Pub Date : 2024-09-25DOI: 10.1016/j.waojou.2024.100972
Background
Precautionary Allergen (“may contain”) Labelling (PAL) is used by industry to communicate potential risk to food-allergic individuals posed by unintended allergen presence (UAP). In 2014, the World Allergy Organization (WAO) highlighted that PAL use was increasing, but often applied inconsistently and without regulation — which reduces its usefulness to consumers with food allergy and those purchasing food for them. WAO proposed the need for a regulated, international framework to underpin application of PAL. In 2019, the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) of the United Nations convened an expert consultation to address the issue of PAL, the outputs of which are now being considered by the Codex Committee on Food Labelling (CCFL).
Objectives
To summarise the latest data to inform the application of PAL in a more systematic way, for implementation into global food standards.
Methods
A non-systematic review of issues surrounding precautionary labelling and food allergens in pre-packaged products.
Results
Approximately, 100 countries around the world have legislation on the declaration of allergenic ingredients. Just a few have legislation on UAP. Given the risks that UAP entails, non-regulated PAL creates inconvenience in real life due to its unequal, difficult interpretation by patients. The attempts made so far to rationalize PAL present lights and shadows.
Conclusions
At a time when CCFL is considering the results of the FAO/WHO Expert Consultation 2020–2023, we summarise the prospects to develop an effective and homogeneous legislation at a global level, and the areas of uncertainty that might hinder international agreement on a regulated framework for PAL of food allergens.
背景预防性过敏原（"可能含有"）标签（PAL）被工业界用来向食物过敏者传达无意过敏原存在（UAP）所带来的潜在风险。2014 年，世界过敏组织（WAO）强调，PAL 的使用在不断增加，但其应用往往不一致且缺乏监管，这降低了其对食物过敏消费者和为其购买食品的消费者的实用性。WAO 建议需要一个规范的国际框架来支持 PAL 的应用。2019 年，世界卫生组织 (WHO) 和联合国粮食及农业组织 (FAO) 召开了一次专家磋商会，讨论 PAL 问题，食品标签法典委员会 (CCFL) 目前正在审议磋商会的成果。方法 对预包装产品中的预防性标签和食品过敏原相关问题进行非系统性审查。结果 全球约有 100 个国家制定了有关过敏原成分声明的法律。只有少数几个国家制定了有关 UAP 的法律。鉴于 UAP 所带来的风险，不规范的 PAL 在现实生活中造成了不便，因为患者很难对其做出不平等的解释。结论当食品标签委员会正在审议粮农组织/世卫组织 2020-2023 年专家磋商会的结果时，我们总结了在全球范围内制定有效和统一立法的前景，以及可能阻碍就食品过敏原 PAL 的规范框架达成国际协议的不确定领域。
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Pub Date : 2024-09-23DOI: 10.1016/j.waojou.2024.100968
Eosinophilic esophagitis (EoE) and allergic rhinitis (AR) usually represent the latest manifestations of the atopic march, sharing a common type 2 inflammation response. A relevant prevalence of AR in EoE cohorts has been widely confirmed. An increasing literature assessed the involvement of aeroantigens in EoE pathogenesis, focusing foremost on the seasonality of new diagnoses, symptoms, and response to therapy. Unfortunately, no diriment direction has been achieved, probably due to the retrospective design of the studies so far available, which chose surrogate markers of EoE activity (mostly the date of new diagnosis) which may be affected by geographical, logistic and personal factors, probably not dependent by the disease itself. EoE exacerbations reported in the context of the pollen levels (preferably pollen counts) may represent a more reliable marker. AR might promote the onset and the re-exacerbation of EoE through mechanisms that are both local (ie, massive exposure to airborne antigens mediated by post-nasal drip) and systemic (type 2 inflammation). Furthermore, AR may facilitate EoE onset by predisposing to pollen food allergic syndrome (PFAS), and EoE patients with PFAS reported higher rate of AR, thus suggesting a bond among these 3 conditions whose causative relationship have still to be ascertained. In addition, because of its shifting activity from Th2 to Th1 inflammation, several case reports focused on the effect of allergen immunotherapy (AIT) employed to treat AR in EoE patients. Also in this instance, no certainties could be guaranteed, although sublingual immunotherapy (SLIT) is more frequently reported to exacerbate EoE, while SCIT is mostly described as a remission adjuvant. The real life experience reported from our allergy service appears to confirm such hypothesis. Finally, a watchful eye should be reserved to monoclonal antibodies as a potential future option for concomitant EoE and AR. In light of all this, an attentive evaluation of allergic history of EoE patients should be relevant. Future perspectives should be addressed on prospective studies targeted to shed light on causative relations among airborne antigens, AR and EoE, and to viable comprehensive treatments.
