Journal of Asthma and Allergy最新文献

Background: Biologic therapy in asthma can be life-changing and affect health-related quality of life, but symptoms are rarely used in the assessment of response.

Aim: To examine the change in health-related quality of life and asthma control between starting a biologic and assessment of biologic response, assessing whether this change can provide early prediction of eventual clinical response at 12 months.

Methods: A service evaluation of severe asthmatics initiating a biologic at the Royal Devon NHS trust between 2019 and 22. Health-Related Quality of Life (Severe Asthma Questionnaire) and asthma control (Asthma Control Questionnaire-6) was captured at baseline, 8 weeks, 16 weeks and 12 months. Patients were classified as responder or non-responder using NICE Criteria for biologic response. Independent samples t-tests were used to determine statistical difference in change from baseline patient reported outcome measure scores between responder and non-responders.

Results: One hundred and eight initiations (103 patients) of biologic therapy were included. At 8 weeks and 16 weeks, responders had greater improvement in Severe Asthma Questionnaire & Severe Asthma Questionnaire Global compared to non-responders (p<0.05). Improvement in Asthma Control Questionnaire only achieved significance between all-responders and non-responders at 16 weeks (p<0.05).

Conclusion: This study provides evidence of the early and sustained improvement in health-related quality of life and symptoms after starting biologic therapy. The findings support the use of the Severe Asthma Questionnaire and the Asthma Control Questionnaire as per the Core Outcome Measures Sets for Severe Asthma (COMSA). We have shown that health-related quality of life and asthma control can assist earlier assessment of response and non-response to biologics.

Introduction: Cow's Milk Allergy (CMA) is the most common food allergy among children. The global prevalence of CMA ranges from 1.8% to 7.5% among children. Data regarding CMA is scarce and only a few studies have been conducted in Saudi Arabia. Therefore, this study was undertaken to determine the factors associated with CMA among children in Abha city and to explore the knowledge and practice regarding CMA among parents in Abha city.

Methods: This retrospective one-year case control study was conducted amongst children with CMA (cases) and healthy children without CMA (controls) and their parents attending Abha Maternity and Children Hospital, Saudi Arabia. Data regarding CMA was extracted from the hospital medical records. A validated questionnaire was used to collect detailed information from the identified cases and controls after obtaining informed consent. SPSS software was used for data analysis.

Results: The study groups consisted of 31 cases and 37 controls. Children between 0 and 36 months of age were included. The male-to-female ratio was 1:1. The parent's knowledge level was good regarding the association between early introduction of cow's milk and increased risk of CMA (Mean Score: 3.96). Having a sibling with a CMA is actually a risk factor for developing CMA (P-value = 0.03).

Conclusion: To reduce the risk of CMA, the study recommends dietary strategies that exclude CMA allergens and the use of suitable alternative milk formulas. It highlights the protective role of breastfeeding and advises against the early introduction of cow's milk formulas during infancy. Furthermore, the study advocates for hospital nurseries and new parents to refrain from administering artificial milk formulas to newborns.

Objective: Numerous studies have highlighted a link between COVID-19 and respiratory allergic conditions such as asthma and allergic rhinitis (AR). Despite the growing volume of research, there remains a notable gap in the form of a comprehensive bibliometric analysis that consolidates the findings on this association. This study aims to fill that gap by systematically exploring how asthma and AR interact with COVID-19.

Methods: By using the Web of Science Core Collection, we selected publications from January 2020 to October 2024 that related to COVID-19 and asthma/AR. Analysis tools such as VOSviewer and CiteSpace were employed to perform network mappings and citation analyses, focusing on co-authorship networks, keyword co-occurrences, and citation impacts to understand the research dynamics and collaborative patterns within this field.

Results: A collection of 553 publications was obtained, revealing an upward trend in research volume over the study period. The United States, China, and the United Kingdom were predominant in the research output, demonstrating extensive international collaborations. The study highlighted key areas of impact, such as the influence of asthma types on COVID-19 severity and the protective effects of specific treatments like inhaled corticosteroids and biologics. Emerging trends identified included the significance of socioeconomic factors and obesity in disease outcomes, as well as evolving strategies in vaccination and interventions.

Conclusion: This bibliometric analysis highlights the significant role of global research in exploring the interactions between COVID-19 and asthma/AR. It points out the reported safety and effectiveness of COVID-19 vaccines for these conditions and acknowledges the challenges in vaccine uptake among minority and socioeconomically disadvantaged groups. The study also identifies unique risks for children and obese patients during the pandemic and underscores the need for increased international collaboration and more comprehensive clinical trials, to evaluate the efficacy of treatments like inhaled corticosteroids and biologics.

Purpose and methods: Biological therapies have revolutionized the approach to treating asthma. This retrospective study evaluates the biologics impact on asthma outcomes, clinical remission, adherence prevalence, and the influence of adherence on outcomes. Baseline characteristics and post-therapy changes were analysed, and adherence was measured using percentage of days covered with therapy (PDC%).

