Current Allergy and Asthma Reports最新文献

Purpose of review: CD8 T cells comprise a large portion of cells in inflamed tissues in many autoimmune diseases, yet their roles in autoimmune pathogenesis have been unclear.

Recent findings: Newer studies have demonstrated that CD8 T cells perform many effector functions that may play a vital role in autoimmune disease pathogenesis. In some autoimmune diseases, such as type 1 diabetes and polymyositis, classical cytotoxic T lymphocytes are thought to play a driving role, but in most tissues affected by autoimmune disease, granzyme K-expressing CD8 T cells are the most abundant. These cells have low cytotoxic potential and instead stimulate nearby cells by releasing cytokines and granzyme K, which can activate complement cascades. Resident memory CD8 T cells are also present in autoimmune tissues, although their roles in pathogenesis are less clear. Foxp3⁺ CD8 T cells exist, but regulatory functions of CD8 T cells extend beyond this population, as CD39 and GzmB expressed by other CD8 T cell subsets can suppress or kill nearby antigen-presenting cells and other pro-inflammatory cells. In this review, we describe CD8 T cell subsets and functions, their associations with human autoimmune diseases, as well as current and in-development treatments that target CD8 T cells.

Purpose of review: This review aims to raise awareness of the Allergic Rhinitis and its Impact on Asthma (ARIA) and European Forum for Research and Education in Allergy and Airway Disease (EUFOREA) guidelines for allergic rhinitis (AR) by presenting a side-by-side summary of their key elements. Drawing on the authors' direct involvement in the development of both, it highlights their evolution toward precision medicine and patient-centred care to support stronger doctor-patient partnerships.

Recent findings: Both ARIA and EUFOREA offer evidence-based guidance to support AR management, with increasing emphasis on personalisation and digital integration. While aligned in goals, they differ in patient classification, treatment delivery, and implementation strategies. Barriers to real-world use include the need for contextual adaptation, targeted education for healthcare providers and patients, and inconsistent alignment between guideline-based prescriptions and patient behaviour. Mobile health (mHealth) tools offer valuable support but require sustained engagement. Greater awareness of these guidelines can improve implementation, harmonise treatment approaches, and ultimately enhance care delivery and outcomes for individuals with AR.

Purpose of the review: In this review we explore expanding options for monitoring following anaphylaxis in the home or community setting. We review recent literature to help identify who might benefit from watchful waiting at home versus immediate emergency medical service (EMS) activation following anaphylaxis.

Recent findings: Recent studies confirm that most patients respond promptly, completely, with a durable response to a single dose of epinephrine for anaphylaxis. In monophasic anaphylaxis, reflexive emergency monitoring has been found to have minimal benefit. In recent years, studies show increasing emergency department utilization for anaphylaxis, though the risk of fatal anaphylaxis remains exceedingly low. Identifying patients at risk for severe anaphylaxis is imprecise, though several risk factors have been associated with higher chances of severe reactions. Reflexive emergency monitoring following anaphylaxis is not necessary in all cases of anaphylaxis. Carefully selected patients may benefit from watchful waiting at home. Engaging in shared decision making is critical in this new era of personalized allergy action plans. Future studies are necessary to refine our understanding of the full risks and benefits of home monitoring following anaphylaxis.

Purpose of review: Metal exposures are widespread, and ensuing allergic sensitization leads to secondary disease processes, especially contact dermatitis, with chronic implications. This review covers recently described mechanisms of sensitization, sources of exposure, and treatment options.

Recent findings: Sensitization to metals is similar to other allergic processes: it is triggered by innate responses, which then facilitate allergic priming. Early oral exposures may lead to tolerance, whereas initial cutaneous exposures by piercings start the pathway toward sensitization. Nickel 'allergy' may be ubiquitous because of multiple pathways of immune response. Although the most frequent reaction to metals is a type IV immune response, some metals, including platinum and sometimes nickel, can also trigger a type I IgE mediated response. Current treatment involves avoidance of exposure and suppression of the response, although inducing tolerance by early oral exposure may be the best method to avoid disease. Better understanding of the factors and contacts that drive metal sensitization will enable better management of the types and timing of exposure, which then may instead induce tolerance and prevent disease.

PURPOSE OF REVIEW: This review explores the transformative potential of artificial intelligence (AI) and next-generation sequencing (NGS) in allergy diagnostics and treatment. It focuses on leveraging these technologies to enhance precision in biomarker discovery, patient stratification, and personalized management strategies for allergic diseases. RECENT FINDINGS: AI-driven algorithms, particularly machine learning and deep learning, have enabled the identification of complex molecular patterns and predictive markers in allergies, such as IgE levels and cytokine profiles. Integration with NGS techniques, including single-cell RNA sequencing, has uncovered unique immune response signatures, providing insights into molecular mechanisms driving allergic reactions. These innovations have advanced diagnostic accuracy, treatment personalization, and real-time monitoring capabilities, especially in allergen immunotherapy. Combining AI and NGS technologies represents a paradigm shift in allergy research and clinical practice. These advancements facilitate precision diagnostics and personalized treatments, ensuring safer and more effective interventions tailored to individual patient profiles. Despite data integration and clinical implementation challenges, these technologies promise improved outcomes and quality of life for allergy sufferers.

Purpose of review: Hypereosinophilia is defined as an absolute eosinophil count greater than 1500 cells/mm3. This is a condition often observed in the pediatric population, with benign/self-resolving to life-threatening etiologies. Identifying the cause of hypereosinophilia can be challenging, given its broad associated differential diagnosis and diversity of presentations. This review provides an overview of eosinophil biology and explores causes of hypereosinophilia in children, emphasizing diagnostic and therapeutic challenges, while underscoring the importance of recognizing rare causes including primary hypereosinophilic syndrome (HES).