嗜酸性粒细胞食管炎（EoE）和过敏性鼻炎（AR）通常是特应性进展的最新表现，具有共同的 2 型炎症反应。嗜酸性粒细胞性食管炎队列中 AR 的相关患病率已得到广泛证实。越来越多的文献评估了航空抗原在特应性鼻炎发病机制中的作用，主要关注新诊断、症状和治疗反应的季节性。遗憾的是，迄今为止的研究还没有确定方向，这可能是由于这些研究采用了回顾性设计，选择了肠易激综合征活动的代用指标（主要是新诊断的日期），而这些指标可能会受到地理、物流和个人因素的影响，很可能与疾病本身无关。根据花粉水平（最好是花粉计数）报告的肠易激综合征加重可能是更可靠的标志物。AR 可能会通过局部机制（即通过鼻后滴流大量接触空气中的抗原）和全身机制（2 型炎症）促进咽喉炎的发病和再次恶化。此外，AR 可能会导致花粉食物过敏综合征（PFAS），从而促进 EoE 的发生，而患有 PFAS 的 EoE 患者报告的 AR 发生率较高，这表明这三种疾病之间存在联系，其因果关系仍有待确定。此外，由于过敏原的活性从 Th2 炎症转变为 Th1 炎症，一些病例报告重点探讨了过敏原免疫疗法（AIT）治疗咽喉炎患者 AR 的效果。同样，虽然舌下免疫疗法（SLIT）经常被报道会加重咽喉炎，而 SCIT 则大多被描述为缓解病情的辅助疗法，但在这种情况下，并不能保证一定会产生效果。我们过敏服务部门的实际经验似乎证实了这一假设。最后，单克隆抗体作为一种潜在的治疗同时伴有肠易激综合征和 AR 的未来选择，应保持警惕。有鉴于此，应该对呃逆患者的过敏史进行仔细评估。未来应着眼于前瞻性研究，以阐明空气传播的抗原、AR 和咽喉炎之间的致病关系，并找到可行的综合治疗方法。
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Pub Date : 2024-09-19DOI: 10.1016/j.waojou.2024.100964
Background
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a prevalent inflammatory disorder affecting the upper respiratory tract. Recent studies have indicated an association between CRSwNP and mitochondrial metabolic disorder characterized by impaired metabolic pathways; however, the precise mechanisms remain unclear. This study aims to investigate the mitochondrial-related signature in individuals diagnosed with CRSwNP.
Methods
Through the integration of differentially expressed genes (DEGs) with the mitochondrial gene set, differentially expressed mitochondrial-related genes (DEMRGs) were identified. Subsequently, the hub DEMRGs were selected using 4 integrated machine learning algorithms. Immune and mitochondrial characteristics were estimated based on CIBERSORT and ssGSEA algorithms. Bioinformatic findings were confirmed through RT-qPCR, immunohistochemistry, and ELISA for nasal tissues, as well as Western blotting analysis for human nasal epithelial cells (hNECs). The relationship between hub DEMRGs and disease severity was assessed using Spearman correlation analysis.
Results
A total of 24 DEMRGs were screened, most of which exhibited lower expression levels in CRSwNP samples. Five hub DEMRGs (ALDH1L1, BCKDHB, CBR3, HMGCS2, and OXR1) were consistently downregulated in both the discovery and validation cohorts. The hub genes showed a high diagnostic performance and were positively correlated with the infiltration of M2 macrophages and resting mast cells. Experimental results confirmed that the 5 genes were downregulated at both the mRNA and protein levels within nasal polyp tissues. Finally, a significant and inverse relationship was identified between the expression levels of these genes and both the Lund-Mackay and Lund-Kennedy scores.
Conclusion
Our findings systematically unraveled 5 hub markers correlated with mitochondrial metabolism and immune cell infiltration in CRSwNP, suggesting their potential to be based to design diagnostic and therapeutic strategies for the disease.
{"title":"Integrated machine learning and bioinformatic analysis of mitochondrial-related signature in chronic rhinosinusitis with nasal polyps","authors":"","doi":"10.1016/j.waojou.2024.100964","DOIUrl":"10.1016/j.waojou.2024.100964","url":null,"abstract":"<div><h3>Background</h3><div>Chronic rhinosinusitis with nasal polyps (CRSwNP) is a prevalent inflammatory disorder affecting the upper respiratory tract. Recent studies have indicated an association between CRSwNP and mitochondrial metabolic disorder characterized by impaired metabolic pathways; however, the precise mechanisms remain unclear. This study aims to investigate the mitochondrial-related signature in individuals diagnosed with CRSwNP.</div></div><div><h3>Methods</h3><div>Through the integration of differentially expressed genes (DEGs) with the mitochondrial gene set, differentially expressed mitochondrial-related genes (DEMRGs) were identified. Subsequently, the hub DEMRGs were selected using 4 integrated machine learning algorithms. Immune and mitochondrial characteristics were estimated based on CIBERSORT and ssGSEA algorithms. Bioinformatic findings were confirmed through RT-qPCR, immunohistochemistry, and ELISA for nasal tissues, as well as Western blotting analysis for human nasal epithelial cells (hNECs). The relationship between hub DEMRGs and disease severity was assessed using Spearman correlation analysis.</div></div><div><h3>Results</h3><div>A total of 24 DEMRGs were screened, most of which exhibited lower expression levels in CRSwNP samples. Five hub DEMRGs (<em>ALDH1L1</em>, <em>BCKDHB</em>, <em>CBR3</em>, <em>HMGCS2</em>, and <em>OXR1</em>) were consistently downregulated in both the discovery and validation cohorts. The hub genes showed a high diagnostic performance and were positively correlated with the infiltration of M2 macrophages and resting mast cells. Experimental results confirmed that the 5 genes were downregulated at both the mRNA and protein levels within nasal polyp tissues. Finally, a significant and inverse relationship was identified between the expression levels of these genes and both the Lund-Mackay and Lund-Kennedy scores.</div></div><div><h3>Conclusion</h3><div>Our findings systematically unraveled 5 hub markers correlated with mitochondrial metabolism and immune cell infiltration in CRSwNP, suggesting their potential to be based to design diagnostic and therapeutic strategies for the disease.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1939455124000954/pdfft?md5=0aa4daa07b7c3b9fd971ce2e75c9690d&pid=1-s2.0-S1939455124000954-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1016/j.waojou.2024.100975
Background
Seasonal allergic rhinoconjunctivitis (SAR) is a worldwide health problem, especially in Westernized countries. Previous studies of the “Panallergens in Pediatrics” (PAN-PED) cohort found that molecular spreading (ie, the progressive increase in serum specific IgE antibody levels) of the IgE response to the grass pollen, Phleum pratense, molecules is directly associated with polysensitization to pollen in general.
