Annals of Allergy Asthma & Immunology最新文献_第6页

Hyperglycemia, receptor for advanced glycation end products, and small airways dysfunction in asthma 高血糖、晚期糖基化终产物受体和哮喘小气道功能障碍。

IF 4.7 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2026-02-01 Epub Date: 2025-10-24 DOI: 10.1016/j.anai.2025.10.023

Paula Sierra Salas MD , Dennis T. Villareal MD , Vickram Tejwani MD , Amrit Koirala PhD , Cristian Coarfa PhD , Meredith C. McCormack MD, MHS , Nicola A. Hanania MD, MS , Tianshi David Wu MD, MHS

Background

Diabetes and insulin resistance are associated with higher risk of asthma exacerbation and preserved ratio impaired spirometry (PRISm), but the pathophysiology is unclear. These conditions may cause small airways dysfunction (SAD), which is an under-recognized cause of PRISm.

Objective

To determine whether insulin resistance and poor glucose control associate with SAD and to explore whether proteins prognostic of diabetes end-organ complications predict lung function abnormalities.

Methods

We recruited a prospective cohort of adults with physician-diagnosed asthma. Fasting insulin, glucose, hemoglobin A1c, and concentrations of 13 proteins prognostic of diabetes end-organ complications were measured. Static insulin resistance was calculated by the homeostatic model assessment of insulin resistance. Lung function was measured by spirometry, and SAD was assessed by impulse oscillometry.

Results

A total of 65 participants were recruited. Mean body mass index was 32.7 kg/m² and 77% were female. There was effect modification by whether participants were taking medications for diabetes, dyslipidemia, or hypertension. Among 53 participants without treated metabolic disease, elevated hemoglobin A1c level was associated with oscillometry abnormalities consistent with SAD and higher odds of PRISm (adjusted odds ratio 5.12; 95% CI 1.15-22.55). Serum soluble receptor for advanced glycation end products, a protein protective of diabetes end-organ complications and which also suppresses airway inflammation in asthma, was associated with lower systemic inflammation, lower hemoglobin A1c level, and improved lung function.

Conclusion

Hyperglycemia was associated with SAD and PRISm in asthma. Soluble receptor for advanced glycation end products may be a biomarker of hyperglycemia-associated lung dysfunction. Longitudinal study is necessary to validate biomarker relationships and understand structural and physiological consequences.

背景：糖尿病和胰岛素抵抗与哮喘加重和保留比值肺功能受损（PRISm）的高风险相关，但其病理生理机制尚不清楚。这些情况可能导致小气道功能障碍（SAD），这是PRISm的一个未被认识的原因。目的：探讨胰岛素抵抗和血糖控制不良是否与SAD相关，并探讨糖尿病终末器官并发症的蛋白预后是否能预测肺功能异常。方法：我们招募了一组医生诊断为哮喘的成人前瞻性队列。测定空腹胰岛素、葡萄糖、血红蛋白A1c和糖尿病终末器官并发症预后的13种蛋白浓度。静态胰岛素抵抗通过胰岛素抵抗的稳态模型评估来计算。肺活量法测定肺功能，脉冲振荡法测定SAD。结果：共招募了65名参与者。平均体重指数为32.7 kg/m2，女性占77%。受试者是否正在服用治疗糖尿病、血脂异常或高血压的药物，会对结果产生影响。在53名未治疗代谢性疾病的参与者中，升高的A1c水平与振荡测量异常相关，与SAD和PRISm的高几率一致（校正优势比5.12;95% CI 1.15-22.55）。晚期糖化终产物的血清可溶性受体，一种保护糖尿病终末器官并发症的蛋白质，也抑制哮喘患者的气道炎症，与较低的全身炎症、较低的血红蛋白A1c水平和改善的肺功能相关。结论：哮喘患者高血糖与SAD、PRISm相关。晚期糖基化终产物可溶性受体可能是高血糖相关肺功能障碍的生物标志物。纵向研究是必要的，以验证生物标志物的关系，并了解结构和生理后果。

