Pub Date : 2025-02-01DOI: 10.1016/j.waojou.2025.101027
James H. Clark, MD , Eli O. Meltzer, MD , Robert M. Naclerio, MD
Diphenhydramine, once a pioneering antihistamine, is now overshadowed by second-generation antihistamines with similar efficacy and fewer adverse effects. Current data suggest that the adverse side-effect profile of diphenhydramine is higher among children and older adults. This has led to countries such as Germany and Sweden restricting access to first-generation antihistamines and societal guidelines advocating for the use of second-generation antihistamines. Despite its well-documented problematic therapeutic ratio, diphenhydramine remains available in over 300 formulations, most of which are over-the-counter.
Based on a comprehensive evaluation of practice patterns and the prevalence and incidence of adverse clinical events, we believe that diphenhydramine has reached the end of its life cycle, and in its class of therapies it is a relatively greater public health hazard. We recommend it should no longer be widely prescribed or continue to be readily available over the counter.
{"title":"Diphenhydramine: It is time to say a final goodbye","authors":"James H. Clark, MD , Eli O. Meltzer, MD , Robert M. Naclerio, MD","doi":"10.1016/j.waojou.2025.101027","DOIUrl":"10.1016/j.waojou.2025.101027","url":null,"abstract":"<div><div>Diphenhydramine, once a pioneering antihistamine, is now overshadowed by second-generation antihistamines with similar efficacy and fewer adverse effects. Current data suggest that the adverse side-effect profile of diphenhydramine is higher among children and older adults. This has led to countries such as Germany and Sweden restricting access to first-generation antihistamines and societal guidelines advocating for the use of second-generation antihistamines. Despite its well-documented problematic therapeutic ratio, diphenhydramine remains available in over 300 formulations, most of which are over-the-counter.</div><div>Based on a comprehensive evaluation of practice patterns and the prevalence and incidence of adverse clinical events, we believe that diphenhydramine has reached the end of its life cycle, and in its class of therapies it is a relatively greater public health hazard. We recommend it should no longer be widely prescribed or continue to be readily available over the counter.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 2","pages":"Article 101027"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143179818","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}
This study examined the relationship between the disciplinary diversity of research teams and research output (RO) in allergy and immunology programs funded by the National Institutes of Health (NIH) in the United States, Medical Research Council (MRC) in the United Kingdom, and Japan Society for the Promotion of Science (JSPS).
Methods
Using a dataset containing 1243, 3645, and 1468 articles funded by the NIH, MRC, and JSPS, respectively, we analyzed the correlation between disciplinary diversity and RO in allergy and immunology programs that received grants from 2017 to 2021. Diversity was measured using All Science Journal Classification codes counts, Shannon-Wiener index, and newly developed Omnidisciplinary index (o-index). The impact of diversity on RO was evaluated Normalized Paper Count (reflecting research quantity), Normalized Top 1% Paper Count (reflecting research excellence), and Normalized Top 10% Paper Count (reflecting research substantiality).
Results
There were no significant differences in diversity between the funding agencies, indicating a marginal relationship between team composition and RO (p = 0.641 for Shannon-Winner index). RO was positively correlated with team diversity in NIH- and MRC-funded programs and positively correlated with the degree of specialization in JSPS-funded programs.
Conclusions
These results underscore the complexity of the relationship between research team diversity and RO and the influence of contextual factors such as country-specific characteristics and grant program objectives. Specifically, the analysis of JSPS-funded groups suggests that the degree of specialization has a greater impact on RO than disciplinary diversity. This study contributes to ongoing efforts to optimize team composition to improve RO in allergy and immunology programs.
背景：本研究考察了由美国国立卫生研究院（NIH）、英国医学研究委员会（MRC）和日本科学促进会（JSPS）资助的过敏和免疫学项目中研究团队的学科多样性与研究成果（RO）之间的关系。方法：使用由NIH、MRC和JSPS分别资助的1243、3645和1468篇文章的数据集，我们分析了2017年至2021年获得资助的过敏和免疫学项目的学科多样性与RO之间的相关性。多样性采用All Science Journal Classification codes计数、Shannon-Wiener指数和新开发的omndidisciplinary index （o-index）来衡量。评估了多样性对RO的影响：标准化论文数量（反映研究数量）、标准化前1%论文数量（反映研究卓越性）和标准化前10%论文数量（反映研究实质性）。结果：各资助机构的多样性差异不显著，团队构成与RO之间存在边际关系（Shannon-Winner指数p = 0.641）。RO与NIH和mrc资助项目的团队多样性正相关，与jsps资助项目的专业化程度正相关。结论：这些结果强调了研究团队多样性与RO之间关系的复杂性，以及国家具体特征和资助计划目标等背景因素的影响。具体而言，对jsps资助小组的分析表明，专业化程度对RO的影响大于学科多样性。本研究有助于持续优化团队组成，以提高过敏和免疫项目的RO。
{"title":"Research team diversity impacts scientific output in allergy and immunology programs","authors":"Takeya Adachi, MD, PhD , Norika Narimatsu , Yasushi Ogawa, MD, PhD , Masako Toriya, PhD , Tamami Fukushi, PhD , Masashi Shirabe, PhD , Masaki Futamura, MD, PhD , Takenori Inomata, MD, PhD, MBA , Keigo Kainuma, MD, PhD , Keiko Kan-o, MD, PhD , Yosuke Kurashima, PhD , Katsunori Masaki, MD, PhD , Saeko Nakajima, MD, PhD , Masafumi Sakashita, MD, PhD , Sakura Sato, MD , Mayumi Tamari, MD, PhD , Hideaki Morita, MD, PhD , Amane Koizumi, MD, PhD","doi":"10.1016/j.waojou.2024.101004","DOIUrl":"10.1016/j.waojou.2024.101004","url":null,"abstract":"<div><h3>Background</h3><div>This study examined the relationship between the disciplinary diversity of research teams and research output (RO) in allergy and immunology programs funded by the National Institutes of Health (NIH) in the United States, Medical Research Council (MRC) in the United Kingdom, and Japan Society for the Promotion of Science (JSPS).</div></div><div><h3>Methods</h3><div>Using a dataset containing 1243, 3645, and 1468 articles funded by the NIH, MRC, and JSPS, respectively, we analyzed the correlation between disciplinary diversity and RO in allergy and immunology programs that received grants from 2017 to 2021. Diversity was measured using All Science Journal Classification codes counts, Shannon-Wiener index, and newly developed Omnidisciplinary index (o-index). The impact of diversity on RO was evaluated Normalized Paper Count (reflecting research quantity), Normalized Top 1% Paper Count (reflecting research excellence), and Normalized Top 10% Paper Count (reflecting research substantiality).