The research question is aimed at verifying whether this association can also be detected for non-pollen allergens, specifically Dermatophagoides pteronyssinnus (D.pt), to better understand the relationship between a perennial allergen (D.pt) and a seasonal allergen (Phleum pratense).
To this end, our first objective was to analyze the biobank of the PAN-PED cohort serum by measuring the IgE levels to D.pt and its major recombinant molecules (Der p1, Der p2, Der p23); subsequently we investigated their correlation towards Phleum pratense IgE response, studying also the relationship between the molecular spreading of these 2 different allergens.
Methods
Among 1120 patients positive to Phleum pratense, 638 were also sensitized to D.pt. Patients underwent skin prick tests (SPT) for inhalant extracts, and their serum was tested for total IgE (tIgE), and sIgE to pollen and perennial allergens. Considering the molecular allergen detection through the component resolved diagnosis (CRD), out of 638 patients, 146 were further investigated by performing IgE tests of the 3 major D.pt. molecules: Der p1, Der p2, and Der p23.
Results
We found that a broader molecular response to Phleum pratense molecules, assessed by CRD, was associated with higher tIgE levels, polysensitization to pollens, and higher IgE levels to pollens, but also to lower IgE levels to D.pt and lower degree of sensitization to rDer p1, r Der p2, and rDer p23. In a multivariate linear model, the number of Phleum pratense molecules recognized by IgE was still inversely associated with the IgE level to D.pt extract.
Conclusions
The main finding of this study was the detection of an inverse association, never described in the literature, between the molecular spreading of the IgE response to Phleum pratense and the IgE response to D.pt. This led us to speculate on the etiopathogenetic hypothesis according to which, among the majority of pollen allergic patients, a strong and molecularly diversified IgE response may be limited to pollen allergens and may be preventing or contrasting the development of an equally strong and diversified IgE sensitization to D.pt molecules. The biological mechanisms underlying this phenomenon deserve to be investigated.
{"title":"Inverse association between the molecular spreading of IgE to grass pollen and the IgE response to Dermatophagoides pteronyssinus among children with seasonal allergic rhinitis","authors":"","doi":"10.1016/j.waojou.2024.100975","DOIUrl":"10.1016/j.waojou.2024.100975","url":null,"abstract":"<div><h3>Background</h3><div>Seasonal allergic rhinoconjunctivitis (SAR) is a worldwide health problem, especially in Westernized countries. Previous studies of the “Panallergens in Pediatrics” (PAN-PED) cohort found that molecular spreading (ie, the progressive increase in serum specific IgE antibody levels) of the IgE response to the grass pollen, <em>Phleum pratense</em>, molecules is directly associated with polysensitization to pollen in general.</div><div>The research question is aimed at verifying whether this association can also be detected for non-pollen allergens, specifically <em>Dermatophagoides pteronyssinnus</em> (<em>D.pt</em>), to better understand the relationship between a perennial allergen (<em>D.pt</em>) and a seasonal allergen (<em>Phleum pratense</em>).</div><div>To this end, our first objective was to analyze the biobank of the PAN-PED cohort serum by measuring the IgE levels to <em>D.pt</em> and its major recombinant molecules (Der p1, Der p2, Der p23); subsequently we investigated their correlation towards <em>Phleum pratense</em> IgE response, studying also the relationship between the molecular spreading of these 2 different allergens.</div></div><div><h3>Methods</h3><div>Among 1120 patients positive to <em>Phleum pratense</em>, 638 were also sensitized to <em>D.pt</em>. Patients underwent skin prick tests (SPT) for inhalant extracts, and their serum was tested for total IgE (tIgE), and sIgE to pollen and perennial allergens. Considering the molecular allergen detection through the component resolved diagnosis (CRD), out of 638 patients, 146 were further investigated by performing IgE tests of the 3 major D.pt. molecules: Der p1, Der p2, and Der p23.