Pub Date : 2025-10-01DOI: 10.1016/j.waojou.2025.101126
Changcan Jiang MD, Xiaoqiong Wang MD, Ruoqi Li MD, Liyan Ni MD, Xuejun Liu PhD
Objective
Eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) involves extensive tissue remodeling, but its underlying mechanisms remain unclear. This study aimed to identify key regulatory proteins contributing to this process.
Methods
Proteomic analysis was conducted on nasal tissues from 8 eCRSwNP patients, 8 non-eosinophilic CRSwNP (neCRSwNP) patients, and 8 healthy controls. Differentially expressed proteins (DEPs) were selected based on the top 50 overlapping DEPs from both comparison groups. Selected candidates were validated using Western blotting, immunofluorescence, and qRT-PCR in an independent cohort. Correlations with eosinophil infiltration and remodeling markers were assessed. Human nasal epithelial cells (HNECs) were used to explore functional mechanisms in vitro.
Result
Proteomic profiling revealed a distinct protein expression signature in the eCRSwNP group compared to both neCRSwNP and control groups. By intersecting the top 50 DEPs from both comparisons, 4 candidate proteins were identified, among which lysyl oxidase-like protein 2 (LOXL2) exhibited the most prominent upregulation. Validation in an independent cohort confirmed significantly elevated LOXL2 expression in eCRSwNP, predominantly localized to the nasal epithelial region (P < 0.001). LOXL2 mRNA levels were strongly correlated with eosinophil infiltration in nasal tissues (r = 0.349, P = 0.006), and ROC curve analysis supported its high diagnostic utility for eCRSwNP (AUC = 0.746, P = 0.001). Furthermore, the expression of EMT markers including vimentin, α-smooth muscle actin (α-SMA), and N-cadherin was markedly increased in eCRSwNP tissues (all P < 0.01) and positively associated with LOXL2 expression (all P < 0.05). In vitro, stimulation of HNECs with recombinant LOXL2 induced TGF-β1 and EMT marker expression, while co-treatment with the TGF-β1/Smad signaling inhibitor LY364947 significantly attenuated these effects and inhibited Smad2/3 phosphorylation.
Conclusion
Our findings revealed a disease-specific protein profile in eCRSwNP, characterized by selective upregulation of LOXL2 in the nasal epithelium and strong association with eosinophilic inflammation. Functional studies suggest that LOXL2 promotes EMT and may drive tissue remodeling in eCRSwNP via the TGF-β1/Smad signaling pathway.
{"title":"Increased LOXL2 facilitates tissue remodeling in eosinophilic chronic rhinosinusitis with nasal polyps","authors":"Changcan Jiang MD, Xiaoqiong Wang MD, Ruoqi Li MD, Liyan Ni MD, Xuejun Liu PhD","doi":"10.1016/j.waojou.2025.101126","DOIUrl":"10.1016/j.waojou.2025.101126","url":null,"abstract":"<div><h3>Objective</h3><div>Eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) involves extensive tissue remodeling, but its underlying mechanisms remain unclear. This study aimed to identify key regulatory proteins contributing to this process.</div></div><div><h3>Methods</h3><div>Proteomic analysis was conducted on nasal tissues from 8 eCRSwNP patients, 8 non-eosinophilic CRSwNP (neCRSwNP) patients, and 8 healthy controls. Differentially expressed proteins (DEPs) were selected based on the top 50 overlapping DEPs from both comparison groups. Selected candidates were validated using Western blotting, immunofluorescence, and qRT-PCR in an independent cohort. Correlations with eosinophil infiltration and remodeling markers were assessed. Human nasal epithelial cells (HNECs) were used to explore functional mechanisms in vitro.</div></div><div><h3>Result</h3><div>Proteomic profiling revealed a distinct protein expression signature in the eCRSwNP group compared to both neCRSwNP and control groups. By intersecting the top 50 DEPs from both comparisons, 4 candidate proteins were identified, among which lysyl oxidase-like protein 2 (LOXL2) exhibited the most prominent upregulation. Validation in an independent cohort confirmed significantly elevated LOXL2 expression in eCRSwNP, predominantly localized to the nasal epithelial region (P < 0.001). LOXL2 mRNA levels were strongly correlated with eosinophil infiltration in nasal tissues (r = 0.349, P = 0.006), and ROC curve analysis supported its high diagnostic utility for eCRSwNP (AUC = 0.746, P = 0.001). Furthermore, the expression of EMT markers including vimentin, α-smooth muscle actin (α-SMA), and N-cadherin was markedly increased in eCRSwNP tissues (all P < 0.01) and positively associated with LOXL2 expression (all P < 0.05). In vitro, stimulation of HNECs with recombinant LOXL2 induced TGF-β1 and EMT marker expression, while co-treatment with the TGF-β1/Smad signaling inhibitor LY364947 significantly attenuated these effects and inhibited Smad2/3 phosphorylation.</div></div><div><h3>Conclusion</h3><div>Our findings revealed a disease-specific protein profile in eCRSwNP, characterized by selective upregulation of LOXL2 in the nasal epithelium and strong association with eosinophilic inflammation. Functional studies suggest that LOXL2 promotes EMT and may drive tissue remodeling in eCRSwNP via the TGF-β1/Smad signaling pathway.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 10","pages":"Article 101126"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Respiratory allergy (RA), one of the most prevalent global chronic diseases, is often suboptimally managed by both patients and healthcare professionals (HCPs). This qualitative survey investigated the RA healthcare journey from the patient perspective to better understand the challenges faced at key stages and the unmet needs for potential improvements in physician-patient relationship, shared decision-making and patient quality of life outcomes.
