Pub Date : 2025-04-17DOI: 10.1016/j.alit.2025.03.007
Yoshiko Mizukawa, Tetsuo Shiohara
Drug-induced hypersensitivity syndrome (DIHS) or drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe drug reaction characterized by a range of clinical manifestations. These range from mild cases resolving upon cessation of the causative drug to severe cases involving complex disease progression and potential fatality. A hallmark of DIHS/DRESS is the sequential reactivation of herpesviruses, particularly human herpesvirus 6 (HHV-6), during the disease course, contributing to recurrent symptoms. Viral reactivation can lead to critical complications, including infectious DIHS/DRESS-associated complications (iDACs) and autoimmune sequelae (aDACs). Managing DIHS/DRESS remains challenging due to its complexity, requiring precise prediction and tailored treatment strategies. Recent studies suggest that early-stage classification using the DIHS/DRESS Severity (DDS) score may help identify refractory cases, including DACs. Furthermore, early intervention with anti-cytomegalovirus (anti-CMV) therapy can mitigate iDACs caused by CMV reactivation, preventing progression to severe CMV-related diseases. Long-term follow-up is crucial, as aDACs can manifest even 3 years postonset. Serial monitoring is recommended, particularly in patients treated with intravenous immunoglobulin or corticosteroid pulse therapy, which are recognized risk factors for aDAC development. This review highlights DIHS/DRESS management strategies, focusing on its clinical features, the role of viral reactivation, and therapeutic interventions.
{"title":"Recent advances in the diagnosis and treatment of DIHS/DRESS in 2025","authors":"Yoshiko Mizukawa, Tetsuo Shiohara","doi":"10.1016/j.alit.2025.03.007","DOIUrl":"10.1016/j.alit.2025.03.007","url":null,"abstract":"<div><div>Drug-induced hypersensitivity syndrome (DIHS) or drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe drug reaction characterized by a range of clinical manifestations. These range from mild cases resolving upon cessation of the causative drug to severe cases involving complex disease progression and potential fatality. A hallmark of DIHS/DRESS is the sequential reactivation of herpesviruses, particularly human herpesvirus 6 (HHV-6), during the disease course, contributing to recurrent symptoms. Viral reactivation can lead to critical complications, including infectious DIHS/DRESS-associated complications (iDACs) and autoimmune sequelae (aDACs). Managing DIHS/DRESS remains challenging due to its complexity, requiring precise prediction and tailored treatment strategies. Recent studies suggest that early-stage classification using the DIHS/DRESS Severity (DDS) score may help identify refractory cases, including DACs. Furthermore, early intervention with anti-cytomegalovirus (anti-CMV) therapy can mitigate iDACs caused by CMV reactivation, preventing progression to severe CMV-related diseases. Long-term follow-up is crucial, as aDACs can manifest even 3 years postonset. Serial monitoring is recommended, particularly in patients treated with intravenous immunoglobulin or corticosteroid pulse therapy, which are recognized risk factors for aDAC development. This review highlights DIHS/DRESS management strategies, focusing on its clinical features, the role of viral reactivation, and therapeutic interventions.</div></div>","PeriodicalId":48861,"journal":{"name":"Allergology International","volume":"74 3","pages":"Pages 372-379"},"PeriodicalIF":6.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-17DOI: 10.1016/j.alit.2025.04.001
Daigo Kato , Takako Miyamae , Yuzaburo Inoue
{"title":"Medical treatment recipient ratio for metal allergy among Japanese children and adolescents: A retrospective cohort study using health insurance claims data (2016–2020)","authors":"Daigo Kato , Takako Miyamae , Yuzaburo Inoue","doi":"10.1016/j.alit.2025.04.001","DOIUrl":"10.1016/j.alit.2025.04.001","url":null,"abstract":"","PeriodicalId":48861,"journal":{"name":"Allergology International","volume":"74 3","pages":"Pages 491-493"},"PeriodicalIF":6.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-04DOI: 10.1016/j.alit.2025.03.002
Taisei Mushiroda
The association of human leukocyte antigen (HLA) with the risk of drug-induced skin eruptions has been extensively studied. The sensitivity of the association of specific HLA alleles with drug eruptions ranges from approximately 50 to 100%, indicating a significant influence of HLA alleles on the risk of developing such reactions. Consequently, HLA testing holds substantial clinical potential as a genetic diagnostic tool to avoid drug eruptions. For instance, when prescribing drugs like carbamazepine and lamotrigine, which are known to cause severe drug eruptions, preemptive HLA genetic testing can help predict an individual’s risk. This approach enables clinicians to reduce the overall incidence of drug eruptions by selecting alternative therapeutic agents or adjusting dosages based on the results of HLA genetic testing.