</div></div><div><h3>Results</h3><div>There were no significant differences in diversity between the funding agencies, indicating a marginal relationship between team composition and RO (p = 0.641 for Shannon-Winner index). RO was positively correlated with team diversity in NIH- and MRC-funded programs and positively correlated with the degree of specialization in JSPS-funded programs.</div></div><div><h3>Conclusions</h3><div>These results underscore the complexity of the relationship between research team diversity and RO and the influence of contextual factors such as country-specific characteristics and grant program objectives. Specifically, the analysis of JSPS-funded groups suggests that the degree of specialization has a greater impact on RO than disciplinary diversity. This study contributes to ongoing efforts to optimize team composition to improve RO in allergy and immunology programs.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 1","pages":"Article 101004"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11700296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933477","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 : 2025-01-01DOI: 10.1016/j.waojou.2024.101009
Yutong Sima MD , Ming Zheng MD , Yan Zhao PhD , Siqi Ge PhD , Chengyao Liu MD , Ping Wang BS , Xiangdong Wang MD, PhD , Luo Zhang MD, PhD
Background
The treatment of refractory chronic rhinosinusitis with nasal polyps (CRSwNP) with omalizumab has been well studied based on clinical evaluation. Nevertheless, ideal quantitative or qualitative biomarkers for predicting a different response to biologics urgently need to be explored. We aim to identify potential biomarkers for predicting a good or poor response in patients with refractory CRSwNP.
Methodology
Patients received an endoscopic and radiological evaluation, a visual analogue scale (VAS) assessment, and a 22-item sinonasal outcome test (SNOT-22). Forty-eight biomarkers involving type 1 (T1), type 2 (T2), and type 3 (T3) inflammatory factors, chemokines, and remodeling factors were detected in nasal secretion and serum samples at baseline and after 24 weeks of omalizumab treatment.
Results
Eighteen patients with CRSwNP and 16 patients as control were enrolled. Patients with CRSwNP who received oamlizumab treatment with the SNOT-22 and VAS scores improved by 8.9 and 2 points in 72.22% and 50%, respectively. The nasal polyp score (NPS) and Lund-Mackay score were significantly improved in 55.56% of patients. The concentrations of T2 inflammatory biomarker, granulocyte-macrophage colony-stimulating factor (GM-CSF), T3 inflammatory biomarkers, granulocyte colony-stimulating factor (G-CSF), chemokine (C-X-C motif) ligand (CXCL)-1, and chemokine (C–C motif) ligand-20 (CCL-20), T1 inflammatory biomarker, IP-10 (CXCL-10), and granzyme B in nasal secretion and serum periostin were significantly decreased. Serum CCL-3 (AUC = 0.836) and CCL-4 (AUC = 0.909) levels predicted the improvement of SNOT-22 score, respectively. Serum IL-8 (AUC = 0.883) predicted poor improvement in nasal congestion score. Nasal secretion CXCL-1 (AUC = 0.812), GM-CSF (AUC = 0.813), IgE (AUC = 0.900) and IP-10 (AUC = 0.800) effectively predicted none or less improvement in nasal polyp score.
Conclusions
Omalizumab remarkably affects inflammatory mediators in different pathways. CCL-3 and CCL-4 in serum and IgE, CXCL-1, GM-CSF, and IP-10 in nasal secretion may be considered as preferable biomarkers for predicting favorable or ineffective response to omalizumab therapy in patients with refractory CRSwNP comorbid with asthma, based on various clinical indicators.
{"title":"Predicting the effectiveness of omalizumab in patients with refractory chronic rhinosinusitis with nasal polyps comorbid with asthma based on inflammatory biomarkers","authors":"Yutong Sima MD , Ming Zheng MD , Yan Zhao PhD , Siqi Ge PhD , Chengyao Liu MD , Ping Wang BS , Xiangdong Wang MD, PhD , Luo Zhang MD, PhD","doi":"10.1016/j.waojou.2024.101009","DOIUrl":"10.1016/j.waojou.2024.101009","url":null,"abstract":"<div><h3>Background</h3><div>The treatment of refractory chronic rhinosinusitis with nasal polyps (CRSwNP) with omalizumab has been well studied based on clinical evaluation. Nevertheless, ideal quantitative or qualitative biomarkers for predicting a different response to biologics urgently need to be explored. We aim to identify potential biomarkers for predicting a good or poor response in patients with refractory CRSwNP.</div></div><div><h3>Methodology</h3><div>Patients received an endoscopic and radiological evaluation, a visual analogue scale (VAS) assessment, and a 22-item sinonasal outcome test (SNOT-22). Forty-eight biomarkers involving type 1 (T1), type 2 (T2), and type 3 (T3) inflammatory factors, chemokines, and remodeling factors were detected in nasal secretion and serum samples at baseline and after 24 weeks of omalizumab treatment.</div></div><div><h3>Results</h3><div>Eighteen patients with CRSwNP and 16 patients as control were enrolled. Patients with CRSwNP who received oamlizumab treatment with the SNOT-22 and VAS scores improved by 8.9 and 2 points in 72.22% and 50%, respectively. The nasal polyp score (NPS) and Lund-Mackay score were significantly improved in 55.56% of patients. The concentrations of T2 inflammatory biomarker, granulocyte-macrophage colony-stimulating factor (GM-CSF), T3 inflammatory biomarkers, granulocyte colony-stimulating factor (G-CSF), chemokine (C-X-C motif) ligand (CXCL)-1, and chemokine (C–C motif) ligand-20 (CCL-20), T1 inflammatory biomarker, IP-10 (CXCL-10), and granzyme B in nasal secretion and serum periostin were significantly decreased. Serum CCL-3 (AUC = 0.836) and CCL-4 (AUC = 0.909) levels predicted the improvement of SNOT-22 score, respectively. Serum IL-8 (AUC = 0.883) predicted poor improvement in nasal congestion score. Nasal secretion CXCL-1 (AUC = 0.812), GM-CSF (AUC = 0.813), IgE (AUC = 0.900) and IP-10 (AUC = 0.800) effectively predicted none or less improvement in nasal polyp score.</div></div><div><h3>Conclusions</h3><div>Omalizumab remarkably affects inflammatory mediators in different pathways. CCL-3 and CCL-4 in serum and IgE, CXCL-1, GM-CSF, and IP-10 in nasal secretion may be considered as preferable biomarkers for predicting favorable or ineffective response to omalizumab therapy in patients with refractory CRSwNP comorbid with asthma, based on various clinical indicators.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 1","pages":"Article 101009"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11700293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933555","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}
While epidemiological data suggest a connection between atopic dermatitis (AD) and COVID-19, the molecular mechanisms underlying this relationship remain unclear.
