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[IS INHALED CORTICOSTEROID STEP-DOWN RECOMMENDED FOR ADULT ASTHMA PATIENTS HAVE BEEN WELL CONTROLLED OVER THE LONG TERM WITH MODERATE OR HIGH-DOSE INHALED CORTICOSTEROIDS?] [成年哮喘患者长期使用中等或大剂量吸入皮质类固醇后病情得到良好控制,是否建议减量使用吸入皮质类固醇?]
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.15036/arerugi.73.206
Naoki Okada, Hiroki Kabata, Yoshihito Tanaka, Tetsuya Homma, Sunao Mikura

We conducted a systematic review to examine whether step-down of inhaled corticosteroid (ICS) is recommended for adult patients with asthma have been well controlled with moderate or high-dose inhaled corticosteroids for more than 12 weeks. Seven randomized controlled trials were included. ICS step-down did not increase asthma exacerbations requiring systemic steroid therapy and hospitalization. There was no effect on respiratory function, asthma control, or QOL. No significant differences were observed in serious adverse events or steroid-related adverse events, but the observation period was insufficient to assess long-term effects. Based on these results, we weakly recommend ICS step-down in adult patients with asthma have been well controlled with moderate or high-dose inhaled corticosteroids, but long-term asthma control and the incidence of steroid-related adverse events should be further investigated in the future.

我们进行了一项系统性综述,以研究是否建议成年哮喘患者在使用中度或大剂量吸入皮质类固醇超过 12 周后再减量使用吸入皮质类固醇(ICS)。研究纳入了七项随机对照试验。减量 ICS 不会增加需要全身类固醇治疗和住院治疗的哮喘加重。对呼吸功能、哮喘控制或 QOL 均无影响。在严重不良事件或类固醇相关不良事件方面未观察到明显差异,但观察期不足以评估长期影响。根据上述结果,我们不强烈建议哮喘已得到中度或大剂量吸入皮质类固醇良好控制的成年患者减量使用 ICS,但今后应进一步研究长期哮喘控制情况和类固醇相关不良事件的发生率。
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引用次数: 0
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.15036/arerugi.73.1219
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引用次数: 0
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.15036/arerugi.73.1220
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引用次数: 0
[BRONCHOPULMONARY ASPERGILLOSIS WITH COMORBID GRANULOMATOUS POLYANGIITIS IN A PATIENT WHO PRESENTED WITH EXOPHTHALMOS: A CASE REPORT]. [支气管肺曲霉病合并肉芽肿性多血管炎:病例报告]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.15036/arerugi.73.1000
Akari Kodama, Tomoko Tajiri, Toru Yamabe, Yuki Furukawa, Yutaka Ito, Keima Ito, Yuta Mori, Kensuke Fukumitsu, Satoshi Fukuda, Yoshihiro Kanemitsu, Takehiro Uemura, Masaya Takemura, Tetsuya Oguri, Taio Naniwa, Akio Niimi

There have been no reports of the coexistence of allergic bronchopulmonary aspergillosis (ABPA) and granulomatosis with polyangiitis (GPA). The first case of ABPA with comorbid GPA that developed exophthalmos is reported. A 69-year-old man was referred to our hospital for exophthalmos, fever, anorexia and weight loss. The patient had been diagnosed with ABPA six years earlier, which had been repeatedly treated but recurred with oral corticosteroids with or without antifungal therapy. The laboratory data on referral showed elevations of the white blood cell count, C-reactive protein and specific immunoglobulin E against Aspergillus fumigatus, but antineutrophil cytoplasmic antibody was not positive. Urinalysis showed proteinuria. Paranasal sinus and chest computed tomography showed sinusitis with osteochondral destruction, bronchiectasis, mucus plugging, and a pulmonary nodule. Orbital magnetic resonance imaging showed swelling of the medial rectus muscle and peripheral mass. The intraorbital tissue biopsy showed a necrotic granuloma and necrotizing vasculitis. The patient was diagnosed with GPA, on the basis of the Ministry of Health, Labour and Welfare's criteria of Japan. The patient was treated with induction therapy consisting of glucocorticoids and rituximab, and his symptoms improved. Though the pathogenesis common to ABPA and GPA remains unknown, neutrophilic inflammation induced by airway Aspergillus persistent infection might be involved. Study of further cases is needed.

