Journal of Allergy and Clinical Immunology-In Practice最新文献_第4页

Differential Diagnosis of Eosinophilic Lung Diseases 嗜酸性肺疾病的鉴别诊断

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.2026.02.001

引用次数: 0

Novel Diagnostic Approaches for Eosinophilic Lung Diseases 嗜酸性肺疾病的新诊断方法。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2026-02-05 DOI: 10.1016/j.jaip.2026.01.023

Alexander Ruzic BSc , Merritt L. Fajt MD, FAAAAI , Mark M. Hammer MD , Manali Mukherjee MSc, PhD

Eosinophilic lung diseases (ELDs) represent a heterogeneous group of airway and parenchymal disorders unified by eosinophilic inflammation but distinguished by diverse clinical features, mechanisms of persistence, and variable therapeutic responses. Traditional diagnostic tools, including blood eosinophil counts, bronchoalveolar lavage, sputum cytology, and exhaled nitric oxide, predict the eosinophilic/T2 burden of the disease but often fail to distinguish IL-5–dependent from IL-5–independent pathways, overlook compartment-specific inflammation, and inadequately predict or monitor response to targeted biologics. The inconsistent efficacy of IL-5/IL-5R–directed monoclonal antibodies despite normalization of blood eosinophils across the ELD spectrum (robust clinical response in eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome, partial in asthma and largely absent in chronic obstructive pulmonary disease) underscores the limitations of current biomarkers and the need for refined precision endotyping. To address these gaps, emerging biomarker platforms move beyond eosinophil enumeration to define upstream drivers, activation states, tissue localization, and immune pathways sustaining persistent eosinophilia. These advances include noninvasive tools such as lateral-flow devices for assaying eosinophil peroxidase (eosinophil activity biomarker), breathomics and volatile organic compound profiling, cytokine-level inflammatory mapping, and composite biomarker models integrating airway, blood, and molecular signatures. In parallel, functional imaging modalities, including hyperpolarized gas magnetic resonance imaging, phase-resolved functional lung magnetic resonance imaging, and quantitative computed tomography, provide noninvasive, high-resolution visualization of regional ventilation, perfusion, and inflammation. This enables clinicians to look into the lungs and offer powerful stand-alone or complementary biomarker capability. Collectively, these innovations mark a shift toward mechanistically-informed, tissue-specific, multimodal biomarker strategies that refine diagnosis, improve therapeutic selection, and enhance monitoring across the ELD spectrum, advancing the promise of precision medicine.

嗜酸性粒细胞肺疾病（ELDs）是由嗜酸性粒细胞炎症引起的气道和实质疾病的异质组，但具有不同的临床特征、持续机制和不同的治疗反应。传统的诊断工具——包括血液嗜酸性粒细胞计数、支气管肺泡冲洗、痰细胞学和呼出的一氧化氮——预测疾病的嗜酸性粒细胞/T2负荷，但往往不能区分il -5依赖性途径和il -5非依赖性途径，忽略了室特异性炎症，并且不能充分预测/监测对靶向生物制剂的反应。IL-5/ il - 5r定向单克隆抗体的疗效不一致，尽管在整个ELD谱中血液嗜酸性粒细胞正常化，即在嗜酸性粒细胞肉芽肿合并多血管炎和嗜酸性粒细胞过多综合征，哮喘部分，copd大部分缺乏的临床反应中，强调了当前生物标志物的局限性和对精细精确内分型的需求。为了解决这些差距，新兴的生物标志物平台超越了嗜酸性粒细胞计数，以定义上游驱动因素、激活状态、组织定位和维持持续嗜酸性粒细胞的免疫途径。这些进步包括非侵入性工具，如用于分析嗜酸性粒细胞过氧化物酶（嗜酸性粒细胞活性生物标志物）的侧流装置、呼吸组学和挥发性有机化合物谱、细胞因子水平的炎症图谱，以及整合气道、血液和分子特征的复合生物标志物模型。与此同时，功能成像方式——包括超极化气体MRI、相位分辨功能肺MRI和定量计算机断层扫描（CT）——提供了非侵入性、高分辨率的局部通气、灌注和炎症可视化。这使临床医生能够“观察肺部”，并提供强大的独立或补充生物标志物能力。总的来说，这些创新标志着向机械信息、组织特异性、多模式生物标志物策略的转变，这些策略可以改进诊断、改善治疗选择，并加强整个ELD谱的监测，从而推进精准医学的发展。

