Allergology International最新文献

Background: Data on the long-term efficacy and safety of topical therapy for atopic dermatitis (AD) remain limited.

Methods: This prospective cohort study included all children with AD who had their first visit to the Allergy Center at the National Center for Child Health and Development between December 2020 and September 2022. Participants were evaluated at enrollment, 6, and 12 months, and also monitored via questionnaires. We analyzed those with an Eczema Area and Severity Index (EASI) score ≥7.1 and complete EASI data at both follow-up points. The primary endpoint was the proportion achieving ≥75 % improvement in EASI from baseline (EASI-75) at 12 months. Secondary outcomes included other clinical endpoints, QOL scores, and skin and ocular complications.

Results: Of 763 enrolled children, 107 had EASI ≥7.1, and 77 (72.0 %) had complete follow-up data. Median age at enrollment was 57.0 months [quartile: 13.0-141.0], and 58.4 % were male. Fifty-three had moderate (7.1≤EASI≤21.0) AD, and 24 had severe to very severe (21.1≤EASI) AD. Only two children (2.6 %) required systemic therapy during the study period. Median EASI scores significantly improved from 14.8 at baseline to 0.8 at both 6 and 12 months (P < 0.001). EASI-75 was achieved by 80.5 % at 6 months and 85.7 % at 12 months. Other clinical endpoints, including POEM, pruritus and sleep-disturbance NRS, and QOL scores, were improved. New dermatologic complications were rare, and no ophthalmologic complications occurred.

Conclusions: Most pediatric AD cases with moderate or greater severity can be effectively and safely controlled with topical therapy alone.

Background: Severe Th2 inflammatory diseases, including food allergy, are known to be associated with osteoporosis. However, while IL-4 inhibits osteoclast differentiation, detailed mechanisms of osteoporosis caused under IL-4-excessive environments remain unclear.

Methods: OVA23-3 mice are transgenic mice expressing OVA-specific T-cell receptors and develop significant IL-4-producing T-cell responses resulting in food-allergic enteropathy associated with osteoporosis when fed an egg white (EW) diet. This enteropathy is characterized by phases of inflammation and desensitization; bone loss develops during the inflammatory phase with the onset of allergic enteropathy and is maintained during the desensitization phase when the enteropathy is alleviated by immunological tolerance induction by continuous EW-feeding. We used this model to elucidate the mechanism of food antigen-induced osteoporosis, particularly in an IL-4-dominant environment.

Results: During the inflammatory phase, EW-feeding promoted osteoclastogenesis with increased mast cells, suppressed by administering anti-IL-4 antibody to the model. This finding suggests a critical role for IL-4 in the induction of osteoclastogenesis, which may be associated with mast cells and eosinophils over-differentiation and lead to osteoporosis. However, during the desensitization phase, the bone loss mechanism switched to high metabolic bone turnover, maintaining osteoclast activity despite amelioration of the enteropathy by continuous EW feeding. The increased number of IL-10-producing Tregs from mesenteric lymph nodes may reduce osteoclastogenesis during the desensitization phase, but did not suppress osteoporosis.

Conclusions: The present study provides a new perspective on a poorly understood mechanism of osteoporosis in severe allergies, suggesting the importance of maintaining bone health in allergic patients, including food allergies.

Background: Dosing intervals are important in determining oral food challenge (OFC) safety; however, the optimal interval remains unclear. This study aimed to investigate symptom onset time in low-dose OFCs, utilizing 60-min intervals, involving four common pediatric allergens.

Methods: We retrospectively analyzed symptom onset time for low-dose OFCs involving two doses at 60-min intervals in children allergic to egg, milk, wheat, and peanut. Challenges were performed to diagnose allergies or confirm tolerance acquisition. Total challenge doses were 250, 102, 52, and 133 mg of egg, milk, wheat, and peanut proteins, respectively. OFCs were positive when objective symptoms were observed.

Results: Of the 1610 children (379, 430, 431, and 370 had allergies to egg, milk, wheat, and peanut, respectively), 552 (34 %) were OFC-positive: 103 (27 %) with egg allergy, 210 (49 %) with milk allergy, 105 (24 %) with wheat allergy, and 134 (36 %) with peanut allergy. The median (interquartile range) onset times of symptom were 45 (29-60) min for egg allergy, 30 (15-45) min for milk allergy, 42 (30-55) min for wheat allergy, and 30 (14-45) min for peanut allergy after the first dose, and 35 (17-60) min for egg allergy, 30 (15-45) min for milk allergy, 35 (24-55) min for wheat allergy, and 25 (15-40) min peanut allergy after the second dose. Late-onset reactions (≥30 min) occurred in 64 % of first doses and 54 % of second doses across all allergens.

Conclusions: OFC dose intervals at >30 min are necessary to ensure safety and accurate assessment.

Background: Anaphylaxis is a life threatening complication of allergy and one of the treatment approaches for allergy is immunotherapy. Allergen immunotherapy is the only treatment that can alter the natural history of allergic disease. Oral immunotherapy is a viable therapeutic route in patients with food allergies, during which peripheral plasmablasts, which are activated B cells, expand, and allergen-specific IgG4 is induced. We aimed to characterize the profile of plasmablasts undergoing oral immunotherapy.