The survey employed an ethnographic approach consisting of getting rid of any preconceived ideas and adopting an attitude of listening and empathy devoid of any prejudices. It involved 105 participants distributed across 3 countries (France, Germany, and Italy) who took part in a 2-h interview. All were diagnosed with intermittent or persistent RA and were at different stages of the journey/treatment (without treatment, antihistamine, undergoing Allergen Immunotherapy [AIT], completed AIT, reluctant to AIT, or discontinued AIT). Regional differences and variations related to medical subspecialties are considered, offering a comprehensive and nuanced perspective on RA management at an international level.
The examination of a complex and lengthy journey revealed 4 key stages and explored the corresponding emotional experiences. Physician-patient communication, clinical and emotional support and timing are found to be crucial factors in treatment choice, adherence and the psychological impact of the journey. Additionally, the data collected identified 4 distinct profiles related to AIT, based on their approach to managing RA and their level of access to treatment information: the “skeptic”, the “skittish”, the “determined”, and the “convinced”. This patient stratification can help physicians tailor their strategies and adopt more personalized approaches.
{"title":"The respiratory allergy patient's healthcare journey: An international qualitative survey employing an ethnographic approach","authors":"Julien Cottet MD , Sarah Court-Devilliers MD , Cristiano Caruso MD , Léa Ahmed MSc , Arianna Delfino Spiga MD , Ludovica Fabbroni MD , Oana Tuca Radu MSc , Silvia Scurati PhD , Natalija Novak MD","doi":"10.1016/j.waojou.2025.101111","DOIUrl":"10.1016/j.waojou.2025.101111","url":null,"abstract":"<div><div>Respiratory allergy (RA), one of the most prevalent global chronic diseases, is often suboptimally managed by both patients and healthcare professionals (HCPs). This qualitative survey investigated the RA healthcare journey from the patient perspective to better understand the challenges faced at key stages and the unmet needs for potential improvements in physician-patient relationship, shared decision-making and patient quality of life outcomes.</div><div>The survey employed an ethnographic approach consisting of getting rid of any preconceived ideas and adopting an attitude of listening and empathy devoid of any prejudices. It involved 105 participants distributed across 3 countries (France, Germany, and Italy) who took part in a 2-h interview. All were diagnosed with intermittent or persistent RA and were at different stages of the journey/treatment (without treatment, antihistamine, undergoing Allergen Immunotherapy [AIT], completed AIT, reluctant to AIT, or discontinued AIT). Regional differences and variations related to medical subspecialties are considered, offering a comprehensive and nuanced perspective on RA management at an international level.</div><div>The examination of a complex and lengthy journey revealed 4 key stages and explored the corresponding emotional experiences. Physician-patient communication, clinical and emotional support and timing are found to be crucial factors in treatment choice, adherence and the psychological impact of the journey. Additionally, the data collected identified 4 distinct profiles related to AIT, based on their approach to managing RA and their level of access to treatment information: the “skeptic”, the “skittish”, the “determined”, and the “convinced”. This patient stratification can help physicians tailor their strategies and adopt more personalized approaches.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 10","pages":"Article 101111"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.waojou.2025.101124
Zhengxiu Xiao BSN , Haiqin Luo BSN , Hao Liu MSc , Hui Chen BSN , Jun Bai MSc , Wang Liao MSc , Shi Wu Wen PhD , Daniel Krewski PhD , Huiling Shang PhD , Rihua Xie PhD
Background
Early-life gut microbial colonization is crucial for immune system development, but the efficacy of probiotic interventions during pregnancy or infancy in preventing allergic rhinitis (AR) and atopic sensitization (AS) remains unclear. This systematic review synthesized evidence from randomized controlled trials (RCTs) assessing probiotics for AR and AS prevention.
