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

英文中文

Splenectomy allows remission of angioedema with acquired C1-inhibitor deficiency associated with splenic marginal zone lymphoma 脾切除术可使伴有脾边缘区淋巴瘤的获得性 C1-INH 缺乏症的血管性水肿得到缓解。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-09-01 DOI: 10.1016/j.jaip.2024.05.047

引用次数: 0

Comorbid Scenarios in Contact Dermatitis: Atopic Dermatitis, Irritant Dermatitis, and Extremes of Age 接触性皮炎的合并症：特应性皮炎、刺激性皮炎和极端年龄

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-09-01 DOI: 10.1016/j.jaip.2024.08.002

引用次数: 0

Preserved antibody responses to COVID-19 vaccination and lower odds of developing COVID-19 in adults with severe asthma 严重哮喘成人接种 COVID-19 疫苗后可保留抗体反应，并降低 COVID-19 的发病几率

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-09-01 DOI: 10.1016/j.jaip.2024.05.026

引用次数: 0

Food Sublingual Immunotherapy: Safety and Simplicity of a Real Food Updosing Protocol 食物舌下免疫疗法：真实食物更新方案的安全性和简易性

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-09-01 DOI: 10.1016/j.jaip.2024.05.007

Background

Sublingual immunotherapy (SLIT) using food extracts is safe and effective in desensitizing patients with food allergy, yet not often used in clinical practice.

Objectives

To propose a cost-effective, expedited SLIT protocol using real food.

Methods

Patients with food allergy aged 5 to 50 years (median, 11 years) initiated food SLIT in a single-clinic setting. The daily maintenance dose was 4 to 11 mg protein in 0.1 to 0.5 mL volume, depending on the food. Some foods were available in liquid form at the local grocery (milk, egg white liquid, and cashew/walnut/sunflower/hazelnut milk), whereas others were prepared in the office using flour and 50% glycerin saline (peanut/sesame/wheat). The first cohort of 20 patients began dosing at a 1:1000 dilution, the next 30 patients at 1:100 dilution. An exercise challenge was performed in a subset of patients on maintenance dosing to evaluate the need for a predose or postdose rest period.

Results

The 1:1000 and 1:100 cohorts both completed day 1 without adverse reactions beyond itchy mouth. There were no systemic reactions requiring epinephrine throughout the study period and 88% reached their maintenance dose. Skin testing of 6-month-old peanut flour solution was not diminished from fresh solution and similar to food extract. Exercise challenge test results in 12 patients were negative.

Conclusions

Allergen extract food SLIT as used in published trials has limitations of cost and multiple office visits. Inexpensive real food, at the same or slightly higher protein dose, was well tolerated in 4 updose visits, a minimum of a week apart. Unlike food oral immunotherapy, a predose or postdose rest period may not be necessary.

背景：使用食物提取物的舌下免疫疗法（SLIT）对食物过敏患者脱敏安全有效，但在临床实践中并不常用：我们提出了一种使用真实食物的经济高效、快速的舌下免疫疗法方案：方法：食物过敏患者年龄在 5-50 岁之间，中位数为 11 岁，在一家诊所开始使用食物 SLIT。根据食物的不同，每日维持剂量为 4-11 毫克蛋白质，体积为 0.1-0.5 毫升。一些食物在当地杂货店有售（牛奶、蛋白液和腰果/核桃/葵花/榛子奶），而其他食物则在诊所用面粉和 50%甘油盐水配制（花生/芝麻/小麦）。第一批 20 名患者以 1:1,000 的稀释比例开始配药，随后的 30 名患者以 1:100 的稀释比例开始配药。对一部分服用维持剂量的患者进行了运动挑战，以评估是否需要在服药前或服药后休息一段时间：结果：1:1,000 和 1:100 两组患者在完成第一天用药后，除口腔瘙痒外均未出现其他不良反应。在整个研究期间，没有出现需要使用肾上腺素的全身反应，88%的人达到了维持剂量。对 6 个月的花生粉溶液进行的皮肤测试结果与新鲜溶液相比没有降低，与食物提取物相似。12名患者的运动挑战测试结果均为阴性：结论：已发表的试验中使用的过敏原提取物食品 SLIT 有成本和多次就诊的局限性。价格低廉的真实食物，蛋白质剂量相同或稍高，患者在至少间隔一周的时间内分 4 次服用，耐受性良好。与食物口服免疫疗法不同，服用前或服用后可能无需休息。