</div></div><div><h3>Results</h3><div>We found that a broader molecular response to <em>Phleum pratense</em> molecules, assessed by CRD, was associated with higher tIgE levels, polysensitization to pollens, and higher IgE levels to pollens, but also to lower IgE levels to <em>D.pt</em> and lower degree of sensitization to rDer p1, r Der p2, and rDer p23. In a multivariate linear model, the number of <em>Phleum pratense</em> molecules recognized by IgE was still inversely associated with the IgE level to <em>D.pt</em> extract.</div></div><div><h3>Conclusions</h3><div>The main finding of this study was the detection of an inverse association, never described in the literature, between the molecular spreading of the IgE response to <em>Phleum pratense</em> and the IgE response to <em>D.pt</em>. This led us to speculate on the etiopathogenetic hypothesis according to which, among the majority of pollen allergic patients, a strong and molecularly diversified IgE response may be limited to pollen allergens and may be preventing or contrasting the development of an equally strong and diversified IgE sensitization to <em>D.pt</em> molecules. The biological mechanisms underlying this phenomenon deserve to be investigated.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1939455124001078/pdfft?md5=efafb3c2672f9aa2cace5377145e41a1&pid=1-s2.0-S1939455124001078-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1016/j.waojou.2024.100973
{"title":"Corrigendum to “Disease burden and unmet need for acute allergic reactions – A patient perspective” [World Allergy Organ J 17(4) (2024 Apr) 100896]","authors":"","doi":"10.1016/j.waojou.2024.100973","DOIUrl":"10.1016/j.waojou.2024.100973","url":null,"abstract":"","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1939455124001054/pdfft?md5=21ec3cfed707143f13d13f6cf80e344c&pid=1-s2.0-S1939455124001054-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1016/j.waojou.2024.100965
{"title":"Epinephrine infusion as an adjuvant treatment for breakthrough reactions during desensitization to methotrexate","authors":"","doi":"10.1016/j.waojou.2024.100965","DOIUrl":"10.1016/j.waojou.2024.100965","url":null,"abstract":"","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1939455124000966/pdfft?md5=a8e47eedf24f8870d55a711132b7ade3&pid=1-s2.0-S1939455124000966-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1016/j.waojou.2024.100970
Background
Allergic rhinitis (AR) is an allergic reaction dominated by the Th2 immune response in the nasal mucosa. The bacterial infection process affects the balance between Th1 and Th2 immune responses, and the level of exposure to environmental flora is closely related to the development of AR. Hydrogen (H2) is a medical molecule with anti-inflammatory and antioxidant properties. This study aimed to explore the possible mechanism of action of H2 on AR through its ability to regulate the balance of nasal flora.
Methods
Serum eosinophil count (EOS), immunoglobulin E (IgE) concentration, visual analog scale (VAS), total nasal symptom score (TNSS), and rhinoconjunctivitis quality of life questionnaire (RQLQ) were observed before and after hydrogen inhalation in AR patients. Skin prick test (SPT) was used to determine allergen sensitisation. Community composition and relative abundance of nasal flora were examined before and after hydrogen inhalation and in normal subjects using 16S rRNA gene sequencing.
Results
There were no adverse reactions during and after hydrogen inhalation in AR patients, with a favorable safety profile and significant improvements in VAS, TNSS, EOS, and IgE (P < 0.05). Cavity flora 16S rRNA gene sequencing showed higher abundance of Ruminococcus and Erysipelotrichaceae flora in the nasal cavity of AR patients than in normal subjects, and their abundance could be down-regulated after H2 inhalation. H2 significantly increased the abundance of Blautia_faecis and negatively correlated with VAS, TNSS, EOS, and IgE.
Conclusions
H2 may improve symptoms in AR patients by modulating the distribution of nasal flora. Trials with larger sample sizes are required to further test this hypothesis.
Trial registration
This trial was registered in the China Clinical Trial Registry (Registration No. ChiCTR2200062253).