Methods: A detailed profile of plasmablasts in 2 patients with milk allergies undergoing oral immunotherapy is provided by single cell analysis. The involvement of the subclasses and isotypes in plasmablasts in individuals undergoing oral immunotherapy was clarified by single-cell transcriptomics analysis and B cell immune receptor analysis and profile analysis of recombinant antibodies.

Results: Some clonally expanded antibodies and IgD clones were found to recognize allergens. Furthermore, constructing a clonal tree, over 80 % matched complementarity-determining region (CDR) clones were identified. Several IgA1 antibodies in the clonal trees were also found to recognize allergens.

Conclusions: Plasmablasts developed clonal differentiation in patients with milk allergy undergoing OIT. And somatic hypermutations and the allergen-positive rate of plasmablast are dependent on their subclasses and isotypes.

Clinical remission in asthma has gained prominence as both a therapeutic goal and a research endpoint, although its operational definitions have varied. To harmonize Japanese practice with emerging global frameworks, the Japanese Society of Allergology (JSA) conducted a two-round modified Delphi survey to establish a consensus definition for inclusion in the 2024 Asthma Prevention and Management Guidelines (JGL 2024). In Round 1 (January 2024), 81 JGL 2024 guideline committee members representing adult and pediatric specialties were invited. Seventy-four percent agreed that clinical remission should be defined, and 50 % supported including both on- and off-treatment remission. Four core components emerged: absence of exacerbations, well-controlled symptoms, no continuous oral corticosteroid use, and optimization of pulmonary function. Round 2 refined operational thresholds for symptom control, adopting ACT ≥23 (C-ACT ≥23 for children) and ACQ ≤0.75, consistent with JGL's long-standing goal of achieving a truly symptom-free state without reliever use. Pulmonary function was defined as "optimization," encompassing normalization where achievable and stabilization when normalization is unlikely (e.g., airway remodeling), which received strong agreement. Collaboration between adult and pediatric experts affirmed clinical remission as a milestone toward off-treatment remission and potential cure, broadening its applicability across severities and age groups. This review further summarizes evidence supporting remission as an outcome of biologic therapy, its key predictors (e.g., smoking, obesity, disease duration), pediatric perspectives, and future directions. JGL 2024 formally adopts these criteria, providing a rigorous and pragmatic framework to advance patient-centered asthma care and reframe management toward disease modification and eventual cure.

Background: In the era of asthma remission, quality of life (QOL) in daily activities is increasingly valued in addition to exacerbation control. However, the value of the Asthma Control Test (ACT) for assessing QOL remains unclear. This study compared the use of the ACT with the Asthma Quality of Life Questionnaire (AQLQ), with a focus on activity limitations.

Methods: We first analyzed biologic-treated asthma patients who were attending our institution and assessed the relationship between stable-phase ACT scores and AQLQ scores (including both overall scores and domain-specific scores). Receiver operating characteristic (ROC) curves were analyzed to identify the optimal ACT threshold for predicting favorable AQLQ scores. The findings were subsequently validated in a nonbiologic-treated group.

Results: Among biologic-treated patients (n = 69), the median ACT and AQLQ scores were 22 (IQR: 18-25) and 5.5 (IQR: 4.7-6.4), respectively. Discrepancies between the ACT and AQLQ were most evident in the activity limitation domain. Half of the patients with well-controlled ACT scores (≥20) reported difficulty with high-intensity exercise and avoiding environmental triggers, regardless of asthma duration. ROC curve analysis revealed that an ACT score ≥23 predicted favorable AQLQ activity limitation scores (≥6) (AUC: 0.83; sensitivity: 86 %; specificity: 76 %). Favorable scores were more commonly observed in the ACT ≥23 group than in the 20-22 group (p < 0.01). Similar findings were observed in the nonbiologic group (n = 123).

Conclusions: A cutoff score of ≥23 for the ACT may better reflect patient-perceived QOL than the conventional cutoff score of 20.

Background: Allergic diseases are highly prevalent chronic inflammatory conditions. They often co-occur because of shared immunological pathways. However, population-level studies covering a broad range of allergic diseases across the lifespan remain limited. The objective of this study was to examine the age-specific trends in allergic disease prevalence, patterns of multimorbidity, and longitudinal interrelationships among nine allergic conditions using a nationwide cohort.

Methods: We analyzed data from 1,137,861 individuals in the Korean National Health Insurance Service-National Sample Cohort from 2002 to 2019. Nine allergic diseases were tracked: atopic dermatitis, asthma, allergic rhinitis, food allergies, drug allergies, anaphylaxis, allergic conjunctivitis, acute urticaria, and chronic urticaria. We assessed the annual prevalence, concurrent comorbidities, and estimated hazard ratios (HRs) for inter-disease associations using conditional Cox models adjusted for socioeconomic and geographic factors. Network graphs visualized significant associations (HR ≥ 2).

Results: The prevalence of most allergic diseases increased, including in children and older adults. The proportion of individuals with ≥2 allergic conditions rose from 0.7 % to 4.2 %. Chronic urticaria, atopic dermatitis, and asthma were major precursors of the development of additional allergic diseases. Disease-to-disease associations varied by age, with stronger interconnections observed in adulthood. Predictive modeling suggested increasing future burdens of chronic urticaria and late-onset asthma.

Conclusions: Allergic diseases exhibit increasing prevalence and multimorbidity across all ages, with strong age-dependent interrelationships. These findings highlight the need for integrated life-course-oriented strategies for allergic disease surveillance and management.