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引用次数: 0

Continuing Medical Education Calendar 继续医学教育日历

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/S2213-2198(26)00102-9

引用次数: 0

The Associations Between Neighborhood Factors on Asthma Medication Adherence in Adults 邻里因素对成人哮喘药物依从性的影响

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2025-10-30 DOI: 10.1016/j.jaip.2025.10.030

Christian Carrier MD , Barbara Polivka RN, PhD , Luz Huntington-Moskos RN, PhD , Kamal Eldeirawi RN, PhD , Emily Cramer PhD , Sharmilee M. Nyenhuis MD

Background

A significant portion of patients with asthma do not adhere to their medication regimen, and the influence of their neighborhood characteristics on their adherence is unclear.

Objective

To examine how certain neighborhood factors are associated with asthma medication adherence in adults.

Methods

Between 2020 and 2022, adults with asthma were recruited into the Global COVID-19 Asthma Study and completed an online questionnaire. A secondary post hoc analysis was performed. Perceived neighborhood and adherence responses were dichotomized, and a backward elimination change-in-estimate method was performed to choose variables for logistic regression analysis. A cumulative problem score was constructed from these perceptions, and a bivariate analysis was performed comparing adherent and nonadherent groups for each perception.

Results

A total of 988 participants provided complete data, and almost half (44%) were medication nonadherent. Participants who reported a perceived problem with the presence of litter, homes not being well maintained, vacant homes, and vandalism in their neighborhood were more likely to be nonadherent, as well as those who felt unsafe walking alone at night and that their neighborhood was not a good place to live. Those who felt their neighborhood was not a good place to live were 1.79 times more likely to have reported nonadherence (95% confidence interval, 1.07-2.09) compared with those who did not have this feeling. Those with higher cumulative problem scores were also more likely to be nonadherent.

Conclusion

Neighborhood factors are associated with asthma medication adherence and provide valuable insights for providers when evaluating patient adherence.

背景：相当一部分哮喘患者不坚持其药物治疗方案，其社区特征对其依从性的影响尚不清楚。目的：探讨某些社区因素与成人哮喘药物依从性的关系。方法：在2020年至2022年期间招募患有哮喘的成人加入全球COVID-19哮喘研究（GCAS），并完成在线问卷调查。进行二次事后分析。对感知邻域反应和依从性反应进行二分类，并采用反向消除估计变化法选择变量进行逻辑回归分析。从这些感知构建了一个累积问题评分，并对每个感知进行了双变量分析，比较了坚持组和非坚持组。结果：共有988名参与者提供了完整的数据，几乎一半（44%）的患者没有依从性。那些认为附近有垃圾、房屋维护不善、空置房屋和故意破坏行为等问题的参与者更有可能不遵守规定，那些在晚上独自行走感到不安全、他们的社区不适合居住的人也更有可能不遵守规定。与没有这种感觉的人相比，那些觉得自己的社区不是一个好地方的人报告不遵守规定的可能性高出1.79倍（95%置信区间（CI）， 1.07-2.09）。那些累积问题得分较高的人也更有可能不坚持。结论：邻里因素与哮喘药物依从性相关，为医疗服务提供者评估患者依从性提供了有价值的见解。

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引用次数: 0

Values and Preferences of Patients and Caregivers Regarding the Management of Moderate-to-Severe Asthma: A Systematic Review and Qualitative Evidence Synthesis 患者和护理人员对中重度哮喘管理的价值观和偏好：系统回顾和定性证据综合

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2025-11-07 DOI: 10.1016/j.jaip.2025.10.041

