Current Allergy and Asthma Reports最新文献

Purpose of review: It seeks to answer key questions about the molecular and cellular mechanisms underlying Hyper IgE Syndrome (HIES), the genetic mutations responsible, and their contributions to both immunodeficiency and allergic manifestations. Additionally, it aims to explore diagnostic strategies and therapeutic approaches that address these overlapping domains, thereby improving disease management.

Recent findings: Recent research has identified several pivotal genetic mutations, including those in STAT3, DOCK8, and PGM3, which play critical roles in disrupting immune pathways such as Th17 differentiation and IgE regulation. These molecular defects have been linked to the hallmark features of HIES, including recurrent infections and elevated serum IgE levels, as well as its overlap with atopic conditions like eczema, asthma, and food allergies. Advances in diagnostic tools, such as biomarker identification and genetic testing, have improved the differentiation of HIES from more common atopic disorders. Therapeutic advancements, including the use of targeted biologics and interventions addressing both immunodeficiency and allergic symptoms, have shown promise in enhancing patient outcomes. This review highlights the role of specific genetic mutations in shaping the clinical and immunological phenotype of HIES. Key takeaways include the necessity of integrating molecular insights with clinical observations for accurate diagnosis and the potential of emerging targeted therapies to address both immunological and allergic aspects of the syndrome.

Purpose of review: To set the context of current knowledge regarding the role of herbal medicine in acute and chronic rhinosinusitis treatment.

Recent findings: It is estimated that adults experience 1-3 episodes of viral rhinosinusitis per year and this number increases up to 8-10 episodes in preschool children. The symptoms of acute rhinosinusitis tend to significantly overlap with symptoms of other upper respiratory infections, making the diagnosis quite difficult. The division of rhinosinusitis into bacterial or non-bacterial is clinically important in order to determine appropriate treatment and the administration of antibiotic treatment. Treatment of acute rhinosinusitis is symptomatic and includes nasal rinsing, decongestants, corticosteroids, and combinations of the above. Herbal medicine has been traditionally underestimated in Western world. Nowadays, however, treatment of diseases with the use of medicinal plant treatments is gaining more and more followers. In this context, certain herbal extracts have been tested for viral, post- viral and chronic rhinosinusitis. Phytoneering is an innovative pharmaceutical technique in research and production of herbal medicines. Herbal extracts produced with phytoneering vary in quality and active substances. In terms of quality, safety and efficacy, herbal medicines are at least on par with synthetically produced medicines, having significantly less unwanted side effects. Certain herbal extracts have been tested, and in cases of acute rhinosinusitis are effective. In chronic sinusitis those extracts show promising results and might prove a good alternative without side effects.

Purpose of review: The purpose of the review is to summarize the current literature and evaluate how different environmental exposures may contribute to the development and course of chronic rhinosinusitis (CRS). The review aims to explore the relationship between host factors and environmental exposures in the pathogenesis of CRS.

Recent findings: Recent studies have helped establish the role of air pollutants, tobacco smoke, occupational exposures, and microplastics in the pathogenesis of CRS. These exposures have been shown to cause epithelial dysfunction and promote inflammation through different mechanisms and to different degrees. The pathogenesis of CRS is complex and multifactorial, with environmental exposures playing a key role in its onset and exacerbation. Research indicates that pollutants can damage the sinonasal epithelial barrier and disrupt the microbiome, leading to increased inflammation. A deeper understanding of the mechanisms behind this inflammatory process and its link to environmental exposures could enhance strategies for preventing and treating CRS.

Purpose of review: Accumulating data indicate that asthma and chronic obstructive pulmonary disease (COPD) increase the risk of severe respiratory syncytial virus (RSV) infection. This systematic literature review assessed the burden of RSV disease among adults ≥ 18 years with asthma or COPD.