过敏性支气管肺曲霉病(ABPA)和多血管炎肉芽肿病(GPA)并存的病例尚未见报道。本报告是首例 ABPA 合并 GPA 并出现眼球外翻的病例。一名 69 岁的男性因眼球外翻、发热、厌食和体重减轻被转诊至我院。该患者六年前被诊断为 ABPA,曾多次接受治疗,但在口服皮质类固醇激素和抗真菌治疗(或不抗真菌治疗)后病情复发。转诊时的实验室数据显示白细胞计数、C反应蛋白和针对曲霉菌的特异性免疫球蛋白E升高,但抗中性粒细胞胞浆抗体未呈阳性。尿检显示有蛋白尿。鼻旁窦和胸部计算机断层扫描显示鼻窦炎伴骨软骨破坏、支气管扩张、粘液堵塞和肺部结节。眼眶磁共振成像显示内侧直肌肿胀和周围肿块。眶内组织活检显示有坏死性肉芽肿和坏死性血管炎。根据日本厚生劳动省的标准,患者被诊断为 GPA。患者接受了由糖皮质激素和利妥昔单抗组成的诱导治疗,症状有所改善。虽然 ABPA 和 GPA 的共同发病机制尚不清楚,但气道曲霉菌持续感染诱发的中性粒细胞炎症可能与之有关。还需要对更多病例进行研究。
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引用次数: 0
[A CASE OF A GIRL WITH ANAPHYLAXIS INDUCED BY INHALATION OF SOYBEAN DUST]. [吸入大豆粉尘引发过敏性休克的女孩病例]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.15036/arerugi.73.353
Emiko Hitomi, Youichi Nishimura, Tomohiro Hitomi, Tatsunori Itabashi, Osamu Kawano, Kimiaki Uetake

The patient was a 3-year-old girl whose father was employed sorting and washing soybeans. She exhibited transient respiratory distress and loss of activity on the same day or the next day after her father came home wearing work clothes with soybean dust on them. One day, she developed anaphylaxis after being lifted into her father's arms while he was wearing his work clothes. Although a blood test was positive for soybean and Gly m 4-specific IgE antibodies, the girl was able to consume soy products (not including soy milk, which she had never consumed) without any issues. The father was instructed to change clothes before leaving work and bathe immediately upon returning home, and the girl has not had any further episodes of respiratory distress, loss of activity, or anaphylaxis. Though reports of anaphylaxis from soybean antigen inhalation are extremely rare, it is very likely that inhalation of soybean dust from the father's work clothes induced anaphylaxis in this case.

患者是一名 3 岁的女孩,其父亲受雇分拣和清洗大豆。父亲穿着沾有大豆粉尘的工作服回家后,她在当天或第二天就表现出短暂的呼吸困难和活动能力下降。有一天,当她父亲穿着工作服回家时,她被父亲抱在怀里,随后出现过敏性休克。虽然验血结果显示大豆和 Gly m 4 特异性 IgE 抗体呈阳性,但女孩仍能顺利食用豆制品(不包括豆奶,因为她从未喝过豆奶)。女孩的父亲被要求在下班前换衣服,回家后立即洗澡,此后女孩再也没有出现过呼吸困难、活动能力下降或过敏性休克等症状。虽然吸入大豆抗原引起过敏性休克的报告极为罕见,但在本病例中,父亲工作服上的大豆粉尘很可能诱发了过敏性休克。
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引用次数: 0
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.15036/arerugi.73.783
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引用次数: 0
[A CASE OF IgG4-RELATED DISEASE WITH CONFIRMED RESPONSE TO DUPILUMAB BY SMALL SALIVARY GLAND BIOPSY]. [一例 IgG4 相关疾病,通过小唾液腺组织切片检查确定对杜比鲁胺有反应]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.15036/arerugi.73.1158
Kiyokazu Yoshinoya, Satoshi Watanabe, Saki Nakazima, Hidehiro Honda, Yoshinori Harada, Keita Kudo, Miyuki Okuda, Shiro Ohshima

