Journal of Investigational Allergology and Clinical Immunology最新文献

Mast cell diseases (MCDs) comprise several entities that are characterized by activation and/or proliferation of mast cells (MCs), leading to the appearance of cardinal symptoms. Such activation may be due to exaggerated functioning of MCs or to a mutation in a tyrosine kinase (usually the D816V mutation in KIT), which is a characteristic feature of systemic mastocytosis (SM) and/or clonal MC activation syndromes. Depending on the MC burden and tissue infiltration, SM can be classified as advanced or nonadvanced. Traditionally, the treatment of MCDs has been based on best supportive care. In cases of advanced SM that responds poorly to best supportive care, management can also take the form of non-target-directed cytoreductive treatment, administration of monoclonal antibodies, targeted therapies, and even bone marrow transplantation. The advance of personalized medicine has led to the emergence of new and more specific tyrosine kinase inhibitors (TKIs), which achieve greater symptom control and improve disease course, sometimes leading to remission. In recent years, clinical trials have been carried out to evaluate the effectiveness of some of these TKIs in nonadvanced forms of mastocytosis, with eventual approval for this subtype in some cases. TKIs represent a major advance in the management of MCDs, with more patients being able to benefit from a treatment that addresses pathophysiology. We review the main TKIs currently available for SM, their indications, and their safety and effectiveness.

Background and objectives: The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines classify rhinitis as "intermittent" or "persistent" and "mild" or "moderate-severe". Objectives: To assess ARIA classes in a real-world study in terms of phenotypic differences and their association with asthma.

Methods: We performed a cross-sectional real-world study based on users of the MASK-air® app who reported data for at least 3 different months. We assessed the frequency of users according to the ARIA classes and compared these classes in terms of rhinitis symptoms, use of comedication, frequency of comorbid asthma, and the association between comorbid asthma and rhinitis control.

Results: A total of 2273 users (180 796 days) were assessed. Most users had moderate-severe rhinitis (n=2003; 88.1%) and persistent rhinitis (n=1144; 50.3%). The frequency of patients with probable asthma was 35.7% (95%CI, 34.5%-37.0%) for intermittent rhinitis and 48.5% (95%CI, 47.1%-49.9%) for persistent rhinitis. The maximum values on the visual analog scale (VAS) for rhinitis symptoms and the combined symptom-medication score were lower in patients with mild rhinitis than in those with moderate-severe rhinitis (irrespective of whether they had persistent or intermittent rhinitis). In most ARIA classes, VAS nose and VAS eye and rhinitis comedication were more frequent in patients with rhinitis+asthma than in those with rhinitis alone.

Conclusions: This study suggests that the presence of asthma is more closely related to persistence of rhinitis than to severity and that the presence of comorbid asthma may be associated with poorer control of rhinitis across the different ARIA classes.

The efficacy and safety of allergen immunotherapy (AIT) have been demonstrated in randomized controlled trials (RCTs). However, differences in study protocols, populations, and AIT products lead to variability in outcomes. The World Allergy Organization and the European Academy of Allergy and Clinical Immunology advise assessing individual AIT products rather than assuming a universal class effect. We conducted a meta-analysis on the efficacy and safety of 5-grass pollen liquid sublingual immunotherapy (SLIT) (5-grass SLIT liquid) in patients affected by allergic rhinoconjunctivitis (ARC) with and without asthma. We searched computerized databases (MEDLINE, ISI Web of Science, LILACS, the Cochrane Library, ClinicalTrial.gov) up to June 2023, supplemented our approach with manual literature searches, and included RCTs comparing 5-grass SLIT-liquid to placebo, irrespective of primary endpoints or treatment duration. Efficacy was assessed based on standardized mean differences (SMDs) in symptom score (SS) and medication score (MS). Subgroup analyses included age and sensitization status, while meta-regression was applied to evaluate asthma comorbidity, dose, and treatment duration. Bias and certainty of evidence were assessed using the Cochrane Risk of Bias 2 tool and the Grading of Recommendations Assessment, Development and Evaluation approach. Data from 8 RCTs for SS (621 patients) and 6 RCTs for MS (507 patients) showed a significant benefit for SLIT over placebo in SS (SMD, -0.34; 95%CI, -0.62 to -0.06; P<.05) and MS (SMD, -0.54; 95%CI, -0.97 to -0.10; P<.05). Subgroup analyses showed no differences based on age or sensitization status. Meta-regression revealed no significant impact of cumulative dose, treatment duration, or asthma on efficacy. No safety issues were observed. This meta-analysis confirms that 5-grass SLIT-liquid offers significant clinical benefits and is safe, providing an effective option for treating the cause of ARC in patients with and without asthma.

