Pub Date : 2025-01-01DOI: 10.1016/j.waojou.2024.101006
Shumeng Guo , Liangchun Wang MD, PhD , Dingfang Bu MD, PhD , Fengjie Liu MD, PhD
Dupilumab is the first monoclonal antibody approved for treating moderate-to-severe atopic dermatitis (AD) and has significantly improved the quality of life of AD patients. However, the safety of dupilumab is yet unclear in the context of cancer. Therefore, we aimed to investigate the safety of dupilumab and its relationship with the progression and occurrence of tumors. By reviewing relevant medical records of 90 patients who had pre-existing tumors before dupilumab treatment or presented new tumors after dupilumab treatment, we found that dupilumab probably had no significant negative effects on most tumors, but several patients with Cutaneous T-cell lymphomas (CTCLs) had relatively unfavorable outcomes during dupilumab treatment. Besides, CTCLs and lymphomas accounted for the majority of patients who presented new tumors after dupilumab treatment. Several patients were first diagnosed with presumed AD and probably were the presentations of CTCL at an early stage, and they developed typical CTCL symptoms after dupilumab treatment. Finally we came to the conclusion that dupilumab is safe for most patients with cancer. However, the effect of dupilumab on CTCLs is disputable. The use of dupilumab requires individual evaluation and closely monitored. When the efficacy is poor, re-evaluation of the diagnosis, especially of CTCLs and related diseases, is necessary.
{"title":"Tumors in the setting of dupilumab use: A review of the literature","authors":"Shumeng Guo , Liangchun Wang MD, PhD , Dingfang Bu MD, PhD , Fengjie Liu MD, PhD","doi":"10.1016/j.waojou.2024.101006","DOIUrl":"10.1016/j.waojou.2024.101006","url":null,"abstract":"<div><div>Dupilumab is the first monoclonal antibody approved for treating moderate-to-severe atopic dermatitis (AD) and has significantly improved the quality of life of AD patients. However, the safety of dupilumab is yet unclear in the context of cancer. Therefore, we aimed to investigate the safety of dupilumab and its relationship with the progression and occurrence of tumors. By reviewing relevant medical records of 90 patients who had pre-existing tumors before dupilumab treatment or presented new tumors after dupilumab treatment, we found that dupilumab probably had no significant negative effects on most tumors, but several patients with Cutaneous T-cell lymphomas (CTCLs) had relatively unfavorable outcomes during dupilumab treatment. Besides, CTCLs and lymphomas accounted for the majority of patients who presented new tumors after dupilumab treatment. Several patients were first diagnosed with presumed AD and probably were the presentations of CTCL at an early stage, and they developed typical CTCL symptoms after dupilumab treatment. Finally we came to the conclusion that dupilumab is safe for most patients with cancer. However, the effect of dupilumab on CTCLs is disputable. The use of dupilumab requires individual evaluation and closely monitored. When the efficacy is poor, re-evaluation of the diagnosis, especially of CTCLs and related diseases, is necessary.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 1","pages":"Article 101006"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933480","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}
Children allergic to milk and egg, but tolerant to baked products, display higher reactivity thresholds than the general population of children allergic to milk and egg. We sought to verify the reactivity thresholds of milk- and egg-allergic children who also react to baked milk and baked egg, respectively.
Methods
We retrospectively assessed consecutive oral food challenge (OFC) for baked milk and egg between January 2018 and March 2022 in a population of baked milk- and baked-egg allergic children.
Results
Among 407 children included (median age 56 - IQR 31.1–103.7 months, 67.1% male), 93 (23.6%) returned positive OFC results, 41 with baked milk, and 52 with baked egg. The most conservative ED01 was 0.4 mg total protein (IQR 0.1–2.7) for milk and 2.2 mg total protein (IQR 0.6–7.3) for egg. The respective ED05 was 3.9 (IQR 1.1–14) mg for milk and 11.7 (IQR 5–27.2) mg for egg. Such thresholds are consistent to those found for fresh milk (0.8 times for ED01, 1.1 times for ED05). For egg, they are 6.5 (egg ED01), and 7.5 (egg ED05) times lower than for native form.Compared to the currently used thresholds, they are 1.3 (milk ED01), 1.3 (milk ED05), 11 (egg ED01), and 4.9 (egg ED05) times higher.
Conclusions
Milk thresholds are similar to those already observed in baked allergic versus baked tolerant children, while EDs for egg are at least 1.6 times higher than those currently indicated.Egg-allergic patients could be exempt from the recommendations of absolute avoidance of foods when present in infinitesimal quantities, represented by precautionary allergen labelling based on current EDs.