A 71-year-old man was referred to our department due to a cough that occurred one year after surgery for papillary duodenal cancer. We clinically diagnosed the patient with bronchial asthma, with an increase in peripheral blood eosinophil count, exhaled NO, and IgE and obstructive ventilation disorders based on pulmonary function tests. Fluticasone-vilanterol was introduced, but there was little improvement in the cough. We suspected bronchial asthma complicated by IgG4-related disease due to the high serum IgG4 levels and diagnosed the patient with IgG4-related disease through a pancreatic tissue stain of a previously resected duodenal papillectomy section. When dupilumab was initiated for bronchial asthma complicated by IgG4-related disease, the cough resolved. In addition, serum IgG4 levels decreased after the initiation of dupilumab treatment, and a decrease in IgG4-positive plasma cells was observed on small salivary gland biopsy. Thus, the treatment of inhaled steroid-resistant bronchial asthma with dupilumab can also improve IgG4-related disease, and we confirmed a decrease in IgG4-positive plasma cells in the small salivary glands.

一名 71 岁的男性因十二指肠乳头状癌术后一年出现咳嗽而被转诊至我科。我们临床诊断该患者患有支气管哮喘,外周血嗜酸性粒细胞计数、呼出NO和IgE增加,肺功能检查显示其患有阻塞性通气障碍。患者服用了氟替卡松-维兰特罗,但咳嗽症状改善甚微。由于血清 IgG4 水平较高,我们怀疑支气管哮喘并发 IgG4 相关疾病,并通过之前切除的十二指肠乳头切片的胰腺组织染色诊断患者患有 IgG4 相关疾病。在开始使用杜匹单抗治疗因 IgG4 相关疾病并发的支气管哮喘时,咳嗽症状有所缓解。此外,开始使用杜必鲁单抗治疗后,血清 IgG4 水平下降,小唾液腺活检也观察到 IgG4 阳性浆细胞减少。因此,用杜必鲁单抗治疗吸入类固醇耐药支气管哮喘也能改善IgG4相关疾病,而且我们证实小唾液腺中IgG4阳性浆细胞减少。
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引用次数: 0
[EVALUATION OF THE BASIC PERFORMANCE IN THE SPECIFIC IGE ANTIBODY TEST KITS, VIEW ALLERGY 39 AND SILIS ALLERGY 45+1]. [特异性 ig 抗体检测试剂盒、view 过敏 39 和 silis 过敏 45+1 的基本性能评估]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.15036/arerugi.73.1150
Kiwako Yamamoto-Hanada, Kenji Toyokuni, Miori Sato, Sayaka Hamaguchi, Fumi Ishikawa, Mayako Saito-Abe, Yasuaki Matsumoto, Hisako Ogasawara, Daichi Suzuki, Kotaro Umezawa, Hideaki Morita, Tatsuki Fukuie, Misao Oda, Shintaro Suzuki, Ken Fukuda, Takeshi Nakahara, Shigeharu Fujieda, Yukihiro Ohya

Background and objective: The aim of this study was to evaluate the basic performance and accuracy as a screening test by comparing SiLIS Allergy 45+1 with View Allergy 39.

Methods: Measurements were performed with reagents and measuring instruments for View Allergy 39 and SiLIS Allergy 45+1 using blood samples of individuals with a previous history of IgE sensitizations. We compared the results between SiLIS Allergy 45+1 with View Allergy 39.

Results: The agreement rates for positive, negative, judgment, and class of inhalant allergens were 88.7%, 95.1%, 90.8%, and 93.8%, respectively. The correlation rates for food allergens were 90.9%, 69.9%, 78.2%, and 89.2%, respectively. In triplicate measurements, the class agreement rate for SiLIS Allergy 45+1 was 94.2%. In correlation tests with previously approved drugs (FEIA method), the positive agreement rate for specific IgE was 94.9%, negative agreement rate was 95.0%, judgment agreement rate was 95.0%, and the class agreement rate for nonspecific IgE correlation tests was 100.0%, showing good results.

Conclusion: Multi-item screening tests with SiLIS Allergy 45+1 showed high correlation with existing products such as View Allergy 39, suggesting high accuracy as a measurement method.