Objective
To investigate whether COVID-19-related CpGs may contribute to AD development and whether this association is mediated through the regulation of specific genes’ expression.
Methods
We combined Mendelian randomization and transcriptome analysis for data-driven explorations.
Results
Among the 172 CpGs -associated with COVID-19 infection, merely 3 of them exhibited significant impacts on the risk of AD, including cg04543273, cg11916609, and cg10636246. In the following analysis of the causal effects of CpGs and their related gene expression, cg04543273 inhibited LMAN2 expression. However, there was not a significant impact of cg11916609 and cg10636246 on the expression of their corresponding genes. Besides, transcriptome analysis suggested that LMAN2 expression was significantly upregulated among the COVID-19-infected population, and LMAN2 expression was obviously correlated with Type 2 helper cells across different post-infection time points.
Conclusion
Overall, this study provides new insights of the COVID-19-related onset and exacerbation of AD-COVID-19-related epigenetic changes and their regulatory impact on transcription. A novel role of LMAN2 was proposed in the relationship between viral infection and AD. More studies are warranted to further explore the mechanism of LMAN2-related immunopathology.
{"title":"COVID-19 related epigenetic changes and atopic dermatitis: An exploratory analysis","authors":"Zhenwei Tang MD , Yu Chen MBBS , Yuzhen Ouyang MBBS , Yu Peng MD, PhD , Xiaoyong Man MD, PhD","doi":"10.1016/j.waojou.2024.101022","DOIUrl":"10.1016/j.waojou.2024.101022","url":null,"abstract":"<div><h3>Background</h3><div>While epidemiological data suggest a connection between atopic dermatitis (AD) and COVID-19, the molecular mechanisms underlying this relationship remain unclear.</div></div><div><h3>Objective</h3><div>To investigate whether COVID-19-related CpGs may contribute to AD development and whether this association is mediated through the regulation of specific genes’ expression.</div></div><div><h3>Methods</h3><div>We combined Mendelian randomization and transcriptome analysis for data-driven explorations.</div></div><div><h3>Results</h3><div>Among the 172 CpGs -associated with COVID-19 infection, merely 3 of them exhibited significant impacts on the risk of AD, including cg04543273, cg11916609, and cg10636246. In the following analysis of the causal effects of CpGs and their related gene expression, cg04543273 inhibited LMAN2 expression. However, there was not a significant impact of cg11916609 and cg10636246 on the expression of their corresponding genes. Besides, transcriptome analysis suggested that LMAN2 expression was significantly upregulated among the COVID-19-infected population, and LMAN2 expression was obviously correlated with Type 2 helper cells across different post-infection time points.</div></div><div><h3>Conclusion</h3><div>Overall, this study provides new insights of the COVID-19-related onset and exacerbation of AD-COVID-19-related epigenetic changes and their regulatory impact on transcription. A novel role of LMAN2 was proposed in the relationship between viral infection and AD. More studies are warranted to further explore the mechanism of LMAN2-related immunopathology.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 1","pages":"Article 101022"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048570","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 : 2025-01-01DOI: 10.1016/j.waojou.2024.101013
Chih-Yung Chiu MD, PhD , Meng-Han Chiang MS , Chieh-Ni Kuo BS , Mei-Ling Cheng PhD , Gigin Lin MD, PhD
Background
Childhood rhinitis and asthma are allergic respiratory diseases triggered by common allergens, but they affect different parts of the respiratory system, leading to distinct symptoms. However, a comprehensive multi-biofluid metabolomics-based approach to uncover valuable insights into childhood allergies and allergen sensitization remains unaddressed.
Methods
Seventy-six children, comprising 26 with rhinitis, 26 with asthma, and 24 healthy controls, were enrolled. Fecal, blood, and urine metabolomic analyses using 1H nuclear magnetic resonance (NMR) spectroscopy were conducted. An integrative analysis of their associations with allergen-specific IgE levels in the context of allergic rhinitis and asthma were also assessed.
Results
The analysis of 228 various biofluid samples revealed strong positive correlations between stool and blood metabolites, while blood metabolites exhibited negative correlations with most urine metabolites. Five and 19 metabolites were significantly different in children with rhinitis and asthma, respectively (P < 0.05). Among them, blood isovaleric acid correlated positively with stool IgE levels in rhinitis, while stool butyric acid and acetic acid in asthma exhibited strong negative correlations with total serum and mite allergen-specific IgE levels (P < 0.01). Blood metabolic profiles appeared to have the highest area under the curve (AUC) of 0.732 for rhinitis, whereas stool metabolic profiles had the highest AUC of 0.799 for asthma.