背景过敏性鼻炎（AR）是一种以鼻粘膜 Th2 免疫反应为主的过敏反应。细菌感染过程会影响 Th1 和 Th2 免疫反应之间的平衡，环境菌群的暴露水平与 AR 的发生密切相关。氢气（H2）是一种具有抗炎和抗氧化特性的医用分子。本研究旨在探讨氢气通过调节鼻腔菌群平衡对 AR 的可能作用机制。方法观察 AR 患者吸入氢气前后的血清嗜酸性粒细胞计数（EOS）、免疫球蛋白 E（IgE）浓度、视觉模拟量表（VAS）、鼻腔症状总评分（TNSS）和鼻结膜炎生活质量问卷（RQLQ）。皮肤点刺试验（SPT）用于确定过敏原致敏性。结果AR 患者在吸入氢气前后均未出现不良反应，安全性良好，VAS、TNSS、EOS 和 IgE 均有显著改善（P < 0.05）。腔内菌群 16S rRNA 基因测序显示，AR 患者鼻腔内的反刍球菌和绿脓杆菌菌群丰度高于正常人，吸入氢气后它们的丰度可被下调。结论 H2 可通过调节鼻腔菌群的分布来改善 AR 患者的症状。本试验已在中国临床试验注册中心注册（注册号：ChiCTR2200062253）。
{"title":"Hydrogen inhalation: A novel approach to alleviating allergic rhinitis symptoms by modulating nasal flora","authors":"","doi":"10.1016/j.waojou.2024.100970","DOIUrl":"10.1016/j.waojou.2024.100970","url":null,"abstract":"<div><h3>Background</h3><p>Allergic rhinitis (AR) is an allergic reaction dominated by the Th2 immune response in the nasal mucosa. The bacterial infection process affects the balance between Th1 and Th2 immune responses, and the level of exposure to environmental flora is closely related to the development of AR. Hydrogen (H<sub>2</sub>) is a medical molecule with anti-inflammatory and antioxidant properties. This study aimed to explore the possible mechanism of action of H<sub>2</sub> on AR through its ability to regulate the balance of nasal flora.</p></div><div><h3>Methods</h3><p>Serum eosinophil count (EOS), immunoglobulin E (IgE) concentration, visual analog scale (VAS), total nasal symptom score (TNSS), and rhinoconjunctivitis quality of life questionnaire (RQLQ) were observed before and after hydrogen inhalation in AR patients. Skin prick test (SPT) was used to determine allergen sensitisation. Community composition and relative abundance of nasal flora were examined before and after hydrogen inhalation and in normal subjects using 16S rRNA gene sequencing.</p></div><div><h3>Results</h3><p>There were no adverse reactions during and after hydrogen inhalation in AR patients, with a favorable safety profile and significant improvements in VAS, TNSS, EOS, and IgE (P < 0.05). Cavity flora 16S rRNA gene sequencing showed higher abundance of Ruminococcus and Erysipelotrichaceae flora in the nasal cavity of AR patients than in normal subjects, and their abundance could be down-regulated after H<sub>2</sub> inhalation. H<sub>2</sub> significantly increased the abundance of Blautia_faecis and negatively correlated with VAS, TNSS, EOS, and IgE.</p></div><div><h3>Conclusions</h3><p>H<sub>2</sub> may improve symptoms in AR patients by modulating the distribution of nasal flora. Trials with larger sample sizes are required to further test this hypothesis.</p></div><div><h3>Trial registration</h3><p>This trial was registered in the China Clinical Trial Registry (Registration No. ChiCTR2200062253).</p></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1939455124001029/pdfft?md5=6057376b9ebb8c62876dc1de4c1e1586&pid=1-s2.0-S1939455124001029-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.waojou.2024.100947
<div><h3>Background</h3><p>Cow's milk allergy (CMA) is the most complex and common food allergy in infants. Elimination of cow's milk from the diet and replacement with a specialized formula for infants with cow's milk allergy who cannot be breastfed is an established approach to minimize the risk of severe allergic reactions while avoiding nutritional deficiencies. Given the availability of multiple options, such as extensively hydrolyzed cow's milk-based formula (eHF-CM), aminoacid formula (AAF), hydrolyzed rice formula (HRF), and soy formula (SF), there is some uncertainty regarding which formula might represent the most suitable choice with respect to health outcomes. The addition of probiotics to a specialized formula has also been proposed as a potential approach to possibly increase the benefit. We systematically reviewed specialized formulas for infants with CMA to inform the updated World Allergy Organization (WAO) DRACMA guidelines.</p></div><div><h3>Objective</h3><p>To systematically review and synthesize the available evidence about the use of specialized formulas for the management of individuals with CMA.</p></div><div><h3>Methods</h3><p>We searched from inception PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and the websites of selected allergy organizations, for randomized and non-randomized trials of any language investigating specialized formulas with or without probiotics. We included all studies irrespective of the language of the original publication. The last search was conducted in January 2024. We synthesized the identified evidence quantitatively or narratively as appropriate and summarized it in the evidence profiles. We conducted this review following the PRISMA, Cochrane methods, and the GRADE approach.