Annals of Allergy Asthma & Immunology最新文献

英文中文

Dupilumab impact on psychiatric and sleep disorder risk reduction in atopic dermatitis Dupilumab降低特应性皮炎患者的精神和睡眠障碍风险：一项基于人群的队列研究

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-03-01 DOI: 10.1016/j.anai.2024.11.016

Teng-Li Lin MD , Yi-Hsuan Fan MD , Kuo-Sheng Fan MD , Chao-Kuei Juan MD , Yi-Ju Chen MD, PhD , Chun-Ying Wu MD, MPH, PhD

Background

Patients with atopic dermatitis (AD) have a higher risk of developing psychiatric and sleep disorders.

Objective

To compare the risk of psychiatric and sleep disorders in patients with AD treated with dupilumab vs those on conventional drugs (systemic corticosteroids, methotrexate, cyclosporin, and azathioprine).

Methods

This retrospective cohort study used the TriNetX Global Collaborative Network (LLC, Cambridge, MA) and included adult patients with AD newly prescribed dupilumab (DUPI-cohort) or conventional drugs without previous dupilumab exposure (CONV-cohort). Propensity score matching was performed for age, sex, race, comorbidities, and laboratory measures. Risks of various psychiatric disorders, such as anxiety, depressive disorders, adjustment disorders, and attention deficit hyperactivity disorder, including sleep disorders, were compared between cohorts, with hazard ratios determined using Cox regression.

Results

After matching, both the DUPI- and CONV-cohorts included 6114 patients each, with an average age of 44 years and 53% female. The racial distribution in both cohorts was approximately 49% White, 15% Black or African American, and 12% Asian. During the 3-year follow-up, the DUPI-cohort had reduced risks of anxiety (hazard ratio 0.76, 95% CI 0.64-0.89), depressive disorders (0.70, 0.58-0.86), adjustment disorders (0.535, 0.37-0.78), and sleep disorders (0.78, 0.65-0.94), whereas the risk of attention deficit hyperactivity disorder was not significantly affected (0.92, 0.61-1.38). These findings were consistent across age groups, sexes, races, and atopic comorbidities, with a more pronounced effect in Black or African American patients.

Conclusion

Patients with AD prescribed dupilumab exhibited a lower risk of psychiatric and sleep disorders, with the effect being more evident within the Black or African American subgroup.

背景：特应性皮炎（AD）患者发生精神和睡眠障碍的风险较高。目的：比较dupilumab与常规药物（全身皮质类固醇、甲氨蝶呤、环孢素、硫唑嘌呤）治疗的AD患者发生精神和睡眠障碍的风险。方法：这项回顾性队列研究使用TriNetX全球协作网络，包括新开杜匹单抗（dupi -队列）或未暴露于杜匹单抗的常规药物的成年AD患者（conv队列）。对年龄、性别、种族、合并症和实验室测量进行倾向评分匹配。各种精神疾病的风险，如焦虑、抑郁、适应障碍、注意缺陷多动障碍（ADHD）以及睡眠障碍，在队列之间进行比较，并使用Cox回归确定风险比（hr）。结果：匹配后，DUPI-和convo -队列各纳入6114例患者，平均年龄44岁，53%为女性。两组的种族分布大致为49%的白人，15%的黑人或非裔美国人，12%的亚洲人。在3年的随访中，dupi队列的焦虑（HR 0.76, 95% CI 0.64-0.89）、抑郁障碍（0.70,0.58-0.86）、调整障碍（0.535,0.37-0.78）和睡眠障碍（0.78,0.65-0.94）的风险降低，而ADHD的风险未受显著影响（0.92,0.61-1.38）。这些发现在不同年龄组、性别、种族和特应性合并症中是一致的，在黑人或非裔美国人患者中效果更明显。结论：服用dupilumab的AD患者出现精神和睡眠障碍的风险较低，在黑人或非裔美国人亚组中效果更为明显。

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引用次数: 0

A second look at secondary hypogammaglobulinemia 重新审视继发性低丙种球蛋白血症

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-03-01 DOI: 10.1016/j.anai.2024.12.003

Rose Monahan MD , Iris M. Otani MD , Heather K. Lehman MD , S. Shahzad Mustafa MD

Hypogammaglobulinemia is defined as a reduced immunoglobulin level, which can be either primary due to inborn errors of immunity or acquired in the setting of poor antibody production or increased antibody loss. Secondary hypogammaglobulinemia (SHG) should be considered in patients with a history of immunosuppressive therapy, transplant, protein loss syndromes, certain autoimmune conditions, and malignancies, as it can be associated with increased infectious risk. Appropriate history and lab-based screening in these populations can identify SHG allowing treatment and close monitoring as appropriate. Ideally, treatment focuses on control of the underlying condition or removal of iatrogenic causes of SHG. However, in many cases, treatment of the underlying condition does not reverse SHG or immunosuppressive therapy cannot be discontinued without significant risk to the patient. For these patients, strategies for risk mitigation against infectious complications include vaccination, antibiotic prophylaxis, and immunoglobulin replacement therapy. This report aims to summarize the existing and emerging data in the evaluation and management of SHG and highlight areas that require further investigation.