Conclusions
Multiple biofluid metabolomics provides comprehensive insights into childhood allergies, with blood profiles associated with allergic rhinitis and fecal profiles linked to asthma. Their short-chain fatty acid metabolites related to IgE levels emphasize the significant role of the gut microbiota in childhood rhinitis and asthma.
{"title":"Multi-biofluid metabolomics analysis of allergic respiratory rhinitis and asthma in early childhood","authors":"Chih-Yung Chiu MD, PhD , Meng-Han Chiang MS , Chieh-Ni Kuo BS , Mei-Ling Cheng PhD , Gigin Lin MD, PhD","doi":"10.1016/j.waojou.2024.101013","DOIUrl":"10.1016/j.waojou.2024.101013","url":null,"abstract":"<div><h3>Background</h3><div>Childhood rhinitis and asthma are allergic respiratory diseases triggered by common allergens, but they affect different parts of the respiratory system, leading to distinct symptoms. However, a comprehensive multi-biofluid metabolomics-based approach to uncover valuable insights into childhood allergies and allergen sensitization remains unaddressed.</div></div><div><h3>Methods</h3><div>Seventy-six children, comprising 26 with rhinitis, 26 with asthma, and 24 healthy controls, were enrolled. Fecal, blood, and urine metabolomic analyses using <sup>1</sup>H nuclear magnetic resonance (NMR) spectroscopy were conducted. An integrative analysis of their associations with allergen-specific IgE levels in the context of allergic rhinitis and asthma were also assessed.</div></div><div><h3>Results</h3><div>The analysis of 228 various biofluid samples revealed strong positive correlations between stool and blood metabolites, while blood metabolites exhibited negative correlations with most urine metabolites. Five and 19 metabolites were significantly different in children with rhinitis and asthma, respectively (<em>P</em> < 0.05). Among them, blood isovaleric acid correlated positively with stool IgE levels in rhinitis, while stool butyric acid and acetic acid in asthma exhibited strong negative correlations with total serum and mite allergen-specific IgE levels (<em>P</em> < 0.01). Blood metabolic profiles appeared to have the highest area under the curve (AUC) of 0.732 for rhinitis, whereas stool metabolic profiles had the highest AUC of 0.799 for asthma.</div></div><div><h3>Conclusions</h3><div>Multiple biofluid metabolomics provides comprehensive insights into childhood allergies, with blood profiles associated with allergic rhinitis and fecal profiles linked to asthma. Their short-chain fatty acid metabolites related to IgE levels emphasize the significant role of the gut microbiota in childhood rhinitis and asthma.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 1","pages":"Article 101013"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985334","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 : 2025-01-01DOI: 10.1016/j.waojou.2024.101017
Bingqian Du MA.Sc , Aga Shama BA.Sc , Yi Zhang BA.Sc , Baolan Chen MA.Sc , Yongqi Bu BA.Sc , Pei-an Chen MA.Sc , Chuzhi Lin BA.Sc , Jie Liu MA.Sc , Juan Zheng MA.Sc , Zhenjun Li MD, PhD , Qingsong Chen PhD , Yu Sun PhD , Xi Fu PhD
Background
Many studies reported the influence of infants' gut microbiota on atopic dermatitis (AD) postnatally, yet the role of maternal gut microbiota and plasma metabolites in infants’ AD remains largely unexplored.
Methods
Sixty-three pregnant mother-infants were enrolled and followed after childbirth in Guangzhou, China. Demographic information, maternal stool and plasma samples, and records for infants’ AD were collected. Maternal gut microbiota/metabolome and plasma metabolome were profiled using shotgun metagenomics and non-targeted metabolomics. Logistic regression and multi-omics analysis were used to explore characteristic maternal gut microbiota in the AD and health groups.
Results
The α-diversity of maternal gut microbiota in health group was significantly higher than AD group (Shannon diversity P = 0.02, Simpson diversity P = 0.04). Short-chain fatty acids (SCFAs) producing microorganisms, including Faecalibacterium, Roseburia, Butyricicoccus, and Ruminococcus, as well as the abundance of phenylalanine, tyrosine, and tryptophan biosynthesis pathway, were enriched in health group (LDA>2 and P < 0.05). Virulent factors (VFs) involved in immune modulation were enriched in the health group, while VFs involving in adhesin were enriched in the AD group (P < 0.05). Metabolomic analysis showed that a polyunsaturated fatty acid/linoleic acid, 13S-hydroxyoctadecadienoic, were negatively associated with AD in both the gut and plasma samples (FDR<0.05). Several other linoleic acids and flavonoids were negatively associated with AD (FDR<0.05). Neural network analysis revealed that microorganisms enriched in health group may produce these protective fatty acids.
Conclusions
Our findings show that maternal gut microorganisms/metabolites and plasma metabolites during pregnancy impact subsequent pathogenesis of infants AD. This illuminates new strategies against early AD in offspring.