</p></div><div><h3>Results</h3><p>We identified 3558 records including 14 randomized trials and 7 observational studies. Very low certainty evidence suggested that in infants with IgE-mediated CMA, eHF-CM, compared with AAF, might have higher probability of outgrowing CMA (risk ratio (RR) 2.32; risk difference (RD) 25 more per 100), while showing potentially lower probability of severe vomiting (RR 0.12, 95% CI 0.02 to 0.88; RD 23 fewer per 100, 95% CI 3 to 26) and developing food protein-induced enterocolitis syndrome (FPIES) (RR 0.15, 95% CI 0.03 to 0.82; RD 34 fewer per 100, 95% CI 7 to 39). We also found, however, that eHF-CM might be inferior to AAF in supporting a physiological growth, with respect to both weight (−5.5% from baseline, 95%CI -9.5% to −1.5%) and length (−0.7 z-score change, 95%CI -1.15 to −0.25) (very low certainty). We found similar effects for eHF-CM, compared with AAF, also in non-IgE CMA. When compared with SF, eHF-CM might favor weight gain for IgE CMA infants (0.23 z-score change, 95%CI 0.01 to 0.45), and tolerance acquisition (RR 1.86, 95%CI 1.03 to 3.37; RD 27%, 95%CI 1%–74%) for non-IgE CMA (both at very low certainty of the evidence (CoE)). The compa
背景牛奶过敏（CMA）是婴儿最复杂、最常见的食物过敏。对于不能母乳喂养的牛奶过敏婴儿来说，从饮食中剔除牛奶并用专门配方奶粉替代是一种既能最大限度降低严重过敏反应风险又能避免营养缺乏的既定方法。目前有多种配方奶粉可供选择，如广泛水解牛乳配方奶粉（eHF-CM）、氨基酸配方奶粉（AAF）、水解大米配方奶粉（HRF）和大豆配方奶粉（SF）。也有人提出在专用配方奶粉中添加益生菌，作为一种可能增加益处的潜在方法。我们系统地回顾了用于治疗 CMA 婴儿的专用配方奶粉，以便为世界过敏组织 (WAO) 更新的 DRACMA 指南提供信息。方法我们从开始时的 PubMed、Medline、Embase、Cochrane 对照试验中央登记册 (CENTRAL) 和选定的过敏组织网站上搜索了调查添加或不添加益生菌的专用配方奶粉的任何语言的随机和非随机试验。我们收录了所有研究，无论原始出版物的语言如何。最后一次搜索于 2024 年 1 月进行。我们酌情对已确认的证据进行了定量或叙述性综合，并在证据简介中进行了总结。我们按照PRISMA、Cochrane方法和GRADE方法进行了此次综述。结果我们发现了3558条记录，包括14项随机试验和7项观察性研究。确定性极低的证据表明，对于 IgE 介导的 CMA 婴儿，eHF-CM 与 AAF 相比，可能具有更高的 CMA 长大概率（风险比 (RR) 2.32；风险差 (RD) 25/100），同时可能显示出更低的严重呕吐概率（RR 0.12, 95% CI 0.02 to 0.88; RD 23 fewer per 100, 95% CI 3 to 26），以及患食物蛋白诱发的小肠结肠炎综合征（FPIES）（RR 0.15, 95% CI 0.03 to 0.82; RD 34 fewer per 100, 95% CI 7 to 39）的概率可能更低）。不过，我们还发现，在体重（与基线相比-5.5%，95%CI -9.5%至-1.5%）和身长（-0.7 z分数变化，95%CI -1.15至-0.25）方面，eHF-CM在支持生理生长方面可能不如AAF（确定性很低）。我们发现，与 AAF 相比，eHF-CM 对非 IgE CMA 也有类似的效果。与 SF 相比，eHF-CM 可能有利于 IgE CMA 婴儿体重的增加（0.23 z 评分变化，95%CI 0.01 至 0.45），并有利于非 IgE CMA 婴儿耐受性的获得（RR 1.86，95%CI 1.03 至 3.37；RD 27%，95%CI 1%-74%）（两者的证据确定性（CoE）都很低）。eHF-CM与HRF、HRF与SF的比较显示效果无差异（确定性极低）。对于IgE型CMA患者，低确定性证据表明，添加益生菌（鼠李糖GG、干酪乳杆菌CRL431和乳酸杆菌Bb-12）可提高CMA耐受性（RR为2.47，95%CI为1.03至5.93；RD为27%，95%CI为1%至91%），并降低严重喘息的风险（RR为0.12，95%CI为0.02至0.95；RD为-23%，95%CI为-8%至-0.4%）。结论目前可用的研究对 eHF-CM、AAF、HRF 和 SF 进行了比较，为它们在 IgE 媒介和非 IgE 媒介 CMA 婴儿中的效果提供了确定性很低的证据。我们的综述显示，目前的证据存在一些局限性，主要是研究质量、参与人群规模有限，最重要的是所比较的干预措施缺乏多样性和标准化。因此，未来的研究必须在方法上严格把关，并对更广泛的干预措施进行调查。我们鼓励临床医生和研究人员查阅世界过敏组织（WAO）目前的《牛乳过敏诊断与行动指南》（DRACMA），以了解如何在临床实践中使用代乳品配方以及哪些额外研究最有益。
{"title":"World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guideline update – XI – Milk supplement/replacement formulas for infants and toddlers with CMA – Systematic review","authors":"","doi":"10.1016/j.waojou.2024.100947","DOIUrl":"10.1016/j.waojou.2024.100947","url":null,"abstract":"<div><h3>Background</h3><p>Cow's milk allergy (CMA) is the most complex and common food allergy in infants. Elimination of cow's milk from the diet and replacement with a specialized formula for infants with cow's milk allergy who cannot be breastfed is an established approach to minimize the risk of severe allergic reactions while avoiding nutritional deficiencies. Given the availability of multiple options, such as extensively hydrolyzed cow's milk-based formula (eHF-CM), aminoacid formula (AAF), hydrolyzed rice formula (HRF), and soy formula (SF), there is some uncertainty regarding which formula might represent the most suitable choice with respect to health outcomes. The addition of probiotics to a specialized formula has also been proposed as a potential approach to possibly increase the benefit. We systematically reviewed specialized formulas for infants with CMA to inform the updated World Allergy Organization (WAO) DRACMA guidelines.</p></div><div><h3>Objective</h3><p>To systematically review and synthesize the available evidence about the use of specialized formulas for the management of individuals with CMA.</p></div><div><h3>Methods</h3><p>We searched from inception PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and the websites of selected allergy organizations, for randomized and non-randomized trials of any language investigating specialized formulas with or without probiotics. We included all studies irrespective of the language of the original publication. The last search was conducted in January 2024. We synthesized the identified evidence quantitatively or narratively as appropriate and summarized it in the evidence profiles. We conducted this review following the PRISMA, Cochrane methods, and the GRADE approach.