低丙种球蛋白血症被定义为免疫球蛋白水平降低，这可能是由于先天免疫缺陷引起的原发性疾病，也可能是在抗体产生不良或抗体损失增加的情况下获得的。继发性低γ球蛋白血症（SHG）在有免疫抑制治疗、移植、蛋白质丢失综合征、某些自身免疫性疾病和恶性肿瘤病史的患者中应考虑，因为它可能与感染风险增加有关。在这些人群中进行适当的病史和基于实验室的筛查可以确定SHG，以便进行适当的治疗和密切监测。理想情况下，治疗的重点是控制基础疾病或消除SHG的医源性原因。然而，在许多情况下，对基础疾病的治疗并不能逆转SHG，或者免疫抑制治疗不能在不给患者带来重大风险的情况下停止。对于这些患者，减轻感染并发症风险的策略包括疫苗接种、抗生素预防和免疫球蛋白替代疗法。本报告旨在总结SHG评估和管理方面的现有和新数据，并突出需要进一步调查的领域。

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引用次数: 0

Keeping up with recent developments in immunodeficiency 紧跟免疫缺陷的最新发展。

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-03-01 DOI: 10.1016/j.anai.2024.12.016

Michael W. Tsoulis MD, MS , Kelli W. Williams MD, MPH

Inborn errors of immunity (IEIs) are a rapidly expanding group of monogenetic disorders affecting the immune system. Advancements in genetic testing and functional validation studies have accelerated the pace of IEI gene discovery and mechanism of disease, particularly in the past 5 years. To keep up with this rapid expansion, the International Union of Immunological Societies Expert Committee has periodically, since 1999, released updated IEI classifications with corresponding genotypic and phenotypic catalogues with its most recent update in 2022. Now, there are more than 485 monogenetic disorders of the immune system described among 10 main groups of classification. This article reviews recent clinical developments in IEI, including a closer look at some of the more recently described IEI disorders. In particular, we highlight a few disorders with the following clinical phenotypes of IEI: severe atopy, immunodeficiency with immune dysregulation, immune dysregulation with lymphoproliferation, autoinflammation, and innate phenotype. To aid the clinician, we also provide a diagnostic approach to use when there is suspicion of IEI and a discussion of management and treatment.

先天性免疫缺陷是一种影响免疫系统的单基因疾病。基因检测和功能验证研究的进步加快了IEI基因发现和疾病机制的步伐，特别是在过去五年中。为了跟上这种快速扩张，国际免疫学会联合会（IUIS）专家委员会自1999年以来定期发布最新的IEI分类，包括相应的基因型和表型目录，最近一次更新是在2022年至2015年。目前，免疫系统的单遗传疾病在10个主要分类组中被描述为485多种。本文回顾了最近IEI的临床发展，包括对一些最近描述的IEI障碍的更仔细的研究。我们特别强调了一些具有以下IEI临床表型的疾病：严重特应性、免疫失调的免疫缺陷、淋巴增生的免疫失调、自身炎症和先天表型。为了帮助临床医生，我们还提供了一种诊断方法，用于怀疑IEI和讨论管理和治疗。

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引用次数: 0

Authors’ response

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-03-01 DOI: 10.1016/j.anai.2024.12.020

Jennilee Luedders MD , Sara May MD , Elizabeth Lyden MS , Andrew Rorie MD , Joel Van De Graaff MD , José Zamora-Sifuentes DO , Rhonda Walenz BS , Jill A. Poole MD

引用次数: 0

Modulating mental health risk in atopic dermatitis with dupilumab

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-03-01 DOI: 10.1016/j.anai.2024.12.013

Joy Wan MD, MSCE , Donald Leung MD, PhD

引用次数: 0

Targeted treatment for activated phosphoinositide 3-kinase delta syndrome, CTLA-4 insufficiency, and STAT1 gain-of-function 靶向治疗APDS， CTLA-4, STAT1 - GOF。

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-03-01 DOI: 10.1016/j.anai.2024.11.018

Rebecca R. Saff MD, PhD , Daniel DiGiacomo MD, MPH

引用次数: 0

Functional testing of humoral immunity in the Prevnar 20 era 20世纪20年代体液免疫功能检测。

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-03-01 DOI: 10.1016/j.anai.2024.12.011