Results: A total of 67 patients initiated on biologics were included. Clinical improvements and statistically significant outcomes were observed across all biologics, including reduced asthma attacks, a lower dose of daily steroids, and improved symptom control and FEV1. Clinical remission was achieved in 24% of those who started on biologics. Patients demonstrated high adherence to biologics in the first year (average PDC% of 86%), though a modest decline to 84.5% was noted in the following year. Logistic regression revealed that adherence trends were not significantly associated with worsening asthma outcomes in the study cohort.

Conclusion: These findings underscore the importance of sustained patient support and education in maintaining high adherence to biological therapies, which can lead to improved asthma outcomes and, in some cases, clinical remission. The study highlights the potential of personalized treatment strategies and adherence-focused programs to optimize asthma management, particularly in severe asthma patients. Future research should explore long-term adherence patterns and the impact of patient-specific factors on treatment success.

Aim: The impact of sensitization on asthma outcomes in adults is still being discussed. This study aims to describe the sensitization profiles and allergic comorbidities of patients with severe asthma, and to analyze their association with asthma severity.

Patients and methods: This retrospective study included adult patients, evaluated at the Severe Asthma Clinic of Bichat University Hospital (Paris, France) during a 1-day hospital stay between May 2022 and January 2024. Sensitization, defined by a positive skin prick test and/or allergen-specific IgE levels greater than 0.10 kUA/L, was analysed alongside allergic comorbidities. The ASSESS score was used to grade asthma severity.

Results: Of the 201 patients included, 142 (70.6%) exhibited at least one sensitization to an aeroallergen, of whom 38 (26.8%) were monosensitized, and 104 (73.2%) were polysensitized. Compared to polysensitized patients, monosensitized patients were older at diagnosis (years: 30.6 ± 20.1 vs 21.7 ± 17.6, p = 0.01), had a higher ASSESS score (median (Q1; Q3); 13 (11; 15) vs 11 (9; 14), p = 0.02), a lower pre-bronchodilator forced expiratory volume in 1 second (%pred: 70.3 ± 23.2 vs 79.3 ± 21.8, p = 0.03), and experienced a greater burden of exacerbations (p = 0.03). There were significantly more polysensitized patients with at least three allergic comorbidities, but the number of allergic comorbidities did not correlate with asthma severity.

Conclusion: Monosensitized patients exhibited more severe disease and greater airway obstruction compared to polysensitized individuals. These findings suggest that allergies, especially in cases of late-onset asthma, may not be a significant determinant of asthma severity in adults.

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by intense pruritus. The principal pathological features include abnormalities in the structure and function of the epidermis, as well as skin inflammation marked by the overexpression of T helper 2 cell (Th2) cytokines. Throughout the progression of AD, various immune cells contribute to its pathogenesis. Basophils, the least abundant granulocytes in the human peripheral circulation, have historically been overlooked. However, the advent of novel research tools has facilitated a renewed focus on the role of basophils in diverse physiological and pathological conditions, including AD. Accordingly, this review will primarily summarize the association between AD and basophils, the alterations observed in basophils among AD patients, and the implications of these changes for AD patients.

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe systemic disorder characterized by fever, rash, and multi-organ involvement, often complicated by drug-induced liver injury. Hemophagocytic lymphohistiocytosis (HLH) and vanishing bile duct syndrome (VBDS) are rare but life-threatening complications that can be triggered by antiepileptic drugs such as carbamazepine. Given the high mortality associated with these conditions, early recognition and timely intervention are crucial for improving patient outcomes.

Case: We report a unique case of an elderly woman who developed DRESS syndrome after using carbamazepine, complicated by both HLH and VBDS. The patient exhibited typical DRESS symptoms, including fever, rash, and eosinophilia, alongside signs of HLH such as hemocytopenia and elevated ferritin levels; along with persistent significant hyperbilirubinemia and coagulation abnormalities.

Results: After six months, liver function showed substantial improvement, with no signs of HLH recurrence. Additionally, our review of HLH cases induced by antiepileptic drugs highlights that the absence of eosinophilia, hemocytopenia, and elevated ferritin levels is key for early HLH identification.

Conclusion: Our findings highlight key diagnostic indicators for early HLH recognition in antiepileptic drug-induced DRESS, especially the absence of eosinophilia. This case represents the first successful management of DRESS syndrome complicated by HLH and VBDS without liver transplantation in the past decade, emphasizing the critical role of early identification and prompt, targeted treatment strategies in optimizing patient outcomes.

Background:  Allergen immunotherapy (AIT) is a well-established treatment for allergic diseases, particularly in patients with allergic rhinitis and asthma. In regions where patients are polysensitized, AIT can have broader immunomodulatory effects. This study investigates the impact of house dust mite AIT on IgE responses to both dust mites and non-target allergens, specifically Artemisia pollen, in polysensitized allergic rhinitis patients.