{"title":"Gut microbiota and plasma metabolites in pregnant mothers and infant atopic dermatitis: A multi-omics study","authors":"Bingqian Du MA.Sc , Aga Shama BA.Sc , Yi Zhang BA.Sc , Baolan Chen MA.Sc , Yongqi Bu BA.Sc , Pei-an Chen MA.Sc , Chuzhi Lin BA.Sc , Jie Liu MA.Sc , Juan Zheng MA.Sc , Zhenjun Li MD, PhD , Qingsong Chen PhD , Yu Sun PhD , Xi Fu PhD","doi":"10.1016/j.waojou.2024.101017","DOIUrl":"10.1016/j.waojou.2024.101017","url":null,"abstract":"<div><h3>Background</h3><div>Many studies reported the influence of infants' gut microbiota on atopic dermatitis (AD) postnatally, yet the role of maternal gut microbiota and plasma metabolites in infants’ AD remains largely unexplored.</div></div><div><h3>Methods</h3><div>Sixty-three pregnant mother-infants were enrolled and followed after childbirth in Guangzhou, China. Demographic information, maternal stool and plasma samples, and records for infants’ AD were collected. Maternal gut microbiota/metabolome and plasma metabolome were profiled using shotgun metagenomics and non-targeted metabolomics. Logistic regression and multi-omics analysis were used to explore characteristic maternal gut microbiota in the AD and health groups.</div></div><div><h3>Results</h3><div>The α-diversity of maternal gut microbiota in health group was significantly higher than AD group (Shannon diversity <em>P</em> = 0.02, Simpson diversity <em>P</em> = 0.04). Short-chain fatty acids (SCFAs) producing microorganisms, including <em>Faecalibacterium</em>, <em>Roseburia</em>, <em>Butyricicoccus</em>, and <em>Ruminococcus</em>, as well as the abundance of phenylalanine, tyrosine, and tryptophan biosynthesis pathway, were enriched in health group (LDA>2 and <em>P</em> < 0.05). Virulent factors (VFs) involved in immune modulation were enriched in the health group, while VFs involving in adhesin were enriched in the AD group (<em>P</em> < 0.05). Metabolomic analysis showed that a polyunsaturated fatty acid/linoleic acid, 13S-hydroxyoctadecadienoic, were negatively associated with AD in both the gut and plasma samples (FDR<0.05). Several other linoleic acids and flavonoids were negatively associated with AD (FDR<0.05). Neural network analysis revealed that microorganisms enriched in health group may produce these protective fatty acids.</div></div><div><h3>Conclusions</h3><div>Our findings show that maternal gut microorganisms/metabolites and plasma metabolites during pregnancy impact subsequent pathogenesis of infants AD. This illuminates new strategies against early AD in offspring.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 1","pages":"Article 101017"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030328","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 : 2025-01-01DOI: 10.1016/j.waojou.2024.100990
Yu Ri Kang MD , Hyunkyoung Kim MS, MPH , Chae Eun Lee BS , Jae-Woo Jung MD, PhD , Ji-Yong Moon MD, PhD , So Young Park MD, MS , Sae-Hoon Kim MD, PhD , Min-Suk Yang MD, PhD , Byung Keun Kim MD, PhD , Jae-Woo Kwon MD, PhD , Hye-Kyung Park MD, PhD , Young-Hee Nam MD, PhD , Young-Joo Cho MD, PhD , Taehoon Lee MD, PhD , Ian M. Adcock MD, PhD , Pank Bhavsar MD, PhD , Kian Fan Chung MD, PhD , Tae-Bum Kim MD, PhD
Background
Eosinophils are crucial in allergic inflammation, and their correlation with asthma severity has made them a focal point in predicting treatment outcomes. Blood eosinophil count is a commonly utilized marker. However, its limitations have prompted alternative biomarker exploration, such as eosinophil-derived neurotoxin (EDN).
Objective
This research was conducted over 24 weeks on 56 patients with severe asthma treated with mepolizumab, reslizumab, and dupilumab. We aimed to evaluate the clinical significance of blood eosinophil count and their potential, including those of blood EDN levels and urine EDN values as biomarkers for predicting treatment response.
Methods
The analysis encompassed examining correlations between biomarkers and clinical features, including exacerbation rates and lung function, through ELISA assays and subsequent statistical analyses. The study protocol is registered at ClinicalTrials.gov (NCT05164939).
Results
The findings underscore strong correlations between serum EDN levels, blood eosinophil counts, and treatment responses, with EDN demonstrating comparable predictive capabilities to blood eosinophil counts to determine treatment responses. Different biologics exhibited varying efficacy regarding baseline eosinophil counts and EDN levels.
Conclusions
Blood eosinophil counts and EDN levels show potential as predictive markers for treatment responses in patients with severe asthma undergoing biologic therapies. However, further comprehensive studies are warranted to enhance the reliability and applicability of EDN as an effective asthma treatment biomarker.
{"title":"Serum and urine eosinophil-derived neurotoxin (EDN) levels predict biologic response in severe asthma","authors":"Yu Ri Kang MD , Hyunkyoung Kim MS, MPH , Chae Eun Lee BS , Jae-Woo Jung MD, PhD , Ji-Yong Moon MD, PhD , So Young Park MD, MS , Sae-Hoon Kim MD, PhD , Min-Suk Yang MD, PhD , Byung Keun Kim MD, PhD , Jae-Woo Kwon MD, PhD , Hye-Kyung Park MD, PhD , Young-Hee Nam MD, PhD , Young-Joo Cho MD, PhD , Taehoon Lee MD, PhD , Ian M. Adcock MD, PhD , Pank Bhavsar MD, PhD , Kian Fan Chung MD, PhD , Tae-Bum Kim MD, PhD","doi":"10.1016/j.waojou.2024.100990","DOIUrl":"10.1016/j.waojou.2024.100990","url":null,"abstract":"<div><h3>Background</h3><div>Eosinophils are crucial in allergic inflammation, and their correlation with asthma severity has made them a focal point in predicting treatment outcomes. Blood eosinophil count is a commonly utilized marker. However, its limitations have prompted alternative biomarker exploration, such as eosinophil-derived neurotoxin (EDN).</div></div><div><h3>Objective</h3><div>This research was conducted over 24 weeks on 56 patients with severe asthma treated with mepolizumab, reslizumab, and dupilumab. We aimed to evaluate the clinical significance of blood eosinophil count and their potential, including those of blood EDN levels and urine EDN values as biomarkers for predicting treatment response.</div></div><div><h3>Methods</h3><div>The analysis encompassed examining correlations between biomarkers and clinical features, including exacerbation rates and lung function, through ELISA assays and subsequent statistical analyses. The study protocol is registered at <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (<span><span>NCT05164939</span><svg><path></path></svg></span>).</div></div><div><h3>Results</h3><div>The findings underscore strong correlations between serum EDN levels, blood eosinophil counts, and treatment responses, with EDN demonstrating comparable predictive capabilities to blood eosinophil counts to determine treatment responses. Different biologics exhibited varying efficacy regarding baseline eosinophil counts and EDN levels.</div></div><div><h3>Conclusions</h3><div>Blood eosinophil counts and EDN levels show potential as predictive markers for treatment responses in patients with severe asthma undergoing biologic therapies. However, further comprehensive studies are warranted to enhance the reliability and applicability of EDN as an effective asthma treatment biomarker.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 1","pages":"Article 100990"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081236","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}
Allergen immunotherapy (AIT) is the only treatment that modifies the natural course of allergies. However, AIT is only used in some eligible patients, is frequently underused, and only a few studies investigated this aspects. Understanding AIT utilization patterns might disclose information about why it is underused, thus providing valuable insights on how to broaden the positive impact it can have on the population.