Daniel G. Rayner MSc , Shelly-Anne Li PhD , Dario M. Ferri MD, MSc , Isabella Silang BSc , Athena Fernandes , Alexandro W.L. Chu MD , Solomon Tse , Kaharu Sumino MD , Sharmilee M. Nyenhuis MD , John Oppenheimer MD , Tamara T. Perry MD , Flavia Hoyte MD , Bradley Chipps MD , Katherine Rivera-Spoljaric MD, MSCI , Elliot Israel MD , Lindsay E. Shade MHS, PA-C , Susana Rangel MSN, FNP-C , Ellen McCabe PhD , Paul M. O’Byrne MBChB , Valerie G. Press MD, MPH , Derek K. Chu MD, PhD

Background

Understanding patient values and preferences can inform optimal care of moderate-to-severe asthma.

Objective

To systematically synthesize studies addressing the values and preferences of patients with moderate-to-severe asthma and their caregivers toward the management of asthma.

Methods

As part of updating the American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma, and Immunology (AAAAI/ACAAI) Joint Task Force on Practice Parameters severe asthma guidelines, we searched MEDLINE, Embase, PsycINFO, and CINAHL from inception to June 1, 2025, for studies addressing the values and preferences of patients with moderate-to-severe asthma or their caregivers. Paired reviewers independently screened citations, extracted data, and assessed risk of bias. We used iterative thematic content analysis to qualitatively synthesize findings and the Grading of Recommendations Assessment, Development and Evaluation–Confidence in the Evidence from Reviews of Quantitative Research (GRADE-CERQual) approach to rate the confidence of the evidence. We prospectively registered our review in PROSPERO (CRD42024572812).

Results

Synthesizing 88 studies enrolling 9,593 patients and 274 caregivers, we identified 5 key themes: (1) Patients and their caregivers place high value on avoiding potential adverse effects of asthma treatment (high confidence). Patients probably place high value toward (2) avoiding severe asthma exacerbations, (3) having autonomy in the administration of advanced therapies, such as biologics, and (4) are probably more willing to accept treatment if provided counselling by clinicians knowledgeable in asthma (moderate confidence). (5) Patients may place a high value on asthma treatments that are practical and logistically simple to implement (low confidence).

Conclusions

We identified 5 key themes on the values and preferences of patients with moderate-to-severe asthma and their caregivers to inform optimal clinical care, practice guidelines, and future research.

背景：了解患者的价值观和偏好可以为中重度哮喘的最佳护理提供信息。目的：系统综合研究中重度哮喘患者及其护理人员对哮喘管理的价值观和偏好。方法：作为更新AAAAI/ACAAI重度哮喘实践参数联合工作组指南的一部分，我们检索了MEDLINE、Embase、PsycINFO和CINAHL，从成立到2025年6月1日，以研究中重度哮喘患者或其护理人员的价值观和偏好。配对审稿人独立筛选引文、提取数据并评估偏倚风险。我们使用迭代主题内容分析来定性地综合研究结果，并使用GRADE-CERQual方法来评价证据的可信度。我们在PROSPERO （CRD42024572812）前瞻性注册了我们的综述。结果：综合88项研究，纳入9593名患者和274名护理人员，我们确定了5个关键主题：(1)患者及其护理人员高度重视避免哮喘治疗的潜在不良反应（高置信度）。患者可能高度重视(2)避免严重的哮喘恶化，(3)在高级疗法（如生物制剂）的管理方面拥有自主权，以及(4)如果有了解哮喘的临床医生提供咨询，他们可能更愿意接受治疗（中等信心）。(5)患者可能会高度重视实用且易于实施的哮喘治疗（低置信度）。结论：我们确定了中重度哮喘患者及其护理人员的价值观和偏好的5个关键主题，以指导最佳临床护理、实践指南和未来的研究。

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引用次数: 0

Validation of the Visual Analog Scale in Perennial Allergic and Non-Allergic Rhinitis: Association With Symptom Severity and Quality of Life 常年性变应性和非变应性鼻炎视觉模拟量表的验证：与症状严重程度和生活质量的关系。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2025-12-24 DOI: 10.1016/j.jaip.2025.11.041

