Allergology International最新文献

英文中文

Corrigendum to “Effectiveness of benralizumab in the Tokyo Asthma Study (TOAST): A real-world prospective interventional trial” [Allergol Int 74 (2025) 274-82] “benralizumab在东京哮喘研究（TOAST）中的有效性：一项现实世界的前瞻性干预性试验”的更正[Allergol Int 74(2025) 274-82]。

IF 6.2 2区医学 Q1 ALLERGY

Allergology International

Pub Date : 2025-06-13 DOI: 10.1016/j.alit.2025.05.001

Katsunori Masaki , Maho Suzukawa , Hitoshi Sasano , Norihiro Harada , Yasunari Miyazaki , Hideki Katsura , Etsuko Tagaya , Junko Terada , Masayuki Hojo , Naoya Sugimoto , Hiroyuki Nagase , Yuta Kono , Hisato Hiranuma , Yasuhiro Gon , Ryo Takemura , Misato Irie , Reina Nakamura , Hiroki Kabata , Jun Miyata , Koichi Fukunaga

引用次数: 0

Recent advances in the diagnosis and treatment of Stevens–Johnson syndrome/toxic epidermal necrolysis Stevens-Johnson综合征/中毒性表皮坏死松解症的诊断和治疗进展。

IF 6.2 2区医学 Q1 ALLERGY

Allergology International

Pub Date : 2025-06-10 DOI: 10.1016/j.alit.2025.05.008

Yuko Watanabe , Natsumi Hama

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but serious mucocutaneous disorders primarily caused by medications. Despite their low incidence, both conditions remain associated with high mortality and significant long-term complications. Recent studies have advanced the understanding of their pathogenesis, including the roles of neutrophil extracellular traps and several cell death pathways. However, reliable biomarkers for early diagnosis are lacking, and no internationally standardized diagnostic criteria have been established.

To address these gaps, new diagnostic frameworks have been proposed that incorporate conventional cutaneous and mucosal findings with mandatory histopathological confirmation. These are expected to enhance diagnostic precision and facilitate global comparability. The increasing incidence of SJS/TEN-like reactions associated with immune checkpoint inhibitors and molecular targeted therapies further highlights the importance of accurate histopathological differentiation.

Prognostic tools are essential for therapeutic planning. Although the Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) score remains widely used, newer systems offer improved risk stratification and practical utility in diverse clinical settings.

However, the optimal use of immunomodulatory therapies remains uncertain owing to limited consensus and evidence. Corticosteroids continue to serve as first-line treatment, but more selective agents are gaining attention for their potential efficacy and reduced toxicity.

This review summarizes recent progress in SJS/TEN diagnosis, severity assessment, and management. It discusses the utility and limitations of novel scoring systems and emerging therapies while highlighting persistent challenges, including high mortality, regional practice variation, and delayed standardization. International collaboration and high-quality evidence generation remain essential for improving patient outcomes.

史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）是罕见但严重的粘膜皮肤疾病，主要由药物引起。尽管发病率低，但这两种疾病仍然与高死亡率和显著的长期并发症有关。最近的研究提高了对其发病机制的理解，包括中性粒细胞胞外陷阱和几种细胞死亡途径的作用。然而，缺乏可靠的早期诊断生物标志物，也没有建立国际标准化的诊断标准。为了解决这些差距，新的诊断框架被提出，包括常规的皮肤和粘膜检查结果与强制性的组织病理学证实。这些方法有望提高诊断精度，促进全球可比性。与免疫检查点抑制剂和分子靶向治疗相关的SJS/ ten样反应发生率的增加进一步强调了准确的组织病理学分化的重要性。预后工具对治疗计划至关重要。尽管中毒性表皮坏死松解的疾病严重程度评分（SCORTEN）仍然被广泛使用，但更新的系统提供了改进的风险分层和在不同临床环境中的实际应用。然而，由于共识和证据有限，免疫调节疗法的最佳使用仍然不确定。皮质类固醇继续作为一线治疗，但更多的选择性药物因其潜在的疗效和降低的毒性而受到关注。本文综述了SJS/TEN的诊断、严重程度评估和治疗方面的最新进展。它讨论了新型评分系统和新兴疗法的实用性和局限性，同时强调了持续存在的挑战，包括高死亡率、地区实践差异和延迟标准化。国际合作和高质量的证据生成对于改善患者预后仍然至关重要。