{"title":"The baked side: Cow's milk and egg protein threshold dose distributions in children reacting to baked milk and baked egg","authors":"Rocco Luigi Valluzzi MD , Carla Riccardi MD , Sara Urbani MD , Davide Ursi MD , Deborah Zavettieri MD , Francesco Di Girolamo PhD , Lamia Dahdah MD , Veronica Calandrelli PharmD , Vincenzo Fierro MD , Alessandro Fiocchi MD","doi":"10.1016/j.waojou.2024.101012","DOIUrl":"10.1016/j.waojou.2024.101012","url":null,"abstract":"<div><h3>Background</h3><div>Children allergic to milk and egg, but tolerant to baked products, display higher reactivity thresholds than the general population of children allergic to milk and egg. We sought to verify the reactivity thresholds of milk- and egg-allergic children who also react to baked milk and baked egg, respectively.</div></div><div><h3>Methods</h3><div>We retrospectively assessed consecutive oral food challenge (OFC) for baked milk and egg between January 2018 and March 2022 in a population of baked milk- and baked-egg allergic children.</div></div><div><h3>Results</h3><div>Among 407 children included (median age 56 - IQR 31.1–103.7 months, 67.1% male), 93 (23.6%) returned positive OFC results, 41 with baked milk, and 52 with baked egg. The most conservative ED01 was 0.4 mg total protein (IQR 0.1–2.7) for milk and 2.2 mg total protein (IQR 0.6–7.3) for egg. The respective ED05 was 3.9 (IQR 1.1–14) mg for milk and 11.7 (IQR 5–27.2) mg for egg. Such thresholds are consistent to those found for fresh milk (0.8 times for ED01, 1.1 times for ED05). For egg, they are 6.5 (egg ED01), and 7.5 (egg ED05) times lower than for native form.Compared to the currently used thresholds, they are 1.3 (milk ED01), 1.3 (milk ED05), 11 (egg ED01), and 4.9 (egg ED05) times higher.</div></div><div><h3>Conclusions</h3><div>Milk thresholds are similar to those already observed in baked allergic versus baked tolerant children, while EDs for egg are at least 1.6 times higher than those currently indicated.Egg-allergic patients could be exempt from the recommendations of absolute avoidance of foods when present in infinitesimal quantities, represented by precautionary allergen labelling based on current EDs.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 1","pages":"Article 101012"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11714411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958869","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.2024.101018
Wanjun Wang , Mo Xian , Ruchong Chen , Jing Li , Lulu Wu
Background
While much of the evidence linking the rapid urbanization and the increasing prevalence of allergen sensitization, but little is known regarding rural-to-urban migrants. The aim of this study was to identify the disparities in allergy, the gut microbiome and factors among native urban, migrating, and native rural Chinese.
Methods
We redesigned the dataset of the China Alliance of Research on Respiratory Allergic Disease secondary survey, and after stratified sampling, a subsample of 2422 subjects were enrolled for the analysis of a questionnaire, skin prick tests (SPT), and specific immunoglobulin E (sIgE) titer measurements against 8 common allergens. Fecal microbiotal composition was also sequenced by 16S rRNA and regression-based analyses with covariate adjustment applied.
Results
From urban to migrant and rural populations, IgE sensitization was predominantly directed against Dermatophagoides pteronyssinus (Der p). The titers of Der p-sIgE decreased sequentially across the 3 respective populations and co-sensitization to other allergens also showed a sequential decrease. Rural-to-urban migrants showed a low prevalence of Der p-SPT and Der p-sIgE initially, but developed substantial IgE titers and their gut microbiotal diversity, as well as species richness, appeared to change along with residential time spent in the urban area. High-fat diet, using a mattress, an SPT wheal size from Der p ≥ 6 mm, and duration of immigration >5 years were significantly associated with sIgE positivity in the migrants.
Conclusion
The Der p-sIgE responses and the composition of gut microbiota differs synchronously with extended living time in an urban area. Studies in immigrants provide a unique opportunities to evaluate the effects of environmental factors in the pathogenesis of allergic disorders.
{"title":"Gradient disparities in allergy and the gut microbiome among rural, migrant, and urban populations across China","authors":"Wanjun Wang , Mo Xian , Ruchong Chen , Jing Li , Lulu Wu","doi":"10.1016/j.waojou.2024.101018","DOIUrl":"10.1016/j.waojou.2024.101018","url":null,"abstract":"<div><h3>Background</h3><div>While much of the evidence linking the rapid urbanization and the increasing prevalence of allergen sensitization, but little is known regarding rural-to-urban migrants. The aim of this study was to identify the disparities in allergy, the gut microbiome and factors among native urban, migrating, and native rural Chinese.</div></div><div><h3>Methods</h3><div>We redesigned the dataset of the China Alliance of Research on Respiratory Allergic Disease secondary survey, and after stratified sampling, a subsample of 2422 subjects were enrolled for the analysis of a questionnaire, skin prick tests (SPT), and specific immunoglobulin E (sIgE) titer measurements against 8 common allergens. Fecal microbiotal composition was also sequenced by 16S rRNA and regression-based analyses with covariate adjustment applied.</div></div><div><h3>Results</h3><div>From urban to migrant and rural populations, IgE sensitization was predominantly directed against Dermatophagoides pteronyssinus (Der p). The titers of Der p-sIgE decreased sequentially across the 3 respective populations and co-sensitization to other allergens also showed a sequential decrease. Rural-to-urban migrants showed a low prevalence of Der p-SPT and Der p-sIgE initially, but developed substantial IgE titers and their gut microbiotal diversity, as well as species richness, appeared to change along with residential time spent in the urban area. High-fat diet, using a mattress, an SPT wheal size from Der p ≥ 6 mm, and duration of immigration >5 years were significantly associated with sIgE positivity in the migrants.</div></div><div><h3>Conclusion</h3><div>The Der p-sIgE responses and the composition of gut microbiota differs synchronously with extended living time in an urban area. Studies in immigrants provide a unique opportunities to evaluate the effects of environmental factors in the pathogenesis of allergic disorders.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 1","pages":"Article 101018"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025847","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.2024.101014
Xingling Tan MD , Zhouyouyou Xiao MB , Yao Wen MD , Han Liu MD , Wei Yu MD
Background
Allergic rhinitis (AR) is a common chronic respiratory disease that can lead to the development of various other conditions. Although genetic risk loci associated with AR have been reported, the connections between these loci and AR comorbidities or other diseases remain unclear.