Chamard Wongsa MD , Pakpoom Wongyikul MD , Piyaporn Chokevittaya MD , Anapat Nititammaluk MD , Mongkhon Sompornrattanaphan MD , Kawita Atipas MD , Navarat Kasemsuk MD , Dichapong Kanjanawasee MD, PhD , Triphoom Suwanwech MD , Pongsakorn Tantilipikorn MD, PhD , Wannada Laisuan MD , Phichayut Phinyo MD, PhD , Jonathan A. Bernstein MD , Torpong Thongngarm MD

Background

Although the visual analog scale (VAS) is recommended in guidelines for assessing perennial allergic rhinitis (PAR), its validity in non-allergic rhinitis (NAR) remains unclear.

Objective

To evaluate the concurrent validity of the VAS in assessing symptom severity and its association with quality of life (QoL) outcomes in PAR and NAR.

Methods

This cross-sectional study prospectively included adults with moderate to severe PAR and NAR, all of whom had experienced symptoms for more than 6 months and underwent skin prick and/or specific IgE testing. Individual nasal symptoms, total nasal symptom score (TNSS), VAS, and Rhinoconjunctivitis Quality of Life-36 (RCQ-36) scores were compared between groups. We assessed VAS validity via Spearman’s correlation with TNSS. Participants were dichotomized at the median VAS to examine associations with RCQ-36 and symptom profiles.

Results

Among 445 patients (298 PAR and 147 NAR), TNSS was lower in NAR, but VAS global scores and RCQ-36 domains were similar, except for a trend toward higher eye symptom burden in PAR. The VAS correlated moderately with TNSS in PAR (Spearman correlation = 0.49, 95% CI, 0.40-0.57) but weakly in NAR (Spearman correlation = 0.35; 95% CI, 0.20-0.49). Patients with a VAS result of 70 mm or greater (median cutoff) had significantly worse RCQ-36 in both groups, along with higher VAS for eye itching, postnasal drip, nasal voice, facial pressure, hyposmia, and cough. Greater nasal obstruction and rhinorrhea severity strongly correlated with poorer QoL.

Conclusions

The VAS demonstrates comparable validity in PAR and NAR, effectively categorizing disease severity and QoL impairment. Nasal congestion and rhinorrhea severity are key drivers of reduced QoL in both conditions.

背景：虽然视觉模拟量表（VAS）被推荐用于评估常年性变应性鼻炎（PAR），但其在非变应性鼻炎（NAR）中的有效性尚不清楚。目的：评价VAS在评估PAR和NAR患者症状严重程度及其与生活质量（QoL）结果的同时有效性。方法：本横断面研究前瞻性纳入了患有中重度PAR和NAR的成年人，所有患者均出现症状60 - 6个月，并接受皮肤穿刺和/或特异性IgE检测。比较两组间个体鼻症状、鼻症状总评分（TNSS）、VAS和鼻结膜炎生活质量36 （RCQ-36）评分。通过Spearman与TNSS的相关来评估VAS效度。在VAS中位数对参与者进行二分，以检查与RCQ-36和症状概况的关联。结果：445例患者（298例PAR， 147例NAR）中，NAR的TNSS较低，但VAS整体评分和RCQ-36域相似，除了PAR有更高的眼部症状负担的趋势。VAS与PAR的TNSS中度相关（Spearman相关= 0.49,95% CI: 0.40-0.57），但与NAR的相关性较弱（0.35,95% CI: 0.20-0.49）。VAS≥70 mm（中位截止值）的患者，两组的RCQ-36均明显较差，同时眼痒、鼻后滴涕、鼻音、面部压力、低体温和咳嗽的VAS也较高。较大的鼻塞和鼻漏严重程度与较差的生活质量密切相关。结论：VAS在PAR和NAR中具有相当的有效性，可有效地对疾病严重程度和生活质量损害进行分类。鼻塞和鼻漏严重程度是两种情况下生活质量降低的关键驱动因素。

