Allergy Asthma and Clinical Immunology最新文献

Background: Antibiotic use in infants is hypothesized to alter the gut microbiota, influencing immune system dysregulation and increasing allergy risk. We aim to assess the prevalence of allergic diseases in children treated with different classes of antibiotics in early life.

Methods: A retrospective cohort study was conducted from April 2024 to January 2025 in three main hospitals in the West Bank in Palestine. Records of pediatric admissions of children who received antibiotic treatment within their first six months of life were reviewed, followed by parents' interview regarding the development of allergies.

Results: A total of 423 medical records were included. The average age of children was 7.33 ± 1.38 years (mean ± SD), and 62.41% of them were males. The total prevalence of allergic diseases was 29.55%. Common manifestations of allergies were skin reactions (70.4%), wheezing (16.8%), and respiratory symptoms (10.4%). Among the most common reported triggers were food (10.17%) and dust (7.33%). The most commonly prescribed antibiotics were Beta-lactams; cefotaxime (78.49%), and ampicillin (63.59%). No statistically significant association was found between the number of antibiotics used and the development of allergies (p = 0.45). Similarly, different classes of antibiotics did not show an impact on developing allergies except for Trimethoprim/Sulfamethoxazole (p = 0.05). A significant decrease in allergy was observed with increasing age (p = 0.011).

Conclusion: Allergic conditions affect about one third of children treated with antibiotics in early life. While allergic conditions tended to decrease with age, no association was observed between antibiotic number/class and later allergy, except for a hypothesis-generating signal toward lower odds with TMP-SMX.

Objective: observing the clinical effects of dust mite sublingual immunotherapy (SLIT) on children with asthma, changes of Th17 / Treg cells and related cytokines in order to investigate the possible pathological mechanism of immune tolerance induced by SLIT.

Methods: Sixty children with asthma allergic to dust mites were included, divided into SLIT group (n = 30) and non-SLIT group (n = 30). Clinical symptoms of asthma in each group had been scored before, 1 year and 2 years after treatment. Meanwhile we also evaluated the proportion of Th17 and CD4⁺CD25⁺ Treg cells in peripheral blood using flow cytometry. Besides, cell culture supernatant was collected to detect the changes of IL-6, IL-10 and IL-17 levels.

Results: We found that in SLIT group, asthma symptom and drug use score, Th17 cell percentages, IL-6 and IL-17 levels have significantly decreased throughout the study period (p < 0.05), while FEV1%, Treg cell percentages and IL-10 level have prominently increased throughout the study period (p < 0.05). By contrast, in non-SLIT group, asthma symptom score, lung function, Th17 cell percentages, IL-6 and IL-17 levels have all significantly improved, but on the whole lower than SLIT group (p < 0.05). However, we have observed no statistical differences in drug use score, Treg cell percentages, IL-10 level for non-SLIT group throughout the study period.

Conclusions: SLIT of Dust mite drops could change T immune cell profiles whereas improve asthma symptoms. SLIT might reverse the functional imbalance of Th 17 / Treg cells and induce immune tolerance by upregulating Treg cell function and downregulating Th17 cell function.

Background: WHIM syndrome is a rare autosomal dominant primary immunodeficiency characterized by the classical tetrad of warts, hypogammaglobulinemia, infections, and myelokathexis. The majority of cases are associated with gain-of-function mutations in the CXCR4 gene. Recent studies have expanded the clinical spectrum of the disease, revealing that only a subset of patients present with all four hallmark features. This underscores the syndrome's variable expression and the need for greater clinical awareness of its atypical forms.

Case presentation: We report a case of a 6-year-old Saudi girl who presented with persistent neutropenia, recurrent upper respiratory infections, and an episode of thrombocytopenia following a dental procedure. She did not exhibit warts, hypogammaglobulinemia, or myelokathexis. Immunological workup revealed marked lymphopenia affecting T, B, and NK cells, while immunoglobulin levels remained within normal limits. Bone marrow findings were unremarkable. Whole-exome sequencing identified a heterozygous de novo CXCR4 frameshift mutation (c.1172_1173del), confirming the diagnosis of WHIM syndrome. The patient was clinically stable and managed conservatively with precautions.

Conclusion: This case contributes to the evolving understanding of the clinical variability in WHIM syndrome and highlights the importance of genetic testing in patients with unexplained neutropenia and recurrent infections, even in the absence of the complete clinical tetrad.