Methods
Seven English and Chinese databases were systematically searched up to February 13, 2025. Eligible studies were RCTs with clearly defined probiotic interventions and specified AR or AS outcomes. Risk of bias was assessed using the Cochrane tool. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using fixed-effects models.
Results
Fourteen RCTs involving 5886 children were included. Probiotics did not significantly reduce the odds of AR at any age (≤ 1 year: ORp = 0.73, 95% CI = 0.46–1.15, P = 0.17; > 1 year: ORp = 0.95, 95% CI = 0.83–1.09, P = 0.46). However, probiotics significantly reduced AS odds in children over 1 year (ORp = 0.87, 95% CI = 0.76–0.99, P = 0.04). Subgroup analyses revealed greater reductions in AS odds for postnatal interventions initiated after 6 months of age (ORp = 0.82, 95% CI = 0.68–0.99, P = 0.04) and for combined prenatal-postnatal supplementation (ORp = 0.85, 95% CI = 0.74–0.98, P = 0.03). Probiotics were also associated with transient increases in the abundance of targeted gut microbial strains.
Conclusion
Probiotics during pregnancy and/or infancy may reduce AS odds in children over 1 year and correlate with age-related changes in gut microbial composition but failed to reduce AR odds at any age.
早期肠道微生物定植对免疫系统发育至关重要,但孕期或婴儿期益生菌干预在预防过敏性鼻炎(AR)和特应性致敏(AS)方面的功效尚不清楚。本系统综述综合了评估益生菌预防AR和AS的随机对照试验(rct)的证据。方法系统检索截至2025年2月13日的7个中英文数据库。符合条件的研究是具有明确定义的益生菌干预和指定的AR或AS结果的随机对照试验。使用Cochrane工具评估偏倚风险。比值比(ORs)和95%置信区间(ci)采用固定效应模型进行汇总。结果共纳入14项随机对照试验,涉及儿童5886名。益生菌没有显著降低任何年龄段的AR发生率(≤1岁:ORp = 0.73, 95% CI = 0.46 - 1.15, P = 0.17; 1岁:ORp = 0.95, 95% CI = 0.83-1.09, P = 0.46)。然而,益生菌显著降低1岁以上儿童AS的发生率(ORp = 0.87, 95% CI = 0.76-0.99, P = 0.04)。亚组分析显示,6个月后开始的产后干预(ORp = 0.82, 95% CI = 0.68-0.99, P = 0.04)和产前-产后联合补充(ORp = 0.85, 95% CI = 0.74-0.98, P = 0.03)降低了AS的几率。益生菌也与目标肠道微生物菌株丰度的短暂增加有关。结论妊娠期和/或婴儿期益生菌可降低1岁以上儿童AS的发生率,并与肠道微生物组成的年龄相关变化相关,但不能降低任何年龄段的AR发生率。
{"title":"Probiotic supplementation during pregnancy or infancy for the prevention of allergic rhinitis in infants: A systematic review and meta-analysis of Randomized controlled trials","authors":"Zhengxiu Xiao BSN , Haiqin Luo BSN , Hao Liu MSc , Hui Chen BSN , Jun Bai MSc , Wang Liao MSc , Shi Wu Wen PhD , Daniel Krewski PhD , Huiling Shang PhD , Rihua Xie PhD","doi":"10.1016/j.waojou.2025.101124","DOIUrl":"10.1016/j.waojou.2025.101124","url":null,"abstract":"<div><h3>Background</h3><div>Early-life gut microbial colonization is crucial for immune system development, but the efficacy of probiotic interventions during pregnancy or infancy in preventing allergic rhinitis (AR) and atopic sensitization (AS) remains unclear. This systematic review synthesized evidence from randomized controlled trials (RCTs) assessing probiotics for AR and AS prevention.</div></div><div><h3>Methods</h3><div>Seven English and Chinese databases were systematically searched up to February 13, 2025. Eligible studies were RCTs with clearly defined probiotic interventions and specified AR or AS outcomes. Risk of bias was assessed using the Cochrane tool. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using fixed-effects models.</div></div><div><h3>Results</h3><div>Fourteen RCTs involving 5886 children were included. Probiotics did not significantly reduce the odds of AR at any age (≤ 1 year: OR<sub>p</sub> = 0.73, 95% CI = 0.46–1.15, <em>P</em> = 0.17; > 1 year: OR<sub>p</sub> = 0.95, 95% CI = 0.83–1.09, <em>P</em> = 0.46). However, probiotics significantly reduced AS odds in children over 1 year (OR<sub>p</sub> = 0.87, 95% CI = 0.76–0.99, <em>P</em> = 0.04). Subgroup analyses revealed greater reductions in AS odds for postnatal interventions initiated after 6 months of age (OR<sub>p</sub> = 0.82, 95% CI = 0.68–0.99, <em>P</em> = 0.04) and for combined prenatal-postnatal supplementation (OR<sub>p</sub> = 0.85, 95% CI = 0.74–0.98, <em>P</em> = 0.03). Probiotics were also associated with transient increases in the abundance of targeted gut microbial strains.</div></div><div><h3>Conclusion</h3><div>Probiotics during pregnancy and/or infancy may reduce AS odds in children over 1 year and correlate with age-related changes in gut microbial composition but failed to reduce AR odds at any age.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 10","pages":"Article 101124"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hymenoptera venom allergy is a major cause of life-threatening anaphylaxis. Molecular diagnostics have improved the characterisation of sensitisation patterns, although the clinical role of cross-reactive allergens such as DPPIV and hyaluronidases remains unclear.
Objective
To define IgE sensitisation to venom components, examine associations with clinical phenotypes, and assess the immunological impact of venom immunotherapy (VIT) in an Italian cohort.
Methods
In this monocentric study, 378 patients with documented Hymenoptera adverse reactions underwent extract-based and component-resolved diagnostics. A prospective subset (n = 113) was followed during VIT. Commercial venom extracts were characterised by inhibition assays.
Results
Systemic reactions occurred in 36% of patients, predominantly males, while large local reactions were more common in females. Sensitisation to Vespula spp. (52%) and Polistes dominula (48%) exceeded Apis mellifera (26%). Api m 1/3/10 and Ves v 5/Pol d 5 were the most relevant allergens. Multivariate analysis identified IgE to Api m 1, Api m 3, Ves v 1, and Ves v 5 as independent predictors of systemic reactions. Mixed-effect models revealed a progressive decline of species-specific IgE during VIT, with an earlier progressive reduction of Ves v 1 and Ves v 5 and a delayed decrease of Api m 1, while IgE to panallergens remained stable.
Conclusion
Molecular diagnostics refine risk stratification and monitoring of VIT. Species-specific allergens provide reliable clinical markers, whereas panallergens help distinguish true double sensitisation from cross-reactivity. VIT induces a progressive but differential reduction in specific IgE and confers protection, supporting precision allergy care.
