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

Adults 65 years or older are more susceptible to infectious diseases, representing a significant public health concern worldwide. Although newer vaccines have been developed for older adults, confusion over frequently changing guidelines often contributes to vaccine hesitancy and low vaccination rates. An American Academy of Allergy, Asthma & Immunology work group was convened to provide a clearer summary of these guidelines from the Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention. This article reviews the epidemiology and pathology of key infectious diseases in older adults, the mechanism of action of the vaccines targeting these diseases, commercially available vaccines, their potential side effects, and current vaccination recommendations for adults 65 years or older. The primary focus of this work is on adults 65 years or older; however, when possible, newer vaccination recommendations that begin at age 50 years have also been included. The diseases covered in this review include coronavirus disease 2019, pneumococcal pneumonia, respiratory syncytial virus, influenza, shingles, and tetanus. A summary table of vaccination guidelines is also included in Table III.

Background: Newborn screening (NBS) for severe combined immunodeficiency (SCID) using T cell receptor excision circles (TREC) in dried blood spots (DBS) has been implemented in the U.S. and many other regions and countries globally. The Clinical Immunology Society (CIS) and the Association of Public Health Laboratories (APHL) jointly formed the SCID Harmonization Initiative to facilitate comparison of NBS reporting practices to promote global consensus and collaboration.

Objective: To assess current NBS SCID practices using a global survey and to report the findings from the Phase 1 component.

Methods: An eighteen-question survey was distributed to all known SCID screening programs worldwide. Only one response per region was analyzed. Examples of international screening algorithms were also solicited and included.

Results: A total of 200 responses were received, of which eighty responses were unique and used for further analysis. Of the 39 non-U.S. countries, 15 (38%) reported national universal screening, and 24 (62%) reported regional, pilot, or other screening. Additional questions pertained to methodology and reporting with particular emphasis on communication of the clinical urgency of an abnormal TREC result.

Conclusions: This global survey confirmed that the approach to NBS SCID varies widely, underscoring the need for harmonization at multiple steps, particularly for reporting and interpretation. This is the first study to capture global NBS SCID practices, and these findings provide the basis for creation of a Phase 2 consensus reporting framework, which will be developed by the same SCID Harmonization Committee that created the current study.

Background: Managing food allergy (FA) entails complex lifestyle changes and development of specific coping strategies. How we cope with long-term conditions is associated with clinical and psychological outcomes and so it is important that adaptive strategies are promoted.

Objective: To develop and establish the reliability and validity of new coping with FA scales (CoFAS) for children and young people (CYP) aged 8-16 and for parents.

Methods: The CoFAS were developed following interviews with 32 CYP aged 8-16 years and 8 parents, a systematic review of literature and consultation with FA experts. Reliability and validity analysis was conducted on 151 CYP aged 8-16 who completed the CoFAS-C and 390 caregivers who completed the CoFAS-P. Participants also completed validation measures of generic coping, anxiety and depression, quality of life and self-efficacy.

Results: Exploratory factor analysis resulted in four sub-scales for the CoFAS-C (Avoidance and Minimisation, Positive Beliefs, Self-Management and Social Support) and three sub-scales for the CoFAS-P (Avoidance and Minimisation, Planning and Preparation and Dealing with Emotions). All had good to excellent internal reliability (Cronbach alphas = 0.74 to 0.84). and low to medium correlations with validation measures.

Conclusion: The CoFAS are reliable and valid scales to identify coping strategies used for FA management by CYP and parents. Planning and preparation appear to be the most adaptive strategies, with avoidance and minimisation the least, but managing emotions is also important to promote. Knowledge of the types of coping strategies used by patients could direct clinical care.

Background: The absence of nonspecific bronchial hyperresponsiveness (NSBH) has been documented in a substantial proportion of workers with occupational asthma (OA).

Objective: We investigated the clinical and inflammatory characteristics associated with the absence of baseline NSBH in a cohort of subjects with OA ascertained by a positive specific inhalation challenge (SIC).

Methods: A retrospective study was conducted among 1068 subjects who completed an SIC with various occupational agents at three tertiary centers.

Results: Among 377 subjects with a positive SIC, 63 (16.7%) did not exhibit baseline NSBH. Upon post-challenge assessment of these 63 subjects, 45 developed NSBH, while 18 still lacked demonstrable NSBH. Multivariate analysis revealed that quiescent asthma -defined by untreated asthma associated with the absence of airway obstruction- was the predominant clinical feature associated with undetectable NSBH at baseline (odds ratio: 3.59, 95% confidence interval: 1.86-6.93). Subjects with and without baseline NSBH exhibited similar rates of post-challenge increases in fractional exhaled nitric oxide ≥13 ppb (47.8% and 43.6%, respectively) and sputum eosinophil count ≥2% (72.2% and 74.2%, respectively). Baseline NSBH assessment identified positive SICs with a substantially lower sensitivity (68%) and negative predictive value (71%) among subjects with quiescent asthma (n=211) than among those (n=857) with active disease (87% and 88%, respectively).

Conclusions: The absence of NSBH does not allow OA to be ruled out without further investigation in subjects with quiescent asthma. On the other hand, a negative NSBH test has a high negative predictive value for OA among subjects with active disease.

Background: Although omalizumab is now approved for the treatment of food allergy (FA), little is known about its use in the clinical setting.

