Annals of Allergy Asthma & Immunology最新文献

Background: Biologic therapies are recommended for severe, uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP), but evidence in moderate disease remains limited.

Objective: To evaluate the effectiveness of omalizumab in patients with moderate CRSwNP and mild-to-moderate IgE-mediated asthma without prior sinus surgery.

Methods: In this randomized, controlled, open-label study, adult patients were recruited through integrated otolaryngology and allergy clinics. Fifty-nine patients were randomized (3:2) to omalizumab plus standard therapy (n = 36) or standard therapy alone (n = 23) and followed for 12 months. The primary endpoint was change in Nasal Polyp Score (NPS). Secondary endpoints included nasal obstruction, asthma control, exacerbations, systemic corticosteroid use, and biomarkers of type 2 inflammation.

Results: Omalizumab significantly reduced NPS, improved nasal obstruction and asthma control, reduced asthma exacerbations and systemic corticosteroid exposure, and improved biomarkers of type 2 inflammation compared with controls.

Conclusion: Omalizumab is effective in patients with moderate CRSwNP and mild-to-moderate asthma and may have a role earlier in the treatment algorithm for selected patients, pending confirmation in larger, multicenter studies.

Background: Food Protein-Induced Enterocolitis Syndrome (FPIES) is a non-IgE-mediated food allergy presenting in infancy with delayed gastrointestinal symptoms. While cow's milk and soy are common triggers globally, fish has emerged as a significant culprit in Mediterranean regions.

Objective: To describe the clinical profile, natural history, and tolerance development of fish-induced FPIES in a pediatric Greek population.

Methods: A retrospective review was conducted on 96 children, diagnosed with acute fish-induced FPIES at a tertiary pediatric allergy unit in Greece between October 2014 and June 2024. Demographic, clinical, and follow-up data were analyzed, including oral food challenge (OFC) outcomes and multivariable predictors of tolerance.

Results: Median age at first reaction was 11 months, and diagnosis was confirmed by 2 years. Codfish was the most common offending fish and was used in all OFCs. During follow-up, 73% of patients developed tolerance at a median age of 5.5 years. The amount of fish protein tolerated during the OFC exceeded 3 grams (median 10 grams). A higher number of FPIES episodes prior to diagnosis was associated with non-achievement of tolerance (p<0.001). A subset of children (14%) reported mild delayed abdominal discomfort after reintroduction despite a negative OFC, leading to partial avoidance. No IgE sensitization was observed. Atopic comorbidities, particularly allergic rhinitis, were common.

Conclusion: Fish-induced FPIES represents a clinically significant diagnosis among Greek children. Most patients develop tolerance in early childhood, though a subset experiences lingering gastrointestinal discomfort post-reintroduction. These findings highlight the need for awareness, early diagnosis, and careful reintroduction strategies in the management of fish-FPIES.

Background: Inaccurate penicillin allergy (PA) labels are associated with clinical and public health burdens. Although delabeling programs are effective, long-term data on the sustainability of delabeling and patient-centered outcomes remain limited.

Objective: To evaluate 12-month relabeling rates, antibiotic use, and changes in health-related quality of life (HRQoL) after PA evaluation.

Methods: HK-SPADE study was a prospective, longitudinal cohort embedded within the Hong Kong Drug Allergy Delabelling Initiative. Adults referred for suspected PA underwent standardized evaluation including skin test and drug provocation test. Patients were stratified into delabeled (negative drug provocation test result) and confirmed to have allergy groups. Incorrect relabeling, antibiotic reuse, and HRQoL using the Drug Hypersensitivity Quality-of-Life Questionnaire were assessed at 6 and 12 months.

Results: Of 141 patients, 117 (83%) were delabeled and 24 (17%) were confirmed to have allergy. Among 88 delabeled patients with complete follow-up, one-third had reused penicillins but 15 (17%) were incorrectly relabeled within 12 months, despite a territory-wide unified electronic medical record system. Both delabeled and confirmed to have allergy groups demonstrated sustained improvements in Drug Hypersensitivity Quality-of-Life Questionnaire scores at 6 and 12 months (P < .001). Notably, within the confirmed to have allergy group, patients who safely reused non-penicillin antibiotics had further HRQoL improvements compared with those who did not (P = .043).

Conclusion: Incorrect PA relabeling persists despite integrated electronic records, highlighting factors beyond mere documentation errors. Structured PA evaluation confers durable HRQoL improvements for all patients, regardless of delabeling outcome. The findings underscore the need for reinforced educational interventions to protect delabeling success and uphold the broader therapeutic and psychological benefits of delabeling.

Background: Over the past decade, significant progress has occurred with utilizing oral immunotherapy (OIT) in the treatment of IgE-mediated food allergies. Eosinophilic esophagitis (EoE) is a known potential adverse effect of OIT.