</p></div><div><h3>Results</h3><p>We identified 3558 records including 14 randomized trials and 7 observational studies. Very low certainty evidence suggested that in infants with IgE-mediated CMA, eHF-CM, compared with AAF, might have higher probability of outgrowing CMA (risk ratio (RR) 2.32; risk difference (RD) 25 more per 100), while showing potentially lower probability of severe vomiting (RR 0.12, 95% CI 0.02 to 0.88; RD 23 fewer per 100, 95% CI 3 to 26) and developing food protein-induced enterocolitis syndrome (FPIES) (RR 0.15, 95% CI 0.03 to 0.82; RD 34 fewer per 100, 95% CI 7 to 39). We also found, however, that eHF-CM might be inferior to AAF in supporting a physiological growth, with respect to both weight (−5.5% from baseline, 95%CI -9.5% to −1.5%) and length (−0.7 z-score change, 95%CI -1.15 to −0.25) (very low certainty). We found similar effects for eHF-CM, compared with AAF, also in non-IgE CMA. When compared with SF, eHF-CM might favor weight gain for IgE CMA infants (0.23 z-score change, 95%CI 0.01 to 0.45), and tolerance acquisition (RR 1.86, 95%CI 1.03 to 3.37; RD 27%, 95%CI 1%–74%) for non-IgE CMA (both at very low certainty of the evidence (CoE)). The compa","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1939455124000784/pdfft?md5=66ff2824624436ea1fd9a9f7a05e7b14&pid=1-s2.0-S1939455124000784-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.waojou.2024.100962
<div><h3>Background</h3><p>Anaphylaxis is an acute-onset, life-threatening clinical emergency involving more than one system. The World Allergy Organization (WAO) published anaphylaxis guidelines in 2020. The European Academy of Allergy and Clinical Immunology (EAACI) published anaphylaxis guidelines in 2021 and reviewed the diagnosis of anaphylaxis, risk factors, comorbid diseases, treatment management, and prevention studies.</p><p>In this study, clinical features, demographic characteristics, risk factors, treatment management, and evaluations according to EAACI and WAO diagnostic criteria were analysed in patients diagnosed with anaphylaxis. In this way, it was aimed to provide a perspective on the diagnosis, etiology, and treatment management in patients with anaphylaxis and to open a window for new studies.</p></div><div><h3>Methods</h3><p>We retrospectively analysed the data recording system of patients who were evaluated with a history of systemic allergic reaction in the Allergy and Immunology outpatient clinic of our tertiary referral hospital in a ninety-month period between January 2016 and June 2023. The total number of patients admitted to our Allergy and Immunology Clinic between January 2016 and June 2023 was 14,9425. Among these patients, 1032 patients were evaluated in the outpatient clinic according to the ICD-10 (International Statistical Classification of Diseases and Related Health Problems) coding system and diagnosed as T78.2 Anaphylaxis by Allergy and Immunology Specialist. Each patient file was re-evaluated by the authors of the study and 689 eligible patients were included.</p></div><div><h3>Results</h3><p>Included in the study were 689 patients. The mean age of the patients was 46.2 ± 14.2 (35–57) years. 64.4% (n = 444) of the patients were female. Venom, drugs, and food were the 3 leading causes of anaphylaxis. In our study, younger age was determined as a statistically significant risk factor for food-induced anaphylaxis, female gender for drug-induced anaphylaxis and male gender for venom-induced anaphylaxis. (p < 0.001) If the cause of anaphylaxis can be identified, such as venom, drug or food, the frequency of anaphylaxis decreases statistically significantly compared to idiopathic anaphylaxis. (p < 0.001) The rate of acute hypotension, bronchospasm, or laryngeal involvement without skin involvement according to WAO and the rate of WAO severity classification grade 5 were significantly higher in patients who developed anaphylaxis due to venom compared to other patients (p < 0.001). The rate of Grade 3 in the EAACI classification was significantly higher in patients who developed anaphylaxis due to venom compared to other cases (p < 0.001).</p></div><div><h3>Conclusion</h3><p>Our study was conducted in a city such as Istanbul, which connects both Asian and European continents. Moreover, it is important because it was conducted in a centre with the highest number of Allergy and Immunology outpatients per
