Current Allergy and Asthma Reports最新文献

Purpose of review: The capacity to rapidly and objectively detect impending anaphylaxis is a crucial unmet need in food allergy, as clinical impression remains the only means of anaphylaxis diagnosis. Changes in the cutaneous barrier during an allergic reaction might offer an objective, rapid, and accessible anaphylaxis detection method.

Recent findings: Changes in cutaneous temperature and skin permeability might serve as markers of anaphylaxis. Existing methods around facial thermography, cutaneous blood flow measurements, electrical impedance spectroscopy, and transepidermal water loss (TEWL) offer varied data as possible food anaphylaxis biomarkers. Further data is needed to validate these and other methods as a means to non-invasively detect anaphylaxis. This review describes key advances in anaphylaxis detection through the cutaneous barrier, most notably around skin barrier function in the context of atopic dermatitis and food allergy.

Purpose of review: This study aimed to determine whether patients with newly diagnosed mild asthma benefit more from initiating treatment with maintenance inhaled corticosteroids (ICS) plus formoterol versus ICS alone. We compared the effects of these two 4-week maintenance strategies on asthma control, lung function, and airway inflammation.

Recent findings: Recent evidence supports the effectiveness of as-needed ICS-formoterol in mild asthma management. However, data on initial short-term maintenance strategies remain limited. Most studies focus on long-term outcomes or symptom-driven therapy, with little insight into the early phase and its impact on inflammation and lung function. Notably, GINA 2024 emphasizes that "mild asthma" is a retrospective label and may not reliably guide the selection of the appropriate initial treatment step. Even in so-called mild asthma, severe outcomes may occur, highlighting the need for early, objective assessment to guide treatment decisions. In this retrospective analysis of two prospective studies including 128 patients with newly diagnosed mild asthma, both the ICS-formoterol and ICS groups showed improvements in asthma control, lung function, and airway inflammation. However, the ICS-formoterol group achieved significantly greater improvements in Asthma Control Test scores, Asthma Control Questionnaire scores, large airway function (FEV₁, FEV₁/FVC), small airway function, and eosinophil reduction, particularly in patients with baseline small airway dysfunction. FEV₁ reversibility in baseline bronchodilation test was positively correlated with improvements in FEV₁, FEV₁/FVC, and eosinophil count reduction in the ICS-formoterol group. These findings support 4-week ICS-formoterol maintenance therapy as an effective initial strategy in mild asthma, with reassessment guiding longer-term management.

Purpose of review: Asthma is a heterogeneous respiratory condition and a common childhood disease. The effects of exercise on childhood asthma have not been fully clarified. This study aims to systematically evaluate the impact of exercise on children with asthma, specifically examining lung function, exercise capacity, airway inflammation, and health-related quality of life (HRQoL).

Recent findings: 13 randomized controlled trials (RCTs) involving 673 children with asthma, with a mean age ranging from 7.3 to 14 years, were included. The results of the meta-analysis showed that exercise can improve the six-minute walk test (6MWT) distance and the pediatric asthma quality of life questionnaire (PAQLQ) scores in children with asthma but cannot reduce the fractional exhaled nitric oxide (FeNO) level. Exercise intervention within 8 weeks only had a positive effect on forced vital capacity percentage (FVC%) and forced expiratory flow between 25% and 75% of forced vital capacity (FEF 25-75%) in children with asthma but had no positive effect on forced expiratory volume in 1 s percentage (FEV1%). Exercise intervention for more than 8 weeks had no positive effect on the above indicators. In children with asthma, exercise training has the potential to improve exercise ability and health quality of life but not inflammation. Additionally, exercise intervention does not provide sustained improvement of lung function, although training within 8 weeks can temporarily increase FVC% and FEF 25-75%.

Purpose of review: Lymphoproliferative disorders encompass a variety of hematologic diseases that are increasingly recognized. Patients with these conditions may present to rheumatologists or other specialists prior to a hematologist-oncologist. This review is intended to highlight key distinguishing features between rheumatologic conditions and lymphoproliferative disorders, and suggest diagnostic approaches.