{"title":"Pharmacogenetic biomarkers associated with risk of developing severe drug eruptions and clinical implementation of HLA genetic testing","authors":"Taisei Mushiroda","doi":"10.1016/j.alit.2025.03.002","DOIUrl":"10.1016/j.alit.2025.03.002","url":null,"abstract":"<div><div>The association of human leukocyte antigen (HLA) with the risk of drug-induced skin eruptions has been extensively studied. The sensitivity of the association of specific HLA alleles with drug eruptions ranges from approximately 50 to 100%, indicating a significant influence of HLA alleles on the risk of developing such reactions. Consequently, HLA testing holds substantial clinical potential as a genetic diagnostic tool to avoid drug eruptions. For instance, when prescribing drugs like carbamazepine and lamotrigine, which are known to cause severe drug eruptions, preemptive HLA genetic testing can help predict an individual’s risk. This approach enables clinicians to reduce the overall incidence of drug eruptions by selecting alternative therapeutic agents or adjusting dosages based on the results of HLA genetic testing.</div></div>","PeriodicalId":48861,"journal":{"name":"Allergology International","volume":"74 3","pages":"Pages 380-385"},"PeriodicalIF":6.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-02DOI: 10.1016/j.alit.2024.12.007
Rafael José Vieira , Ana Margarida Pereira , Maciej Kupczyk , Frederico S. Regateiro , Desirée E. Larenas-Linnemann , Sanna Toppila-Salmi , Tomohisa Iinuma , Piotr Kuna , Alvaro A. Cruz , Luisa Brussino , Bilun Gemicioglu , Boleslaw Samolinski , Luis Taborda-Barata , Maria Teresa Ventura , Violeta Kvedariene , Ludger Klimek , Oliver Pfaar , Torsten Zuberbier , Luís Filipe Azevedo , João A. Fonseca , Sabina Skrgat
Background
Allergic rhinitis may impair work productivity. This study aimed to assess (i) the differential impact of allergic rhinitis symptoms on work performance, assessed by means of Visual Analogue Scale (VAS) work; and (ii) the effect of asthma comorbidity on work productivity.
Methods
We assessed data from the MASK-air mHealth app of patients with allergic rhinitis. We identified factors associated with the impact of allergic symptoms on work productivity through multivariable linear mixed effects models.
Results
We studied 260,378 days from 20,724 patients. In multivariable regression models, nasal symptoms showed the strongest association with VAS work (regression coefficient = 0.38 [95%CI = 0.38; 0.38]). Poor rhinitis control, measured by the combined symptom-medication score, was associated with worse VAS work (regression coefficient = 0.96 [95%CI = 0.96; 0.97]). The median VAS work in patients with probable or possible asthma (median = 9, interquartile range = 22 for probable and 23 for possible asthma) was greater than for patients with no evidence of asthma (median = 3, interquartile range = 12) (Cohen's d = 0.60). In patients with probable asthma, nasal and asthma symptoms showed a similar impact on work productivity (regression coefficient for VAS nose = 0.32 [95%CI = 0.31; 0.32]; regression coefficient for VAS asthma = 0.30 [95%CI = 0.29; 0.31]).
Conclusions
Allergy symptoms, especially nasal symptoms, are associated with worse work productivity. In addition, patients with allergic rhinitis and asthma display more impairment in work productivity than patients with allergic rhinitis alone.