Methods
This study conducted a phenome-wide association study (PheWAS) using known AR risk loci to explore the impact of known AR risk variants on a broad spectrum of phenotypes. Subsequently, linkage disequilibrium score regression (LDSC) and bidirectional two-sample mendelian randomization (TSMR) analyses were used to further analyze the genetic correlation and causal relationships between significant and potentially related phenotypes and AR.
Results
The PheWAS analysis indicated significant associations between asthma, eczema, nasal polyps, hypothyroidism, and AR risk variants. Additionally, potential associations were observed with ulcerative colitis, psoriasis, chalazion, pernicious anemia, glaucoma, multiple sclerosis, arthritis, prostate cancer, varicose veins of lower extremities, and heart attack. LDSC analysis showed that only asthma, eczema, and nasal polyps have significant positive genetic correlations with AR. Furthermore, TSMR analysis revealed causal relationships between AR and asthma, eczema, and nasal polyps.
Conclusion
This study highlights the impact of AR risk loci on a variety of diseases. By revealing new associations and shared genetic pathways, our findings provide valuable insights into the pathophysiology of AR and pave the way for more effective targeted interventions to manage AR and its related diseases.
{"title":"Advancing allergic rhinitis research through phenome-wide association studies: Insights from known genetic loci","authors":"Xingling Tan MD , Zhouyouyou Xiao MB , Yao Wen MD , Han Liu MD , Wei Yu MD","doi":"10.1016/j.waojou.2024.101014","DOIUrl":"10.1016/j.waojou.2024.101014","url":null,"abstract":"<div><h3>Background</h3><div>Allergic rhinitis (AR) is a common chronic respiratory disease that can lead to the development of various other conditions. Although genetic risk loci associated with AR have been reported, the connections between these loci and AR comorbidities or other diseases remain unclear.</div></div><div><h3>Methods</h3><div>This study conducted a phenome-wide association study (PheWAS) using known AR risk loci to explore the impact of known AR risk variants on a broad spectrum of phenotypes. Subsequently, linkage disequilibrium score regression (LDSC) and bidirectional two-sample mendelian randomization (TSMR) analyses were used to further analyze the genetic correlation and causal relationships between significant and potentially related phenotypes and AR.</div></div><div><h3>Results</h3><div>The PheWAS analysis indicated significant associations between asthma, eczema, nasal polyps, hypothyroidism, and AR risk variants. Additionally, potential associations were observed with ulcerative colitis, psoriasis, chalazion, pernicious anemia, glaucoma, multiple sclerosis, arthritis, prostate cancer, varicose veins of lower extremities, and heart attack. LDSC analysis showed that only asthma, eczema, and nasal polyps have significant positive genetic correlations with AR. Furthermore, TSMR analysis revealed causal relationships between AR and asthma, eczema, and nasal polyps.</div></div><div><h3>Conclusion</h3><div>This study highlights the impact of AR risk loci on a variety of diseases. By revealing new associations and shared genetic pathways, our findings provide valuable insights into the pathophysiology of AR and pave the way for more effective targeted interventions to manage AR and its related diseases.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 1","pages":"Article 101014"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980468","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.2024.101021
Jean Bousquet MD , Ludger Klimek MD , Hans-Christian Kuhl PhD , Duc Tung Nguyen MD , Rajesh Kumar Ramalingam MD , G. Walter Canonica MD , William E. Berger MD
Some double-blind, placebo-controlled trials have shown that Azelastine (Aze) high dose (0.15%) was effective in seasonal (SAR) and perennial allergic rhinitis (PAR). However, there was no long-term comparison between Aze 0.15% and intranasal corticosteroids (INCS) on safety and quality of life in perennial allergic rhinitis.
An open-label, active-controlled, parallel-group one-year study comparing mometasone furoate and Aze 0.15% in adults assessed safety over 1 year. Efficacy using the 28-item rhino-conjunctivitis quality of life questionnaire (RQLQ) was a secondary end point.
A total of 703 patients were randomized and 687 (97.7%) were included in the intent-to-treat (ITT) population. The present formulation was shown to be safe with long-term use over 12 months, with a mean duration of exposure of 270.7 days.