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引用次数: 0

Updates on the ocular manifestations and treatment of SJS/TEN SJS/TEN眼部表现及治疗进展。

IF 6.2 2区医学 Q1 ALLERGY

Allergology International

Pub Date : 2025-06-10 DOI: 10.1016/j.alit.2025.05.003

Chie Sotozono, Mayumi Ueta

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute inflammatory disorders that affect the skin and mucous membranes, and in 40–84 % of SJS/TEN cases, the ocular complications that are often overlooked due to severe systemic symptoms. Specific ocular findings at the acute-phase include conjunctival hyperemia, pseudomembrane formation, and epithelial defects, and severe acute-phase ocular involvement strongly correlates with long-term visual impairment. Thus, it is vital to diagnose ocular involvement early at the acute stage and suppress inflammation on the ocular surface to protect corneal epithelial stem cells. As outlined in the official Japanese treatment guidelines for SJS/TEN cases with ocular involvement, corticosteroid pulse therapy and topical application of 0.1 % betamethasone eye-drops within four days of disease onset significantly reduces ocular sequelae. Early intervention with amniotic membrane transplantation helps reduce scarring and potential loss of vision. As for genetic-related factors, NSAIDs (nonsteroidal anti-inflammatory drugs) and cold medications are major triggers for SJS/TEN with severe ocular complications, with genetic predispositions involving TLR3 and prostaglandin E receptor 3 (subtype EP3) contributing to disease susceptibility. These genetic–environment interactions influence disease onset and progression. At chronic phase, severe dry eye and visual impairment are major long-term sequelae, and both surgical and non-surgical interventions have been applied to obtain favorable long-term treatment outcomes. In summary, early ophthalmic intervention is critical in preventing SJS/TEN-related ocular sequelae, and further research into genetic and immunological mechanisms is essential for better diagnosis and treatment.

史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）是影响皮肤和粘膜的急性炎症性疾病，在40- 84%的SJS/TEN病例中，由于严重的全身症状，眼部并发症往往被忽视。急性期的特异性眼部表现包括结膜充血、假膜形成和上皮缺损，严重的急性期眼部受累与长期视力损害密切相关。因此，在急性期早期诊断眼部受累，抑制眼表炎症以保护角膜上皮干细胞至关重要。正如日本官方的SJS/TEN眼部受累病例治疗指南所述，在发病4天内，皮质类固醇脉冲治疗和局部使用0.1%倍他米松滴眼液可显著减少眼部后遗症。早期干预羊膜移植有助于减少疤痕和潜在的视力丧失。在遗传相关因素方面，NSAIDs（非甾体抗炎药）和感冒药是SJS/TEN伴严重眼部并发症的主要诱因，涉及TLR3和前列腺素E受体3 （EP3亚型）的遗传易感性与疾病易感性有关。这些遗传-环境相互作用影响疾病的发生和发展。在慢性期，严重的干眼和视力损害是主要的长期后遗症，手术和非手术干预均可获得良好的长期治疗效果。综上所述，早期眼科干预对于预防SJS/ ten相关眼部后遗症至关重要，进一步研究遗传和免疫机制对于更好地诊断和治疗至关重要。