{"title":"Impact of allergic symptoms on work productivity in allergic rhinitis: A MASK-air direct patient data study","authors":"Rafael José Vieira , Ana Margarida Pereira , Maciej Kupczyk , Frederico S. Regateiro , Desirée E. Larenas-Linnemann , Sanna Toppila-Salmi , Tomohisa Iinuma , Piotr Kuna , Alvaro A. Cruz , Luisa Brussino , Bilun Gemicioglu , Boleslaw Samolinski , Luis Taborda-Barata , Maria Teresa Ventura , Violeta Kvedariene , Ludger Klimek , Oliver Pfaar , Torsten Zuberbier , Luís Filipe Azevedo , João A. Fonseca , Sabina Skrgat","doi":"10.1016/j.alit.2024.12.007","DOIUrl":"10.1016/j.alit.2024.12.007","url":null,"abstract":"<div><h3>Background</h3><div>Allergic rhinitis may impair work productivity. This study aimed to assess (i) the differential impact of allergic rhinitis symptoms on work performance, assessed by means of Visual Analogue Scale (VAS) work; and (ii) the effect of asthma comorbidity on work productivity.</div></div><div><h3>Methods</h3><div>We assessed data from the MASK-air mHealth app of patients with allergic rhinitis. We identified factors associated with the impact of allergic symptoms on work productivity through multivariable linear mixed effects models.</div></div><div><h3>Results</h3><div>We studied 260,378 days from 20,724 patients. In multivariable regression models, nasal symptoms showed the strongest association with VAS work (regression coefficient = 0.38 [95%CI = 0.38; 0.38]). Poor rhinitis control, measured by the combined symptom-medication score, was associated with worse VAS work (regression coefficient = 0.96 [95%CI = 0.96; 0.97]). The median VAS work in patients with probable or possible asthma (median = 9, interquartile range = 22 for probable and 23 for possible asthma) was greater than for patients with no evidence of asthma (median = 3, interquartile range = 12) (Cohen's d = 0.60). In patients with probable asthma, nasal and asthma symptoms showed a similar impact on work productivity (regression coefficient for VAS nose = 0.32 [95%CI = 0.31; 0.32]; regression coefficient for VAS asthma = 0.30 [95%CI = 0.29; 0.31]).</div></div><div><h3>Conclusions</h3><div>Allergy symptoms, especially nasal symptoms, are associated with worse work productivity. In addition, patients with allergic rhinitis and asthma display more impairment in work productivity than patients with allergic rhinitis alone.</div></div>","PeriodicalId":48861,"journal":{"name":"Allergology International","volume":"74 3","pages":"Pages 445-452"},"PeriodicalIF":6.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-02DOI: 10.1016/j.alit.2025.03.004
Loren D. Erickson , Jeffrey M. Wilson , Kayla Cramton , Claudia M. Rival
Alpha-gal syndrome (AGS) is a unique allergic condition triggered by IgE antibody production against the mammalian oligosaccharide galactose-α-1,3-galactose (α-gal). The syndrome, acquired by bites from multiple tick species, leads to delayed allergic reactions after consuming mammalian-derived products containing α-gal, including red meat, dairy, and select medications. AGS is especially prevalent in regions with high tick exposure and has become a global public health concern, with rising cases across continents. Despite growing research, including recent findings suggesting that asymptomatic α-gal sensitization may contribute to coronary artery disease, the precise immune mechanisms—particularly B cell-mediated IgE production following tick bites—remain poorly understood. Additionally, the tick saliva components that trigger sensitization and the role of the skin-gut axis in food allergy development are knowledge gaps. AGS research has benefited from animal models like mice, zebrafish, and pigs, which replicate key syndrome features, though have limitations. Humanized mouse models and human organoid systems now offer promising tools for investigating AGS pathogenesis and testing potential therapies. This review explores current pre-clinical methodologies, challenges, and the future of AGS research, emphasizing innovative models that may bridge knowledge gaps and advance therapeutic development.
{"title":"Pre-clinical strategies and emerging technologies driving advances in the alpha-gal syndrome","authors":"Loren D. Erickson , Jeffrey M. Wilson , Kayla Cramton , Claudia M. Rival","doi":"10.1016/j.alit.2025.03.004","DOIUrl":"10.1016/j.alit.2025.03.004","url":null,"abstract":"<div><div>Alpha-gal syndrome (AGS) is a unique allergic condition triggered by IgE antibody production against the mammalian oligosaccharide galactose-α-1,3-galactose (α-gal). The syndrome, acquired by bites from multiple tick species, leads to delayed allergic reactions after consuming mammalian-derived products containing α-gal, including red meat, dairy, and select medications. AGS is especially prevalent in regions with high tick exposure and has become a global public health concern, with rising cases across continents. Despite growing research, including recent findings suggesting that asymptomatic α-gal sensitization may contribute to coronary artery disease, the precise immune mechanisms—particularly B cell-mediated IgE production following tick bites—remain poorly understood. Additionally, the tick saliva components that trigger sensitization and the role of the skin-gut axis in food allergy development are knowledge gaps. AGS research has benefited from animal models like mice, zebrafish, and pigs, which replicate key syndrome features, though have limitations. Humanized mouse models and human organoid systems now offer promising tools for investigating AGS pathogenesis and testing potential therapies. This review explores current pre-clinical methodologies, challenges, and the future of AGS research, emphasizing innovative models that may bridge knowledge gaps and advance therapeutic development.</div></div>","PeriodicalId":48861,"journal":{"name":"Allergology International","volume":"74 3","pages":"Pages 397-405"},"PeriodicalIF":6.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elderly asthma has distinct pathophysiologic and phenotypic characteristics compared with asthma in younger patients. However, a potential relationship between sex hormones and the severity of asthma remains unknown in the elderly population. The aim of the present study was to elucidate the relationship between the level of circulating free testosterone and severity of asthma among Japanese with elderly asthma.