Over the one-year period, there was no significant difference for any RQLQ domains between Aze and mometasone furoate (MF) for all evaluations (baseline, 6, 9, and 12 months). This study suggests that Aze 0.15% and MF display a similar improvement of RQLQ ( 2.80 [2.78] for Aze 0.15% vs 2.81 [2.75] for MF).
Clinical trial registry number
NCT00720382.
{"title":"In perennial allergic rhinitis, RQLQ is improved similarly by Azelastine 0.15 and mometasone furoate","authors":"Jean Bousquet MD , Ludger Klimek MD , Hans-Christian Kuhl PhD , Duc Tung Nguyen MD , Rajesh Kumar Ramalingam MD , G. Walter Canonica MD , William E. Berger MD","doi":"10.1016/j.waojou.2024.101021","DOIUrl":"10.1016/j.waojou.2024.101021","url":null,"abstract":"<div><div>Some double-blind, placebo-controlled trials have shown that Azelastine (Aze) high dose (0.15%) was effective in seasonal (SAR) and perennial allergic rhinitis (PAR). However, there was no long-term comparison between Aze 0.15% and intranasal corticosteroids (INCS) on safety and quality of life in perennial allergic rhinitis.</div><div>An open-label, active-controlled, parallel-group one-year study comparing mometasone furoate and Aze 0.15% in adults assessed safety over 1 year. Efficacy using the 28-item rhino-conjunctivitis quality of life questionnaire (RQLQ) was a secondary end point.</div><div>A total of 703 patients were randomized and 687 (97.7%) were included in the intent-to-treat (ITT) population. The present formulation was shown to be safe with long-term use over 12 months, with a mean duration of exposure of 270.7 days.</div><div>Over the one-year period, there was no significant difference for any RQLQ domains between Aze and mometasone furoate (MF) for all evaluations (baseline, 6, 9, and 12 months). This study suggests that Aze 0.15% and MF display a similar improvement of RQLQ ( 2.80 [2.78] for Aze 0.15% vs 2.81 [2.75] for MF).</div></div><div><h3>Clinical trial registry number</h3><div>NCT00720382.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 1","pages":"Article 101021"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069730","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 : 2024-12-01DOI: 10.1016/j.waojou.2024.101011
Dorra Gharbi PhD , Dilys Berman PhD , Frank H. Neumann PhD , Trevor Hill PhD , Siyavuya Sidla BSc , Sarel S. Cillers PhD , Jurgens Staats MD , Nanike Esterhuizen PhD , Linus Ajikah PhD , Moteng E. Moseri MSc , Lynne J. Quick PhD , Erin Hilmer BSc , Andri Van Aardt PhD , Juanette John PhD , Rebecca Garland PhD , Jemma Finch PhD , Werner Hoek MD , Marion Bamford PhD , Riaz Y. Seedat MD , Ahmed I. Manjra MD , Jonny Peter MD, PhD
Background
Ragweed is an invasive, highly allergenic weed predicted to expand its habitat with warming global temperatures. Several Ambrosia species have been identified in South Africa for well over a century; however, its presence remained undetected by allergists and aerobiologists until the development of an extensive aerospora monitoring system across South African urban areas since 2019. This paper presents the inventory of preliminary investigation of the Ambrosia airborne pollen and the taxonomic identification of ragweed species.
Methods
Burkard volumetric spore traps for collecting pollen samples are set up in 9 South African cities (Johannesburg, Cape Town, Pretoria, Kimberley, Durban, Potchefstroom, Ermelo, Bloemfontein, and Gqeberha). Light microscopic identification was combined with environmental DNA metabarcoding analysis to confirm the species level of airborne Ambrosia at selected monitoring stations. Ragweed sensitisation was examined in Cape Town between February 2019 and February 2024, using Allergy Xplorer (ALEX2) multicomponent allergen array.
Results
Ambrosia pollen was detected in 5 aerobiological monitoring stations over the sampling period (Durban, Kimberley, Pretoria, Potchefstroom, Johannesburg). Periods of 4 consistent pollination years were observed in Kimberley (min: 1; max: 16 p.g/m3) and Durban (min: 26; max: 66 p.g/m3). In Pretoria, ragweed pollen was detected for 2 years (2020–2021; 2022–2023) with average total annuals (5-17 p.g/m3). A peak flowering period between March and April was observed in Potchefstroom, and several ragweed pollen peaks were present between the end of December and the beginning of May in Durban. The highest number of Ambrosia pollen grains was recorded in Potchefstroom, with 308 grains, and a maximum peak of 47 p.g/m3. eDNA metabarcoding confirmed the presence of Ambrosia artemisiifolia and A.trifida species. The overall prevalence of Ambrosia-sensitisation amongst 673 tests (age range 7–72 years) was 8.2% (55/673), with no significant difference in sensitisation patterns between age groups.
Conclusion
Our study confirms the need to monitor the spread of ragweed, and an increasing awareness of Ambrosia as an allergen of concern in Southern Africa. Extension of aerobiological networks and testing for Ambrosia sensitisation across urban and rural sites will be required.