Jenna Zuzolo MD , Muhammad F. Zulfiqar BA , Brian Spoelhof PharmD , Rebecca Revell BSPH , James T. Patrie MS , Larry Borish MD , Monica G. Lawrence MD

Humoral immune disorders such as common variable immunodeficiency and specific antibody deficiency are prevalent in clinical practice and require accurate functional testing of humoral immunity for diagnosis and to guide treatment approach. Traditionally, the 23-valent pneumococcal polysaccharide vaccine (PPSV23) has been used to assess polysaccharide antibody responses by measuring pre- and post-vaccination pneumococcal titers. However, the recent introduction of pneumococcal conjugate vaccines (PCVs), such as PCV13, PCV15, and PCV20, into the childhood and adult vaccine schedules has significantly reduced the number of unique serotypes available for testing and in turn has complicated the evaluation process. We retrospectively analyzed serotype-specific antibody responses in patients aged 2 to 65 years who received PPSV23 at the University of Virginia Health System to compare diagnostic outcomes using all 23 serotypes vs the limited number of unique serotypes not included in previous PCVs—11 serotypes for PCV13 recipients and 4 for PCV20 recipients. Our findings reveal that although previous PCVs mean that there is a reduced number of serotypes available for interpretation, PPSV23 testing maintains diagnostic accuracy between 81% and 84%. Despite limitations, the use of PPSV23 remains a valuable tool for identifying patients with clinically significant humoral immune deficiencies. In the future, alternative diagnostic approaches such as Salmonella typhi polysaccharide vaccine response and opsonophagocytosis assays may become more frequently used as part of the evaluation of humoral immune disorders.

体液免疫疾病（如常见变异性免疫缺陷症（CVID）和特异性抗体缺乏症（SAD））在临床实践中很普遍，需要对体液免疫进行准确的功能检测，以便诊断和指导治疗方法。传统上，23 价肺炎球菌多糖疫苗 (PPSV23) 被用于通过测量接种前和接种后的肺炎球菌滴度来评估多糖抗体反应。然而，最近在儿童和成人疫苗接种计划中引入了肺炎球菌结合疫苗 (PCV)，如 PCV13、PCV15 和 PCV20，这大大减少了可用于检测的独特血清型的数量，进而使评估过程复杂化。我们回顾性地分析了弗吉尼亚大学卫生系统接种 PPSV23 的 2-65 岁患者的血清型特异性抗体反应，比较了使用全部 23 种血清型与之前 PCV 未包含的有限数量的独特血清型（PCV13 接种者为 11 种血清型，PCV20 接种者为 4 种血清型）的诊断结果。我们的研究结果表明，尽管以前的 PCV 意味着可用于解释的血清型数量减少，但 PPSV23 检测的诊断准确率仍保持在 81% 到 84% 之间。尽管存在局限性，但使用 PPSV23 仍是识别临床上严重体液免疫缺陷患者的重要工具。未来，伤寒沙门氏菌多糖疫苗反应和嗜蛋白溶血试验等替代诊断方法可能会更常用于体液免疫紊乱的评估。

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引用次数: 0

Information for Readers

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-03-01 DOI: 10.1016/S1081-1206(25)00061-4

引用次数: 0

Perturbations in the airway microbiome are associated with type 2 asthma phenotype and severity 气道微生物组的紊乱与 2 型哮喘的表型和严重程度有关。

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-03-01 DOI: 10.1016/j.anai.2024.11.005

Wei Zhang MD , Lifei Li PhD , Yu Zhang MD , Junjie Dai MD , Chen Qiu MD, PhD , Rongchang Chen MD , Fei Shi MD, PhD

Background

Airway microbiome has been linked to asthma heterogeneity, yet little is known about the associations between airway microbiota and type 2 (T2) asthma phenotype and severity.

Objective

To determine the relationship of nasopharyngeal (NP) and induced sputum (IS) microbiota to the phenotypic features of T2 asthma.

Methods

NP and IS samples from subjects with T2 mild-to-moderate asthma (n = 23), subjects with severe asthma (n = 21), and healthy controls (n = 16) were analyzed. Bacterial microbiota and functional profiles were compared. The correlation between microbial communities and clinical and inflammatory features was evaluated in individuals with asthma of 2 statuses.

Results

Differences in NP and IS microbiota were associated with T2 asthma phenotype. Alterations in NP microbiota were more reflective of T2 inflammation and severity, with additional stratification of a subgroup characterized by significant elevations in T2 inflammatory biomarkers and reductions in bacterial richness and diversity (P < .05). Burkholderia-Caballeronia-Paraburkholderia, Ralstonia, and Rhodococcus were identified as hub taxa within NP microbial network in T2 severe asthma, which were prevalent in the entire airway and involved in bacterial functions including inflammatory and steroid responses (P < .05). The composition and diversity of IS microbiota were complex, with Veillonella as the most altered genus, having an increase with increasing asthma severity.