{"title":"Molecular allergens drive risk stratification and immunotherapy in Hymenoptera venom allergy","authors":"Enrico Scala MD , Valeria Villella PhD , Damiano Abeni MD, MPH , Mauro Giani MD , Emma Cristina Guerra MD , Maria Locanto MD , Giorgia Meneguzzi MD , Lia Pirrotta MD , Donato Quaratino MD , Alessandra Zaffiro MD , Elisabetta Caprini PhD , Riccardo Asero MD , Lorenzo Cecchi MD , Danilo Villalta MD , Valerio Pravettoni MD","doi":"10.1016/j.waojou.2025.101128","DOIUrl":"10.1016/j.waojou.2025.101128","url":null,"abstract":"<div><h3>Background</h3><div>Hymenoptera venom allergy is a major cause of life-threatening anaphylaxis. Molecular diagnostics have improved the characterisation of sensitisation patterns, although the clinical role of cross-reactive allergens such as DPPIV and hyaluronidases remains unclear.</div></div><div><h3>Objective</h3><div>To define IgE sensitisation to venom components, examine associations with clinical phenotypes, and assess the immunological impact of venom immunotherapy (VIT) in an Italian cohort.</div></div><div><h3>Methods</h3><div>In this monocentric study, 378 patients with documented Hymenoptera adverse reactions underwent extract-based and component-resolved diagnostics. A prospective subset (n = 113) was followed during VIT. Commercial venom extracts were characterised by inhibition assays.</div></div><div><h3>Results</h3><div>Systemic reactions occurred in 36% of patients, predominantly males, while large local reactions were more common in females. Sensitisation to <em>Vespula</em> spp. (52%) and <em>Polistes dominula</em> (48%) exceeded <em>Apis mellifera</em> (26%). Api m 1/3/10 and Ves v 5/Pol d 5 were the most relevant allergens. Multivariate analysis identified IgE to Api m 1, Api m 3, Ves v 1, and Ves v 5 as independent predictors of systemic reactions. Mixed-effect models revealed a progressive decline of species-specific IgE during VIT, with an earlier progressive reduction of Ves v 1 and Ves v 5 and a delayed decrease of Api m 1, while IgE to panallergens remained stable.</div></div><div><h3>Conclusion</h3><div>Molecular diagnostics refine risk stratification and monitoring of VIT. Species-specific allergens provide reliable clinical markers, whereas panallergens help distinguish true double sensitisation from cross-reactivity. VIT induces a progressive but differential reduction in specific IgE and confers protection, supporting precision allergy care.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 10","pages":"Article 101128"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.waojou.2025.101127
Vera Veith PhD , Frauke Pedersen PhD , Henrik Watz MD PhD , Anne-Marie Kirsten MD , Folke Brinkmann MD (Prof) , Matthias V. Kopp MD (Prof) , Anna-Maria Dittrich MD (Prof) , Gesine Hansen MD (Prof) , Nicole Maison MD , Bianca Schaub MD (Prof) , Erika von Mutius MD (Prof) , Klaus F. Rabe MD (Prof) , Thomas Bahmer MD (Prof) , Mustafa Abdo MD PhD , the ALLIANCE Study Group
Rationale
Asthma remission is a state of low to no disease activity. To date, little is known about predictors and the achievability of long-term asthma remission.
Objective
To identify clinical predictors and trends of long-term remission in a cohort of adults with mild to severe asthma.
Methods
This study included 203 adults with mild to severe asthma from the All Age Asthma Cohort, followed over 6 years. Participants attended 5 visits, during which type 2 inflammation markers (blood and sputum eosinophils, fractional exhaled nitric oxide), lung function measurements (oscillometry, spirometry), atopy and systemic comorbidities were assessed. Clinical remission was defined by an Asthma Control Test score of ≥20 plus the absence of both severe exacerbations and systemic corticosteroid use in the past 12 months, and normal or stable lung function. Long-term remission was defined as remission lasting at least 3 consecutive years, while short-term remission lasted 1 or 2 consecutive years.
Results
The frequencies of long-term, short-term, and no remission were 27%, 34%, and 39%, respectively. 16% of all patients with severe asthma achieved long-term remission, compared to 65% of those with mild-to-moderate disease. Over one-third of all patients never achieved remission and had persistent T2 markers despite high-dose ICS. Predictors of no asthma remission included number of persistent T2-markers (OR:0.26, CI: 0.11, 0.61), frequency dependence of resistance (FDR, R5-R20Hz; OR:0.36, CI: 0.15, 0.82), FEV1/FVC (OR:0.16, CI: 0.06, 0.37), GERD (OR:0.23, CI: 0.1, 0.5), CVD (OR:0.44, CI: 0.22, 0.87), dyslipidemia (OR:0.38, CI: 0.13, 1.05), whereas sensitization to house dust mite was associated with a higher remission rate (OR:2.06, CI: 1.03, 4.17). During long-term follow-up, significant adjusted predictors of no remission were sputum eosinophils, small airway dysfunction, and airflow obstruction.