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引用次数: 0

Real-World Data on Tezepelumab in Patients With Severe Asthma in Germany 德国重症哮喘患者使用替塞单抗的实际数据。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-09-01 DOI: 10.1016/j.jaip.2024.05.052

Background

Tezepelumab is a novel biologic blocking thymic stromal lymphopoetin, approved for severe asthma irrespective of biomarker levels or phenotype.

Objective

To characterize a real-world tezepelumab patient cohort and the efficacy among various asthma phenotypes.

Methods

We performed a retrospective, multicenter study on patients with severe asthma initiating tezepelumab. Clinical response was evaluated at 3 and 6 months.

Results

We included 129 patients with an average age of 52.5 ± 13.1 years, 59.7% were female. The majority (86.0%) had increased type 2 (T2) biomarkers, 68.2% an allergic and 31.8% an eosinophilic phenotype. 23.3% of patients were biologic-naive. 22 (18.2%) patients discontinued tezepelumab therapy owing to suspected side effects or insufficient efficacy. At 6 months’ follow-up, median reduction in annualized exacerbation rate was–1 [25th percentile; 75% percentile {–2.9; 0.0}], the reduction of oral corticosteroid dose among patients with long-term oral corticosteroid therapy was –5 mg [–10; 0] and the Asthma Control Test (ACT) improved by 2 [0; 5] points. A treatment response according to Biologic Asthma Response Score of 80.8% was demonstrated. There were no significant differences in treatment response between T2-high versus T2-low, early- versus adult-onset and eosinophilic versus non-eosinophilic asthma. Prior treatment with other biologics was associated with inferior treatment response.

Conclusions

In this real-life cohort, including a large proportion of patients with history of previous biologic use and encompassing various subgroups, the majority responded to tezepelumab. Our data further suggest a steroid-sparing effect of tezepelumab.

背景特珠单抗是一种阻断胸腺基质淋巴细胞素（TSLP）的新型生物制剂，已被批准用于治疗重症哮喘，与生物标志物水平或表型无关：目的：描述真实世界中替塞鲁单抗患者群的特征以及不同哮喘表型的疗效：我们对开始使用替塞单抗的重症哮喘患者进行了一项多中心回顾性研究。结果：我们共纳入了 129 名患者，平均年龄为 65 岁：我们共纳入了 129 名患者，平均年龄为（52.5 ± 13.1）岁，其中 59.7% 为女性。大多数患者（86.0%）的T2生物标志物增高，68.2%为过敏性表型，31.8%为嗜酸性表型。23.3%的患者未使用过生物制剂。22例（18.2%）患者因疑似副作用或疗效不佳而中断了替塞普鲁单抗治疗。随访6个月时，年化恶化率（AE）的中位数减少了-1 [-2.9; 0.0]，长期接受口服皮质类固醇（OCS）治疗的患者口服皮质类固醇（OCS）剂量减少了-5 mg [-10; 0]，哮喘控制测试（ACT）提高了2 [0; 5]分。根据生物哮喘反应评分，80.8% 的患者表现出治疗反应。T2高与T2低、早期发病与成年发病、嗜酸性粒细胞性与非嗜酸性粒细胞性哮喘之间的治疗反应无明显差异。曾接受过其他生物制剂治疗的患者治疗反应较差：在这个现实生活中的队列中，有很大一部分患者既往使用过生物制剂，而且包括不同的亚组，大多数患者对替塞普鲁单抗有反应。我们的数据进一步表明，替塞单抗具有节省类固醇的作用。

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引用次数: 0

Radiocontrast media–induced sialadenitis 放射造影剂诱发的唾液腺炎症。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-09-01 DOI: 10.1016/j.jaip.2024.06.026