Recent findings: Recent studies have shown that lymphoproliferative diseases can mimic rheumatologic disease, and differentiation is complex. Advances in imaging techniques such as FDG PET/CT, and improved understanding of lymph node histopathology have improved diagnostic accuracy. Attention to specific details such as the pattern of organ involvement, the presence or absence of key clinical features, and the consistency of treatment response can assist in accurate diagnosis. Our review highlights the importance of considering lymphoproliferative disorders in the differential diagnosis of rheumatologic disease. A thorough clinical history, targeted biopsies, and collaboration with hematopathologists are essential for timely diagnosis and care. Future research should concentrate on identifying biomarkers and formulating diagnostic algorithms to aid in differentiating lymphoproliferative disorders from autoimmune diseases, which will ultimately improve patient outcomes.

Purpose of review: Allergic rhinitis (AR) is a very common and troubling disorder that severely affects patients' quality of life. There is an urgent need to understand the immunopathologic factors behind the disease. Acetylcholine is a neurotransmitter that has emerged as one of the critical regulators of AR pathogenesis.

Recent findings: The elevation of cholinergic transmitters and their muscarinic receptors is a major driver of nasal hypersensitivity and excessive nasal secretion in AR pathogenesis. In addition to inducing extensive mucus secretions, the relevant research data for acetylcholine in immune regulation and airway remodeling remain fragmented. The immunopathological mechanisms underlying acetylcholine signaling pathways associated with AR may provide clinical practitioners with novel insights for medication selection in controlling patients' symptoms. We highlight the roles of acetylcholine in AR pathogenesis and the findings of clinical trials on intranasal anticholinergics use in AR, and hope to provide a reference for patients' management.

Purpose of review: This review aims to explore an effective and scalable approach for early asthma detection using cough sounds. The main objective is to evaluate whether a multi-model deep learning fusion framework can improve diagnostic accuracy and generalizability in real-world settings.

Recent findings: Recent research in respiratory sound analysis has demonstrated the potential of deep learning models in detecting pulmonary diseases. However, most studies focus on single-network architectures and often overlook class imbalance and training stability, which can limit model performance in practical applications. This study presents an asthma detection model that integrates ResNet18, VGG16, and DenseNet121 through a fusion layer. SMOTE is used to address data imbalance, and a weighted cross-entropy loss enhances training robustness. Mixed precision training and StepLR scheduling further improve performance. The proposed model achieved 95.9% accuracy on the test set, demonstrating strong generalization and potential for real-time, non-invasive screening in clinical environments.

Purpose of review: This review aims to provide a comprehensive overview of the role of arginine and its metabolic pathways in regulating immune cell function, with a particular focus on their involvement in pulmonary inflammatory diseases. Additionally, it highlights recent advances in therapeutic strategies that target arginine metabolism as a potential therapeutic approach for the treatment of these conditions.

Recent findings: Arginine is a conditionally essential amino acid that plays a pivotal role in numerous physiological processes, including immune regulation, tissue repair, airway tone modulation, and vasodilation. We found emerging evidence underscores that arginine metabolism is tightly controlled by various regulatory mechanisms, with two key enzymes-nitric oxide synthase (NOS) and arginase (ARG)-occupying central roles. These enzymes exert opposing yet coordinated effects within immune cells, contributing to the delicate balance between immune activation and resolution. Dysregulation of arginine metabolism has been implicated in the pathogenesis of several pulmonary inflammatory diseases, including respiratory infections, asthma, chronic obstructive pulmonary disease (COPD), and pulmonary fibrosis. Aberrant arginine metabolic activity in immune cells promotes either excessive inflammation or impaired immune defense, depending on the context. Understanding the immunometabolic functions of arginine offers valuable insights into the mechanisms underlying pulmonary inflammatory diseases. Therapeutic modulation of the arginine metabolic pathway represents a promising strategy for controlling disease progression and improving clinical outcomes, paving the way for the development of novel targeted treatments.