Recent findings: Classification of hypereosinophilic subtypes has evolved, as has understanding of etiologies with advances in modern diagnostic tools. Newer therapeutic options with low side-effect profiles have expanded treatment options in patients with HES. Despite recent improvements in medical management, HES remains a serious medical condition with considerable morbidity and potential mortality. Early identification and appropriate treatment can improve prognosis and reduce the burden of disease in children.

Purpose of review: The frequency of natural disasters, other extreme weather events, and downstream emissions of emerging contaminants is increasing. One category of health outcome that is now experiencing increased prevalence due to these environmental threats is respiratory disease, specifically asthma and allergies; though a review summarizing current knowledge and research gaps has not been synthesized on this topic in recent years despite growing evidence.

Recent findings: We identified recent literature that connects allergy/asthma with environmental events that are increasing in prevalence alongside natural disasters and other extreme weather events, including algal blooms, floods, heat stress, wildfires, and thunderstorms. Coinciding emissions of per-and polyfluoroalkyl substances (PFAS) and microplastics (MPs) are also discussed as downstream outcomes of these environmental events. Available evidence ranged according to environmental event/stressor type, with over 50 papers identified as relevant to this research scope in the last five years. Narrative synthesis of these papers highlighted exposure-disease linkages for stressors related to natural disasters, other extreme weather events, and downstream emissions of emerging contaminants with pulmonary asthma and allergy outcomes. Underlying biological mechanisms are beginning to be elucidated and include widespread inflammation in the lungs and changes in immune cell signaling and function across the pulmonary system. Take home points in this review pave the way for future investigations to better understand the impacts of these environmental events amongst the complex milieu of threats becoming increasingly prevalent worldwide.

Purpose of review: The aim of our review is to summarize the available literature where metabolomics was used in studies on childhood asthma, and to find metabolites that are diagnostic biomarker candidates in childhood asthma. Moreover, the review also describes studies related to metabo-endotypes and heterogeneity of childhood asthma, severity of the disease, and response to drug treatment.

Recent findings: Metabolomics has opened up new perspectives in childhood asthma investigation. Based on the available literature, we found nine metabolites that demonstrated the highest diagnostic potential for differentiation between children with asthma and healthy controls: adenine, adenosine, benzoic acid, hypoxanthine, p-cresol, taurocholate, threonine, tyrosine, and 1-methyl nicotinamide. Many of the identified metabolites are closely associated with inflammatory processes responsible for asthma. Metabolomic analysis also contributed to characterizing new asthma endotypes highlighting the heterogeneity of pediatric asthma. Metabolomics can bring about valuable insights, which, when integrated with other omic disciplines, can facilitate the diagnosis and management of childhood asthma and the search for new biomarkers of the disease. Improvements in the detection of asthma in preschool children, including asthma endotypes, will ease application of proper treatment and enable elimination of unnecessary test treatment of corticosteroids in young patients.

Purpose of review: Systemic autoinflammatory disorders (SAIDs) are a group of diseases that are characterized by recurrent or persistent unprovoked attacks of inflammation resulting from innate immunity dysregulation and leading to significant sequelae in many cases. The concept of autoinflammatory disorders has been widely studied in the last 28 years since the genetic mutation responsible for familial Mediterranean fever (FMF) was discovered. These disorders are mainly hereditary autoinflammatory diseases with key immunological pathways affected and particularly involving inflammasomes, nuclear factor-κB dysregulation and interferon upregulation. This article serves as an overview of pediatric systemic autoinflammatory disorders, their presentation, workup, complications, and therapeutic management.

Recent findings: Advances in genetic analysis have allowed for the rapid identification of mutations responsible for many autoinflammatory disorders. Advances in biomolecular techniques, which have allowed for identifying key players such as inflammasomes, have led to treatment options that have significantly improved morbidity and mortality in affected patients. This review provides an overview of the proposed pathogenesis, presenting features, potential complications and suggested therapies of systemic autoinflammatory disorders. Providers should have a high clinical suspicion for autoinflammatory disorders in children who present with fever, a heightened inflammatory response and negative evaluation for an infectious, malignant, and autoimmune etiology. Understanding and identifying these disorders in a timely manner and implementing prompt treatment allow for the best possible outcome for these patients.

Purpose of the review: A comprehensive literature review was conducted in order to identify and summarize recent research on IgE-mediated occupational respiratory allergy to flour, focusing on the impact of modern developments in the baking industry characterized by industrialization of production processes and a growing use of baking "improvers".

Recent findings: Although respiratory allergy to flour is a potentially preventable condition through effective workplace control measures, available data indicate that exposure to flour dust has not decreased in the last decade and flour remains the most prevalent cause of occupational respiratory allergy. The development of the baking industry has led to the introduction of new allergen sources, although their contribution to the development of clinical respiratory allergy remains largely uncertain. In recent years, the diagnostic performance of serum-specific IgE antibody determination against wheat/rye flour and α-amylase compared with specific inhalation challenge with flour as the reference standard has been clarified, making these tests a first-line component of diagnostic algorithms. Available information on the prevalence and incidence of respiratory allergy to flour in recent decades indicates that this condition still imposes a substantial health and socioeconomic burden worldwide. Available data highlight the need to reinforce workplace health-related policies and regulations.