Methods
The level of free testosterone was measured using sera from elderly patients with asthma aged ≥60 years (n = 192), and its association with the severity of asthma was examined after stratification by sex.
Results
Based on previous literature and our preliminary analysis showing that current oral corticosteroid (OCS) use might be a risk factor for a lower free testosterone level regardless of severity of asthma, analyzed patients were limited to those who were not currently using OCS (n = 164). Regarding elderly men who were not currently using OCS (n = 62), there was no significant association between free testosterone level and severity of asthma. However, in female counterparts (n = 102), a low free testosterone level was significantly associated with severe asthma even after adjustment for age (p for trend, 0.03).
Conclusions
The present study showed a significant association between the serum free testosterone level and severity of asthma among elderly women who were not currently using OCS. Although the causal relationship is unclear, this finding may provide a clue to understand the sex difference in the mechanisms of severe asthma in elderly populations.
{"title":"Association between low serum testosterone level and severe asthma among elderly women","authors":"Kai Ryu , Yuma Fukutomi , Eiji Nakatani , Yosuke Kamide , Kiyoshi Sekiya , Takeo Ishikawa , Takanori Numata , Jun Araya , Kazuyoshi Kuwano , Masami Taniguchi , Hiroaki Masuzaki","doi":"10.1016/j.alit.2024.12.008","DOIUrl":"10.1016/j.alit.2024.12.008","url":null,"abstract":"<div><h3>Background</h3><div>Elderly asthma has distinct pathophysiologic and phenotypic characteristics compared with asthma in younger patients. However, a potential relationship between sex hormones and the severity of asthma remains unknown in the elderly population. The aim of the present study was to elucidate the relationship between the level of circulating free testosterone and severity of asthma among Japanese with elderly asthma.</div></div><div><h3>Methods</h3><div>The level of free testosterone was measured using sera from elderly patients with asthma aged ≥60 years (n = 192), and its association with the severity of asthma was examined after stratification by sex.</div></div><div><h3>Results</h3><div>Based on previous literature and our preliminary analysis showing that current oral corticosteroid (OCS) use might be a risk factor for a lower free testosterone level regardless of severity of asthma, analyzed patients were limited to those who were not currently using OCS (n = 164). Regarding elderly men who were not currently using OCS (n = 62), there was no significant association between free testosterone level and severity of asthma. However, in female counterparts (n = 102), a low free testosterone level was significantly associated with severe asthma even after adjustment for age (p for trend, 0.03).</div></div><div><h3>Conclusions</h3><div>The present study showed a significant association between the serum free testosterone level and severity of asthma among elderly women who were not currently using OCS. Although the causal relationship is unclear, this finding may provide a clue to understand the sex difference in the mechanisms of severe asthma in elderly populations.</div></div>","PeriodicalId":48861,"journal":{"name":"Allergology International","volume":"74 3","pages":"Pages 453-460"},"PeriodicalIF":6.2,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-17DOI: 10.1016/j.alit.2025.02.003
N. Sabrina Idrose , Don Vicendese , E. Haydn Walters , Jennifer L. Perret , Jennifer J. Koplin , Jo A. Douglass , Rachel CA. Tham , Peter Frith , Dinh S. Bui , Adrian J. Lowe , Michael J. Abramson , Gayan Bowatte , Bircan Erbas , Luke D. Knibbs , Chamara Senaratna , Caroline J. Lodge , Shyamali C. Dharmage
{"title":"Multiple at-risk groups have lower lung function during the grass pollen season","authors":"N. Sabrina Idrose , Don Vicendese , E. Haydn Walters , Jennifer L. Perret , Jennifer J. Koplin , Jo A. Douglass , Rachel CA. Tham , Peter Frith , Dinh S. Bui , Adrian J. Lowe , Michael J. Abramson , Gayan Bowatte , Bircan Erbas , Luke D. Knibbs , Chamara Senaratna , Caroline J. Lodge , Shyamali C. Dharmage","doi":"10.1016/j.alit.2025.02.003","DOIUrl":"10.1016/j.alit.2025.02.003","url":null,"abstract":"","PeriodicalId":48861,"journal":{"name":"Allergology International","volume":"74 3","pages":"Pages 482-484"},"PeriodicalIF":6.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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