Recent findings: Data on the prevalence of asthma or COPD among RSV-infected adults, RSV-related hospitalizations, complications, and mortality were collected from studies published between January 1, 2000 and November 28, 2023 in PubMed, Embase, and grey literature. All extracted data were analyzed descriptively. Pooled estimates of asthma or COPD prevalence among RSV-infected adults were calculated from generalized linear mixed effects model meta-analyses. Forty studies were included. The prevalence of asthma and COPD among RSV-infected adults was high, especially in inpatient settings with pooled estimates (95% confidence interval) of 19.3% (15.0-24.6) for asthma and 30.8% (26.1-36.0) for COPD. Adults with asthma or COPD were more likely to be hospitalized following RSV infection than those without these conditions. The incidence rate ratios of hospitalization were 2.0-3.6 (crude) and 6.7-8.2 (adjusted) for asthma and 3.2-13.4 (crude) and 9.6-9.7 (adjusted) for COPD. The most frequently reported RSV-related complications were exacerbation of asthma (up to 64.9%) and COPD (up to ≥ 83.0%). In-hospital case fatality rates were 2.6-4.3% (asthma) and 2.8-17.8% (COPD). These comprehensive data showing a high RSV disease burden in adults with asthma or COPD can be used to inform policy decisions around RSV vaccines and improve preventive care in this high-risk population.

Purpose of review: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a debilitating inflammatory condition that significantly impacts quality of life. Despite treatment advances, recurrence is common, prompting the exploration of novel therapies such as monoclonal antibodies targeting the type 2 immune response, notably dupilumab. This research aims to evaluate the real-world evidence (RWE) of dupilumab in treating severe CRSwNP, comparing sinonasal outcomes to those observed in randomized clinical trials.

Recent findings: Significant improvements were noted, with the average SNOT-22 score reduction being 37.2 points post-dupilumab treatment. The nasal polyp size (NPS) showed an average decrease of 3.6 points. The analysis highlighted the practical effectiveness of dupilumab, emphasizing its benefit over conventional therapies in reducing NPS and improving nasal symptoms. The findings advocate for the integration of dupilumab into standard treatment protocols for severe CRSwNP, providing a robust alternative that could potentially reduce the high recurrence rates associated with current management strategies. This study underscores the utility of RWE in assessing the effectiveness of new medical treatments, suggesting that dupilumab offers substantial real-world benefits for patients suffering from this challenging condition.

Background: Antiepileptics are the mainstay of treatment for seizure management. Immediate and delayed hypersensitivity reactions associated with antiepileptics are common. It is important to differentiate between these reactions as management and prognosis varies.

Objective: This review article aims to describe the types of hypersensitivity reactions reported with antiepileptics with emphasis on delayed hypersensitivity reactions, as these can be life-threatening.

Methods: Online databases including PubMed and Cochrane were searched, from the inception of the literature to 5/10/24. Studies focusing on hypersensitivity reactions to antiepileptics were reviewed. Case reports, case series, observational studies, and clinical trials were included. Abstracts and studies published in languages other than English were not included.

Results: Immediate reactions can occur with antiepileptics however the incidence is lower than that of delayed hypersensitivity reactions. Delayed hypersensitivity reactions include benign rash as well as severe cutaneous adverse reactions. Acute generalized exanthematous pustulosis, drug rash with eosinophilia and systemic symptoms, Steven Johnson syndrome, and toxic epidermal necrolysis are discussed in detail in this review. We focused on pathogenesis, genetic predisposition, clinical presentation, treatment, and prognosis.

Conclusion: Severe cutaneous adverse reactions can be lethal. It is important to make the correct diagnosis and treat patients accordingly. More studies comparing therapeutic options head-to-head are needed.

Purpose of review: This manuscript reviews the impact of important indoor environmental exposures on pediatric asthma, with a focus on recent literature in the field.

Recent findings: Studies continue to support an association between numerous indoor aeroallergens and air pollutants found in homes and schools and increased asthma morbidity overall. Several recent home and school intervention studies have shown promise, though results have been overall mixed. Indoor environmental exposures contribute to the development of asthma and impact asthma morbidity. Further research is needed to improve our understanding of how to optimize mitigation of these indoor exposures to significantly affect asthma outcomes.