Conclusion
This study highlights a substantial unmet need in achieving long-term remission, particularly in patients with persistent type 2 inflammation and impaired lung function, prompting re-evaluation of targeting T2 inflammation earlier to prevent lung function impairment.
{"title":"Exploring trends and predictors of long-term asthma remission","authors":"Vera Veith PhD , Frauke Pedersen PhD , Henrik Watz MD PhD , Anne-Marie Kirsten MD , Folke Brinkmann MD (Prof) , Matthias V. Kopp MD (Prof) , Anna-Maria Dittrich MD (Prof) , Gesine Hansen MD (Prof) , Nicole Maison MD , Bianca Schaub MD (Prof) , Erika von Mutius MD (Prof) , Klaus F. Rabe MD (Prof) , Thomas Bahmer MD (Prof) , Mustafa Abdo MD PhD , the ALLIANCE Study Group","doi":"10.1016/j.waojou.2025.101127","DOIUrl":"10.1016/j.waojou.2025.101127","url":null,"abstract":"<div><h3>Rationale</h3><div>Asthma remission is a state of low to no disease activity. To date, little is known about predictors and the achievability of long-term asthma remission.</div></div><div><h3>Objective</h3><div>To identify clinical predictors and trends of long-term remission in a cohort of adults with mild to severe asthma.</div></div><div><h3>Methods</h3><div>This study included 203 adults with mild to severe asthma from the All Age Asthma Cohort, followed over 6 years. Participants attended 5 visits, during which type 2 inflammation markers (blood and sputum eosinophils, fractional exhaled nitric oxide), lung function measurements (oscillometry, spirometry), atopy and systemic comorbidities were assessed. Clinical remission was defined by an Asthma Control Test score of ≥20 plus the absence of both severe exacerbations and systemic corticosteroid use in the past 12 months, and normal or stable lung function. Long-term remission was defined as remission lasting at least 3 consecutive years, while short-term remission lasted 1 or 2 consecutive years.</div></div><div><h3>Results</h3><div>The frequencies of long-term, short-term, and no remission were 27%, 34%, and 39%, respectively. 16% of all patients with severe asthma achieved long-term remission, compared to 65% of those with mild-to-moderate disease. Over one-third of all patients never achieved remission and had persistent T2 markers despite high-dose ICS. Predictors of no asthma remission included number of persistent T2-markers (OR:0.26, CI: 0.11, 0.61), frequency dependence of resistance (FDR, R5-R20Hz; OR:0.36, CI: 0.15, 0.82), FEV1/FVC (OR:0.16, CI: 0.06, 0.37), GERD (OR:0.23, CI: 0.1, 0.5), CVD (OR:0.44, CI: 0.22, 0.87), dyslipidemia (OR:0.38, CI: 0.13, 1.05), whereas sensitization to house dust mite was associated with a higher remission rate (OR:2.06, CI: 1.03, 4.17). During long-term follow-up, significant adjusted predictors of no remission were sputum eosinophils, small airway dysfunction, and airflow obstruction.</div></div><div><h3>Conclusion</h3><div>This study highlights a substantial unmet need in achieving long-term remission, particularly in patients with persistent type 2 inflammation and impaired lung function, prompting re-evaluation of targeting T2 inflammation earlier to prevent lung function impairment.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 10","pages":"Article 101127"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-22DOI: 10.1016/j.waojou.2025.101120
Hehe Wang PhD , Jiali Tu MMed , Junge Zhang MMed , Wenxin Wang MMed , Ziyi Yuan MMed , Chunlin Li MMed , Yaowen Wang MD
Background
Asthma (AS) and allergic rhinitis (AR), though sharing Th2-driven inflammation, exhibit distinct clinical trajectories, with molecular mechanisms underlying their comorbidity remaining poorly characterized. This study aimed to delineate conserved and divergent immunometabolic pathways and develop a blood-based diagnostic framework integrating multi-omics biomarkers.
Methods
We harmonized 8 peripheral blood transcriptomic cohorts (n = 1,073) using ComBat correction, performed Mendelian randomization (MR) across 5 asthma cohorts (FinnGen Release 12), and constructed a combinatorial machine learning model (113 configurations) validated in 5 independent cohorts.