Objective: To examine the outcome of oral food challenges (OFCs) after treatment with omalizumab.

Methods: We conducted a retrospective chart review of clinic patients who underwent OFCs after treatment with omalizumab, including cumulative tolerated doses and all adverse events.

Results: 51 patients (45% female; median age 9 [range 1-23] years; median total IgE 512 [IQR: 285, 1080] IU/mL) underwent 73 OFCs, with milk (n=27), egg (n=23), and wheat (n=9) accounting for 81% of the OFCs. A reaction history was documented for 95% and all challenged foods had a positive allergen-specific IgE (median 34 [IQR: 12, >100] kUA/L). OFCs were performed at a median of 7 months (range: 4-14) after starting omalizumab. Among OFCs to any food with a goal dose ≥6000 mg (n=56), 89% successfully consumed ≥1000 mg, 86% ≥2000 mg, 75% ≥4000 mg, and 66% ≥6000 mg. Allergic reactions occurred in 45% (n=33) of all OFCs with 21 treated with antihistamines and 2 treated with epinephrine. Dietary introduction of allergenic foods was permitted following 92% of OFCs. Omalizumab treatment response was associated with higher baseline total IgE, q2 versus q4 week dosing, higher total omalizumab dose per 4-weeks per weight, and lower allergen-specific IgE to total IgE ratio.

Conclusion: Omalizumab can be effectively used for the treatment of FA in the clinical setting and may enable the introduction of allergenic foods into the diet for most patients.

Background: Although previous studies have found an association between eosinophilic esophagitis (EoE) and asthma, no studies to date have assessed the prevalence or predictors of EoE among children with severe asthma.

Objective: To assess the prevalence and predictors of EoE among children with severe asthma.

Methods: This was a cross-sectional study of children with recurrent wheeze/severe asthma who underwent bronchoscopy for respiratory symptoms and esophagogastroduodenoscopy for gastrointestinal symptoms. EoE cases were defined according to consensus guidelines. Diagnostic tests included bronchoalveolar lavage (BAL) for cell count/differential and measurements of blood absolute eosinophils (AEC) and total IgE. Differences in demographic and clinical characteristics were compared using chi-square and student's t-tests; predictors of EoE were assessed using logistic regression and Receiver Operating Characteristic (ROC) curves.

Results: A total of 214 children with problematic wheeze or poorly controlled asthma and gastrointestinal symptoms were included. EoE prevalence was 23.4%. EoE was associated with BAL eosinophilia (OR 2.61; 95% CI 1.13-6.00; p=0.001), but this did not persist in adjusted analyses. Patients with co-existing EoE had a higher prevalence of allergic comorbidities and higher blood AEC (672.0±1043.4/μL vs. 235.4±216.9; p value<0.001). AEC demonstrated high diagnostic accuracy for EoE when used in combination with the presence of allergic comorbidities.

Conclusions: We found a high prevalence of co-existing EoE in pediatric severe asthmatics. Severe asthmatics with EoE were more likely to have other allergic conditions and higher blood AEC levels. Future studies should evaluate if AEC can be used to screen for EoE among children with severe asthma.

The high prevalence of allergic conditions, coupled with their substantial impact on quality of life and health, has driven extensive research aimed at identifying preventive strategies. There has been substantial interest in the role of maternal diet during pregnancy and lactation on childhood atopy, as early dietary exposures may influence immune development and allergy risk in offspring. However, prior research has not established that interventions such as the inclusion or avoidance of specific foods, diet patterns, nutrients, and supplements have consistent effects. Here we review recent findings on the effects of maternal diet on the development of food allergies and atopic dermatitis (AD) in offspring. We review results from investigations since 2022 that studied maternal intake of specific foods, diet patterns, nutrients, and supplements. Among dietary patterns, while Mediterranean diet during pregnancy may be associated with a lower risk of AD in offspring, it does not appear to alter risk of offspring food allergies. Regarding nutrients and supplements, there are no consistent associations between maternal intake of n-3 polyunsaturated fatty acids (PUFAs), vitamin D, zinc, or prebiotics/probiotics during pregnancy and lactation and the development of food allergies or AD in offspring. Recent studies suggest potential associations between maternal consumption of n-6 PUFAs and processed foods during pregnancy and increased risk of food allergies in offspring, but further data are needed to support the replicability and degree of these effects in additional populations. Women should not avoid allergenic foods during pregnancy or lactation to prevent allergic outcomes in children.

Mendelian Susceptibility to Mycobacterial Disease (MSMD) is a rare group of immunodeficiencies with high mortality characterized by a failure of communication between phagocytic cells and their regulatory/support networks. The objective of this article is to review key aspects of MSMD management. A defective interleukin-12 (IL-12) / interferon-gamma (IFN-γ) circuit can result in overwhelming intracellular infection leading to lymphadenopathy, organomegaly, and sepsis. In the setting of unexplained lymphadenopathy, early tissue and blood culture, with special attention to mycobacteria, is essential. If MSMD is suspected, genetic testing to assess for pathogenic variants affecting the IFN-γ/IL-12 signaling pathway is available. To date, at least 19 genes with hundreds of unique mutations have been identified; thus, genetic testing is essential to determine the specific defect and direct therapy. Multiple antibiotics, cytokine therapy in selected cases, and bone marrow transplantation should be considered.