Perilla seed (PS), a common food in East Asia, has emerged as a leading cause of seed-induced anaphylaxis in Korean children, yet its allergenic proteins remain unidentified. Oleosins, hydrophobic oil-body (OB)-associated storage proteins, are recognized allergens in peanuts, hazelnuts, and sesame, and preliminary evidence suggests a similar role in PS. However, the intrinsic challenges of extracting lipophilic proteins have hindered systematic investigation. This study aimed to purify PS OBs, isolate oleosin under optimized conditions, and characterize candidate major allergens. Commercial Korean PSs were homogenized, and OBs were purified via sequential flotation. After defatting, proteins were separated by SDS-PAGE and tested by immunoglobulin E (IgE) immunoblotting using sera from pediatric PS-allergic patients. Protein bands corresponding to IgE binding were excised for LC-MS/MS analysis, and peptide spectra were searched against an in-house database using MASCOT. SDS-PAGE revealed multiple protein bands between 12 and 15, 20, 30-35, and ~ 50 kDa. IgE binding was observed at 12, 14-15, 20, 33, and 50 kDa, with inter-individual variability. LC-MS/MS consistently identified PS oleosin and oleosin-like proteins in the 12-15 kDa and 33 kDa regions, with the 14-15 kDa band showing the strongest identification (Mascot score up to 190). In conclusion, oleosin at 14-15 kDa, along with a probable 33 kDa dimeric form, represents the predominant allergenic protein in PS. This study provides the first systematic molecular characterization of PS oleosins and establishes a methodological framework for studying hydrophobic seed allergens.

Jackfruit allergies have been rarely reported in the literature. In this case series, three case reports of jackfruit allergy in British Columbia, Canada are presented. All three patients also had a history of food pollen allergy syndrome to birch related foods. With increasing global trade and immigration, jackfruit will become more popular in non-endemic areas. As birch is a major pollen in North America, we could expect more reported jackfruit allergy in the future.

Background: Hereditary angioedema (HAE) causes recurring swelling attacks, leading to substantial disease burden. This real-world, retrospective study aimed to evaluate HAE attack rates before and after berotralstat initiation stratified by patients' baseline attack frequency.

Methods: Specialty Pharmacy data from Optime Care, Inc. (12/2020-01/2024), the sole berotralstat dispenser in the United States, were analyzed. Eligible patients had  ≥ 2 berotralstat dispensings (first =  index) and ≥ 1 self-assessment of attacks at baseline (90-days pre-index) and follow-up (first-to-last dispensing). Patients were classified by HAE type (based on laboratory measurements) and baseline attacks (≥ 5, 2-4, 1, and 0 attacks/month). Follow-up attack rates were compared with baseline using mean differences, confidence intervals, and P-values. Among those with 0 baseline attacks/month, proportions with 0 follow-up attacks/month were assessed.

Results: Of 390 eligible patients with HAE with C1 esterase inhibitor (C1INH) deficiency (HAE-C1INH) and 311 with HAE with normal C1INH (HAE-nC1INH), most were female (64.1% and 77.5%) with mean ages of 39.3 and 48.1 years, respectively. Mean attack rates decreased from 2.50 to 0.79 attacks/month (HAE-C1INH) and from 4.59 to 1.68 attacks/month (HAE-nC1INH) at 12-months of berotralstat treatment (both P < 0 .001), with sustained reductions at 18-months. Patients with ≥ 1 baseline attack/month experienced significantly lower attack rates after berotralstat initiation. Among patients with 0 baseline attacks/month, most also maintained 0 attacks/month in each follow-up interval (HAE-C1INH: 70-85%; HAE-nC1INH: 61-81%).

Conclusion: Berotralstat was associated with significant and sustained reductions in attack rates among patients with HAE, regardless of baseline attack rate. Patients with 0 baseline attacks/month maintained low attack rates following berotralstat initiation.

Background: The EMPOWER Study (NCT03845400) was a phase 4, observational, non-interventional, multicenter study evaluating the real-world effectiveness and safety of lanadelumab in patients with hereditary angioedema (HAE). This subanalysis focused on lanadelumab effectiveness and safety in patients from Canada.

Methods: Enrollment included patients with HAE due to C1 inhibitor deficiency. Patients were categorized as "newly treated" or "established on lanadelumab" if they had received fewer than four or at least four doses before enrollment, respectively.

Results: Thirteen patients from Canada were enrolled: seven newly treated and six established on lanadelumab; these patients received lanadelumab for a mean (standard deviation [SD]) duration of 315 (224) and 536 (366) days, respectively, during the study. In newly treated patients, the mean (SD) observed HAE attack rate decreased after lanadelumab initiation from 1.5 (2.9) to 0.3 (0.6) attacks per month. In patients established on lanadelumab, the mean (SD) observed HAE attack rate was 0.1 (0.1) attacks per month throughout the study. Most HAE attacks were mild or moderate in severity (newly treated, 94%; established on lanadelumab, 100%). No study discontinuations were attributed to treatment-emergent adverse events. All treatment-emergent adverse events were non-severe, non-serious, and unrelated to lanadelumab treatment.

Conclusions: Lanadelumab lowered the HAE attack rate among newly treated Canadian patients and maintained a low attack rate among those previously established on lanadelumab, demonstrating robust effectiveness across both patient groups. Effectiveness, tolerability, and safety of lanadelumab were consistent with the overall population from the EMPOWER Study, supporting the use of lanadelumab as a first-line long-term prophylactic treatment for patients with HAE in Canada.

Trial registration: NCT03845400, registered February 19, 2019.