{"title":"Validation of the Visual Analog Scale in Perennial Allergic and Non-Allergic Rhinitis: Association With Symptom Severity and Quality of Life","authors":"Chamard Wongsa MD , Pakpoom Wongyikul MD , Piyaporn Chokevittaya MD , Anapat Nititammaluk MD , Mongkhon Sompornrattanaphan MD , Kawita Atipas MD , Navarat Kasemsuk MD , Dichapong Kanjanawasee MD, PhD , Triphoom Suwanwech MD , Pongsakorn Tantilipikorn MD, PhD , Wannada Laisuan MD , Phichayut Phinyo MD, PhD , Jonathan A. Bernstein MD , Torpong Thongngarm MD","doi":"10.1016/j.jaip.2025.11.041","DOIUrl":"10.1016/j.jaip.2025.11.041","url":null,"abstract":"<div><h3>Background</h3><div>Although the visual analog scale (VAS) is recommended in guidelines for assessing perennial allergic rhinitis (PAR), its validity in non-allergic rhinitis (NAR) remains unclear.</div></div><div><h3>Objective</h3><div>To evaluate the concurrent validity of the VAS in assessing symptom severity and its association with quality of life (QoL) outcomes in PAR and NAR.</div></div><div><h3>Methods</h3><div>This cross-sectional study prospectively included adults with moderate to severe PAR and NAR, all of whom had experienced symptoms for more than 6 months and underwent skin prick and/or specific IgE testing. Individual nasal symptoms, total nasal symptom score (TNSS), VAS, and Rhinoconjunctivitis Quality of Life-36 (RCQ-36) scores were compared between groups. We assessed VAS validity via Spearman’s correlation with TNSS. Participants were dichotomized at the median VAS to examine associations with RCQ-36 and symptom profiles.</div></div><div><h3>Results</h3><div>Among 445 patients (298 PAR and 147 NAR), TNSS was lower in NAR, but VAS global scores and RCQ-36 domains were similar, except for a trend toward higher eye symptom burden in PAR. The VAS correlated moderately with TNSS in PAR (Spearman correlation = 0.49, 95% CI, 0.40-0.57) but weakly in NAR (Spearman correlation = 0.35; 95% CI, 0.20-0.49). Patients with a VAS result of 70 mm or greater (median cutoff) had significantly worse RCQ-36 in both groups, along with higher VAS for eye itching, postnasal drip, nasal voice, facial pressure, hyposmia, and cough. Greater nasal obstruction and rhinorrhea severity strongly correlated with poorer QoL.</div></div><div><h3>Conclusions</h3><div>The VAS demonstrates comparable validity in PAR and NAR, effectively categorizing disease severity and QoL impairment. Nasal congestion and rhinorrhea severity are key drivers of reduced QoL in both conditions.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages 693-703.e4"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Information for Readers 读者资讯

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/S2213-2198(26)00100-5

引用次数: 0

Occupational IgE-mediated respiratory allergy to shikakai powder 职业性ige介导的Shikakai散呼吸道过敏。

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2025-12-11 DOI: 10.1016/j.jaip.2025.12.005

Virginie Doyen MD, PhD , Sabine Kespohl PhD , Ines Jadot PhD , Catherine Rifflart MSc , Irene Mittermann PhD , Martina Aumayr PhD , Olivier Vandenplas MD, PhD , Monika Raulf PhD

引用次数: 0

PM2.5, Black Carbon, and NO2 Associations With Rhinitis and Asthma Multimorbidity in Adults: The Constances Cohort PM2.5、黑碳和二氧化氮与成人鼻炎和哮喘多重发病率的关系：康斯坦斯队列

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2026-01-07 DOI: 10.1016/j.jaip.2025.12.031

Marine Savouré PhD , Émeline Lequy PhD , Jean Bousquet PhD , Marcel Goldberg PhD , Kees de Hoogh PhD , Danielle Vienneau PhD , Céline Ribet PhD , Marie Zins PhD , Rachel Nadif PhD , Bénédicte Jacquemin PhD

Background

Rhinitis and asthma often co-occur; however, studies on their associations with air pollution have always considered them separately.