{"title":"Ambrosia (ragweed) pollen — A growing aeroallergen of concern in South Africa","authors":"Dorra Gharbi PhD , Dilys Berman PhD , Frank H. Neumann PhD , Trevor Hill PhD , Siyavuya Sidla BSc , Sarel S. Cillers PhD , Jurgens Staats MD , Nanike Esterhuizen PhD , Linus Ajikah PhD , Moteng E. Moseri MSc , Lynne J. Quick PhD , Erin Hilmer BSc , Andri Van Aardt PhD , Juanette John PhD , Rebecca Garland PhD , Jemma Finch PhD , Werner Hoek MD , Marion Bamford PhD , Riaz Y. Seedat MD , Ahmed I. Manjra MD , Jonny Peter MD, PhD","doi":"10.1016/j.waojou.2024.101011","DOIUrl":"10.1016/j.waojou.2024.101011","url":null,"abstract":"<div><h3>Background</h3><div>Ragweed is an invasive, highly allergenic weed predicted to expand its habitat with warming global temperatures. Several <em>Ambrosia</em> species have been identified in South Africa for well over a century; however, its presence remained undetected by allergists and aerobiologists until the development of an extensive aerospora monitoring system across South African urban areas since 2019. This paper presents the inventory of preliminary investigation of the <em>Ambrosia</em> airborne pollen and the taxonomic identification of ragweed species.</div></div><div><h3>Methods</h3><div>Burkard volumetric spore traps for collecting pollen samples are set up in 9 South African cities (Johannesburg, Cape Town, Pretoria, Kimberley, Durban, Potchefstroom, Ermelo, Bloemfontein, and Gqeberha). Light microscopic identification was combined with environmental DNA metabarcoding analysis to confirm the species level of airborne <em>Ambrosia</em> at selected monitoring stations. Ragweed sensitisation was examined in Cape Town between February 2019 and February 2024, using Allergy Xplorer (ALEX<sup>2</sup>) multicomponent allergen array.</div></div><div><h3>Results</h3><div><em>Ambrosia</em> pollen was detected in 5 aerobiological monitoring stations over the sampling period (Durban, Kimberley, Pretoria, Potchefstroom, Johannesburg). Periods of 4 consistent pollination years were observed in Kimberley (min: 1; max: 16 p.g/m<sup>3</sup>) and Durban (min: 26; max: 66 p.g/m<sup>3</sup>). In Pretoria, ragweed pollen was detected for 2 years (2020–2021; 2022–2023) with average total annuals (5-17 p.g/m<sup>3</sup>). A peak flowering period between March and April was observed in Potchefstroom, and several ragweed pollen peaks were present between the end of December and the beginning of May in Durban. The highest number of <em>Ambrosia</em> pollen grains was recorded in Potchefstroom, with 308 grains, and a maximum peak of 47 p.g/m<sup>3</sup>. eDNA metabarcoding confirmed the presence of <em>Ambrosia artemisiifolia</em> and <em>A.trifida</em> species. The overall prevalence of <em>Ambrosia</em>-sensitisation amongst 673 tests (age range 7–72 years) was 8.2% (55/673), with no significant difference in sensitisation patterns between age groups.</div></div><div><h3>Conclusion</h3><div>Our study confirms the need to monitor the spread of ragweed, and an increasing awareness of Ambrosia as an allergen of concern in Southern Africa. Extension of aerobiological networks and testing for <em>Ambrosia</em> sensitisation across urban and rural sites will be required.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"17 12","pages":"Article 101011"},"PeriodicalIF":3.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758811","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 : 2024-12-01DOI: 10.1016/j.waojou.2024.100996
Zhang Ping'an MD, Ma Yanliang MD, Chen Xi MD, Ma Yifan MD, Yang Luyang MM, Zhang Moqin MD, Gao Zhancheng PhD
Background
Susceptibility to relapse is an important feature of allergic bronchopulmonary aspergillosis (ABPA); early identification of patients at high risk of relapse is urgently needed. A practical score that classifies the severity of ABPA according to its prognosis is not available.
Methods
We retrospectively reviewed patients with a diagnosis of ABPA at our hospital between January 2010 and December 2022. Logistic regression analysis was used to investigate independent risk factors for ABPA treatment escalation and select the variables included in the final score.
Results
One hundred and three patients with ABPA were enrolled in this study. An eosinophil count >1000/μL, Aspergillus fumigatus–specific IgE (Sp-IgE) >3.5 kUA/L, expectoration of brownish-black mucus plugs, high-attenuation mucus (HAM) and a percentage of the predicted diffusing capacity of carbon monoxide (DLCO/pred) < 60% were independent risk factors for ABPA treatment escalation. Initial treatment with antifungals was an independent protective factor. The final scale, designated HEID, incorporated 4 dichotomized variables: HAM (H, 1 point); eosinophil count (E, cutoff 1000/μL, 1 point); Sp-IgE (I, cutoff 3.5 kUA/L, 1 point) and DLCO/pred (D, cutoff 60%, 1 point). A score of 0–1 point indicated a low relapse risk; 2–4 points indicated a high relapse risk.