背景和目的:本研究旨在通过比较 SiLIS Allergy 45+1 和 View Allergy 39,评估其作为筛查试验的基本性能和准确性:方法:使用 View Allergy 39 和 SiLIS Allergy 45+1 的试剂和测量仪器,对曾有 IgE 过敏史的人的血样进行测量。我们比较了 SiLIS Allergy 45+1 和 View Allergy 39 的结果:结果:吸入剂过敏原的阳性、阴性、判断和类别的一致率分别为 88.7%、95.1%、90.8% 和 93.8%。食物过敏原的相关率分别为 90.9%、69.9%、78.2% 和 89.2%。在一式三份的测量中,SiLIS Allergy 45+1 的等级一致率为 94.2%。在与以前批准的药物(FEIA 方法)的相关测试中,特异性 IgE 的阳性一致率为 94.9%,阴性一致率为 95.0%,判断一致率为 95.0%,非特异性 IgE 相关测试的等级一致率为 100.0%,显示出良好的结果:SiLIS过敏45+1的多项目筛查测试与现有产品(如View Allergy 39)具有很高的相关性,表明其作为一种测量方法具有很高的准确性。
{"title":"[EVALUATION OF THE BASIC PERFORMANCE IN THE SPECIFIC IGE ANTIBODY TEST KITS, VIEW ALLERGY 39 AND SILIS ALLERGY 45+1].","authors":"Kiwako Yamamoto-Hanada, Kenji Toyokuni, Miori Sato, Sayaka Hamaguchi, Fumi Ishikawa, Mayako Saito-Abe, Yasuaki Matsumoto, Hisako Ogasawara, Daichi Suzuki, Kotaro Umezawa, Hideaki Morita, Tatsuki Fukuie, Misao Oda, Shintaro Suzuki, Ken Fukuda, Takeshi Nakahara, Shigeharu Fujieda, Yukihiro Ohya","doi":"10.15036/arerugi.73.1150","DOIUrl":"https://doi.org/10.15036/arerugi.73.1150","url":null,"abstract":"<p><strong>Background and objective: </strong>The aim of this study was to evaluate the basic performance and accuracy as a screening test by comparing SiLIS Allergy 45+1 with View Allergy 39.</p><p><strong>Methods: </strong>Measurements were performed with reagents and measuring instruments for View Allergy 39 and SiLIS Allergy 45+1 using blood samples of individuals with a previous history of IgE sensitizations. We compared the results between SiLIS Allergy 45+1 with View Allergy 39.</p><p><strong>Results: </strong>The agreement rates for positive, negative, judgment, and class of inhalant allergens were 88.7%, 95.1%, 90.8%, and 93.8%, respectively. The correlation rates for food allergens were 90.9%, 69.9%, 78.2%, and 89.2%, respectively. In triplicate measurements, the class agreement rate for SiLIS Allergy 45+1 was 94.2%. In correlation tests with previously approved drugs (FEIA method), the positive agreement rate for specific IgE was 94.9%, negative agreement rate was 95.0%, judgment agreement rate was 95.0%, and the class agreement rate for nonspecific IgE correlation tests was 100.0%, showing good results.</p><p><strong>Conclusion: </strong>Multi-item screening tests with SiLIS Allergy 45+1 showed high correlation with existing products such as View Allergy 39, suggesting high accuracy as a measurement method.</p>","PeriodicalId":35521,"journal":{"name":"Japanese Journal of Allergology","volume":"73 9","pages":"1150-1157"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[ADVANCES IN DIAGNOSIS AND TREATMENT IN EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS (EGPA)]. [嗜酸性粒细胞肉芽肿伴多血管炎(egpa)的诊断和治疗进展]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.15036/arerugi.73.26
Masami Taniguchi, Yosuke Kamide, Yuto Nakamura, Kentaro Watai, Yuma Fukutomi, Kiyoshi Sekiya
{"title":"[ADVANCES IN DIAGNOSIS AND TREATMENT IN EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS (EGPA)].","authors":"Masami Taniguchi, Yosuke Kamide, Yuto Nakamura, Kentaro Watai, Yuma Fukutomi, Kiyoshi Sekiya","doi":"10.15036/arerugi.73.26","DOIUrl":"https://doi.org/10.15036/arerugi.73.26","url":null,"abstract":"","PeriodicalId":35521,"journal":{"name":"Japanese Journal of Allergology","volume":"73 1","pages":"26-33"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139973823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[EPIPEN INSTRUCTIONS FOR ANAPHYLAXIS PATIENTS DURING DISPENSING: FACTORS RELATED TO THE QUALITY OF PHARMACISTS' INSTRUCTIONS]. [过敏性休克患者在配药过程中使用表必净的说明:药剂师指导质量的相关因素]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.15036/arerugi.73.279
Tomoyuki Kimura, Shintaro Suzuki, Ryota Kumaki, Keiko Kishimoto, Tomoki Uno, Keisuke Kaneko, Makoto Nojo, Miri Shimamura, Eriko Iwazumi, Nao Sato, Akihiko Tanaka, Hironori Sagara

