serum periostin in AR patients showed a sequential increase corresponding to shortness of breath scores from 0 to 3 (Z=10.137, p=0.017). The predicted probability of serum periostin demonstrated moderate diagnostic accuracy in detecting AR (AUC=0.773, p<0.001).

Conclusion: Serum periostin shows potential as a candidate biomarker for detecting AR and can serve as a surrogate biomarker for assessing airway inflammation in AR patients.

Introduction: Physical inactivity due to shortness of breath is common among patients with uncontrolled asthma. We evaluated the body mass composition and exercise capacity of patients with poorly controlled asthma, despite maximal inhalation therapy.

Methods:  We recruited 56 patients from the Asthma Clinic of the University Hospital of Liège between September 2020 and December 2023, and 14 healthy subjects. Patients with asthma underwent detailed investigations, including induced sputum, exercise testing, and Dual-Energy X-ray Absorptiometry (DXA), to determine overall body fat mass and fat-free mass, while healthy subjects only underwent DXA. This study was approved by the Ethics Committee (2019/362).

Results:  The mean age of patients with asthma was 45 years ± 12; 58% were female, 10% were active smokers, and mean post-BD Forced Expiratory Volume in one second was 85.7% predicted. Compared to healthy subjects, asthmatics had a higher BMI (28.5±5.1 kg/m2 vs 22.5 ±2.8 kg/m2, p<0.0001) and fat mass index (FMI; 10.3 ± 3.7 vs 5.9 ± 2.8 kg/m2, p=0.0005), lower lean and bone mass (62% vs 71%, p=0.0012), and greater android fat distribution (1.00 ± 0.22 vs 0.80 ± 0.13, p<0.0001). Eosinophilic asthma (sputum eosinophil count of ≥3%) was characterized by a better VO₂ max compared to non-eosinophilic asthma (20.7 [17.8-24.3] vs 17.3 [14.0-18.9], p=0.04). Higher lean mass was correlated with better asthma control and lower depression scores. Lean mass and bone mineral content correlated with maximal expiratory, inspiratory, and maximal aerobic power.

Conclusion:  Our study confirmed that patients with uncontrolled asthma were overweight and had decreased exercise capacity.

Background: Pollen is a significant contributor to respiratory allergies worldwide, underscoring the importance of understanding its association with childhood sensitization to enhance clinical management.

Objective: This study focuses on investigating the prevalence of various airborne pollens and their correlation with clinical characteristics of childhood respiratory allergic diseases in southeastern China.

Methods: From November 2020 to October 2021, this research employed Durham monitoring samplers to collect airborne pollen. Simultaneously, skin prick tests (SPTs) were performed on children with respiratory allergic conditions at the Children's Hospital of Soochow University and standardised questionnaires are also administered to assess children's symptoms.

Results: Over the course of November 2020 to October 2021, the study identified more than 36 pollen species. Notably, the spring season (March to May) exhibited the highest pollen concentrations, with Broussonetia accounting for 30.04% and Pinus for 26.38%. Similarly, the autumn months (September to October) saw prominent taxa like Humulus scandens (47.55%) and Gramineae (35.93%). Among the patients, a significant 92.7% exhibited positive reactions, with 81.7% showing sensitization to house dust mites (HMD), 17.8% to pollen, and 3.7% to Cockroach. Noteworthy the five most common pollens were observed for Bermuda (6.0%), Elm pollen (6.0%), Birch pollen (4.6%), and Mugwort (4.6%). The study indicated a substantial multisensitized ratio among pollen-sensitized patients in comparison to non-pollen-sensitized ones (97.4% vs 1.6%, P <0.001). Moreover, weekly total airborne pollen concentrations showed positive correlations with weekly admissions due to allergic rhinitis(AR)(r=0.642, P <0.001), bronchial asthma (BA) (r= 0.472, P<0.001), and the coexistence of AR and BA (r=0.485, P <0.001).

Conclusion: The findings found that there were two peaks of pollen count in a year during March-May and September-October. The findings emphasize the critical role of specific airborne pollens in driving sensitization and exacerbating respiratory allergic diseases in children.

Allergies represent a significant and growing public health concern, affecting millions worldwide and burdening healthcare systems substantially. Accurate diagnosis and understanding of allergy is crucial for effective management and treatment. This review aims to explore the historical evolution, current advances, and prospects of histopathological and cytological techniques in allergy diagnosis, highlighting their crucial role in modern medicine. Major biomedical, public health, and imaging databases such as PubMed, Scopus, Web of Science, and EMBASE were used. The search strategy used include specific keywords and Medical Subject Headings (MeSH) terms related to histopathology, cytology, radiology, allergic diseases, and public health. Histopathological and cytological studies play a pivotal role in elucidating the underlying mechanisms of allergies, offering insights into the cellular and tissue-level changes associated with allergic responses. Histopathology reveals characteristic features such as inflammation, tissue remodeling, and the presence of specific immune cells like eosinophils and mast cells. Cytological analysis can detect cellular changes and abnormalities at a finer scale, providing a complementary perspective to histopathological findings. The correlation between histopathological and cytological findings is critical for achieving accurate and reliable diagnoses. Combined histopathological and cytological studies can reveal the extent of airway inflammation, epithelial damage, and immune cell infiltration, providing a robust basis for clinical decision-making. Recent advancements in diagnostic techniques have further revolutionized the field of allergy diagnosis. These technologies offer increased accuracy, speed, and reproducibility, making them invaluable in both clinical and research settings. Despite these advancements, several challenges and limitations persist. By integrating tissue-level and cellular-level analyses, clinicians can achieve more accurate diagnoses, tailor treatments to individual patients, and ultimately improve the quality of care for those suffering from allergies. In conclusion, histopathological and cytological correlation in allergy diagnosis provides a comprehensive framework for understanding and managing allergic conditions.