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引用次数: 0

Drop ANCHOR with depemokimab or sail to the WAYPOINT with tezepelumab Depemokimab的Drop ANCHOR或Tezepelumab的sail to WAYPOINT: Bucher间接治疗比较

IF 4.7 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2026-02-01 Epub Date: 2025-11-24 DOI: 10.1016/j.anai.2025.11.013

Philipp Suter MD, Robert Greig MbChB, Brian J. Lipworth MD

引用次数: 0

Adherence to inhaled corticosteroid medications after an asthma exacerbation and the risk of subsequent exacerbations 哮喘加重后吸入性皮质类固醇药物的依从性和随后加重的风险。

IF 4.7 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2026-02-01 Epub Date: 2025-08-13 DOI: 10.1016/j.anai.2025.08.007

Mina Khezrian PharmD, PhD , Marjan Kerkhof MD, PhD , Tham T. Le PhD , Tim Harrison MD , Tianshi David Wu MD, MHS , Bill Cook PhD , Jonatan Hedberg MS , Kirsty Rhodes PhD , Nicole Zubizarreta MPH , Joshua Enxing MS , Trung N. Tran MD, PhD

Background

Data on the duration of improved adherence to controller medications after an exacerbation and its impact on asthma outcomes are inconsistent.

Objective

To describe levels and changes in adherence to inhaled corticosteroid (ICS)–containing medication after a severe exacerbation and the association with future exacerbation risk.

Methods

This retrospective cohort study used data from Optum’s deidentified Clinformatics Data Mart Database (October 2015-December 2023). Patients with asthma, 1 or more severe exacerbations, and adherence to ICS-containing therapy (proportion of days covered [PDC]) of less than 80% in the 3 months before an exacerbation were included. Primary and secondary end points were the annualized asthma exacerbation rate and the time to the first subsequent severe exacerbation. End points were compared between patients who improved adherence in the 3 months after the qualifying exacerbation to 80% or more and those who remained at PDC less than 80%. Inverse probability of treatment weighting accounted for between-group imbalances.

Results

Of 68,398 participants, 85% stayed less than 80% PDC, whereas 15% improved to PDC 80% or more at 3 months after the qualifying exacerbation. Of patients with improved PDC, only 40%, 31%, and 22% maintained PDC 80% or more at 3 to 6, 6 to 9, and 9 to 12 months after the qualifying exacerbation, respectively. Improving adherence to PDC 80% or more in the 3 months after the qualifying exacerbation did not reduce annualized asthma exacerbation rate (rate ratio: 0.958 [95% CI 0.912-1.007]) or increase the time to the next exacerbation (hazard ratio: 0.997 [95% CI 0.954-1.041]). Results were consistent in sensitivity analyses.

Conclusion

Improvement in adherence to ICS-containing therapy after a severe exacerbation was transient and not beneficial for exacerbation outcomes, indicating a need to consider alternative treatment strategies in patients with asthma.

背景：关于病情加重后控制药物依从性改善的持续时间及其对哮喘结局的影响的数据不一致。目的：描述严重急性发作后吸入皮质类固醇（ICS）药物依从性的水平和变化及其与未来急性发作风险的关系。方法：本回顾性队列研究使用的数据来自Optum的去识别Clinformatics®数据集市数据库（2015年10月- 2023年12月）。结果：68,398名受试者中，85%的患者坚持使用含ics的治疗（覆盖天数比例[PDC]）。结论：严重加重后对含ics治疗的依从性改善是短暂的，对加重结局没有好处，表明需要考虑哮喘患者的替代治疗策略。

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引用次数: 0

Guidelines and shared decision-making for disruptive innovations in allergy. 变态反应领域颠覆性创新的指导方针和共同决策。

IF 4.7 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2026-02-01 DOI: 10.1016/j.anai.2026.01.019

David B K Golden

引用次数: 0

Peanut sublingual immunotherapy 花生舌下免疫治疗：一种有前途的替代口服免疫治疗嗜酸性食管炎的风险。

IF 4.7 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2026-02-01 Epub Date: 2025-11-28 DOI: 10.1016/j.anai.2025.11.022

