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

Background: Total serum immunoglobulin E (TsIgE) has not been examined in children with food allergy.

Objective: Evaluate associations of TsIgE with patient, household, environmental and community-level characteristics among children with food allergy.

Method: Linear mixed effect models of data from 398 Black and/or African American (B/AA) and White and/or European American (W/EA) children with allergist-diagnosed food allergy from the multi-center, observational cohort FORWARD; TsIgE in kU/L was the primary outcome measure.

Results: In univariable analyses of data from all study sites, children's TsIgE was positively associated with older age (p < .001), B/AA race (p < .001), male sex (p = .014), lower household income (p = .005), lower caregiver education (p = .005), higher area deprivation index (p< .001), presence of allergic rhinitis (p < .001), asthma (p < .001), and eczema (p = .024), and a higher number of food allergies (p< .001), but not with tobacco smoke exposure. With covariable adjustment in multivariable analysis, total serum IgE was higher in older vs. younger children (p < .001), male vs. female children, B/AA vs. W/EA children (p < .001), and in children with allergic rhinitis (p = .010), asthma (p < .001), eczema (p = .007), or a higher number of food allergies (p < .001), but not with tobacco smoke exposure or area deprivation index.

Conclusions: In children with food allergy, age, sex, race, atopic diagnosis, allergic rhinitis, asthma and eczema are associated with TsIgE. These findings are important when TsIgE values are utilized in diagnosis and therapies.

Background: Fish allergy affects children and adults worldwide and there are transient and persistent phenotypes.

Objective: We aimed to analyze persistence, severity and reactivity thresholds in challenge-confirmed fish allergic patients sensitized to parvalbumin.

Methods: Patients 12-65 years-old reporting immediate reactions to fish, with fish skin prick test ≥5 mm and IgE to cod and carp β-parvalbumins ≥0.70 kU_A/L were recruited in 6 European centers. Except if recent severe anaphylaxis, patients were eligible for a double-blind placebo-controlled food challenge with cod, followed, if negative, by an open food challenge. Severity of reported and elicited reactions was graded with FASS, eliciting dose (ED) was calculated using interval-censoring survival analysis and probabilistic models, and factors associated with a positive challenge and severe reactions were analyzed by logistic regression.

Results: Out of 42 patients fulfilling inclusion criteria, fish allergy was confirmed in 30 (71.4%). The median fish allergy duration was 23 yr. Although 70% of cases reported anaphylaxis with respiratory or cardiovascular involvement, food challenges resulted in oropharyngeal symptoms (34.7%) or mild systemic reactions (73.9%), with only 1 anaphylaxis with bronchospasm (4.3%). Male sex was associated with severe reactions (OR 5.44, 95%CI 1.04-28.53). ED₁₀ for objective symptoms range was 0.99-2.54 mg protein. No correlation was found between severity and ED.

Conclusion: Adolescents and adults with persistent fish allergy linked to parvalbumin sensitization have experienced severe allergic reactions in real life and have a low threshold of reactivity. Our findings support the need for large-scale studies and new therapeutic options for these fish allergic patients.

Background: The development of hypersensitivity reactions (HSRs) to carboplatin can interrupt anticancer treatment and may shorten patient survival. Several studies have evaluated the risk factors for carboplatin HSRs, but the results have been inconclusive.

Objective: This systematic review and meta-analysis aim to establish a consensus on the risk factors of HSRs to carboplatin in cancer patients.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, relevant studies were searched across MEDLINE, EMBASE, and Korean Medical Database. Inclusion criteria focused on original articles of case-control or cohort studies that evaluated risk factors for carboplatin HSRs in cancer patients. Exclusion criteria targeted articles with incomplete or overlapping data. The latest search and quality assessment of the included studies, using the Newcastle-Ottawa scale, was performed on February 1, 2023.

Results: Among 1,182 articles identified, 19 studies were included in the final systematic review and meta-analysis. The identified risk factors for carboplatin hypersensitivity included a history of allergy to medicines, food, or environmental factors (OR of 1.76, 95% CI 1.46 - 2.12), BRCA mutation (OR of 4.03, 95% CI 2.00 - 8.13), carboplatin free interval of 12 months or more (OR of 4.93, 95% CI 2.89 - 8.40), increased cumulative dose (SMD of 0.58, 95% CI 0.41 - 0.75), relapse (OR of 2.26, 95% CI 1.58 - 3.25), and younger age (SMD of -0.15, 95% CI: -0.26 - -0.03).