Methods
A questionnaire aiming to assess the trends of the use of AIT in Italy, patient health literacy on AIT, and the impact of respiratory allergies and AIT on patients' lives was submitted to patients affiliated with Respiriamo Insieme APS patient's association during the period between May and October 2023.
Results
Nine hundred forty-four patients completed the questionnaire. Most patients reported to be affected by allergic rhinitis (81.1%), allergic asthma (45.4%), and/or allergic conjunctivitis (41.2%), and many of them presenting a combination of these diseases. Only 53.8% knew about AIT's existence, and AIT was proposed to only 33.1% of the 858 patients affected by allergic rhinitis and/or allergic asthma, of which 29.2% decided not to initiate the therapy. Common reasons for AIT refusal were related to indecisiveness (26.5%), costs (22.9%), and skepticism (19.3%). Among the remaining 70.8% who accepted to start AIT, 21.4% discontinued the treatment beforehand, on average 18.26 months from initiation. There was a high heterogeneity in the suggested duration of AIT, with 20.4% of patients receiving indications to continue AIT for less than 3 years. AIT positively impacted patients' lives as most patients who completed AIT found it effective and safe, and experienced a significant reduction in the workdays/schooldays lost due to disease exacerbations.
Conclusions
The outcomes of this research pointed out a lot of misinformation surrounding AIT, calling for improvements in awareness and information on its efficacy and safety. Also, we noted a significant reduction in work/school days lost in patients who completed AIT and a good patient-reported safety and efficacy profile. We advocate for better economic accessibility through national-level standardization in treatment refundability. Notably, the collaboration with the patient association was crucial, and it would have been challenging to conduct this research otherwise.
背景：过敏原免疫疗法（AIT）是唯一一种可以改变过敏自然过程的治疗方法。然而，AIT仅在一些符合条件的患者中使用，并且经常未被充分利用，只有少数研究调查了这方面。了解AIT的利用模式可以揭示为什么AIT没有得到充分利用，从而为如何扩大AIT对人口的积极影响提供有价值的见解。方法：于2023年5月至10月向Respiriamo Insieme APS患者协会的患者提交了一份问卷，旨在评估意大利AIT使用趋势、患者对AIT的健康素养以及呼吸过敏和AIT对患者生活的影响。结果：944例患者完成问卷调查。大多数患者报告受变应性鼻炎（81.1%）、过敏性哮喘（45.4%）和/或过敏性结膜炎（41.2%）的影响，其中许多患者表现为这些疾病的组合。在858例变应性鼻炎和/或过敏性哮喘患者中，只有53.8%的人知道AIT的存在，只有33.1%的人建议AIT，其中29.2%的人决定不开始治疗。拒绝AIT的常见原因与优柔寡断（26.5%）、成本（22.9%）和怀疑（19.3%）有关。在接受AIT治疗的其余70.8%的患者中，21.4%的患者在开始治疗前平均18.26个月停止治疗。建议的AIT持续时间存在高度异质性，20.4%的患者接受适应症持续AIT少于3年。AIT对患者的生活产生了积极的影响，因为大多数完成AIT的患者认为它是有效和安全的，并且由于疾病恶化而损失的工作日/上学日显著减少。结论：本研究的结果指出了围绕AIT的许多错误信息，呼吁提高对其有效性和安全性的认识和信息。此外，我们注意到完成AIT的患者的工作/上学天数显著减少，并且患者报告的安全性和有效性良好。我们提倡通过国家级的治疗退款标准化来提高经济可及性。值得注意的是，与患者协会的合作至关重要，否则进行这项研究将具有挑战性。
{"title":"Allergen immunotherapy in Italy: How, when, and why—A real-world study conducted through a patient association","authors":"Giovanni Paoletti MD , Emanuele Nappi MD , Maria Chiara Bragato MD , Paola Valli MD , Mattia Giovannini MD , Domenico Gargano MD , Luca Pecoraro MD , Deborah Diso MSc , Simona Barbaglia MSc , Giorgio Walter Canonica MD , Enrico Heffler MD, PhD","doi":"10.1016/j.waojou.2024.101015","DOIUrl":"10.1016/j.waojou.2024.101015","url":null,"abstract":"<div><h3>Background</h3><div>Allergen immunotherapy (AIT) is the only treatment that modifies the natural course of allergies. However, AIT is only used in some eligible patients, is frequently underused, and only a few studies investigated this aspects. Understanding AIT utilization patterns might disclose information about why it is underused, thus providing valuable insights on how to broaden the positive impact it can have on the population.</div></div><div><h3>Methods</h3><div>A questionnaire aiming to assess the trends of the use of AIT in Italy, patient health literacy on AIT, and the impact of respiratory allergies and AIT on patients' lives was submitted to patients affiliated with Respiriamo Insieme APS patient's association during the period between May and October 2023.</div></div><div><h3>Results</h3><div>Nine hundred forty-four patients completed the questionnaire. Most patients reported to be affected by allergic rhinitis (81.1%), allergic asthma (45.4%), and/or allergic conjunctivitis (41.2%), and many of them presenting a combination of these diseases. Only 53.8% knew about AIT's existence, and AIT was proposed to only 33.1% of the 858 patients affected by allergic rhinitis and/or allergic asthma, of which 29.2% decided not to initiate the therapy. Common reasons for AIT refusal were related to indecisiveness (26.5%), costs (22.9%), and skepticism (19.3%). Among the remaining 70.8% who accepted to start AIT, 21.4% discontinued the treatment beforehand, on average 18.26 months from initiation. There was a high heterogeneity in the suggested duration of AIT, with 20.4% of patients receiving indications to continue AIT for less than 3 years. AIT positively impacted patients' lives as most patients who completed AIT found it effective and safe, and experienced a significant reduction in the workdays/schooldays lost due to disease exacerbations.</div></div><div><h3>Conclusions</h3><div>The outcomes of this research pointed out a lot of misinformation surrounding AIT, calling for improvements in awareness and information on its efficacy and safety. Also, we noted a significant reduction in work/school days lost in patients who completed AIT and a good patient-reported safety and efficacy profile. We advocate for better economic accessibility through national-level standardization in treatment refundability. Notably, the collaboration with the patient association was crucial, and it would have been challenging to conduct this research otherwise.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 1","pages":"Article 101015"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985326","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 : 2025-01-01DOI: 10.1016/j.waojou.2024.101019
Elif Soyak Aytekin MD , Seda Şirin MD , Esra Kıratlı Nalbant MD , Naim Ata MD , Ahmet Sertçelik MD , Mustafa Mahir Ülgü MD , Şuayip Birinci MD , Koray Harmancı MD , Zülfikar Akelma MD
Background
The incidence of anaphylaxis is increasing worldwide. However, there is a lack of data on anaphylaxis trends in Türkiye. This study aims to analyse trends in anaphylaxis-related emergency department (ED) visits and examines factors associated with fatal anaphylaxis in Türkiye.