Objective: The primary objective was to assess the rate of a new diagnosis of EoE. Secondary objectives included evaluating the development of EoE among patients undergoing single versus multi-food OIT, assessing the symptoms among those who developed EoE, as well as, identifying which foods were associated with the development of EoE.

Methods: A retrospective review of patients undergoing OIT from 2018 through May 2024 at the Children's Hospital of Philadelphia was performed.

Results: This study identified 1200 children who have undergone or were undergoing OIT. A total of 51 patients underwent evaluation for suspected EoE and 8 were ultimately diagnosed with EoE. No difference in EoE development was observed between those on single versus multi-food OIT. Peanut and egg were the most common foods for which patients experienced gastrointestinal symptoms. No patients on milk, wheat or soy OIT were found to have EoE.

Conclusion: In a cohort of 1200 children on OIT at a tertiary pediatric hospital with robust OIT and EoE programs, the rate of newly diagnosed EoE during OIT was found to be 0.7%, which is lower than prior studies. This study demonstrated regular screening before and during OIT is associated with a reduced rate of EoE. Clinicians should be mindful that patients undergoing OIT with more numerous, severe and persistent gastrointestinal symptoms may be at higher risk for EoE.

Background: Allergic rhinitis (AR) involves nasal inflammation from aeroallergens that is treatable with nasal corticosteroids (NCS). However, NCS efficacy following diesel exhaust (DE) exposure and effects on nasal epigenetic age acceleration (EAA) are unknown.

Objective: To investigate the effects of nasal budesonide on AR-related nasal inflammation and nasal EAA following DE exposure.

Methods: In this double-blinded randomized crossover trial, twenty healthy non-smokers with AR used once-daily 256 mcg budesonide and placebo nasal spray for ≥4 weeks each, with an intervening ≥4-week washout. Initial and re-exposure to allergen and DE was completed over consecutive days in separate periods, preceded by ≥2 weeks of pre-treatment/washout. Nasal lavage fluid, nasal brushings, peak nasal inspiratory flow (PNIF), and total nasal symptom scores (TNSS) were collected at treatment baselines, and before and 24h after each exposure. PNIF and TNSS were additionally collected 0.5h post-exposure. Nasal cytokines and EAA were quantified using multiplex assays and Illumina EPIC arrays, respectively.

Results: Reductions in nasal IL-5 from budesonide pre-treatment persisted 24h after initial and re-exposure to allergen and DE, despite their pro-inflammatory effects. Reductions in IL-17A persisted 24h after initial DE exposure. Budesonide increased PNIF 24h after initial and re-exposure to allergen, and at 0.5h after initial exposure and 24h after re-exposure to DE. Allergen-induced TNSS was suppressed by budesonide at 0.5h and 24h after re-exposure. Budesonide and allergen/DE exposures modulated nasal EAA across different clocks.

Conclusion: In allergic rhinitics, prophylactic nasal budesonide spray attenuated nasal inflammation and modulated nasal EAA and PNIF before and after repeated acute exposures to allergen and DE.

Background: Tezepelumab (an anti-thymic stromal lymphopoietin monoclonal antibody) treatment resulted in reduced exacerbations and improved sino-nasal symptoms and health-related quality of life in patients with severe uncontrolled asthma (SUA) and chronic rhinosinusitis with nasal polyps (CRSwNP) in the NAVIGATOR study.

Objective: This post hoc analysis evaluated the effect of tezepelumab versus placebo on sleep disturbances, activity levels and physical exertion tolerance in NAVIGATOR patients with SUA overall and in those with past medical history of comorbid CRSwNP.

Methods: Patients (12-80 years old) with SUA were randomized to receive tezepelumab 210 mg or placebo subcutaneously every 4 weeks for 52 weeks. Patient responses to questionnaire items for sleep disturbance, activity level and physical exertion tolerance in the Asthma Quality of Life Questionnaire (standardized) for patients 12 years and older (AQLQ[S]+12) and St George's Respiratory Questionnaire (SGRQ) were collected at baseline and week 52, and changes in responses from baseline were assessed.

Results: Of 1059 patients treated in NAVIGATOR (tezepelumab, n = 528; placebo, n = 531), 165 (tezepelumab, n = 90; placebo, n = 75) had a history of CRSwNP. At week 52, greater proportions of tezepelumab recipients than placebo recipients reported improvements in the AQLQ(S)+12 and SGRQ sleep disturbance, activity level and physical exertion tolerance items. Compared with the overall population, patients with CRSwNP demonstrated greater tezepelumab-associated improvements across all measures.

Conclusion: Tezepelumab treatment improved sleep quality, activity levels and physical exertion tolerance in patients with SUA, with greater improvements in those with a history of CRSwNP.