Conclusion
This easy-to-use multidimensional grading system was capable of accurately classifying the risk of treatment escalation in ABPA.
{"title":"A multidimensional grading system for ABPA treatment escalation within the first year: The HEID score","authors":"Zhang Ping'an MD, Ma Yanliang MD, Chen Xi MD, Ma Yifan MD, Yang Luyang MM, Zhang Moqin MD, Gao Zhancheng PhD","doi":"10.1016/j.waojou.2024.100996","DOIUrl":"10.1016/j.waojou.2024.100996","url":null,"abstract":"<div><h3>Background</h3><div>Susceptibility to relapse is an important feature of allergic bronchopulmonary aspergillosis (ABPA); early identification of patients at high risk of relapse is urgently needed. A practical score that classifies the severity of ABPA according to its prognosis is not available.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients with a diagnosis of ABPA at our hospital between January 2010 and December 2022. Logistic regression analysis was used to investigate independent risk factors for ABPA treatment escalation and select the variables included in the final score.</div></div><div><h3>Results</h3><div>One hundred and three patients with ABPA were enrolled in this study. An eosinophil count >1000/μL, <em>Aspergillus fumigatus</em>–specific IgE (Sp-IgE) >3.5 kUA/L, expectoration of brownish-black mucus plugs, high-attenuation mucus (HAM) and a percentage of the predicted diffusing capacity of carbon monoxide (DLCO/pred) < 60% were independent risk factors for ABPA treatment escalation. Initial treatment with antifungals was an independent protective factor. The final scale, designated HEID, incorporated 4 dichotomized variables: HAM (H, 1 point); eosinophil count (E, cutoff 1000/μL, 1 point); Sp-IgE (I, cutoff 3.5 kUA/L, 1 point) and DLCO/pred (D, cutoff 60%, 1 point). A score of 0–1 point indicated a low relapse risk; 2–4 points indicated a high relapse risk.</div></div><div><h3>Conclusion</h3><div>This easy-to-use multidimensional grading system was capable of accurately classifying the risk of treatment escalation in ABPA.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"17 12","pages":"Article 100996"},"PeriodicalIF":3.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748468","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 : 2024-12-01DOI: 10.1016/j.waojou.2024.101005
Ju Hee Kim MD , Eun Kyo Ha MD , Jeewon Shin MD , Nahyun Lee BE , Bo Eun Han BE , Man Yong Han MD , Eun Lee MD, PhD
Background
Understanding the trends of anaphylaxis and risk factors associated with its recurrence is essential for the effective management and prevention of this condition.
Objective
This study aimed to analyze the prevalence trends of anaphylaxis and identify risk factors for recurrence, with a focus on the influence of neighborhood deprivation and comorbidities, across all age groups.
Methods
We conducted a retrospective administrative cohort study on anaphylaxis utilizing the National Health Insurance-National Sample Cohort (NHIS-NSC) database in Korea (2002–2019). Anaphylaxis was defined with ICD-10 codes for the diagnosis combined with prescription codes. The Neighborhood Deprivation Index was used to identify the risk of recurrent anaphylaxis. Trends in the annual prevalence and recurrence of anaphylaxis were assessed through joinpoint regression and Cox proportional hazard models.
Results
Out of the 1,137,861 individuals studied, 37,012 (3.25%) cases of anaphylaxis were identified. Among these, 5783 individuals (15.6%) experienced a recurrence, half of them experiencing it within the first year after the initial episode. The highest incidence of anaphylaxis was observed in children and adolescents, followed by middle-aged adults. A rapid increase in anaphylaxis cases was observed from 2002 to 2006 (Annual Percentage Change [APC], 33.2), followed by a more gradual increase until 2013 (APC, 12.8), and a stable trend from 2013 to 2019 (APC, 0.61). Males and adult age groups exhibited an increased risk of recurrence. Living in an area with neighborhood deprivation and the presence of comorbid conditions were associated with increased recurrence risk.
Conclusions
The increasing prevalence of anaphylaxis and its association with certain risk factors calls for targeted intervention. Addressing neighborhood deprivation and comorbid conditions may aid in reducing the recurrence and overall burden of anaphylaxis.
