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。
{"title":"[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?]","authors":"Naoki Okada, Hiroki Kabata, Yoshihito Tanaka, Tetsuya Homma, Sunao Mikura","doi":"10.15036/arerugi.73.206","DOIUrl":"10.15036/arerugi.73.206","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":35521,"journal":{"name":"Japanese Journal of Allergology","volume":"73 2","pages":"206-212"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140207752","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}
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.
{"title":"[BRONCHOPULMONARY ASPERGILLOSIS WITH COMORBID GRANULOMATOUS POLYANGIITIS IN A PATIENT WHO PRESENTED WITH EXOPHTHALMOS: A CASE REPORT].","authors":"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","doi":"10.15036/arerugi.73.1000","DOIUrl":"10.15036/arerugi.73.1000","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":35521,"journal":{"name":"Japanese Journal of Allergology","volume":"73 8","pages":"1000-1005"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297190","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}
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。
{"title":"[A CASE OF A GIRL WITH ANAPHYLAXIS INDUCED BY INHALATION OF SOYBEAN DUST].","authors":"Emiko Hitomi, Youichi Nishimura, Tomohiro Hitomi, Tatsunori Itabashi, Osamu Kawano, Kimiaki Uetake","doi":"10.15036/arerugi.73.353","DOIUrl":"10.15036/arerugi.73.353","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":35521,"journal":{"name":"Japanese Journal of Allergology","volume":"73 4","pages":"353-356"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141331947","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}
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.
{"title":"[A CASE OF IgG4-RELATED DISEASE WITH CONFIRMED RESPONSE TO DUPILUMAB BY SMALL SALIVARY GLAND BIOPSY].","authors":"Kiyokazu Yoshinoya, Satoshi Watanabe, Saki Nakazima, Hidehiro Honda, Yoshinori Harada, Keita Kudo, Miyuki Okuda, Shiro Ohshima","doi":"10.15036/arerugi.73.1158","DOIUrl":"https://doi.org/10.15036/arerugi.73.1158","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":35521,"journal":{"name":"Japanese Journal of Allergology","volume":"73 9","pages":"1158-1162"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648690","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}
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.
{"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}
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.
{"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}