Purpose of review: Parosmia is a qualitative olfactory disorder in which there is a mismatch between the memory of an odor and the actual experience triggered by an odor. There has been a surge in parosmia-related publications since the COVID-19 pandemic. This review summarizes the latest clinical findings, theories on pathophysiology and potential treatment options.

Recent advances: Potential models of parosmia include peripheral or central hypotheses, which refer to aberrancies in olfactory neuron regeneration or information processing in central olfactory centers respectively. This leads to an incomplete or disorganized pattern of olfactory information relay. Studies using gas chromatography and functional magnetic resonance imaging have identified molecular triggers and intracranial functional connectivity patterns in parosmia respectively. Parosmia tends to occur in a delayed fashion after virus-induced anosmia. It may run a protracted course, but typically improves over time. Currently there are no generally approved, objective ways to ascertain the presence and measure the extent of parosmia. Evidence-based treatment for parosmia remains elusive. In some people, this can lead to health and quality of life issues.

Purpose of review: There is an increasing awareness among clinicians that industrial and household food processing methods can increase or decrease the allergenicity of foods. Modification to allergen properties through processing can enable dietary liberations. Reduced allergenicity may also allow for lower risk immunotherapy approaches. This review will equip physicians, nurses, dieticians and other health care providers with an updated overview of the most clinically oriented research in this field. We summarize studies assessing the allergenicity of processed foods through clinically accessible means, such as oral food challenges, skin prick tests, and sIgE levels.

Recent findings: Baking, boiling, canning, fermenting, pasteurizing, peeling, powdering, and roasting heterogenously impact the likelihood of reactivity in egg-, milk-, peanut- and other legume-, tree nut-, fruit-, and seafood-allergic patients. These variations may be due to the use of different temperatures, duration of processing, presence of a matrix, and the specific allergens involved, among other factors. Accurate prediction of tolerance to processed allergens with skin prick tests and sIgE levels remains largely elusive. Food allergy management strategies, especially with milk and egg, have capitalized on the decreased allergenicity of baking. Many milk- and egg-allergic patients tolerate baked and heated forms of these allergens, and the use of these processed foods in oral immunotherapy (OIT) continues to be extensively investigated. Heat is also well recognized to reduce allergic symptoms from some fruits and vegetables in food-pollen syndrome. Other forms of processing such as boiling, fermenting, and canning can reduce allergenicity to a diverse array of foods. Roasting, on the other hand, may increase allergenicity. The application of food processing to food allergy treatments remains largely unexplored by large clinical studies and provides a key avenue for future research. The recognition that food allergy represents a spectrum of hypersensitivity, rather than an all-or-nothing phenomenon, has led to approaches to enable dietary liberation with processed, less-allergenic foods and their use in food allergy immunotherapies.

We have read with great interest the recent review published by Dr. Ebo and collaborators on cannabis allergy. It highlights the difficulties in getting a valid diagnosis because some patients do not admit its consumption, which may not be legalized, there are no commercial extracts and there are problems in cutaneous tests interpretation due to cross-reactivity with other related allergens. In addition to this, bronchial challenge is considered the confirmatory diagnosis, but it is complex to perform. This also occurs in diagnosis of occupational asthma, such as in baker's asthma, in which we have investigated a reliable marker to avoid the bronchial challenge. However, we think it is necessary to do this test to ensure a correct etiological diagnosis of cannabis asthma, and we have carried out bronchial challenge with cannabis on more than 600 patients since 2009, all them active consumers. In our country cannabis consumption has not been legalized, but to do this challenges we asked the National Court for permission, which we obtained easily. Although molecular diagnosis has helped in revealing the problems caused by cross-reactivity, the gold standard continues to be the provocation. In our articles we detail how to do it safely, and we encourage our colleagues to reach a definitive diagnosis that cannabis is the cause of their bronchial symptoms.