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

英文中文

Early Diagnosis and Treatment in Patients With Eosinophilic Granulomatosis With Polyangiitis 嗜酸性肉芽肿病合并多血管炎的早期诊断与治疗

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2026-03-04 DOI: 10.1016/j.jaip.2026.02.003

引用次数: 0

Adherence to Inhaled Corticosteroids and Clinical Outcomes Following a Year of Tezepelumab Therapy for Severe Asthma 重度哮喘患者接受Tezepelumab治疗一年后吸入皮质类固醇的依从性和临床结果

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2025-11-04 DOI: 10.1016/j.jaip.2025.10.038

Grainne d’Ancona MSc , Faizan Haris MBBS , Jessica Gates MBBS , Niall Stewart-Kelcher BSc , Linda Green MSc , Jodie Lam BSc , Mariana Fernandes MSc , Louise Thomson MSc , Cris Roxas MSc , Zijing Yang PhD , Jaideep Dhariwal PhD , Alexandra M. Nanzer PhD , David J. Jackson PhD

Background

High-dose ICS are associated with adverse effects. Reductions in ICS use during treatment with anti-IL-5/5R therapies can lead to reduced clinical effectiveness in some patients.

Objective

This study explored whether the broader anti-type 2 (T2) effects of the anti-thymic stromal lymphopoietin therapy tezepelumab permitted a reduction in ICS use without deleterious clinical consequences.

Methods

We calculated adherence to ICS/LABA (long-acting β₂-agonist) in the 12 months before and 12 months after commencing tezepelumab for severe asthma using the medication possession ratio methodology and classified results as poor (<0.5), suboptimal (0.51-0.74), or good (≥0.75). We compared clinical outcomes including the exacerbation rate, Asthma Control Questionnaire six-question version score, FEV₁, and the ability to achieve clinical remission, as well as T2 biomarker levels at 1 year across ICS adherence subgroups.

Results

A total of 152 adults with severe asthma who commenced tezepelumab were included. At the end of 12 months’ treatment, there was a significant reduction in the median medication possession ratio from 1.0 (0.83-1.08) at baseline to 0.83 (0.58-1; p = .009). The ICS adherence was good in 69.1%, suboptimal in 12.5%, and poor in 18.4% of patients. At 1 year, improvements in all clinical outcome measures as well as rates of biological remission were similar across ICS adherence groups (all P > .05).

Conclusions

A fall in ICS adherence after initiation of tezepelumab for severe asthma was not associated with evidence of reduced clinical effectiveness of tezepelumab, including the ability to achieve remission. Similar rates of biological remission further suggest that the broad anti-T2 effect of anti-thymic stromal lymphopoietin may be sufficient to permit a safe reduction in ICS exposure.

背景：大剂量吸入皮质类固醇（ICS）与不良反应相关。在使用抗il5 / 5r治疗的同时减少ICS的使用可能导致一些患者的临床疗效降低。目的：本研究探讨抗tslp治疗tezepelumab更广泛的抗t2作用是否允许减少ICS的使用而不产生有害的临床后果。方法：使用药物占有比（MPR）方法计算在开始tezepelumab治疗严重哮喘的前12个月和后12个月对ICS/LABA的依从性，并将其归类为不良（结果：包括152名开始使用tezepelumab治疗严重哮喘的成人）。在12个月治疗结束时，中位MPR从基线时的1.0（0.83-1.08）显著降低到0.83 (0.58-1),p=0.009。69.1%的患者ICS依从性良好，12.5%为次优，18.4%为不良。1年后，所有临床结果指标的改善以及生物缓解率在ICS依从组之间相似（p < 0.05）。结论：在tezepelumab治疗严重哮喘后，ICS依从性的下降与tezepelumab临床有效性降低的证据无关，包括实现缓解的能力。相似的生物缓解率进一步表明，抗tslp的广泛抗t2作用可能足以允许安全减少ICS暴露。

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引用次数: 0

New onset pruritus following discontinuation of cetirizine or levocetirizine 停用西替利嗪或左西替利嗪后新发瘙痒。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2025-12-09 DOI: 10.1016/j.jaip.2025.11.040

Karen Konkel MD, MSHI , Jenni Yoon Lee MD , S. Christopher Jones PharmD, MPH , Modupeola Adereti PharmD, BCPS, BCACP , Sheheryar Muhammad PharmD, BCCCP, BCCP, BCPS, BCACP , Ragha Suresh MD , Rekha Jhamnani MD, MHSc , Jody Green MD , Rajdeep Gill PharmD , Lynda McCulley PharmD, BCPS

引用次数: 0

Acute rhinosinusitis in patients with primary and secondary hypogammaglobulinemia due to B-cell targeted therapy and CAR T-cell therapy b细胞靶向治疗和CAR - t细胞治疗引起的原发性和继发性低丙种球蛋白血症患者的急性鼻窦炎。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2025-12-09 DOI: 10.1016/j.jaip.2025.12.002

