Journal of Investigational Allergology and Clinical Immunology最新文献

Eosinophilic esophagitis (EoE) is a chronic allergic condition affecting the esophagus and driven by food antigens. Many individuals diagnosed with EoE have other allergic conditions, such as food allergy, asthma, allergic rhinitis, and atopic dermatitis. The clinical goals of therapy in EoE include symptomatic, histologic, and endoscopic remission. The current paradigm for the treatment of EoE in Spain includes proton pump inhibitors, swallowed topical corticosteroids, and food elimination diets. These treatments have proven very effective in clinical studies. In April 2024, the Spanish Agency for Medicines and Medical Products approved dupilumab as the second drug for the treatment of EoE, thus adding this biologic to the therapeutic arsenal in EoE. The present review includes a positioning statement by the authors, all of whom are members of the Spanish Society of Allergy and Clinical Immunology Food-EoE Working Group.

Background: Hereditary angioedema (HAE) is a rare and potentially life-threatening disease, and diagnosis is often missed or delayed. We aimed to identify noninvasive urinary protein biomarkers and to evaluate their potential roles in diagnosis and evaluation of disease severity.

Methods: Using data-independent acquisition (DIA)-based urinary proteomics, we identified proteins that were differentially expressed between patients with HAE and healthy control (HC) groups. Then, the parallel reaction monitoring (PRM)-targeted proteomics method was used to validate promising biomarker candidates in other HAE patients and HCs. Furthermore, enzyme-linked immunosorbent assay (ELISA) was conducted to verify levels of several key proteins in HAE, histamine-mediated angioedema, and HCs.

Results: Differential expression between HAE patients and HCs was observed in 269 of the 2562 urinary proteins identified. In the biofunction analysis, these differentially expressed proteins were significantly enriched in leukocyte migration, adhesion of immune cells, endothelial cell development, permeability of the vascular system, and death of immune cells. Moreover, a biomarker panel (C1 esterase inhibitor, pro-epidermal growth factor, and kininogen-1) was validated in 2 independent clinical cohorts with area under the curve values of 0.910 and 0.949 for a diagnosis of HAE. Additionally, the urinary clusterin level was found to be significantly correlated with HAE severity scores (R=-0.758, P<.01).

Conclusions: This study describes the first application of a DIA-PRM-ELISA workflow to identify noninvasive urine biomarkers of HAE. The results will contribute to our understanding of the pathogenesis of HAE and may also provide a potential alternative method for diagnosis and evaluation of disease severity.

Background and objectives: The diagnostic criteria of chronic rhinosinusitis with nasal polyps (CRSwNP) include olfactory dysfunction. We hypothesize that patients with CRSwNP can self-assess their sense of smell better using a visual analog scale (VAS) than using smell tests.

Methods: A controlled cross-sectional study was performed. Adults diagnosed with severe CRSwNP waiting for endoscopic sinus surgery were included. A cohort of healthy controls was also studied. All participants completed the Barcelona Smell Test 24 (BAST-24), the 22-item Sinonasal Outcomes Test 22 (SNOT-22), and a VAS for loss of smell. Patients with CRSwNP underwent blood testing (eosinophil count, total serum IgE), computed tomography (Lund-Mackay Score), and nasal endoscopy.

Results: The study population comprised 138 patients with severe CRSwNP and 40 controls. The BAST-24 identification score was strongly correlated with the VAS score in the CRSwNP group (p=-0.79, P<.001) but not in the control group (p=-0.14; P=.39), this difference between groups being statistically significant (P<.001). A significant correlation was found between SNOT-22 item 21 (loss of smell) and BAST-24 identification (p=-0.65, P<.001), this difference being statistically significant (Z=-2.43; P=.015). The area under the receiver operating curve was 0.85, with 72.5% sensitivity and 93.1% specificity.

Conclusion: This study demonstrates a potential role of the VAS score for the screening of olfactory dysfunction in severe CRSwNP in daily clinical practice.

Background: Allergic disease affects up to 40% of the adult population worldwide. This percentage is increasing as a result of environmental changes related to global warming.

Methods: We undertook a systematic review of the literature to identify and evaluate current evidence on the impact of climate change-related environmental factors on allergen production and the epidemiology and severity of allergic diseases. We applied the Population, Exposure, Comparison, Outcome (PECO) criteria to guide our 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). Study quality was assessed using the Mixed Methods Appraisal Tool.

Results: Of 195 studies, 40 were considered relevant, and 9 provided data that could be included in the quantitative data synthesis. Environmental factors, including the presence of pollutants, temperature, and drought influenced the type, volume, and timing of exposure to local aeroallergens. The most relevant environmental factor was the presence of environmental pollutants, of which tropospheric ozone was the most frequently associated with changes in allergen production and prevalence and severity of allergic disease. Several publications also demonstrated the impact of environmental factors on health care burden.

Conclusions: Climate change-related environmental factors worsened allergic disease in terms of prevalence, severity, and health care burden owing to alterations in allergen exposure (volume and type), with the presence of pollutants such as ozone being the most common drivers of this increase.