{"title":"National trends in the prevalence and recurrence of anaphylaxis across all ages: The role of neighborhood deprivation and comorbidity (2002–2019)","authors":"Ju Hee Kim MD , Eun Kyo Ha MD , Jeewon Shin MD , Nahyun Lee BE , Bo Eun Han BE , Man Yong Han MD , Eun Lee MD, PhD","doi":"10.1016/j.waojou.2024.101005","DOIUrl":"10.1016/j.waojou.2024.101005","url":null,"abstract":"<div><h3>Background</h3><div>Understanding the trends of anaphylaxis and risk factors associated with its recurrence is essential for the effective management and prevention of this condition.</div></div><div><h3>Objective</h3><div>This study aimed to analyze the prevalence trends of anaphylaxis and identify risk factors for recurrence, with a focus on the influence of neighborhood deprivation and comorbidities, across all age groups.</div></div><div><h3>Methods</h3><div>We conducted a retrospective administrative cohort study on anaphylaxis utilizing the National Health Insurance-National Sample Cohort (NHIS-NSC) database in Korea (2002–2019). Anaphylaxis was defined with ICD-10 codes for the diagnosis combined with prescription codes. The Neighborhood Deprivation Index was used to identify the risk of recurrent anaphylaxis. Trends in the annual prevalence and recurrence of anaphylaxis were assessed through joinpoint regression and Cox proportional hazard models.</div></div><div><h3>Results</h3><div>Out of the 1,137,861 individuals studied, 37,012 (3.25%) cases of anaphylaxis were identified. Among these, 5783 individuals (15.6%) experienced a recurrence, half of them experiencing it within the first year after the initial episode. The highest incidence of anaphylaxis was observed in children and adolescents, followed by middle-aged adults. A rapid increase in anaphylaxis cases was observed from 2002 to 2006 (Annual Percentage Change [APC], 33.2), followed by a more gradual increase until 2013 (APC, 12.8), and a stable trend from 2013 to 2019 (APC, 0.61). Males and adult age groups exhibited an increased risk of recurrence. Living in an area with neighborhood deprivation and the presence of comorbid conditions were associated with increased recurrence risk.</div></div><div><h3>Conclusions</h3><div>The increasing prevalence of anaphylaxis and its association with certain risk factors calls for targeted intervention. Addressing neighborhood deprivation and comorbid conditions may aid in reducing the recurrence and overall burden of anaphylaxis.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"17 12","pages":"Article 101005"},"PeriodicalIF":3.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759420","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 : 2024-12-01DOI: 10.1016/j.waojou.2024.100998
Dodi Giulia MD , Di Filippo Paola MD , Di Ludovico Armando MD , Simeone Pasquale PhD , De Bellis Domenico MSc , D'ascanio Francesca MSc , Di Pillo Sabrina MD , Chiarelli Francesco PhD , Lanuti Paola PhD , Attanasi Marina PhD
Basophilic granulocytes, containing and releasing histamine after a specific allergy stimulation, are directly involved in IgE-mediated allergic reactions. CD63 is a transmembrane protein of secretory lysosomes of basophils and its upregulation is related with the release of histamine to the extracellular space during IgE-mediated allergic reactions. Basophil activation test (BAT) measures the activation of circulating basophils upon the in vitro stimulation of living blood cells with specific allergens. Such a test is particularly safe and reproducible and has recently emerged as a new promising diagnostic tool for allergic diseases.
BAT can be used to diagnose food allergy and represents a promising alternative to oral food challenge tests, especially in children as it is less invasive, safer, and cheaper than the gold standard tests. As a biomarker of tolerance and reactivity, it is also useful to monitor natural resolution and clinical response to immune-modulatory treatments. Regarding drug allergies, BAT is even the only possible applicable diagnostic tool for allergy reactions to some drugs, because of the lack of alternative test, or given that those commonly used are unreliable, or equivocal. Additionally, BAT allows to screen patients with more active urticarial and identify Hymenoptera-allergic patients with negative venom-specific immunoglobulin (Ig)E. In respiratory allergic diseases, BAT can facilitate the diagnosis of local allergic rhinitis and evaluate basophil allergen sensitivity in allergic asthma. Although IgE-sensitization in allergic asthma is usually demonstrated by skin prick test and specific IgE, those tests do not predict the clinical allergy contribution to asthma pathogenesis. To date, the potential of BAT in the diagnostic work-up of allergic diseases is well established, but a better standardization of its use is needed. This narrative review summarizes the state-of-the-art BAT technology and applications in pediatric allergic diseases, focusing on immune-related mechanisms and the BAT real clinical utility.