Tejas S. Athni MS , Lingxiao Zhang MPH , Baijun Zhou MHS , Stella E. Lee MD , Sara Barmettler MD, MPH

引用次数: 0

Interrater reliability of laryngoscopic visual criteria for diagnosis of inducible laryngeal obstruction 诱发性喉梗阻的喉镜视觉诊断标准的可靠性。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2025-12-03 DOI: 10.1016/j.jaip.2025.11.034

Melanie Wong MD , Logan Gardner MBBS , Eve Denton MBBS, PhD , Tiffany Lin MBBS , Asger Sverrild MD, PhD , Stephanie Stojanovic MBBS , Janine Mahoney BSpPath, PhD , Mark Hew MBBS, MSc, PhD , Joy Lee MBChB, PhD

引用次数: 0

Alpha-Hairpinin (Pap s 1.0101) Sensitization and Optimized Prick-to-Prick Testing Define Clinical Poppy Seed Allergy in Children α -发夹蛋白（Pap s 1）致敏和优化的针刺试验定义了儿童临床罂粟籽过敏。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2025-12-08 DOI: 10.1016/j.jaip.2025.12.001

Canan Caka MD, Melike Ocak MD, Ozge Soyer MD, Bulent Enis Sekerel MD

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 or a consistent reaction history with documented sensitization. Diagnostic tools included prick-to-prick (PtP) testing, serum specific IgE (sIgE), and multiplex microarray Allergy Xplorer (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 < .001; 3.62 vs 0.79 kU/L, P = .001; and 7.20 vs 0.00 kUA/L, P < .001, respectively). PtP wheal size and α-hairpinin levels showed the best diagnostic performance (area under the curve [AUC] = 0.937, positive likelihood ratio [LR+] = 4.86 and AUC = 0.932, LR+ = 5.88, both P < .001). Many children had multiple food allergies, most commonly to sesame and tree nuts.

Conclusion

Although rare, PS 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.

背景：罂粟籽（Papaver somniferum）过敏是一种罕见但潜在严重的种子过敏形式。尽管全世界对罂粟籽的消费量不断增加，但关于罂粟籽（PS）过敏的数据仍然有限，主要来自病例报告。目的：本研究旨在描述ps过敏儿童的临床和实验室特征，并评价常规和分子检测的诊断效果。方法：对某三级儿科过敏中心2020 - 2024年疑似PS过敏的患儿进行回顾性分析。临床反应性由口腔食物刺激（OFC）或一致的过敏史证实。诊断工具包括刺对刺（PtP）检测、血清特异性IgE （sIgE）和多重芯片（ALEX2）检测PS过敏原，包括α-发夹蛋白。结果：191例ps致敏患者中，临床过敏38例（19.9%）。发生过敏反应10例（26.3%）。过敏患者PtP轮大小、PS-sIgE和α-发夹蛋白水平中位数明显高于耐受患者（8.0 mm vs 3.0 mm）。结论：罂粟籽过敏虽罕见，但可引起严重反应，应考虑多发种子或坚果过敏患儿。PtP和α-发夹蛋白检测显示出较强的诊断能力，其中α-发夹蛋白有望作为区分PS过敏和交叉反应的分子标志物。

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引用次数: 0

Association between asthma and dementia across age groups 哮喘和痴呆在不同年龄组之间的关系。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2025-12-09 DOI: 10.1016/j.jaip.2025.12.003

Yutong Chen PhD , Joohan Kim BA , Timothy G. Chow MD , Arthur S. Hong MD, MPH , Joshua M. Liao MD, MSc , Luyu Xie PharmD, PhD

引用次数: 0

Dupilumab for Functional Impairment—Severe Asthma’s Final Frontier Dupilumab治疗功能障碍-严重哮喘的最后前沿。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2026-03-04 DOI: 10.1016/j.jaip.2026.01.010

Vanessa L. Clark PhD , Mark Hew MBBS, PhD

引用次数: 0

Early Diagnosis and Treatment in Patients With Eosinophilic Granulomatosis With Polyangiitis 嗜酸性肉芽肿病合并多血管炎的早期诊断与治疗。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2025-11-22 DOI: 10.1016/j.jaip.2025.10.051

Salman H. Siddiqui MD, PhD , Harold Wilson-Morkeh MD , Sara Monti MD, PhD , Bernhard Hellmich MD, PhD