Anna A. Ilyasova BSPH, Edwin H. Kim MD, MS

引用次数: 0

Cellular endotypes and nasal cytology 细胞内型和鼻细胞学

IF 4.7 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2026-02-01 Epub Date: 2026-02-02 DOI: 10.1016/j.anai.2025.09.030

Matteo Gelardi MD , Massimo Landi MD , Michele Cassano MD

引用次数: 0

Lessons from the American College of Allergy, Asthma and Immunology inborn errors of immunity survey 来自ACAAI IEI调查的经验教训：为执业过敏症专家-免疫学家推进诊断和治疗策略。

IF 4.7 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2026-02-01 Epub Date: 2025-10-05 DOI: 10.1016/j.anai.2025.09.026

Barbara Ariue MD , Niraj C. Patel MD , Joseph A. Bellanti MD

Background

Inborn errors of immunity (IEIs) have been increasingly well characterized on the molecular and genetic levels. Their clinical recognition and management among practicing allergist-immunologists remain challenging.

Objective

To evaluate the consultative practices of allergist-immunologists in diagnosing and managing IEIs by identifying subtypes encountered, current approaches, multidisciplinary collaboration, barriers, and educational needs.

Methods

The American College of Allergy, Asthma and Immunology distributed a 30-question web-based survey assessing IEI experience through SurveyMonkey to US-based members in a 4-week period during the spring of 2024.

Results

Most IEI consultations originated from outpatient primary care settings (82%), with 56% of respondents providing both outpatient and inpatient consultations. Frequently encountered IEIs included common variable immunodeficiency (100%), specific antibody deficiency (99%), selective IgA deficiency (97%), and C1 esterase inhibitor deficiency (90%). Less frequently encountered were Chediak-Higashi syndrome (40.5%) and type I interferonopathies (41%). The greatest need for subspecialty input was from hematology/oncology for quantitative phagocyte cell defects (89%) and autoimmune lymphoproliferative syndrome caused by a mutation in the FAS gene (74%). Severe combined immunodeficiency and defects of cytotoxicity (50%) most often required expert immunology consultation. The top educational priorities were genetic testing (61%) and gene therapy (60%). The major barriers were complexity and wide range of IEIs (39%) and low referral volume (36%). Comfort levels and need for knowledge varied significantly by practice type and clinician age. A major limitation of this study was the overrepresentation of academic practitioners.

Conclusion

This American College of Allergy, Asthma and Immunology study provides insight into the current consultative practices and management of allergist-immunologists engaging in IEI care. These findings highlight the critical need for enhanced training, improved access to multidisciplinary support, and targeted continuing education to optimize care for patients with these complex disorders.

背景：先天性免疫错误（IEI）在分子和遗传水平上的特征越来越明显。他们的临床识别和管理执业过敏症-免疫学家仍然具有挑战性。目的：通过识别遇到的亚型、目前的方法、多学科合作、障碍和教育需求，评估过敏科-免疫学家在诊断和管理iei方面的咨询实践。方法：美国过敏、哮喘和免疫学学院在2024年春季的四周时间里，通过SurveyMonkey向美国会员分发了一份30个问题的网络调查，评估IEI的体验。结果：大多数IEI咨询来自门诊初级保健机构（82%），56%的受访者同时提供门诊和住院咨询。常见的iei包括常见可变免疫缺陷（CVID）（100%）、特异性抗体缺乏症（99%）、选择性IgA缺乏症（97%）和C1酯酶抑制剂缺乏症（90%）。较少出现的是Chediak-Higashi综合征（40.5%）和I型干扰素病变（41%）。对亚专科输入需求最大的是血液学/肿瘤学的定量吞噬细胞缺陷（89%）和ALPS-FAS（74%）。严重的联合免疫缺陷（SCID）和细胞毒性缺陷（50%）最常需要专家免疫学咨询。最受教育的是基因检测（61%）和基因治疗（60%）。主要障碍是iei的复杂性和范围广（39%）和转诊量低（36%）。舒适程度和知识需求因实践类型和临床医生年龄的不同而有显著差异。本研究的一个主要限制是学术实践者的过度代表性。结论：这项ACAAI研究为目前从事IEI护理的过敏症-免疫学家的咨询实践和管理提供了见解。这些发现强调了加强培训、改善获得多学科支持的机会和有针对性的继续教育的迫切需要，以优化对这些复杂疾病患者的护理。