{"title":"Applications of basophil activation test in paediatric allergic diseases","authors":"Dodi Giulia MD , Di Filippo Paola MD , Di Ludovico Armando MD , Simeone Pasquale PhD , De Bellis Domenico MSc , D'ascanio Francesca MSc , Di Pillo Sabrina MD , Chiarelli Francesco PhD , Lanuti Paola PhD , Attanasi Marina PhD","doi":"10.1016/j.waojou.2024.100998","DOIUrl":"10.1016/j.waojou.2024.100998","url":null,"abstract":"<div><div>Basophilic granulocytes, containing and releasing histamine after a specific allergy stimulation, are directly involved in IgE-mediated allergic reactions. CD63 is a transmembrane protein of secretory lysosomes of basophils and its upregulation is related with the release of histamine to the extracellular space during IgE-mediated allergic reactions. Basophil activation test (BAT) measures the activation of circulating basophils upon the <em>in vitro</em> stimulation of living blood cells with specific allergens. Such a test is particularly safe and reproducible and has recently emerged as a new promising diagnostic tool for allergic diseases.</div><div>BAT can be used to diagnose food allergy and represents a promising alternative to oral food challenge tests, especially in children as it is less invasive, safer, and cheaper than the gold standard tests. As a biomarker of tolerance and reactivity, it is also useful to monitor natural resolution and clinical response to immune-modulatory treatments. Regarding drug allergies, BAT is even the only possible applicable diagnostic tool for allergy reactions to some drugs, because of the lack of alternative test, or given that those commonly used are unreliable, or equivocal. Additionally, BAT allows to screen patients with more active urticarial and identify Hymenoptera-allergic patients with negative venom-specific immunoglobulin (Ig)E. In respiratory allergic diseases, BAT can facilitate the diagnosis of local allergic rhinitis and evaluate basophil allergen sensitivity in allergic asthma. Although IgE-sensitization in allergic asthma is usually demonstrated by skin prick test and specific IgE, those tests do not predict the clinical allergy contribution to asthma pathogenesis. To date, the potential of BAT in the diagnostic work-up of allergic diseases is well established, but a better standardization of its use is needed. This narrative review summarizes the state-of-the-art BAT technology and applications in pediatric allergic diseases, focusing on immune-related mechanisms and the BAT real clinical utility.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"17 12","pages":"Article 100998"},"PeriodicalIF":3.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903945","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 : 2024-12-01DOI: 10.1016/j.waojou.2024.101002
Ana M. Copaescu MD, FRCPC , Effie Mouhtouris BSc , Fiona James BBiomedSci , Michelle S.Y. Goh MBBS, FACD , Elizabeth J. Phillips MD, FRCPC, FRACP , Jason A. Trubiano MBBS, BBiomedSci, FRACP, PhD , for Australasian Registry of Severe Cutaneous Adverse Reactions (AUS-SCAR)
Background
In an exploratory study to assess the potential to individualize T-cell diagnostics in antibiotic-associated severe T-cell mediated hypersensitivity, we focused on drug reaction with eosinophilia and systemic symptoms (DRESS) and the related cytokine outputs IL-4 and IL-5.
Methods
Patients with well-phenotyped RegiSCAR ≥4 DRESS, positive intradermal skin testing, and a previous negative IFN-γ Enzyme-Linked ImmunoSpot (ELISpot) assay were prospectively recruited. We specifically performed an ELISpot assay with IL-4 and IL-5 cytokine outputs. As comparative controls, these cytokine outputs were performed simultaneously in patients with a positive ex vivo IFN-γ release ELISpot result.
Results
Four antibiotic-associated DRESS cases were included. The IL-4 and IL-5 output ELISpot assay demonstrated various results among these patients, with at least 1 cytokine present in all the cases. As for the 2 controls with known positive IFN-γ release, compared to the IFN-γ secretion, the cytokine output using IL-4 and IL-5 showed an increased positivity.
Conclusion
In patients where the early response has suggested a TH2 response such as DRESS, IL-4 and IL-5 cytokine outputs could present an investigational advantage, including when IFN-γ is negative. In the future, larger prospective studies are required to understand the role of varied cytokine outputs in T-cell-mediated hypersensitivities.
{"title":"Exploring cytokine outputs for ex vivo diagnostics in drug reaction with eosinophilia and systemic symptoms (DRESS)","authors":"Ana M. Copaescu MD, FRCPC , Effie Mouhtouris BSc , Fiona James BBiomedSci , Michelle S.Y. Goh MBBS, FACD , Elizabeth J. Phillips MD, FRCPC, FRACP , Jason A. Trubiano MBBS, BBiomedSci, FRACP, PhD , for Australasian Registry of Severe Cutaneous Adverse Reactions (AUS-SCAR)","doi":"10.1016/j.waojou.2024.101002","DOIUrl":"10.1016/j.waojou.2024.101002","url":null,"abstract":"<div><h3>Background</h3><div>In an exploratory study to assess the potential to individualize T-cell diagnostics in antibiotic-associated severe T-cell mediated hypersensitivity, we focused on drug reaction with eosinophilia and systemic symptoms (DRESS) and the related cytokine outputs IL-4 and IL-5.</div></div><div><h3>Methods</h3><div>Patients with well-phenotyped RegiSCAR ≥4 DRESS, positive intradermal skin testing, and a previous negative IFN-γ Enzyme-Linked ImmunoSpot (ELISpot) assay were prospectively recruited. We specifically performed an ELISpot assay with IL-4 and IL-5 cytokine outputs. As comparative controls, these cytokine outputs were performed simultaneously in patients with a positive <em>ex vivo</em> IFN-γ release ELISpot result.</div></div><div><h3>Results</h3><div>Four antibiotic-associated DRESS cases were included. The IL-4 and IL-5 output ELISpot assay demonstrated various results among these patients, with at least 1 cytokine present in all the cases. As for the 2 controls with known positive IFN-γ release, compared to the IFN-γ secretion, the cytokine output using IL-4 and IL-5 showed an increased positivity.</div></div><div><h3>Conclusion</h3><div>In patients where the early response has suggested a TH2 response such as DRESS, IL-4 and IL-5 cytokine outputs could present an investigational advantage, including when IFN-γ is negative. In the future, larger prospective studies are required to understand the role of varied cytokine outputs in T-cell-mediated hypersensitivities.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"17 12","pages":"Article 101002"},"PeriodicalIF":3.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882685","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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