Eosinophilic granulomatosis with polyangiitis (EGPA), originally termed Churg–Strauss syndrome, represents the rarest form of antineutrophil cytoplasmic antibody-associated vasculitis. It is characterized by the presence of asthma, rhinosinusitis with or without nasal polyps, eosinophilic inflammation of the blood, and tissues and necrotizing vasculitis of small to medium-sized blood vessels. Owing to its rare, multisystemic nature with diverse symptom presentation, diagnosis is complex, requiring a multidisciplinary approach and a careful array of diagnostic and clinical assessments. Conventional therapy is composed of the use of oral glucocorticoids, which are associated with long-term adverse effects, and other immunomodulatory drugs. However, earlier diagnosis and prompt tailored treatment can improve clinical outcomes and reduce drug-related toxicity. The initiation of biologic therapies, such as those blocking IL-5 or its receptor, which have recently been approved for the treatment of non-severe relapsing EGPA, has emerged as a paradigm shift in management. An illustrative case is used to present a comprehensive representation of the diagnosis, pathophysiology, and management of EGPA.

嗜酸性肉芽肿病合并多血管炎（EGPA），最初称为Churg-Strauss综合征，是抗中性粒细胞细胞质抗体相关血管炎的最罕见形式。EGPA的特点是哮喘、鼻窦炎伴或不伴鼻息肉、嗜酸性粒细胞性血液炎症、组织和中小血管坏死性血管炎。由于其罕见，多系统的性质和不同的症状表现，诊断是复杂的，需要多学科的方法和一系列仔细的诊断和临床评估。常规治疗包括使用口服糖皮质激素，这与长期不良反应有关，以及其他免疫调节药物。然而，早期诊断和及时治疗可以改善临床结果并减少药物相关毒性。生物疗法的开始，如阻断白细胞介素-5 （IL-5）或其受体的生物疗法，最近已被批准用于治疗非严重复发性EGPA，已成为管理模式的转变。一个说明性的案例是用来提出一个全面的代表诊断，病理生理，和管理的EGPA。

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引用次数: 0

Mucus Plugs and Eosinophilic Inflammation: Expanding the Paradigm to COPD 粘液塞和嗜酸性粒细胞炎症：将范式扩展到COPD。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2025-11-27 DOI: 10.1016/j.jaip.2025.11.028

Shigeharu Ueki MD, PhD , Eleanor Dunican MD, PhD , Alejandro A. Diaz MD, MPH

Mucus plugs are a central, yet often underrecognized, hallmark of eosinophilic inflammation across asthma, chronic obstructive pulmonary disease, and related eosinophilic lung diseases. By obstructing the airway lumen, plugs not only impair airflow and worsen symptoms but are also associated with corticosteroid resistance and accelerated disease progression. Advances in high-resolution computed tomography have improved detection and quantification, linking plug burden to airflow limitation, loss of lung function, and even mortality. Eosinophils contribute to plug pathology through extracellular trap formation, release of cytotoxic proteins, and crystal deposition, which in turn drive airway structural changes and abnormal mucus composition and clearance. These interrelated processes promote the persistence of eosinophilic mucus plugs and reinforce airway dysfunction. Therapeutically, biologics targeting type 2 inflammatory pathways have demonstrated that they reduce mucus plugs in patients with asthma, with emerging evidence suggesting similar potential in eosinophilic chronic obstructive pulmonary disease. Innovative strategies designed to disrupt extracellular traps and reshape plug structure offer promising avenues for intervention. Recent advances in imaging, biology, and therapeutics have established mucus plugs as both a marker and a modifiable target across eosinophilic lung diseases. Future studies integrating imaging and biomarkers are essential to define persistence versus resolution, optimize patient stratification, and establish plugs as a transformative therapeutic target in eosinophilic lung diseases.

粘液塞是哮喘、慢性阻塞性肺病和相关嗜酸性肺疾病（ELDs）中嗜酸性粒细胞炎症的中心特征，但往往未被充分认识。通过阻塞气道管腔，栓子不仅损害气流和加重症状，而且还与皮质类固醇抵抗和加速疾病进展有关。高分辨率计算机断层扫描（CT）的进步改进了检测和量化，将堵塞负担与气流限制、肺功能丧失甚至死亡联系起来。嗜酸性粒细胞通过细胞外陷阱的形成、细胞毒性蛋白的释放和晶体沉积参与堵塞病理，这反过来又驱动气道结构改变和异常粘液成分和清除。这些相互关联的过程促进嗜酸性粘液堵塞的持续存在，并加强气道功能障碍。在治疗方面，针对2型炎症途径的生物制剂已被证明可减少哮喘患者的粘液堵塞，新出现的证据表明，在嗜酸性慢性阻塞性肺病中也有类似的潜力。旨在破坏细胞外陷阱和重塑桥塞结构的创新策略为干预提供了有希望的途径。最近在影像学、生物学和治疗学方面的进展已经将粘液塞作为一种标志物和一种可改变的靶标。整合成像和生物标志物的未来研究对于定义持久性与分辨率，优化患者分层，并将栓塞作为ELDs的变革性治疗靶点至关重要。

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