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引用次数: 0

Basic mechanisms of itch and advances in clinical management 瘙痒的基本机制及临床治疗进展。

IF 4.7 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2026-02-01 Epub Date: 2025-10-02 DOI: 10.1016/j.anai.2025.09.014

Giulia Coscarella MD , Elise Edwards BA , Gil Yosipovitch MD

Chronic pruritus requires comprehensive assessment and management due to its profound impact on quality of life. The etiologies of pruritus are diverse, encompassing dermatologic, neuropathic, systemic, psychogenic, and mixed causes. Pruritogens activate C and Aδ fibers through histaminergic and non-histaminergic pathways. Increasing evidence highlights the role of T_H2 cytokines, particularly interleukin (IL)-4, IL-13, and IL-31, which directly stimulate sensory neurons and perpetuate the itch-scratch cycle. Itch perception arises from dynamic interactions between the immune system and the peripheral and central nervous systems. Signals transmitted by sensory fibers are processed in the dorsal horn and relayed to thalamic and cortical centers, reinforcing chronicity. Diagnostic evaluation begins with detailed history and examination, complemented by laboratory testing such as complete blood cell count, kidney, liver, glucose, and thyroid function tests to uncover systemic or neurologic contributors. For dermatologic conditions, topical immunomodulators, including corticosteroids, calcineurin inhibitors, and PDE4 (phosphodiesterase-4) inhibitors, are first-line options for localized itch. Extensive itch may require systemic immunosuppressants or phototherapy. Biologic agents targeting IL-4/IL-13 and IL-31 pathways have revolutionized treatment for atopic dermatitis and prurigo nodularis, whereas Janus kinase signal transducer and activator of transcription inhibitors also offer significant antipruritic effect in atopic dermatitis and beyond. Neuropathic itch may respond to topical anesthetics, menthol, pramoxine, capsaicin, or compounded ketamine-amitriptyline-lidocaine formulations, and systemic gabapentinoids and antidepressants. Systemic or intractable pruritus may benefit from kappa opioid receptor agonists. New drugs targeting the mast cell such as Bruton’s tyrosine kinase inhibitors, c-KIT inhibitors, and MRGPRX2 antagonists have robust anti-pruritic effects in mast cell–mediated diseases. Supportive measures, including psychosocial interventions, remain integral to long-term management.

由于慢性瘙痒对生活质量的深刻影响，需要全面的评估和管理。瘙痒的病因是多种多样的，包括皮肤病、神经性、全身性、心因性和混合病因。搔痒原通过组胺能和非组胺能途径激活C和Aδ纤维。越来越多的证据强调了Th2细胞因子的作用，特别是白细胞介素(IL)-4、IL-13和IL-31，它们直接刺激感觉神经元并使瘙痒-抓痒循环持续下去。瘙痒感产生于免疫系统与外周和中枢神经系统之间的动态相互作用。由感觉纤维传递的信号在背角被处理并传递到丘脑和皮层中心，从而加强了慢性。诊断评估从详细的病史和检查开始，辅以实验室检查，如全血细胞计数、肾、肝、葡萄糖和甲状腺功能检查，以发现全身性或神经系统疾病。对于皮肤病，局部免疫调节剂——包括皮质类固醇、钙调磷酸酶抑制剂和PDE4抑制剂——是局部瘙痒的一线选择。广泛的瘙痒可能需要全身免疫抑制剂或光疗。靶向IL-4/IL-13和IL-31途径的生物制剂已经彻底改变了特应性皮炎和结节性痒疹的治疗，而JAK-STAT抑制剂也在特应性皮炎及其他疾病中具有显著的止痒作用。神经性瘙痒可能对局部麻醉剂有反应：薄荷醇、普拉莫辛、辣椒素或复合氯胺酮-阿米替林-利多卡因制剂，以及全身加巴喷丁类药物和抗抑郁药。系统性或难治性瘙痒可能受益于阿片受体激动剂。针对肥大细胞的新药物，如BTK抑制剂、c-KIT抑制剂和MRGPRX2拮抗剂，在肥大细胞介导的疾病中具有强大的抗瘙痒作用。支持性措施，包括社会心理干预，仍然是长期管理的组成部分。

