Journal of Investigational Allergology and Clinical Immunology最新文献

Background and objectives: Many fish-allergic patients only react to certain fish species and may tolerate others, mostly because of IgE-mediated recognition of specific epitopes on the major allergen parvalbumin. However, the considerable number of fish species consumed makes it challenging to identify which species are allergenic and which are tolerated by individual patients. In order to improve the diagnosis of fish allergy, we investigated IgE-mediated reactivity to parvalbumins from 12 freshwater fish species that are largely underrepresented in diagnostic tests.

Methods: Parvalbumins were purified from 12 freshwater fish species belonging to 8 families, and their isoform composition was analyzed using mass spectrometry. IgE specific for each parvalbumin was quantified in serum samples from 66 fish allergic individuals, and basophil activation tests were performed for 5 patients. Crosswise inhibition assays were carried out for all parvalbumins for 7 patients to investigate cross-reactivity between the parvalbumins from the different species.

Results: IgE binding and cross-linking potency of the parvalbumins differed, with the strongest reactivities observed for 4 parvalbumins from the salmonid family (results positive for 89%-95% of patients) and the weakest for parvalbumins from Wels catfish, European eel, and tench (results negative for ≥50% of patients). Ninety percent of the patients with negative results for Wels catfish parvalbumin also had negative results for additional parvalbumins from multiple species. Inhibition assays revealed variable recognition of epitopes by several patients, with the primary sensitizers most frequently being parvalbumins from salmonids and percids.

Conclusion: Including freshwater salmonids in the diagnostic work-up for fish allergy may help to identify most fish-allergic patients. IgE to Wels catfish could help distinguish between polysensitized and oligosensitized patients.

Asthma remains a significant public health challenge, requiring precise diagnostic and management strategies. Pulmonary function tests (PFTs) are essential in assessing disease severity, guiding treatment decisions, and monitoring disease progression. The 2022 ERS/ATS technical standards introduced critical updates to enhance the accuracy and standardization of pulmonary function interpretation. These modifications include the adoption of Global Lung Initiative (GLI) reference values, the transition from race-based to race-neutral equations, the replacement of percent-predicted values with z-scores, and a redefinition of bronchodilator responsiveness criteria. Additionally, new spirometric patterns such as dysanaptic impairment and preserved ratio impaired spirometry (PRISm) have been recognized, improving the detection and characterization of airflow limitation. These updates significantly impact asthma management by refining disease phenotyping, improving diagnostic precision, and guiding more personalized treatment strategies. Furthermore, advancements in artificial intelligence are expected to enhance predictive analytics and early intervention strategies in pulmonary function assessment. However, challenges remain in the clinical adoption of these modifications, particularly regarding the classification of disease severity and the impact of race-neutral equations on diagnostic thresholds. Future research is necessary to validate the long-term implications of these changes on asthma outcomes. Clinicians must familiarize themselves with the evolving standards to optimize patient care and reduce health disparities. The 2022 ERS/ATS guidelines represent a substantial advancement in pulmonary function assessment, with the potential to improve both clinical decision-making and patient prognosis in asthma management.

Background: Allergic diseases affect up to 40% of adults worldwide, a percentage that is increasing with environmental changes related to global warming.

Methods: A systematic review of the literature was performed to identify and evaluate current evidence of the effect of climate change-related environmental factors on the prevalence, incidence, and severity of allergic diseases in terms of the impact on patients with allergy. PECO criteria for 2 research questions were established and guided the literature searches of the PubMed and Cochrane databases (January 1, 2016 to December 31, 2021). Study outcomes were categorized and grouped to facilitate data synthesis. Outcomes were classified as significant (P<.05), nonsignificant (P>.05), or undetermined (P value not reported).

Results: Assessment of the 2 questions enabled us to identify 609 publications. Of these, 96 were assessed for eligibility and 42 provided data. Environmental factors, including the presence of pollutants, influenced patients' conditions in terms of effects on allergy, exposure to allergen(s), and the immune system. The pollutants most frequently reported to have an impact were nitrogen dioxide (NO2) and particles <2.5 μm in diameter. The allergic diseases most frequently reported to be affected by environmental factors were respiratory disease (asthma and rhinitis) and atopic dermatitis, with an impact on epidemiology and health care burden.

Conclusion: Environmental pollution increased the frequency and health care burden of allergic diseases. The effect of environmental pollution was predominantly caused by pollutants such as NO2 and particles <2.5 μm in diameter and was observed across allergic diseases, including respiratory disease (asthma and rhinitis) and atopic dermatitis.