Results
Bidirectional regulation of the Y-chromosomal gene RPS4Y1 (upregulated in AR, downregulated in AS) was linked to disease-specific immunometabolic reprogramming (P < 0.001). MR identified 7 causal plasma proteins (GRAMD1C, GSTO1, IL1RAP, MMP9, PDXK, SAT2, SIGLEC12) intersecting transcriptomic signatures, implicating oxidative stress as a shared mechanism. The glmBoost-RF diagnostic model integrating these biomarkers achieved superior accuracy (AUC >95% in 4/5 cohorts), outperforming conventional classifiers reliant on IgE or eosinophils. Immune profiling revealed AR-specific native B-cell expansion and Treg depletion versus AS-associated CD4+ T/NK cell activation (P < 0.05). Coordinated dysregulation of Y-chromosomal genes (EIF1AY, KDM5D) suggested sex-dimorphic immune modulation.
Conclusions
This integrative analysis establishes RPS4Y1 as a central regulator of allergic inflammation dimorphism and delivers a validated multi-omics classifier for precision diagnostics. The findings bridge molecular sex differences, metabolic-immune crosstalk, and clinical heterogeneity, advancing phenotype-specific therapeutic strategies.
{"title":"Integrated multi-omics profiling reveals shared mechanistic pathways in asthma-allergic rhinitis comorbidity: A hybrid machine learning framework leveraging Mendelian randomization for precision diagnostics","authors":"Hehe Wang PhD , Jiali Tu MMed , Junge Zhang MMed , Wenxin Wang MMed , Ziyi Yuan MMed , Chunlin Li MMed , Yaowen Wang MD","doi":"10.1016/j.waojou.2025.101120","DOIUrl":"10.1016/j.waojou.2025.101120","url":null,"abstract":"<div><h3>Background</h3><div>Asthma (AS) and allergic rhinitis (AR), though sharing Th2-driven inflammation, exhibit distinct clinical trajectories, with molecular mechanisms underlying their comorbidity remaining poorly characterized. This study aimed to delineate conserved and divergent immunometabolic pathways and develop a blood-based diagnostic framework integrating multi-omics biomarkers.</div></div><div><h3>Methods</h3><div>We harmonized 8 peripheral blood transcriptomic cohorts (n = 1,073) using ComBat correction, performed Mendelian randomization (MR) across 5 asthma cohorts (FinnGen Release 12), and constructed a combinatorial machine learning model (113 configurations) validated in 5 independent cohorts.</div></div><div><h3>Results</h3><div>Bidirectional regulation of the Y-chromosomal gene RPS4Y1 (upregulated in AR, downregulated in AS) was linked to disease-specific immunometabolic reprogramming (P < 0.001). MR identified 7 causal plasma proteins (GRAMD1C, GSTO1, IL1RAP, MMP9, PDXK, SAT2, SIGLEC12) intersecting transcriptomic signatures, implicating oxidative stress as a shared mechanism. The glmBoost-RF diagnostic model integrating these biomarkers achieved superior accuracy (AUC >95% in 4/5 cohorts), outperforming conventional classifiers reliant on IgE or eosinophils. Immune profiling revealed AR-specific native B-cell expansion and Treg depletion versus AS-associated CD4<sup>+</sup> T/NK cell activation (P < 0.05). Coordinated dysregulation of Y-chromosomal genes (EIF1AY, KDM5D) suggested sex-dimorphic immune modulation.</div></div><div><h3>Conclusions</h3><div>This integrative analysis establishes RPS4Y1 as a central regulator of allergic inflammation dimorphism and delivers a validated multi-omics classifier for precision diagnostics. The findings bridge molecular sex differences, metabolic-immune crosstalk, and clinical heterogeneity, advancing phenotype-specific therapeutic strategies.</div></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 10","pages":"Article 101120"},"PeriodicalIF":4.3,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145120992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-22DOI: 10.1016/j.waojou.2025.101121
Hinpetch Daungsupawong PhD , Viroj Wiwanitkit MD
{"title":"Comment on “Evaluating vaccination dosing strategies for SARS-CoV-2 in patients at high-risk for allergic reactions: Insights from vaccination campaign”","authors":"Hinpetch Daungsupawong PhD , Viroj Wiwanitkit MD","doi":"10.1016/j.waojou.2025.101121","DOIUrl":"10.1016/j.waojou.2025.101121","url":null,"abstract":"","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":"18 10","pages":"Article 101121"},"PeriodicalIF":4.3,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}