Conclusion

Our work revealed the significant associations of microbiota perturbations throughout the entire respiratory tract to the extent of T2 inflammation, phenotype and severity in T2 asthma. The specific taxa identified invite further mechanistic investigations to unravel their possibility as biomarkers and therapeutic targets for T2 severe asthma.

背景：气道微生物群与哮喘的异质性有关：气道微生物群与哮喘的异质性有关，但人们对气道微生物群与2型（T2）哮喘表型和严重程度之间的关系知之甚少：我们旨在确定鼻咽部（NP）和诱导痰（IS）微生物群与 2 型哮喘表型特征之间的关系：方法：对患有轻中度哮喘（23 例）和重度哮喘（21 例）的 T2 受试者以及健康对照组（16 例）的鼻咽和诱导痰样本进行分析。比较了细菌微生物群和功能特征。研究了两种状态的哮喘患者的微生物群落与临床及炎症特征之间的相关性：结果：NP 和 IS 微生物群的差异与 T2 哮喘表型有关。NP微生物群的改变更能反映T2炎症和严重程度，对一个亚组进行了额外分层，该亚组的特征是T2炎症生物标志物显著升高，细菌丰富度和多样性降低（P < .05）。Burkholderia-Caballeronia-Paraburkholderia 、Ralstonia 和 Rhodococcus 被确定为 T2 重症哮喘患者 NP 微生物网络中的枢纽类群，它们在整个气道中普遍存在，并参与细菌功能，包括炎症和类固醇反应（P < .05）。IS微生物群的组成和多样性非常复杂，其中Veillonella是变化最大的属，随着哮喘严重程度的增加而增加：我们的研究揭示了整个呼吸道的微生物群紊乱与 T2 期哮喘的炎症程度、表型和严重性之间的重要关联。我们发现的特定类群需要进一步的机理研究，以揭示它们作为 T2 重症哮喘的生物标记物和治疗靶点的可能性。

{"title":"Perturbations in the airway microbiome are associated with type 2 asthma phenotype and severity","authors":"Wei Zhang MD , Lifei Li PhD , Yu Zhang MD , Junjie Dai MD , Chen Qiu MD, PhD , Rongchang Chen MD , Fei Shi MD, PhD","doi":"10.1016/j.anai.2024.11.005","DOIUrl":"10.1016/j.anai.2024.11.005","url":null,"abstract":"<div><h3>Background</h3><div>Airway microbiome has been linked to asthma heterogeneity, yet little is known about the associations between airway microbiota and type 2 (T2) asthma phenotype and severity.</div></div><div><h3>Objective</h3><div>To determine the relationship of nasopharyngeal (NP) and induced sputum (IS) microbiota to the phenotypic features of T2 asthma.</div></div><div><h3>Methods</h3><div>NP and IS samples from subjects with T2 mild-to-moderate asthma (n = 23), subjects with severe asthma (n = 21), and healthy controls (n = 16) were analyzed. Bacterial microbiota and functional profiles were compared. The correlation between microbial communities and clinical and inflammatory features was evaluated in individuals with asthma of 2 statuses.</div></div><div><h3>Results</h3><div>Differences in NP and IS microbiota were associated with T2 asthma phenotype. Alterations in NP microbiota were more reflective of T2 inflammation and severity, with additional stratification of a subgroup characterized by significant elevations in T2 inflammatory biomarkers and reductions in bacterial richness and diversity (<em>P</em> < .05). <em>Burkholderia-Caballeronia-Paraburkholderia, Ralstonia</em>, and <em>Rhodococcus</em> were identified as hub taxa within NP microbial network in T2 severe asthma, which were prevalent in the entire airway and involved in bacterial functions including inflammatory and steroid responses (<em>P</em> < .05). The composition and diversity of IS microbiota were complex, with <em>Veillonella</em> as the most altered genus, having an increase with increasing asthma severity.</div></div><div><h3>Conclusion</h3><div>Our work revealed the significant associations of microbiota perturbations throughout the entire respiratory tract to the extent of T2 inflammation, phenotype and severity in T2 asthma. The specific taxa identified invite further mechanistic investigations to unravel their possibility as biomarkers and therapeutic targets for T2 severe asthma.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 3","pages":"Pages 296-305.e9"},"PeriodicalIF":5.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645087","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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From the pages of AllergyWatch 来自过敏症观察的页面。

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-03-01 DOI: 10.1016/j.anai.2024.11.020

Stanley M. Fineman MD , Samantha Knox MD , Gerald B. Lee MD , Iris Otani MD

引用次数: 0

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