Methods
We retrospectively analyzed data from Türkiye's Ministry of Health database from 2015 to 2022. Codes from the International Classification of Diseases, 10th revision (ICD-10), were used to identify anaphylaxis.
Results
During the study period, a total 21,370 ED admissions for anaphylaxis were identified, and anaphylaxis admissions increased 1.23-fold from 3.90 to 4.79 per 105 population per year. The anaphylaxis trigger was unknown in 79.9% of cases, followed by drugs (11.7%), food (5.7%) and venom (2.7%). Epinephrine was administered in 49.6% of cases, and a total of 424 patients (2.1% of total cases) died. The frequency of intensive care unit (ICU) hospitalization increased 6.0-fold from 2015 to 2021, and age-adjusted average-weighted mortality rate for anaphylaxis was 0.66 per million. Older age, presence of asthma, and ICU hospitalization were found to be significantly associated with fatal anaphylaxis (p < 0.001 for all). Frequencies of death were 9.1% for venom anaphylaxis, 1.2% in drug anaphylaxis, and 0.2% for food anaphylaxis. Epinephrine autoinjector (EAI) was prescribed for 6.9% of all patients.
Conclusions
This is the first study of ED admissions for anaphylaxis using a large, nationwide data from Türkiye. Increasing numbers of ED admissions, ICU hospitalizations and mortality show that anaphylaxis is an important public health issue in Türkiye.
{"title":"Changes in anaphylaxis trends and characteristics in emergency department admissions in Türkiye: From 2015 to 2021 based on the Ministry of Health database","authors":"Elif Soyak Aytekin MD , Seda Şirin MD , Esra Kıratlı Nalbant MD , Naim Ata MD , Ahmet Sertçelik MD , Mustafa Mahir Ülgü MD , Şuayip Birinci MD , Koray Harmancı MD , Zülfikar Akelma MD","doi":"10.1016/j.waojou.2024.101019","DOIUrl":"10.1016/j.waojou.2024.101019","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of anaphylaxis is increasing worldwide. However, there is a lack of data on anaphylaxis trends in Türkiye. This study aims to analyse trends in anaphylaxis-related emergency department (ED) visits and examines factors associated with fatal anaphylaxis in Türkiye.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from Türkiye's Ministry of Health database from 2015 to 2022. Codes from the International Classification of Diseases, 10th revision (ICD-10), were used to identify anaphylaxis.</div></div><div><h3>Results</h3><div>During the study period, a total 21,370 ED admissions for anaphylaxis were identified, and anaphylaxis admissions increased 1.23-fold from 3.90 to 4.79 per 10<sup>5</sup> population per year. The anaphylaxis trigger was unknown in 79.9% of cases, followed by drugs (11.7%), food (5.7%) and venom (2.7%). Epinephrine was administered in 49.6% of cases, and a total of 424 patients (2.1% of total cases) died. The frequency of intensive care unit (ICU) hospitalization increased 6.0-fold from 2015 to 2021, and age-adjusted average-weighted mortality rate for anaphylaxis was 0.66 per million. Older age, presence of asthma, and ICU hospitalization were found to be significantly associated with fatal anaphylaxis (p < 0.001 for all). Frequencies of death were 9.1% for venom anaphylaxis, 1.2% in drug anaphylaxis, and 0.2% for food anaphylaxis. Epinephrine autoinjector (EAI) was prescribed for 6.9% of all patients.</div></div><div><h3>Conclusions</h3><div>This is the first study of ED admissions for anaphylaxis using a large, nationwide data from Türkiye. Increasing numbers of ED admissions, ICU hospitalizations and mortality show that anaphylaxis is an important public health issue in Türkiye.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 1","pages":"Article 101019"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985331","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}
This study aimed to evaluate the impact of severe asthma (SA) treatments after 12 months in achieving clinical remission (CR) within the context of the Severe Asthma Network in Italy (SANI) using the recent SANI definition of CR on treatment.
Methods
CR has been defined by SANI as complete, partial, and no CR. Complete CR is defined by the absence of oral corticosteroids (OCS), no symptoms, no exacerbations, and stable lung function, and partial CR requires the absence of OCS and the fulfillment of 2 out of the other 3 criteria. Patients who do not meet the previous criteria do not reach CR.