Methods:  This retrospective study included polysensitized patients aged 18 or older with a diagnosis of allergic rhinitis or rhinitis with asthma and positive IgE for both house dust mites and Artemisia pollen. Patients who completed at least three years of AIT for house dust mites were included. IgE levels for Dermatophagoides pteronyssinus (Der p), Dermatophagoides farinae (Der f), and Artemisia pollen were measured at baseline and after 1, 2, and 3 years of treatment. Clinical outcomes were also recorded, including Total Nasal Symptom Score (TNSS), Visual Analog Scale (VAS), and medication use.

Results:  Over three years, SIgE levels for Der p significantly decreased (p = 0.0001), while Der f showed a slight and significant decrease (p = 0.0334). Artemisia pollen-specific IgE decreased modestly (p = 0.0478), despite not being the target allergen. Total IgE levels increased slightly without statistical significance (p = 0.9026). Clinical outcomes improved significantly, with reductions in TNSS, VAS, and medication scores (all p < 0.0001), alongside a decrease in eosinophil counts, reflecting clinical and immunological benefits.

Conclusion:  House dust mite AIT not only reduces dust mite-specific IgE levels but also leads to unexpected reductions in IgE levels for non-target allergens, such as Artemisia pollen. This suggests that AIT has broader immunological benefits, improving overall tolerance to multiple allergens in polysensitized patients.

Purpose: To examine the relationship between Hemoglobin A1c (HbA1c) and asthma outcomes in an urban cohort of children with asthma.

Methods: The AIRWEIGHS Study was a randomized controlled clinical trial of an air cleaner intervention testing the hypothesis that overweight/obese children would experience greater improvement in asthma control compared to normal weight children. The study enrolled 164 children with asthma from Baltimore, MD and assessed HbA1c levels and asthma outcomes during clinic visits at baseline and three months. HbA1c levels were analyzed as a continuous measure and categorized as either normal (<5.7%) or consistent with pre-diabetes (≥5.7%). Asthma outcomes included standardized questionnaires, spirometry, and fractional exhaled nitric oxide (FeNO). Generalized Estimating Equation (GEE) regression models were used to analyze the association between the HbA1c and asthma outcomes.

Results: Participants included 164 children with an average age of 11 (± 2) years, predominately African American (85%), male (59%), moderate or severe asthma by NAEPP criteria (59%), households with an income below $34,999 (60%), publicly insured (83%), and overweight/obese (61%). 52 participants were excluded from the analysis due to unsuccessful blood draws or participant refusal. Twenty of 112 distinct participants (18%) had HbA1c measurements ≥5.7%, consistent with prediabetes. Increased HbA1c levels were associated with worse asthma control as indicated by an increase in the Asthma Therapy Assessment Questionnaire (β-0.74 p<0.05). In the interaction analysis, BMI percentile had a significant interaction with HbA1c such that HbA1c had a stronger association with maximum symptoms days and exacerbation risk among children with lower versus higher BMI percentile values.

Conclusion: Higher HbA1c levels were associated with worse asthma control among children with asthma, adding to evidence that metabolic dysfunction may influence asthma morbidity. Additionally, HbA1c could have a stronger influence among non-obese children with underlying metabolic dysfunction, suggesting the need for future studies to investigate metabolic pathways in asthma.

Purpose: To investigate the effectiveness of impulse oscillometry (IOS) and its combination with fractional expiratory nitric oxide (FeNO) in distinguishing inadequately controlled asthma (ICA) from well-controlled asthma (WCA) in adults.

Patients and methods: Adult patients aged 18 and above with asthma were recruited and underwent routine blood tests, FeNO, IOS, and spirometry before and after bronchodilator administration on the same day. Asthma control level was assessed using Asthma Control Test (ACT) scores; WCA was defined as a score above 20, while ICA was defined as a score of 20 or below. Receiver operating characteristic curve (ROC) and logistic regression analyses were employed to determine the relationship between IOS and FeNO measurements and asthma control.

Results: The z score values of IOS parameters, specifically resistance at 5 hz (R5), resistance at 20 hz (R20), and the area under reactance curve between 5 hz and resonant frequency (AX) after bronchodilator administration were significantly different between the WCA (n = 75) and ICA (n = 77) groups. IOS parameters, R5, R20, and AX, after bronchodilation identified patients with ICA, with areas under receiver operating characteristic curve (AUC) of 0.654, 0.690, and 0.708, respectively, adjusted for smoke exposure, variable airflow limitation and fixed airflow obstruction. Combining IOS parameters with FeNO significantly increased the AUC (0.728, 0.752, and 0.763) for detecting ICA compared to IOS parameters with R5, R20, and AX, alone. Patients with abnormal IOS and FeNO values had significantly higher odds ratio (OR) of having ICA by logistic regression analyses, especially for abnormally higher AX, with an OR of 6.48.

Conclusion: IOS is useful in discriminating ICA from WCA in adults, with its effectiveness further enhanced when combined with FeNO measurements.