Allergology International最新文献

Background: Biologic therapies are pivotal in managing severe asthma. Despite their efficacy, some patients discontinue biologics, with varying outcomes. Predictors of successful versus unsuccessful discontinuation remain poorly defined. This study aimed to identify clinical factors associated with post-discontinuation outcomes in a real-world practice.

Methods: This retrospective cohort included adults with severe asthma who had received biologics for at least 12 months and subsequently discontinued therapy for a minimum of three consecutive months. We assessed the effects of baseline blood eosinophilia (≥300 cells/μL), residual sputum symptoms during biologic therapy, treatment responsiveness, biologic class, and discontinuation reasons on post-discontinuation asthma exacerbation rates using multivariable Cox models.

Results: A total of 118 patients were analyzed. The Kaplan-Meier analysis estimated a 65 % exacerbation-free probability at 12 months after discontinuation. Factors associated with successful discontinuation included a robust clinical response and absence of exacerbations before cessation. Conversely, baseline eosinophilia, residual sputum symptoms during biologics, and discontinuation due to inadequate therapeutic response or financial burden were associated with post-discontinuation exacerbations. In class-stratified restricted models, persistent sputum remained significantly associated with post-discontinuation exacerbations after stopping anti-IL-5 therapies, while baseline eosinophilia was associated with post-discontinuation exacerbations after stopping anti-IgE or anti-IL-4Rα. Among patients with sputum symptoms or poor-response discontinuation, the overall frequency of exacerbations declined after discontinuation.

Conclusions: Baseline eosinophilia, persistent sputum during therapy, and discontinuation prompted by poor response or cost may serve as risk factors for post-discontinuation exacerbations; however, risk is phenotype- and class-dependent. Careful patient selection and monitoring are essential when considering the discontinuation of biologic treatment.

Background: Chronic rhinosinusitis (CRS) often coexists with lower respiratory tract diseases, and such cases tend to be more refractory. However, few studies have specifically investigated chest computed tomography (CT) findings in patients with CRS. This study analyzed chest CT findings in patients with CRS and investigated their associations with CRS phenotypes and clinical characteristics.

Methods: We retrospectively analyzed 278 patients with CRS who underwent preoperative chest CT prior to endoscopic sinus surgery. Patients were stratified based on the presence or absence of abnormal chest CT findings. Clinical parameters related to upper and lower airway inflammation, including CRS phenotypes, were compared between the groups. The prognosis for ECRS was evaluated using the systemic steroid dose as a longitudinal outcome variable in a linear mixed-effects model.

Results: Among the 278 patients, 174 were diagnosed with eosinophilic CRS (ECRS) and 104 with non-eosinophilic CRS (NECRS). Ground-glass attenuation (GGA) and bronchial wall thickening (BWT) were observed in 35 and 27 patients (12.6 %, 9.7 %), respectively. The frequencies of GGA and BWT were significantly higher in the ECRS group than in the NECRS group. Among patients with ECRS, those with GGA had significantly higher tissue eosinophil counts and Lund-Mackay CT scores, as well as significantly lower olfactory function. Steroid dose reduction was significantly slower in the GGA group.

Conclusions: The presence of GGA on chest CT in patients with CRS is associated with the CRS phenotype and greater disease severity, suggesting that chest imaging findings could serve as potential indicators of systemic disease burden in CRS.

Background: Advances in pharmacologic therapy have improved asthma outcomes, yet persistent symptoms can challenge a subset of patients, thereby hindering clinical remission. This study aimed to assess longitudinal trends in symptom control and identify factors associated with persistent symptoms in adult patients with asthma receiving established treatments in Japan.

Methods: We analyzed data from the SApporo Real-world Asthma Survey, a repeated cross-sectional study conducted in Japan over a 26-year period (1997-2023). The participants were adult patients with asthma receiving guideline-based care from respiratory and/or allergy specialists. Data were collected through patient questionnaires and physician records. Multivariable logistic regression analysis was performed to identify risk factors for persistent symptoms.