Background and aim: We previously reported that pharmacists working in pharmacies don't have enough knowledge and enough experience teaching anaphylaxis (An) and EpiPen use. We administered a questionnaire survey to pharmacists with experience handling EpiPen prescriptions. We investigated the relationship between the questionnaire results and the factors in the pharmacists' background regarding the explanation and guidance to patients.

Results: The percentage of pharmacists working in pharmacies who provided guidance using visual information and demonstrations was insufficient. Moreover, this figure decreased after the second guidance session. Objective confirmation of patient understanding was also insufficient. The results indicated that self-examination and participation in drug information sessions were important background factors for pharmacists who provided detailed guidance to patients.

Discussion: For appropriate long-term management of their condition, An patients must master the EpiPen technique. Pharmacists' guidance plays a critical role in this regard. A support system should be established for proper instruction of pharmacy patients by improving pharmacists' self-education and other educational opportunities.

背景和目的:我们以前曾报道过,在药房工作的药剂师没有足够的知识和经验教授过敏性休克(An)和 EpiPen 的使用。我们对有处理 EpiPen 处方经验的药剂师进行了问卷调查。我们调查了问卷结果与药剂师向患者解释和指导的背景因素之间的关系:结果:在药房工作的药剂师中,通过视觉信息和示范提供指导的比例不足。此外,这一比例在第二次指导后有所下降。对患者理解程度的客观确认也不足。结果表明,药剂师为患者提供详细指导时,自我检查和参加药物信息讲座是重要的背景因素:为了对病情进行适当的长期管理,安患者必须掌握 EpiPen 的使用技巧。药剂师的指导在这方面起着至关重要的作用。应通过改善药剂师的自我教育和其他教育机会,为正确指导药剂科患者建立一个支持系统。
{"title":"[EPIPEN INSTRUCTIONS FOR ANAPHYLAXIS PATIENTS DURING DISPENSING: FACTORS RELATED TO THE QUALITY OF PHARMACISTS' INSTRUCTIONS].","authors":"Tomoyuki Kimura, Shintaro Suzuki, Ryota Kumaki, Keiko Kishimoto, Tomoki Uno, Keisuke Kaneko, Makoto Nojo, Miri Shimamura, Eriko Iwazumi, Nao Sato, Akihiko Tanaka, Hironori Sagara","doi":"10.15036/arerugi.73.279","DOIUrl":"https://doi.org/10.15036/arerugi.73.279","url":null,"abstract":"<p><strong>Background and aim: </strong>We previously reported that pharmacists working in pharmacies don't have enough knowledge and enough experience teaching anaphylaxis (An) and EpiPen use. We administered a questionnaire survey to pharmacists with experience handling EpiPen prescriptions. We investigated the relationship between the questionnaire results and the factors in the pharmacists' background regarding the explanation and guidance to patients.</p><p><strong>Results: </strong>The percentage of pharmacists working in pharmacies who provided guidance using visual information and demonstrations was insufficient. Moreover, this figure decreased after the second guidance session. Objective confirmation of patient understanding was also insufficient. The results indicated that self-examination and participation in drug information sessions were important background factors for pharmacists who provided detailed guidance to patients.</p><p><strong>Discussion: </strong>For appropriate long-term management of their condition, An patients must master the EpiPen technique. Pharmacists' guidance plays a critical role in this regard. A support system should be established for proper instruction of pharmacy patients by improving pharmacists' self-education and other educational opportunities.</p>","PeriodicalId":35521,"journal":{"name":"Japanese Journal of Allergology","volume":"73 3","pages":"279-289"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Japanese Journal of Allergology
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