Purpose of the review: This review aims to educate allergists about the concept of autoallergy by addressing five questions: 1) What is autoallergy and how does it differ from classical allergy? 2) How common is autoallergy? 3) Is autoallergy clinically relevant? 4) How can autoallergy be diagnosed? and 5) How is autoallergy treated?

Recent findings: In contrast to type I hypersensitivity against external allergens (allergy), autoallergy involves IgE autoantibodies targeting self-antigens. These are found in conditions like chronic spontaneous urticaria, atopic dermatitis, and asthma, with varying prevalence. While no standardized diagnostic tools exist, ELISA and basophil activation tests help identify the presence and function of IgE autoantibodies. Anti-IgE therapies have shown benefit, supporting their clinical relevance. Autoallergy is emerging as a distinct IgE-mediated mechanism that may contribute to chronic inflammation in immune-mediated diseases. Further investigation of this mechanism can improve disease stratification and enable more effective, targeted treatment strategies.

Purpose of review: There is a clinically important and unmet need for long-term safe and effective preventative and therapeutic options for pediatric allergic diseases. This communication reviewed the use of Traditional Chinese Medicine (TCM) in pediatric allergic disease, including eczema, urticaria, eosinophilic esophagitis (EoE), food allergy (FA), asthma, and allergic rhinitis.

Recent findings: Through evaluation of case studies, series, or clinical trials of pediatric allergy patients, or in vitro studies involving samples collected from pediatric allergy patients and in vivo model systems, naturally occurring small molecule compounds' mechanism of action by evidence-based scientific outcomes were elucidated. Notable clinical outcomes include reduction in severity score, reduction across various allergic diseases that demonstrated no toxicity, no severe adverse effects, and are well-tolerated. Immunological outcomes that attribute to this include a switch from Th2-mediated allergic response to a Th1/Treg response, characterized by reduced total and specific IgE, total eosinophil counts, and levels of exotoxin, TNF-a, IL-6, IL-8, IL-5, and IL-4, with elevated levels of IFN-γ and IL-10. For eczema, both multiple and single herbal formulations are common treatment modalities, including internal administration and external herbal baths and creams, whereby both provide substantial beneficial outcomes. For EoE, internally administrated formulations and use of acupuncture have been reported and shown mitigation of allergic responses. In FA, formulations have been studied in clinical trials showing consistent safety, with protection remaining to be established. More advanced development of single herbal compounds may provide an advantage for use in FA treatment. For allergic rhinitis, several multiple herbal formulations and acupuncture have demonstrated improved symptom scores. Similarly, in asthma herbal formulas and acupuncture were highly clinically effective. TCM has demonstrated high safety and efficacy in both preclinical and clinical models of various allergic diseases, including eczema, food allergy, eosinophilic esophagitis, allergic rhinitis, and asthma. Therefore, this scientific evidence suggests that naturally occurring small molecule compounds are promising preventives and therapeutics for pediatric allergic diseases.

Disclosure: All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and national/institutional guidelines).

Purpose of review: This review evaluates current evidence on tapering strategies for anti-type 2 biologics in chronic inflammatory diseases. Given the need for long-term treatment, optimizing dosage without compromising efficacy is essential for sustainable disease management.

Recent findings: Biologic dose reduction strategies, such as tapering, de-escalation, dose spacing and interval dose prolongation, are increasingly explored in various type 2 inflammatory diseases, particularly in real-life settings. Studies have shown variable outcomes depending on disease type, patient characteristics, and tapering methods. Nineteen studies met inclusion criteria in this systematic review. The evidence supports the feasibility of dose tapering, especially for dupilumab, in maintaining disease control while reducing drug exposure. However, standardized tapering protocols and clear patient selection criteria remain lacking. Further prospective, controlled studies are needed to define optimal, safe, and personalized de-escalation strategies for long-term management of type 2 inflammatory diseases.