引用次数: 0

May 2024 Practice Notes 2024 年 5 月练习笔记

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-09-01 DOI: 10.1016/S2213-2198(24)00787-6

引用次数: 0

Different phenotypes of Non-Steroidal Anti-Inflammatory drugs hypersensitivity in children and negative predictive value of drug provocation test. 儿童对非甾体抗炎药过敏的不同表型及药物激发试验的阴性预测值。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-08-29 DOI: 10.1016/j.jaip.2024.08.043

Erika Paladini, Giulia Liccioli, Leonardo Tomei, Riccardo Pertile, Mattia Giovannini, Simona Barni, Lucrezia Sarti, Benedetta Pessina, Francesca Mori

Clinical implications box: This is the first study trying to correlate the clinical history of patients' previous NSAIDs in terms of the culprit drug, the frequency of reactions and the clinical manifestations with the risk for being diagnosed with a specific phenotype.

临床意义盒：这是第一项尝试将患者既往服用非甾体抗炎药的临床病史（包括罪魁祸首药物、反应频率和临床表现）与被诊断为特定表型的风险相关联的研究。

引用次数: 0

Harmonization of Diagnostic Criteria in Mastocytosis for Use in Clinical Practice: WHO vs ICC vs AIM/ECNM. 统一用于临床实践的肥大细胞增多症诊断标准：WHO vs ICC vs AIM/ECNM。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-08-29 DOI: 10.1016/j.jaip.2024.08.044

Peter Valent, Karin Hartmann, Gregor Hoermann, Andreas Reiter, Iván Alvarez-Twose, Knut Brockow, Patrizia Bonadonna, Olivier Hermine, Marek Niedoszytko, Melody C Carter, Joseph H Butterfield, Frank Siebenhaar, Roberta Zanotti, Deepti H Radia, Mariana Castells, Wolfgang R Sperr, Sigurd Broesby-Olsen, Massimo Triggiani, Lawrence B Schwartz, Tracy I George, Theo Gülen, Karl Sotlar, Jason Gotlib, Stephen J Galli, Hans-Peter Horny, Dean D Metcalfe, Alberto Orfao, Michel Arock, Cem Akin

Mastocytosis is a clonal myeloid disorder defined by an increase and accumulation of mast cells (MC) in one or multiple organ systems. The complex pathology of mastocytosis results in variable clinical presentations, courses, and outcomes. The World Health Organization (WHO) divides the disease into cutaneous mastocytosis (CM), several forms of systemic mastocytosis (SM), and MC sarcoma. In most SM patients, a somatic KIT mutation, usually D816V, is identified. Patients diagnosed with CM or non-advanced SM, including indolent SM, have a near-normal life-expectancy, whereas those with advanced SM, including aggressive SM and MC leukemia, have limited life-expectancy. Since 2001, a multidisciplinary consensus group consisting of experts from the European Competence Network on Mastocytosis (ECNM) and American Initiative in Mast Cell Diseases (AIM), has supported the field by developing diagnostic criteria for mastocytosis. These criteria served as the basis for the WHO classification of mastocytosis over two decades. More recently, an international consensus group (ICC) proposed slightly modified diagnostic criteria and a slightly revised classification. In this article, these changes are discussed. Furthermore, we propose harmonization among the proposals of the AIM/ECNM consensus group, WHO, and ICC. Such harmonization will facilitate comparisons of retrospective study results and the conduct of prospective trials.