Conclusion: This meta-analysis provides the first comprehensive quantitative evaluation of risk factors for carboplatin HSRs in cancer patients. These findings can guide the development of personalized risk assessment tools and preventive strategies, potentially improving patient safety and treatment outcomes in carboplatin-based chemotherapy.

Human activities, primarily the burning of fossil fuels, widespread deforestation, soil erosion or machine-intensive farming methods, manufacturing, food processing, mining, and construction iron, cement, steel, and chemicals industry, have been the main drivers of the observed increase in Earth's average surface temperature and climate change. Rising global temperatures, extreme weather events, ecosystems disruption, agricultural impacts, water scarcity, problems in access to good quality water, food and housing, and profound environmental disruptions such as biodiversity loss and extreme pollution are expected to steeply increase the prevalence and severity of acute and chronic diseases. Its long-term effects cannot be adequately predicted or mitigated without a comprehensive understanding of the adaptive ecosystems. Studying the complex interaction between environmental aggressors and the resilient adaptive responses requires the exposomic and the One Health approaches. The problem is broad and affects the whole ecosystem, plants, pets and animals in addition to humans. The central role of the epithelial barrier, microbiome, and diet as key pillars for an adaptive tolerogenic immune response should be explored for increasing resilience at the individual level. A radical change in mindset worldwide, with sustainable solutions and adaptive strategies and climate-resilience and health equity policies at their center, should be achieved quickly through increased awareness based on solid scientific data.

Autoinflammatory diseases (AIDs) are characterized by dysregulation of innate immunity, leading to systemic inflammation. Familial Mediterranean fever (FMF) is the most common AID, associated with variants in exon 10 of MEFV. This gene codes for pyrin, a key protein in the inflammasome of the same name, involved in the innate immune response. Since the discovery of FMF, many other pathogenic variants of MEFV have been identified. These variants, apart from exon 10, are responsible for a variety of autoinflammatory diseases known as pyrin-associated autoinflammatory diseases (PAAD) or pyrinopathies. Variants in exon 10, 8, 5 and 3 are associated with dominant forms of FMF. Other inflammatory clinical pictures not resembling typical FMF are possible: PAAND (Pyrin-associated autoinflammation with neutrophilic dermatosis) is characterized by febrile attacks and severe neutrophilic dermatosis associated with variants in exon 2, PAAHe (Pyrin-associated autoinflammation with hypereosinophilia) was described among patients displayingsevere inflammation and hypereosinophilia associated variants in exon 2 different from PAAND; and PAANi (Pyrin-associated autoinflammation associated with Neuroinflammation) manifests with systemic inflammation, serositis and neuroinflammation associated with variants in exon 9. Somatic forms of FMF have also been described. We present here a review of the literature on the various autoinflammatory diseases associated with pathogenic MEFV variants and propose a practical approach for the genetic diagnosis of MEFV associated AIDs.

Secondary hypogammaglobulinemia, or decreased IgG levels due to reduced production or increased loss caused by medications or underlying conditions, can be associated with increased infection risk. While immunoglobulin replacement therapy (IgRT) is generally accepted as a strategy to help prevent recurrent bacterial infections in SHG, controversy exists as to whether it should be initiated to prevent the first occurrence of infection. This question has been raised particularly in the setting of anti-CD20 therapy, solid organ transplant, and B-cell malignancies and their treatments once IgG levels fall below 300-400 mg/dL. This article reviews the evidence for and against initiating IgRT in these settings, as well as associated considerations for evaluation and monitoring. While it is relatively clear that infection risk increases with decreasing IgG levels, the exact contribution of SHG to overall infection risk, and the protective benefit of IgRT in the absence of infections remains unclear. In the absence of clear consensus, shared decision-making is often needed to determine if and when to initiate IgRT.

Penicillin allergy labels (PAL) are common but rarely correspond with a patient's likelihood to tolerate penicillin. This results in unnecessary penicillin avoidance in many patients, driving numerous negative health outcomes. Evaluation strategies for PAL are driven by risk stratification and include a spectrum of modalities such as delabeling without any testing, direct oral challenge, and skin testing followed by challenge testing. Historically, PAL delabeling has primarily been the domain of the allergist, but this has resulted in significant limitations in access to testing for many patients globally and in the United States. Novel strategies to increase access to penicillin allergy evaluations are urgently needed, and non-allergist delabeling has been proposed as one strategy to help address this. Using a pro/con format, we review the evidence for non-allergist PAL delabeling in children and adults, focusing on direct challenge testing and highlighting considerations to guide non-allergist implementation of penicillin allergy evaluations.