World Allergy Organization Journal最新文献

Background: Advances in the understanding of type 2 inflammation have driven the development of novel biologics and small molecules for allergic diseases. New therapies targeting cytokines, receptors, and intracellular pathways offer opportunities to refine disease management and modify long-term outcomes.

Methods: The World Allergy Organization (WAO) Biologics Therapies in Allergic Diseases Committee conducted this state-of-the-art review. We analyzed current literature on investigational monoclonal antibodies, nanobody-based agents, kinase inhibitors, and small molecules with potential applications in asthma, chronic rhinosinusitis with nasal polyposis, atopic dermatitis, and chronic spontaneous urticaria. Mechanistic considerations, therapeutic targets, and clinical trial outcomes were evaluated to highlight emerging trends in biologic and small-molecule therapy.

Results: Biologics targeting IL-4, IL-5, IL-13, IL-31, TSLP, and IgE continue to expand therapeutic options across allergic disorders. Innovations such as Fc-engineered antibodies, bispecific antibodies, and nanobody platforms enhance efficacy, extend half-life, and improve tissue penetration. Novel intracellular inhibitors, including JAK, SYK, and STAT6 degraders, show promise as oral alternatives to injectable therapies. Clinical trials report high efficacy and favorable safety profiles, though variability remains across diseases and endotypes. Pediatric data are limited, and the long-term safety and cost-effectiveness of this approach require further evaluation.

Conclusions: Emerging biologics and small molecules are transforming the therapeutic landscape of allergic diseases, providing targeted and personalized interventions. Advances in molecular engineering, particularly nanobody technology and intracellular inhibitors, hold promise for improving patient outcomes and reducing treatment burden. Future research should prioritize long-term safety and standardized approaches to optimize integration of these therapies into clinical practice.

[This corrects the article DOI: 10.1016/j.waojou.2023.100830.].

Aim: The study aimed to analyse the characteristics of subtypes of chronic spontaneous urticaria (CSU) and determine the factors that may influence treatment response.

Methods: Clinical and laboratory characteristics of CSU patients were compared between 3 groups: (1) those with isolated urticaria (CSUwoAE, n = 50, 27.93%), (2) those with both urticaria and angioedema (CSUwAE, n = 86, 48.04%), and (3) those with isolated angioedema, also referred to as chronic histaminergic angioedema (CHA, n = 43, 24.02%). The Visual Analogue Scale for the worst attack (VAS-WA), Visual Analogue Scale for angioedema control (VAS-AEC), angioedema control test (AECT), Urticaria Control Test (UCT) and Angioedema Quality of Life (AEQoL) were the assessment tools.

Results: A weak correlation was observed between disease onset age and BMI (r = 0.295, p < 0.001). The age of onset was higher in CHA than in CSUwAE (p < 0.001). Oropharyngeal angioedema was more frequent in CHA (p = 0.022), whereas eyelid angioedema occurred more often in CSUwAE (p = 0.001). CHA patients had more impaired AEQoL (p = 0.043) and poorer disease control per AECT and VAS-AEC (p < 0.001, p = 0.001, respectively). The rate of high-dose antihistamine response among patients with angioedema was lower in the CHA group (n = 1; 12.5%) compared with the CSUwAE group (n = 10; 66.7%; p = 0.027). Irrespective of CSU subtypes, omalizumab response varied by BMI in patients with angioedema (n = 51; p = 0.002), with the least response in obese patients (p = 0.033).

Conclusion: Our study observed that obesity appeared to be associated with a later age of CSU onset and with a lower likelihood of omalizumab responsiveness in patients with angioedema; however, these findings should be interpreted as associations rather than suggesting any causal relationship. Additionally, CHA patients seem to have more severely impaired quality of life and a less controlled disease compared to CSUwAE.

Background: Dysregulation of gastrointestinal function has been implicated in the pathogenesis of chronic spontaneous urticaria (CSU). Moreover, persistent wheals and pruritus in CSU are frequently accompanied by sleep disturbances and psychological distress. However, whether sleep quality and psychological factors mediate the association between gastrointestinal symptoms and CSU disease severity remains unclear.

Methods: This study retrospectively analyzed data from 499 CSU patients. Associations between CSU disease activity and gastrointestinal symptoms, sleep quality, and psychological status were assessed. Mediation analyses were conducted to evaluate whether sleep quality and psychological status mediated the relationship between gastrointestinal symptoms and disease activity.

Results: Gastrointestinal symptoms were significantly associated with CSU disease activity. Multivariate analysis identified gastrointestinal symptoms as an independent risk factor for increased CSU disease activity (adjusted OR = 1.85, 95% CI: 1.23-2.78). Among individual gastrointestinal symptoms, diarrhea and abdominal pain showed the strongest correlations. Mediation analyses revealed partial mediation by psychological factors, with sleep disturbance (13.17%), anxiety (17.28%), and stress (21.09%) accounting for significant proportions of the total effect.

Conclusion: Gastrointestinal symptoms are independently associated with increased CSU disease activity. This relationship is partially mediated by sleep disturbances, anxiety, and stress, highlighting the relevance of the gut-brain-skin axis in CSU management.

Background: Hereditary angioedema (HAE) is a rare, potentially life-threatening condition. In recent years, the emergence of novel therapies has likely contributed to substantial growth in HAE research; however, a comprehensive review of the HAE research landscape remains lacking.

Methods: We conducted a systematic literature search on the Web of Science Core Collection and extracted metadata for all HAE records from 1972 to 2023. Bibliometric analysis was performed to outline trends in research productivity, participation, collaboration, focus, and global patterns in HAE research.

Results: We analysed a total of 2443 publications. Research output increased over time (annual growth rate = 6.34%) and was correlated to countries' Human Development Index and Gross National Income per capita (Spearman ρ > 0.40, p < 0.001). Regional analysis based on WHO classifications revealed >85% of HAE studies were led by researchers from Europe and America. However, contributions from the Western Pacific rose significantly (1972-2010: 4.6% vs 2011-2023: 8.6%, p < 0.001). International collaboration rose significantly over time, increasing from 10.9% (1972-2010) to 27.7% (2011-2023) (p < 0.001). Keyword and trend analyses indicated that research focus shifted from pathophysiology and diagnosis to patient outcomes, treatment and prophylaxis. Specifically, long-term prophylaxis emerged as a key area in recent research.

Conclusions: The volume of HAE-related publications is rapidly increasing, reflecting a transition from basic science to more clinically oriented research, particularly focusing on long-term prophylaxis. While global research efforts are becoming increasingly collaborative and diverse, participation from Africa, the Eastern Mediterranean, and South-East Asia remains limited. Greater support for these regions is essential to ensure equitable progress in HAE research and care.

Nature prescription is a relatively new clinical approach consisting of recommendations of exposure to natural environments as a complementary intervention to support health. Especially in the treatment of asthma and chronic obstructive pulmonary disease (COPD), increased connection to wider nature appears useful. Nature prescription integrates green space practices such as outdoor walks, other low-grade exercise, contemplation, and mindfulness. We have prepared a scoping review of the relevant literature on nature prescription for patients with chronic respiratory diseases, considering population studies but also clinical experience. The results indicate that regular exposure to green space contributes to increased physical activity, reduced stress and anxiety, improved lung function, reduced need for rescue medication, and better adherence to treatment. A protocol is also proposed to evaluate these outcomes. We conclude that integrating the use of green space and natural outdoor elements into multidisciplinary care represents an accessible, safe enough, and potentially effective strategy to promote respiratory health.