肥大细胞增多症是一种克隆性髓细胞疾病，表现为肥大细胞（MC）在一个或多个器官系统中的增多和积聚。肥大细胞增多症病理复杂，临床表现、病程和预后各不相同。世界卫生组织（WHO）将这种疾病分为皮肤肥大细胞增多症（CM）、几种形式的全身性肥大细胞增多症（SM）和肥大细胞肉瘤。大多数全身性肥大细胞增多症患者会出现体细胞 KIT 突变，通常为 D816V。被诊断为CM或非晚期SM（包括惰性SM）的患者的预期寿命接近正常，而晚期SM（包括侵袭性SM和MC白血病）患者的预期寿命有限。自 2001 年以来，由欧洲肥大细胞增多症能力网络（ECNM）和美国肥大细胞疾病倡议（AIM）的专家组成的多学科共识小组通过制定肥大细胞增多症的诊断标准为该领域提供了支持。二十多年来，这些标准一直是世界卫生组织对肥大细胞增多症进行分类的基础。最近，一个国际共识小组（ICC）提出了略有修改的诊断标准和略有修订的分类。本文将对这些修改进行讨论。此外，我们还建议统一 AIM/ECNM 共识小组、WHO 和 ICC 的建议。这种统一将有助于比较回顾性研究结果和进行前瞻性试验。

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引用次数: 0

Effects of combined aerobic and breathing exercises on asthma control: An RCT. 联合有氧运动和呼吸运动对哮喘控制的影响：一项 RCT 研究。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-08-29 DOI: 10.1016/j.jaip.2024.07.036

Fabiana S Kim, Jaqueline L Rocha, Adriana C Lunardi, Denielli Sg Bos, Eloise A Santos, Cibele Cb Marques da Silva, Alberto Cukier, Celso Rf Carvalho

Background: Breathing and aerobic exercises are the most recommended nonpharmacological treatments to improve asthma control and quality of life in patients with asthma. However, the benefits of combining both interventions in these outcomes have never been tested.

Objective: We aimed to evaluate the effects of the combination of aerobic and breathing exercises on asthma control in individuals with moderate-to-severe asthma.

Methods: Individuals with moderate-to-severe asthma were randomly assigned to the aerobic + muscle-stretching group (Control group (CG), n=25) or aerobic + breathing exercises group (Experimental group (EG), n=26). The aerobic exercise was performed using constant-load training and breathing exercises using the Buteyko technique. The training program lasted 20 sessions. All individuals were blindly assessed before and after the interventions for asthma control, health-related quality of life, anxiety and depression symptoms, sleep quality, hyperventilation, exercise capacity, lung function, levels of physical activity, and thoracoabdominal kinematics. Group x time interactions were tested using a two-way repeated measures analysis of variance. Pearson's correlation test was used to test the association between outcomes.

Results: The groups were similar at baseline (all p>0.05). After the intervention, there were no between-group differences for all outcomes comparing EG and CG.

Conclusion: These results suggest that a combination of aerobic and breathing exercises did not improve asthma control, psychosocial symptoms, sleep quality, hyperventilation, exercise capacity, lung function, levels of daily physical or thoracoabdominal kinematics compared with aerobic exercise alone in individuals with moderate-to-severe asthma.

Clinical trial registration: ClinicalTrials.gov, NCT04412720.

背景：呼吸和有氧运动是改善哮喘患者哮喘控制和生活质量的最推荐的非药物治疗方法。然而，将这两种干预措施结合起来对这些结果的益处却从未进行过测试：我们旨在评估有氧运动和呼吸运动相结合对中重度哮喘患者哮喘控制的影响：中重度哮喘患者被随机分配到有氧运动+肌肉拉伸组（对照组（CG），人数=25）或有氧运动+呼吸练习组（实验组（EG），人数=26）。有氧运动采用恒定负荷训练，呼吸练习采用布提科技术。训练计划持续 20 个疗程。所有受试者在干预前后均接受了哮喘控制、健康相关生活质量、焦虑和抑郁症状、睡眠质量、过度换气、运动能力、肺功能、体力活动水平和胸腹运动学方面的盲法评估。采用双向重复测量方差分析对组别 x 时间的交互作用进行了检验。使用皮尔逊相关性检验来检验结果之间的关联：结果：各组基线结果相似（P>0.05）。干预后，EG 和 CG 的所有结果均无组间差异：这些结果表明，在中重度哮喘患者中，与单独进行有氧运动相比，有氧运动和呼吸运动相结合并不能改善哮喘控制、社会心理症状、睡眠质量、过度换气、运动能力、肺功能、日常体力水平或胸腹运动学：临床试验注册：ClinicalTrials.gov，NCT04412720。

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