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引用次数: 0

Characterization of food protein-induced enterocolitis syndrome among Asian American children 亚裔美国儿童食物蛋白诱导的小肠结肠炎综合征的特征。

IF 4.7 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2026-02-01 Epub Date: 2025-11-11 DOI: 10.1016/j.anai.2025.11.002

Charles Feng MD , Priscilla Wong MD , Satish Mudiganti MS , Xiaowei Yan MS, PhD, MPH , Diamonne Mitchell MPH , Ngoc Tran MD , Latha Palaniappan MD, MS , Anna Chen Arroyo MD, MPH

Background

Limited data currently exist regarding the clinical characteristics of food protein-induced enterocolitis syndrome (FPIES) among Asian American (AsA) children.

Objective

To evaluate a cohort of AsA children with FPIES in a Northern California health care system.

Methods

We performed a retrospective analysis of children below 18 years of age with more than or equal to 1 outpatient clinical encounter with FPIES (International Classification of Diseases, 10th Revision, Clinical Modification, K52.21) diagnosed between October 1, 2015, and December 31, 2022. Patient/parent self-reported race/ethnicity was used. Two board-certified allergists reviewed the charts of all AsA children diagnosed with having FPIES. Market basket analysis was performed to identify correlations among FPIES food categories.

Results

Of 129,989 AsA children, 146 (0.11%) had acute FPIES, most of which were male (52%) and had atopic dermatitis (55.5%). Median age at diagnosis was 7 months. Among 21 children (14%) who underwent oral food challenges, 66.6% (14/21) passed the challenge. Multi-food FPIES was observed in 23.9% (35/146) and atypical FPIES was observed in 14.4% (21/146) of the cohort. Approximately 28% of Asian Indian and 10% of Filipino children had more than 1 trigger food. The most common culprit foods included egg (36.3%), oats (24%), milk (16.4%), avocado (9.6%), rice (6.8%), and peanut (5.5%). Market basket analysis revealed that having an egg-related trigger was associated with not having an avocado-related trigger, with a confidence level of 88% and a lift value of 1.33.

Conclusion

This large pediatric AsA FPIES cohort demonstrates distinguishing features, including a high proportion of egg FPIES and lack of common food co-associations. Understanding these clinical differences may significantly enhance clinicians’ ability to diagnosis and manage FPIES among the rapidly growing heterogeneous AsA population.

背景：目前关于亚裔美国人（AsA）儿童食物蛋白性小肠结肠炎综合征（FPIES）临床特征的数据有限。目的：我们评估北加州医疗保健系统中AsA儿童的FPIES队列。结果：129989例AsA患儿中，146例（0.11%）有急性FPIES，其中多数为男性（52%），并有特应性皮炎（55.5%）。诊断时的中位年龄为7个月。在21名（14%）接受口腔食物挑战的儿童中，66.6%（14/21）通过了挑战。23.9%（35/146）的患者出现多种食物FPIES， 14.4%（21/146）的患者出现非典型FPIES。大约28%的亚洲印度儿童和10%的菲律宾儿童食用了bbb1触发食物。最常见的罪魁祸首食物包括鸡蛋（36.3%）、燕麦（24%）、牛奶（16.4%）、鳄梨（9.6%）、大米（6.8%）和花生（5.5%）。MBA表明，有鸡蛋相关的触发因素与没有鳄梨相关的触发因素相关，置信水平为88%，提升值为1.33。结论：这个大型儿童AsA FPIES队列显示出明显的特征，包括鸡蛋FPIES比例高和缺乏常见的食物联合关联。了解这些临床差异可以显著提高临床医生在快速增长的异质AsA人群中诊断和管理FPIES的能力。