Results: The median age of the analyzed 13,243 patients increased during the study (from 52 years in 1997 to 60 years in 2023), as did the proportion of women. Although nighttime symptoms, dyspnea, and unscheduled visits for exacerbation declined, 10 %-30 % of patients reported persistent cough and 20 %-40 % had sputum despite therapeutic advances. Chronic rhinosinusitis and current smoking were significant predictors of persistent symptoms. Patients undergoing intensive therapies had a higher symptom burden, although the symptom severity and unscheduled visit rates decreased within each treatment category over time.

Conclusions: Despite therapeutic advances and guideline-based specialist care, residual symptoms, especially cough and sputum, persisted in a significant proportion of Japanese adult patients with asthma. Comprehensive management strategies targeting comorbidities such as chronic rhinosinusitis and smoking are essential to achieve clinical remission and improve patient-centered outcomes.

Background: Although Schizophyllum commune is a common causative fungus of allergic bronchopulmonary mycosis, it is often underrecognized in clinical practice. This is because it rarely forms spores under routine culture conditions, typically appears as white, non-sporulating colonies indistinguishable from other fungi, and is frequently dismissed as a contaminant rather than subjected to molecular identification. To minimize the risk of being overlooked, we established a practical protocol for the identification of S. commune based on its ability to produce hydrogen sulfide.

Methods: To evaluate the clinical utility of this protocol, we studied consecutive lower respiratory tract specimens collected for fungal culture from adult patients who visited a tertiary hospital for allergy and respirology. Fungal cultures were performed in accordance with this protocol between January 2023 and December 2024. We calculated the positive and negative predictive value of this protocol as a clinical test for identifying S. commune by detecting genetic analysis-proven S. commune as the reference outcome.

Results: Overall, 196 specimens were assessed during the study period. Based on the protocol, 19 specimens (10 %) were diagnosed as "a specimen CONTAINING S. commune." All these specimens contained genetically-proven S. commune (positive predictive value: 100 %). S. commune was not recovered from any specimens that the protocol diagnosed as "NOT containing S. commune" (negative predictive value: 100 %).

Conclusions: This protocol enables the efficient and cost-effective detection of S. commune in clinical laboratories in a general medical facility, potentially reducing the underdiagnosis of S. commune-related allergic airway diseases and improving medical resource use.

Background: The underlying pathomechanisms of wheal reaction enlargement in chronic spontaneous urticaria (CSU) remain largely unclear. We hypothesized that the activation of mast cells (MCs) and recruitment of basophils to locally inflamed skin would be enhanced by lipid mediators (LMs) following initial skin MC activation. This study aimed to identify the LMs responsible for enhancing the aggregation of IgE-mediated MC activation and basophil chemotaxis.

Methods: We enrolled 77 CSU patients and 36 non-atopic control (NC) subjects. Lipid profiling of plasma from these subjects was performed using liquid chromatography-tandem mass spectrometry/mass spectrometry. We compared LMs before and after omalizumab treatment between responders and non-responders.

Results: The concentration of 5-lipoxygenase-mediated LMs was significantly higher in the plasma obtained from patients than in the plasma obtained from NC subjects. The stepwise model demonstrated that 5-hydroxyeicosatetraenoic acid (HETE) (odds ratio, 3.34; 95 % confidence interval, 1.91-5.86; p = 0.0001) was the strongest independent marker of CSU. Here, 5-HETE significantly upregulated IgE-dependent basophil and MC activation. 12-hydroxyeicosapentaenoic acid (HEPE) demonstrated statistically significant correlations between changes in basophil counts and changes in the LM levels before and after omalizumab administration (p = 0.0146). Additionally, 12-HEPE significantly inhibits TNF-α/IFN-β-induced CCL2 mRNA expression in human keratinocytes. Furthermore, 12-HEPE showed a significant increase in concentration after omalizumab treatment in responders (p = 0.0095), but not in non-responders.

Conclusions: In conclusion, 5-HETE and 12-HEPE may regulate IgE-mediated activation of MCs and basophils and recruitment of basophils in the CSU, respectively, suggesting that these LMs may be involved in the enlargement of wheal reactions.