{"title":"Anaphylaxis in a country where Asia and Europe meet: Evaluation according to World Allergy Organization (WAO) and European Academy of Allergy and Clinical Immunology (EAACI) diagnostic criteria","authors":"","doi":"10.1016/j.waojou.2024.100962","DOIUrl":"10.1016/j.waojou.2024.100962","url":null,"abstract":"<div><h3>Background</h3><p>Anaphylaxis is an acute-onset, life-threatening clinical emergency involving more than one system. The World Allergy Organization (WAO) published anaphylaxis guidelines in 2020. The European Academy of Allergy and Clinical Immunology (EAACI) published anaphylaxis guidelines in 2021 and reviewed the diagnosis of anaphylaxis, risk factors, comorbid diseases, treatment management, and prevention studies.</p><p>In this study, clinical features, demographic characteristics, risk factors, treatment management, and evaluations according to EAACI and WAO diagnostic criteria were analysed in patients diagnosed with anaphylaxis. In this way, it was aimed to provide a perspective on the diagnosis, etiology, and treatment management in patients with anaphylaxis and to open a window for new studies.</p></div><div><h3>Methods</h3><p>We retrospectively analysed the data recording system of patients who were evaluated with a history of systemic allergic reaction in the Allergy and Immunology outpatient clinic of our tertiary referral hospital in a ninety-month period between January 2016 and June 2023. The total number of patients admitted to our Allergy and Immunology Clinic between January 2016 and June 2023 was 14,9425. Among these patients, 1032 patients were evaluated in the outpatient clinic according to the ICD-10 (International Statistical Classification of Diseases and Related Health Problems) coding system and diagnosed as T78.2 Anaphylaxis by Allergy and Immunology Specialist. Each patient file was re-evaluated by the authors of the study and 689 eligible patients were included.</p></div><div><h3>Results</h3><p>Included in the study were 689 patients. The mean age of the patients was 46.2 ± 14.2 (35–57) years. 64.4% (n = 444) of the patients were female. Venom, drugs, and food were the 3 leading causes of anaphylaxis. In our study, younger age was determined as a statistically significant risk factor for food-induced anaphylaxis, female gender for drug-induced anaphylaxis and male gender for venom-induced anaphylaxis. (p < 0.001) If the cause of anaphylaxis can be identified, such as venom, drug or food, the frequency of anaphylaxis decreases statistically significantly compared to idiopathic anaphylaxis. (p < 0.001) The rate of acute hypotension, bronchospasm, or laryngeal involvement without skin involvement according to WAO and the rate of WAO severity classification grade 5 were significantly higher in patients who developed anaphylaxis due to venom compared to other patients (p < 0.001). The rate of Grade 3 in the EAACI classification was significantly higher in patients who developed anaphylaxis due to venom compared to other cases (p < 0.001).</p></div><div><h3>Conclusion</h3><p>Our study was conducted in a city such as Istanbul, which connects both Asian and European continents. Moreover, it is important because it was conducted in a centre with the highest number of Allergy and Immunology outpatients per","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1939455124000930/pdfft?md5=eb3dab98edb1dc50ab64af18ed578987&pid=1-s2.0-S1939455124000930-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.waojou.2024.100967
The prevalence of food allergy (FA) is steadily increasing worldwide. Literature about FA in older people is very scarce since this is predominantly considered as a pediatric condition. However, FA can persist and/or develop across the life course. Given the growing increase in prevalence as well as their persistence, it can be expected that FA will soon represent an important issue in older people. Several age-related factors may potentially mask FA symptoms and/or mediate them in older people. These include mechanisms related to immune senescence, inflammation, and changes in gastrointestinal function as well as micronutrient deficiencies and the use of multiple medications. A multidimensional approach, taking into account the complexity in older people, it is thus important in the evaluation and management of FA during aging. The main and safest strategy in the management of FA is the allergen avoidance since their ingestion may lead to reactions ranging from mild to life-threatening. However, food restrictions should be carefully evaluated, especially in older people, for the risk of nutritional deficiencies and undernutrition.
食物过敏（FA）的发病率在全球范围内稳步上升。有关老年人食物过敏的文献非常少，因为这主要被认为是一种儿科疾病。然而，食物过敏可在整个生命过程中持续存在和/或发展。鉴于其发病率的不断增加及其持续性，可以预见，FA 很快就会成为老年人的一个重要问题。一些与年龄相关的因素可能会掩盖和/或介导老年人的 FA 症状。这些因素包括与免疫衰老、炎症、胃肠功能变化以及微量元素缺乏和使用多种药物有关的机制。因此，考虑到老年人的复杂性，采用多维方法对评估和管理衰老过程中的 FA 非常重要。过敏性哮喘的主要和最安全的治疗策略是避免摄入过敏原，因为摄入过敏原可能导致轻微到危及生命的各种反应。然而，应仔细评估食物限制，尤其是老年人，以防营养缺乏和营养不良的风险。
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