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引用次数: 0

Basophils in atopic dermatitis 嗜碱性粒细胞在特应性皮炎中的免疫学作用和临床意义。

IF 4.7 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2026-02-01 Epub Date: 2025-11-15 DOI: 10.1016/j.anai.2025.11.005

Mrinmoy Das PhD , Raif S. Geha MD

Atopic dermatitis (AD) or eczema is a chronic inflammatory skin disease, characterized by dysfunction of the epidermal skin barrier causing increased sensitization to environmental allergens. The resulting type 2-dominated local and systemic immune responses cause epidermal hyperplasia, dermal infiltration by T cells and eosinophilia, and elevated levels of total and allergen‐specific IgE. In addition, the skin of patients with AD is often colonized with Staphylococcus aureus which correlates with diseases severity. Recent emerging studies highlight a significant role for basophils in both local and systemic responses of AD pathogenesis. Although rare in the circulation, basophils rapidly infiltrate inflamed skin, and on activation, they release IL-4 and IL-13, which are key players in the development of AD. They also secrete mediators such as histamine, leukotrienes, and IL-31 which contribute to inflammation and pruritus. Basophils also influence through their production of IL-4 T-cell polarization and B-cell class switching, supporting systemic sensitization and the development of atopic march. Basophils are gaining recognition as clinically actionable contributors to AD. The basophil activation test, which measures the activation of basophils in the blood in response to specific allergens, offers promising tools for assessing AD pathogenesis and response to treatment. In addition, therapies such as dupilumab, tralokinumab, and nemolizumab which target IL-4, IL-13, and IL-31, respectively, likely exert part of their effect by modulating basophil activity. In this review, we summarize the immunologic functions of basophils in AD pathogenesis, discuss their relevance as biomarkers and therapeutic targets, and outline future directions for integrating basophil-focused strategies in the management of patients with AD.

特应性皮炎（AD）或湿疹是一种慢性炎症性皮肤病，其特征是表皮皮肤屏障功能障碍，导致对环境过敏原的敏感性增加。由此产生的2型主导的局部和全身免疫反应导致表皮增生，T细胞和嗜酸性粒细胞的真皮浸润，总IgE和过敏原特异性IgE水平升高。此外，AD患者的皮肤常定植金黄色葡萄球菌，这与疾病的严重程度有关。最近新出现的研究强调了嗜碱性细胞在AD发病机制的局部和全身反应中的重要作用。虽然在循环中很少见，但嗜碱性细胞迅速浸润炎症皮肤，并在激活后释放IL-4和IL-13，这是AD发展的关键因素。它们还会分泌组胺、白三烯和IL-31等导致炎症和瘙痒的介质。嗜碱性粒细胞还通过产生IL-4 T细胞极化和B细胞类别转换来影响，支持全身致敏和特应性进行的发展。嗜碱性粒细胞被认为是阿尔茨海默病的临床可操作的贡献者。嗜碱性粒细胞激活试验，测量血液中嗜碱性粒细胞对特定过敏原的激活，为评估AD的发病机制和治疗反应提供了有希望的工具。此外，dupilumab、tralokinumab和nemolizumab等分别靶向IL-4、IL-13和IL-31的疗法可能通过调节嗜碱性粒细胞活性来发挥部分作用。在这篇综述中，我们总结了嗜碱性粒细胞在阿尔茨海默病发病机制中的免疫功能，讨论了它们作为生物标志物和治疗靶点的相关性，并概述了在阿尔茨海默病患者管理中整合以嗜碱性粒细胞为重点的策略的未来方向。

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引用次数: 0