Results
After 12 months of treatment, 283 patients were selected to evaluate the effectiveness of biologics (225 patients) and inhaled therapy (58 patients) in achieving CR. Among patients treated with biologic agents, 45.8% reached complete CR, 23.1% partial CR, and 31.1% no CR. Differences in CR achievement according to type of biologic agent administered were observed. Interesting results were found when assessing the inhaled therapy (ICS/LABA/LAMA and no biologics) effectiveness: 34.5% patients reached complete CR, 34.5% partial CR, and 31.0% did not reach CR. This finding is noteworthy since it further supports the efficacy of inhaled treatment in certain SA patients and highlights the relevance of using CR as a modern outcome of SA treatments. Chronic rhinosinusitis with nasal polyps (CRSwNP) comorbidity was associated, though not significantly, with CR achievement in patients treated with biologics. Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ) scores significantly impacted CR (p = 0.003 and p = 0.027, respectively), while biomarkers, namely IgE, blood eosinophils, or fractional exhaled nitric oxide (FeNO), were not associated with CR achievement.
Conclusions
This study confirmed the effectiveness of biologics in reaching CR and demonstrated also inhaled therapies able to achieve CR. These innovative findings should encourage post hoc analysis of randomized clinical trials or even retrospective analysis of SA patient cohorts to evaluate CR with different inhaled treatments and further define the populations eligible for each treatment.
Trial registration
ClinicalTrials.gov ID: NCT06625216; Central Ethics Committee: Comitato Etico Area Vasta Nord-Ovest Toscana (study number 1245/2016, protocol number:73714).
背景：本研究旨在评估在意大利严重哮喘网络（SANI）的背景下，使用最近SANI对治疗中CR的定义，评估12个月后严重哮喘（SA）治疗对实现临床缓解（CR）的影响。方法：SANI将CR定义为完全、部分和无CR。完全CR的定义是无口服皮质类固醇（OCS）、无症状、无恶化和肺功能稳定，部分CR需要无OCS和满足其他3个标准中的2个。结果：治疗12个月后，283例患者分别接受生物制剂治疗（225例）和吸入治疗（58例）达到CR，其中45.8%的患者达到完全CR， 23.1%的患者达到部分CR， 31.1%的患者未达到CR，并观察不同生物制剂治疗类型患者CR的差异。在评估吸入治疗（ICS/LABA/LAMA和无生物制剂）的有效性时，发现了有趣的结果：34.5%的患者达到完全缓解，34.5%达到部分缓解，31.0%未达到缓解。这一发现值得注意，因为它进一步支持了某些SA患者吸入治疗的有效性，并强调了将CR作为SA治疗的现代结果的相关性。慢性鼻窦炎合并鼻息肉（CRSwNP）共病与接受生物制剂治疗的患者实现CR相关，但不显著。哮喘控制测试（ACT）和哮喘控制问卷（ACQ）评分显著影响CR（分别为p = 0.003和p = 0.027），而生物标志物，即IgE、血嗜酸性粒细胞或分数呼出一氧化氮（FeNO）与CR的实现无关。结论：本研究证实了生物制剂在达到CR方面的有效性，也证明了吸入疗法能够达到CR。这些创新发现应该鼓励随机临床试验的事后分析，甚至对SA患者队列进行回顾性分析，以评估不同吸入治疗的CR，并进一步确定每种治疗的适合人群。试验注册：ClinicalTrials.gov ID: NCT06625216；中央伦理委员会：Comitato Etico Area Vasta Nord-Ovest Toscana（研究号1245/2016，协议号：73714）。
{"title":"Biologics as well as inhaled anti-asthmatic therapy achieve clinical remission: Evidence from the Severe Asthma Network in Italy (SANI)","authors":"Giorgio Walter Canonica MD , Francesco Blasi PhD , Pierluigi Paggiaro MD , Enrico Heffler PhD , Fulvio Braido MD , Luisa Brussino PhD , Giulia Scioscia PhD , Cristina Cardini MsC , Chiara Oriecuia MsC , Isabella Sala MsC , Vincenzo Bagnardi PhD","doi":"10.1016/j.waojou.2024.101016","DOIUrl":"10.1016/j.waojou.2024.101016","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate the impact of severe asthma (SA) treatments after 12 months in achieving clinical remission (CR) within the context of the Severe Asthma Network in Italy (SANI) using the recent SANI definition of CR on treatment.</div></div><div><h3>Methods</h3><div>CR has been defined by SANI as complete, partial, and no CR. Complete CR is defined by the absence of oral corticosteroids (OCS), no symptoms, no exacerbations, and stable lung function, and partial CR requires the absence of OCS and the fulfillment of 2 out of the other 3 criteria. Patients who do not meet the previous criteria do not reach CR.</div></div><div><h3>Results</h3><div>After 12 months of treatment, 283 patients were selected to evaluate the effectiveness of biologics (225 patients) and inhaled therapy (58 patients) in achieving CR. Among patients treated with biologic agents, 45.8% reached complete CR, 23.1% partial CR, and 31.1% no CR. Differences in CR achievement according to type of biologic agent administered were observed. Interesting results were found when assessing the inhaled therapy (ICS/LABA/LAMA and no biologics) effectiveness: 34.5% patients reached complete CR, 34.5% partial CR, and 31.0% did not reach CR. This finding is noteworthy since it further supports the efficacy of inhaled treatment in certain SA patients and highlights the relevance of using CR as a modern outcome of SA treatments. Chronic rhinosinusitis with nasal polyps (CRSwNP) comorbidity was associated, though not significantly, with CR achievement in patients treated with biologics. Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ) scores significantly impacted CR (p = 0.003 and p = 0.027, respectively), while biomarkers, namely IgE, blood eosinophils, or fractional exhaled nitric oxide (FeNO), were not associated with CR achievement.</div></div><div><h3>Conclusions</h3><div>This study confirmed the effectiveness of biologics in reaching CR and demonstrated also inhaled therapies able to achieve CR. These innovative findings should encourage post hoc analysis of randomized clinical trials or even retrospective analysis of SA patient cohorts to evaluate CR with different inhaled treatments and further define the populations eligible for each treatment.</div></div><div><h3>Trial registration</h3><div>ClinicalTrials.gov ID: <span><span>NCT06625216</span><svg><path></path></svg></span>; Central Ethics Committee: Comitato Etico Area Vasta Nord-Ovest Toscana (study number 1245/2016, protocol number:73714).</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 1","pages":"Article 101016"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016365","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}
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