Objective

We investigated the association between long-term air pollution exposure and rhinitis and asthma multimorbidity in adults.

Methods

We used data at inclusion from Constances, a large French population-based adult cohort. Current rhinitis (CR) and current asthma (CA) were defined by questionnaire. Annual exposure to nitrogen dioxide (NO₂), particulate matter 2.5 μm or less (PM_2.5), and black carbon were estimated by linking participants' residential address to land-use regression models. We performed cross-sectional multinomial logistic regressions between each air pollutant and CR alone, CA alone, and CR+CA (no-CR/no-CA being the reference) adjusted for age, sex, smoking, education level, and French deprivation index.

Results

Among the 177,968 participants included in the analyses (mean age 47 years; 54% female), 111,108 were classified as no-CR/no-CA (62%), 49,971 CR alone (28%), 6,435 CA alone (4%), and 10,454 CR+CA (6%). One interquartile range (IQR) increase of black carbon and NO₂ was significantly associated with the three phenotypes, with adjusted odds ratios from 1.04 to 1.13 for BC (IQR = 0.55-10^–5·m^–1), and from 1.06 to 1.14 for NO₂ (IQR = 13.7 μg·m^–3). For PM_2.5, one IQR increase (4.09 μg·m^–3) was significantly associated with CR alone and CR+CA. In all our analysis, the highest associations were observed for CR alone.

Conclusion

Our results show that long-term air pollution is more associated with rhinitis alone or with asthma multimorbidity than with asthma alone.

背景：鼻炎常与哮喘并发；然而，关于它们与空气污染关系的研究一直是分开考虑的。目的：探讨长期空气污染暴露与成人鼻炎、哮喘多发病的关系。方法：纳入时的数据来自康斯坦斯，这是一个以法国人口为基础的大型成人队列。通过问卷调查确定当前鼻炎（CR）和当前哮喘（CA）。通过将参与者的居住地址与土地利用回归模型相关联，估算了参与者的年暴露量（NO2）、颗粒物（PM2.5）和黑碳（BC）。在每种空气污染物与单独的CR、单独的CA和CR+CA（无CR/无CA为参考）之间进行横断面多项式logistic回归，调整年龄、性别、吸烟、教育水平和法国剥夺指数。结果：在纳入分析的177,968名参与者中（平均年龄：47岁）。（54%女性），111,108例（62%）为无CR/无CA， 49,971例（28%）为单纯CR， 6,435例（4%）为单纯CA， 10,454例（6%）为CR+CA。BC和NO2的四分位数范围（IQR）增加与三种表型显著相关，BC的调整后的or为1.04 ~ 1.13 （IQR: 0.55 10-5）。NO2在1.06 ~ 1.14之间（IQR: 13.7 μg - m-3）。PM2.5的IQR增加1 （4.09 μg - m-3）与CR单独和CR+CA显著相关。在我们所有的分析中，CR单独观察到最高的相关性。结论：我们的研究结果表明，长期空气污染与鼻炎单独或哮喘多病的关系大于哮喘单独。

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引用次数: 0

Treatment of Eosinophilic Granulomatosis With Polyangiitis (EGPA): Do We Need Immunosuppressives? EGPA的治疗-我们需要免疫抑制剂吗？

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2026-03-01 Epub Date: 2026-01-28 DOI: 10.1016/j.jaip.2026.01.014