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引用次数: 0

Updates in the pathogenesis of SJS/TEN SJS/TEN发病机制的最新进展。

IF 6.2 2区医学 Q1 ALLERGY

Allergology International

Pub Date : 2025-06-04 DOI: 10.1016/j.alit.2025.05.002

Joy Justice , Eric Mukherjee , Michelle Martin-Pozo , Elizabeth Phillips

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions across a spectrum of severity characterized by widespread epidermal detachment and keratinocyte apoptosis. SJS/TEN develops due to a complex immunologic response after exposure to an associated drug antigen and/or its metabolite, and it results in significant morbidity and mortality. Complex immune mechanisms contribute to keratinocyte death. Drug-induced SJS/TEN has been shown to be strongly HLA class I restricted which has contributed to our understanding of mechanisms and has the potential to shape prevention and diagnosis. There is currently no evidence-based treatment outside of aggressive supportive care, and understanding the complete immunopathogenesis of SJS/TEN will be key for the development of efficacious and safe treatments that significantly reduce morbidity and mortality. This article focuses on what is new in the pathogenesis of SJS/TEN, including recent research on the mechanisms of T-cell activation, apoptotic and necroptotic mediators, other related molecules, genetic associations, and possible targeted treatment options.

史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）是严重的皮肤不良反应，其严重程度以广泛的表皮脱离和角化细胞凋亡为特征。SJS/TEN是由于暴露于相关药物抗原和/或其代谢物后的复杂免疫反应而发生的，并导致显著的发病率和死亡率。复杂的免疫机制有助于角化细胞死亡。药物诱导的SJS/TEN已被证明是强烈的HLA I类限制，这有助于我们对机制的理解，并具有塑造预防和诊断的潜力。目前，除了积极的支持治疗之外，还没有基于证据的治疗方法，了解SJS/TEN的完整免疫发病机制将是开发有效和安全的治疗方法的关键，这些治疗方法可以显著降低发病率和死亡率。本文重点介绍SJS/TEN发病机制的最新进展，包括t细胞活化机制、凋亡和坏死介质、其他相关分子、遗传关联以及可能的靶向治疗方案等方面的最新研究。

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引用次数: 0

Examining effects of race and chronic rhinosinusitis on asthma; more evidence for unified-airway diseases 种族和慢性鼻窦炎对哮喘的影响更多关于统一气道疾病的证据。

IF 6.2 2区医学 Q1 ALLERGY

Allergology International

Pub Date : 2025-04-23 DOI: 10.1016/j.alit.2025.03.006

Donyea L. Moore , Evan A. Patel , Bobby A. Tajudeen , Pete S. Batra , Mahboobeh Mahdavinia

引用次数: 0

Recent advances in the diagnosis and treatment of DIHS/DRESS in 2025 2025年DIHS/DRESS诊断和治疗的最新进展。

IF 6.2 2区医学 Q1 ALLERGY

Allergology International

Pub Date : 2025-04-17 DOI: 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.

药物性超敏反应综合征（DIHS）或药物反应伴嗜酸性粒细胞增多和全身症状（DRESS）是一种以一系列临床表现为特征的严重药物反应。这些范围从轻度病例在停止致病药物后消退到涉及复杂疾病进展和潜在死亡的严重病例。DIHS/DRESS的一个特征是疱疹病毒，特别是人类疱疹病毒6 （HHV-6）在病程中连续再激活，导致症状复发。病毒再激活可导致严重并发症，包括感染性DIHS/ dress相关并发症（iDACs）和自身免疫性后遗症（aDACs）。由于其复杂性，管理DIHS/DRESS仍然具有挑战性，需要精确的预测和量身定制的治疗策略。最近的研究表明，使用DIHS/DRESS严重程度（DDS）评分的早期分类可能有助于识别包括dac在内的难治性病例。此外，抗巨细胞病毒（anti-CMV）治疗的早期干预可以减轻由巨细胞病毒再激活引起的iDACs，防止进展为严重的巨细胞病毒相关疾病。长期随访至关重要，因为aDACs甚至可以在发病后3年出现。建议进行连续监测，特别是在接受静脉注射免疫球蛋白或皮质类固醇脉冲治疗的患者中，这是公认的aDAC发展的危险因素。本文综述了DIHS/DRESS的管理策略，重点介绍了其临床特征、病毒再激活的作用和治疗干预措施。

