Journal of Allergy and Clinical Immunology-In Practice最新文献

Food allergies (FA) affect millions of children worldwide, often emerging during the critical early-life period when the gut microbiota and the immune system co-develop. This review examines the current evidence linking infant gut microbiome development to FA risk, gaps in current knowledge, and future directions. Substantial evidence from animal models and human studies implicates the developing gut microbiome in shaping immune tolerance to food antigens through various mechanisms. Early life gut microbiome dysbiosis or imbalance, with associated altered metabolite profiles, has been associated with increased FA risk, especially in infants delivered by Cesarean section, exposed to antibiotics, or lacking certain dietary and environmental exposures. However, findings remain heterogeneous across cohorts, and direct causal mechanisms in humans are not fully established, in part due to logistical challenges and variability in microbiome sequencing and FA definitions. Key gaps include a paucity of mechanistic human studies, limited understanding of the timing and functional impact of dysbiosis, and insufficient standardization of research methodologies. Moreover, while environmental factors such as maternal health, delivery mode, and early-life exposures are linked to microbiome development and FA risk, disentangling their specific contributions remains difficult. Future research focused on standardized, longitudinal studies integrating functional metabolomics and immune profiling to establish causal pathways is critical. Elucidating the precise microbial and metabolic drivers of immune tolerance may enable the development of targeted microbial therapeutics, such as probiotics, dietary modifications, or metabolite supplementation, to reduce FA in at-risk infants. Addressing these gaps is essential to mitigate the rising global burden of pediatric food allergies.

Clinical implications: The majority of individuals with food allergy (FA) choose avoidance for management, while 10% choose OIT or omalizumab. Having commercial insurance, multiple FA, previous use of epinephrine, and lower parental FA-related QoL are predictors to choose omalizumab, while families choosing OIT expressed a desire for FA remission.

Background: Penicillin allergy is frequently mislabelled, leading to unnecessary use of second-line antibiotics and contributing to antimicrobial resistance. Pre-emptive penicillin skin testing (PST) remains mandatory in Mainland China and is associated with high false-positive rates. In contrast, Hong Kong follows evidence-based, standardized allergy assessment protocols under the Hong Kong Drug Allergy Delabelling Initiative (HK-DADI).

Objective: To evaluate longitudinal outcomes of protocol-based penicillin delabelling in real-world clinical practice across Mainland China and Hong Kong.

Methods: This prospective, multi-regional study included 514 patients (206 from Mainland China, 308 from Hong Kong) who underwent allergy evaluation between September 2023 and January 2025. All centres followed HK-DADI protocol, including structured history-taking, skin testing, and drug provocation testing (DPT). Longitudinal outcomes included delabelling rates, penicillin reuse, and health-related quality of life (HR-QoL).

Results: The overall delabelling rate was 90.3%, with significantly higher rates among patients previously labelled due to pre-emptive PST. Among this subgroup, 98.2% had negative skin tests and 99.4% had subsequent negative DPT. One-quarter of delabelled patients reused penicillin within six months (without allergic reactions), with four-fold higher rates in Mainland China (45.5% vs. 12.0%, p<0.001). Sustained HR-QoL improvements were observed at 12 months, particularly among those previously mislabelled by PST.

Conclusion: This study demonstrates the effectiveness of HK-DADI in correcting widespread mislabeling in China and highlights the potential for implementing protocol-based delabelling initiatives across diverse regions. The high rate of mislabelling underscores the urgent need for reform of PST practices and supports global efforts to combat antimicrobial resistance with protocol-based delabelling initiatives.

Clinical implications: This report highlights the respiratory sensitizing potential of shikakai powder used for preparing organic hair products and provides evidence supporting an IgE-mediated mechanism underlying the development of rhinitis and asthma.

Clinical implications box: Acute rhinosinusitis is common in patients with hypogammaglobulinemia, and occurred with a higher incidence rate in patients with CVID compared to secondary immunodeficiency from B-cell targeted therapy or CAR T-cell therapy. Monitoring and multidisciplinary collaboration are essential for these complex patients.

Clinical implications: Current asthma in middle-aged adults was associated with 62% higher dementia odds, suggesting optimal asthma and asthma management may represent potential targets for promoting cognitive health.

Background: Poppy seed (Papaver somniferum) allergy is an uncommon but potentially severe form of seed hypersensitivity. Despite the increasing consumption of seeds worldwide, data on poppy seed (PS) allergy remain limited, mostly derived from case reports.

Objective: This study aimed to describe the clinical and laboratory characteristics of PS-allergic children and evaluate the diagnostic performance of conventional and molecular assays.

Methods: A retrospective review was conducted on children evaluated for suspected PS allergy at a tertiary pediatric allergy center between 2020 and 2024. Clinical reactivity was confirmed by an oral food challenge (OFC) or a consistent reaction history with documented sensitization. Diagnostic tools included prick-to-prick (PtP) testing, serum specific IgE (sIgE), and multiplex microarray (ALEX²) for PS allergens, including α-hairpinin.

Results: Of 191 PS-sensitized patients, 38 (19.9%) were clinically allergic. Anaphylaxis occurred in 10 cases (26.3%). Median PtP wheal size, PS-sIgE, and α-hairpinin levels were significantly higher in allergic patients than in tolerant ones (8.0 mm vs 3.0 mm, p<0.001; 3.62 vs 0.79 kU/L, p=0.001; and 7.20 vs 0.00 kUA/L, p<0.001, respectively). PtP wheal size and alfa-hairpinin (α-hairpinin) levels showed the best diagnostic performance (AUC=0.937, LR+=4.86 and AUC=0.932, LR+=5.88 both p<0.001). Many children had multiple food allergies, most commonly to sesame and tree nuts.

Conclusion: Although rare, poppy seed allergy can induce severe reactions and should be considered in children with multiple seed or nut allergies. PtP and α-hairpinin testing demonstrated strong diagnostic performance, with α-hairpinin emerging as a promising molecular marker for distinguishing true PS allergy from cross-reactivity.

Background: Asthma is a chronic respiratory disease that affects about 300 million people worldwide. Recently, high-intensity interval training (HIIT) has been explored as a therapeutic option in asthma.

Objective: To analyze and update the effectiveness of HIIT in adults with asthma.

Methods: This systematic review followed PRISMA guidelines. The search was conducted in 5 databases from their inception to November 2024. We included randomized clinical trials adults with asthma who underwent a HIIT intervention, compared to a control group (CG)/other types of exercise. Methodological quality, certainty of evidence and risk of bias were assessed.

Results: Four studies were included in the review and three were included in the meta-analysis. Meta-analysis results showed significant differences in favor of HIIT in asthma control, asthma-related quality of life and aerobic capacity in the short term compared to CG. HIIT showed significant differences at long-term follow-up in asthma control and asthma quality of life compared to CG. The meta-analysis did not show significant differences between groups regarding lung function or airway inflammation in the short or the long term.

Conclusion: HIIT improved asthma control, asthma-related quality of life and aerobic capacity in adults with asthma compared to CG. These improvements were also found after a one-year follow-up for asthma control and asthma-related quality of life.