Alexandra M. Nanzer PhD , Benjamin Terrier MD, PhD , Michael E. Wechsler MD

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of antineutrophil cytoplasm antibody (ANCA)–associated vasculitis, distinguished by a complex interplay between type 2 (T2) eosinophilic and non-T2 inflammatory pathways. Systemic glucocorticosteroids remain the mainstay of both induction and maintenance therapy, achieving remission in patients without poor prognostic factors, yet long-term dependence and toxicity remain pervasive challenges. Conventional immunosuppressive agents such as cyclophosphamide (CYC), azathioprine, and methotrexate have been widely used, and rituximab has shown similar remission rates to CYC for induction therapy. However, robust randomized controlled trial evidence supporting their efficacy in EGPA is limited. Biologic therapies targeting eosinophils through IL-5 or IL-5R blockade, notably mepolizumab and benralizumab, have markedly reduced relapse rates, steroid exposure, and improved remission rates in relapsing or refractory disease, with excellent tolerability. Their role in induction is yet to be assessed, alongside novel approaches targeting thymic stromal lymphopoietin and other non-T2 immune pathways. Future priorities include clarifying the contribution of vasculitic versus nonvasculitic mechanisms, the significance of ANCA status, and the immunobiology of relapse. Despite therapeutic inertia in the absence of definitive trials, the collective drive of clinicians and researchers promises to transform and advance management of EGPA in the years ahead.

嗜酸性粒细胞肉芽肿病合并多血管炎（EGPA）是一种罕见的anca相关血管炎，其特点是2型（T2）嗜酸性粒细胞和非T2炎症途径之间的复杂相互作用。系统性糖皮质激素（GC）仍然是诱导和维持治疗的主流，在没有不良预后因素的患者中实现缓解，但长期依赖性和毒性仍然是普遍存在的挑战。传统的免疫抑制剂如环磷酰胺（CYC）、硫唑嘌呤和甲氨蝶呤已被广泛使用，利妥昔单抗在诱导治疗中显示出与CYC相似的缓解率。然而，有力的随机对照试验证据支持其对EGPA的疗效是有限的。通过IL-5或IL-5R阻断靶向嗜酸粒细胞的生物疗法，特别是mepolizumab和benralizumab，在复发或难治性疾病中显著降低复发率、类固醇暴露和改善缓解率，具有优异的耐受性。它们在诱导中的作用还有待评估，此外还有针对胸腺基质淋巴生成素（TSLP）和其他非2型免疫途径的新方法。未来的重点包括澄清血管与非血管机制的贡献，ANCA状态的意义，以及复发的免疫生物学。尽管在缺乏明确试验的情况下存在治疗惰性，但临床医生和研究人员的集体动力有望在未来几年改变和推进EGPA的管理。

{"title":"Treatment of Eosinophilic Granulomatosis With Polyangiitis (EGPA): Do We Need Immunosuppressives?","authors":"Alexandra M. Nanzer PhD , Benjamin Terrier MD, PhD , Michael E. Wechsler MD","doi":"10.1016/j.jaip.2026.01.014","DOIUrl":"10.1016/j.jaip.2026.01.014","url":null,"abstract":"<div><div>Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of antineutrophil cytoplasm antibody (ANCA)–associated vasculitis, distinguished by a complex interplay between type 2 (T2) eosinophilic and non-T2 inflammatory pathways. Systemic glucocorticosteroids remain the mainstay of both induction and maintenance therapy, achieving remission in patients without poor prognostic factors, yet long-term dependence and toxicity remain pervasive challenges. Conventional immunosuppressive agents such as cyclophosphamide (CYC), azathioprine, and methotrexate have been widely used, and rituximab has shown similar remission rates to CYC for induction therapy. However, robust randomized controlled trial evidence supporting their efficacy in EGPA is limited. Biologic therapies targeting eosinophils through IL-5 or IL-5R blockade, notably mepolizumab and benralizumab, have markedly reduced relapse rates, steroid exposure, and improved remission rates in relapsing or refractory disease, with excellent tolerability. Their role in induction is yet to be assessed, alongside novel approaches targeting thymic stromal lymphopoietin and other non-T2 immune pathways. Future priorities include clarifying the contribution of vasculitic versus nonvasculitic mechanisms, the significance of ANCA status, and the immunobiology of relapse. Despite therapeutic inertia in the absence of definitive trials, the collective drive of clinicians and researchers promises to transform and advance management of EGPA in the years ahead.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 3","pages":"Pages 613-618"},"PeriodicalIF":6.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0