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引用次数: 0

Medical treatment recipient ratio for metal allergy among Japanese children and adolescents: A retrospective cohort study using health insurance claims data (2016–2020) 日本儿童和青少年金属过敏的医疗接受率：2016-2020年健康保险索赔数据的回顾性队列研究

IF 6.2 2区医学 Q1 ALLERGY

Allergology International

Pub Date : 2025-04-17 DOI: 10.1016/j.alit.2025.04.001

Daigo Kato , Takako Miyamae , Yuzaburo Inoue

引用次数: 0

Pharmacogenetic biomarkers associated with risk of developing severe drug eruptions and clinical implementation of HLA genetic testing 与发生严重药疹风险相关的药物遗传学生物标志物和HLA基因检测的临床实施。

IF 6.2 2区医学 Q1 ALLERGY

Allergology International

Pub Date : 2025-04-04 DOI: 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.

人类白细胞抗原（HLA）与药物诱发皮肤糜烂风险的关系已被广泛研究。特定 HLA 等位基因与药物疹相关性的灵敏度约为 50%至 100%，表明 HLA 等位基因对发生此类反应的风险有显著影响。因此，HLA 检测作为一种基因诊断工具，在临床上具有很大的潜力，可以避免药物过敏。例如，在处方卡马西平和拉莫三嗪等已知会引起严重药疹的药物时，预先进行 HLA 基因检测有助于预测个人的风险。这种方法使临床医生能够根据 HLA 基因检测的结果选择替代治疗药物或调整剂量，从而降低药物过敏的总体发病率。

引用次数: 0

Two cases of edible cricket allergy: Antigen analysis and cross-reactivity with shrimp and mite allergens 食用蟋蟀过敏2例：抗原分析及与虾、螨过敏原的交叉反应。

IF 6.2 2区医学 Q1 ALLERGY

Allergology International

Pub Date : 2025-04-03 DOI: 10.1016/j.alit.2025.03.005

Masaki Yamamoto , Tomofumi Kawabe , Yasuhiro Osugi , Nayu Sato , Masashi Nakamura , Kayoko Matsunaga , Takahiko Horiguchi , Akiko Yagami

引用次数: 0

Impact of allergic symptoms on work productivity in allergic rhinitis: A MASK-air direct patient data study 变应性鼻炎患者过敏症状对工作效率的影响：一项口罩-空气直接患者数据研究。

IF 6.2 2区医学 Q1 ALLERGY

Allergology International

Pub Date : 2025-04-02 DOI: 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.

背景：变应性鼻炎可能影响工作效率。本研究旨在评估(i)变应性鼻炎症状对工作表现的不同影响，通过视觉模拟量表（VAS）进行评估；（ii）哮喘合并症对工作效率的影响。方法：我们评估来自MASK-air移动健康应用程序的变应性鼻炎患者的数据。我们通过多变量线性混合效应模型确定了与过敏症状对工作效率影响相关的因素。结果：我们从20,724例患者中研究了260,378天。在多变量回归模型中，鼻腔症状与VAS评分的相关性最强(回归系数= 0.38 [95%CI = 0.38；0.38])。以症状-药物联合评分衡量，鼻炎控制不佳与VAS工作较差相关(回归系数= 0.96 [95%CI = 0.96；0.97])。可能哮喘或可能哮喘患者（可能哮喘的中位数= 9，四分位数范围为22，可能哮喘的中位数为23）的VAS评分中位数大于无哮喘患者（中位数= 3，四分位数范围= 12）（Cohen’s d = 0.60）。在可能患有哮喘的患者中，鼻部和哮喘症状对工作效率的影响相似(VAS鼻部回归系数= 0.32 [95%CI = 0.31；0.32);VAS哮喘回归系数= 0.30 [95%CI = 0.29；0.31])。结论：过敏症状，尤其是鼻症状，与工作效率下降有关。此外，变应性鼻炎和哮喘患者比单独变应性鼻炎患者在工作效率方面表现出更多的损害。

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