Background and objectives: Pollen-food allergy syndrome (PFAS) is a frequent comorbidity in individuals with hay fever. Identifying risk factors and allergen clusters can aid targeted interventions and management strategies. Objective: This study characterizes PFAS in patients with hay fever and identifies associated risk factors using the mobile health platform, AllerSearch.

Methods: A digital cross-sectional cohort study was conducted in Japan from August 2020 to September 2024. Participants provided demographic, medical, lifestyle, and environmental data via AllerSearch. PFAS was identified based on self-reported allergic reactions to specific fruits and vegetables. Allergen patterns were analyzed using Uniform Manifold Approximation and Projection clustering, and risk factors were assessed via multivariable logistic regression.

Results: Among 2874 participants, 2352 had hay fever, and 1788 (23.9%) reported PFAS. The most common triggers were melon (22.9%), kiwi (18.3%), and tomato (11.7%). Significant risk factors included a history of allergic disease (OR, 1.58), asthma (1.44), atopic dermatitis (1.90), urticaria (2.73), contact lens discontinuation during hay fever season (1.50), sensitivity to yellow sand or particulate matter 2.5 (3.42), and drug allergy (3.04). Seven allergen clusters were identified, with Cluster 6 exhibiting broad allergen sensitivity and the remaining clusters each associated with a single food. Onset of hay fever was earlier in Clusters 1, 4, and 6 than in non-PFAS individuals (P=.002, P=.002, and P=.002, respectively).

Conclusions: This study highlights key factors and allergen clusters associated with PFAS using a mobile health approach. Our findings may facilitate tailored interventions and improve quality of life for affected individuals.

Background: Dynamic hyperinflation (DH), characterized by an abnormal increase in operative lung volumes during exercise, is associated with breathlessness and exercise intolerance. This study aimed to evaluate the relationship between DH and control of symptoms in patients with moderate-severe asthma.

Methods: A cross-sectional, multicenter, observational study was conducted in patients with moderate-severe asthma. DH was defined as a decrease in inspiratory capacity after a 6-minute walk test (6MWT), and asthma control was measured using the Asthma Control Test (ACT) and Spanish Guidelines for the Management of Asthma (GEMA). Secondary variables included sensitization to aeroallergens (prick test), quality of life (miniAQLQ), anxiety or depression, dyspnea (mMRC), fatigue (Borg scale), and small airway dysfunction (oscillometry).

Results: Among the 154 patients analyzed, 97 (63%) had DH. ACT scores did not differ significantly between patients with and without DH (20.8 [4.4] vs 21.7 [3.6]; P=.411). However, the percentage of patients with partially and poorly controlled asthma according to GEMA was significantly higher in the DH group than in those without DH (40.2% vs 24.6%; P=.048). Compared with patients without DH, patients with DH had higher dyspnea scores (0.9 [0.9] vs 0.5 [0.6]; P=.009), greater fatigue before the 6MWT (1.3 [1.9] vs 0.5 [1.1]; P=.004), higher respiratory reactance (0.7 [1.2] vs 0.4 [1.2] cmH2O/L/s; P=.032), higher depression scores (4.2 [3.7] vs 2.1 [2.1], P=.002), and lower sensitization to aeroallergens (45.4% vs 68.4%; P=.014).

Conclusions: Although no relationship was found between DH and uncontrolled asthma via the ACT, the proportion of patients with uncontrolled asthma according to GEMA was significantly higher in the DH group.