Current Allergy and Asthma Reports最新文献

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.

Purpose of review: To provide an update and new insights into the management of pediatric patients with chronic urticaria.

Recent findings: Chronic urticaria in children may be more prevalent than previously thought, with a high resolution rate within two years. Patient-reported outcome measures (PROMs) are effective tools for assessing disease severity and control in pediatric populations. Children with chronic urticaria generally respond better to H1-antihistamines compared to adults. For patients refractory to antihistamines, omalizumab has shown excellent efficacy. Additionally, dupilumab has emerged as a potential treatment option, as it has been approved for chronic spontaneous urticaria in some countries. Managing chronic urticaria in children remains a diagnostic and therapeutic challenge. However, advancements in understanding disease mechanisms, the validation of tools to assess disease activity and control, the development of reliable biomarkers, and the availability of novel therapies offer significant promise. These developments will enable more effective treatment and improved outcomes for pediatric patients.

Purpose of this review: Climate change affects global temperature, meteorological variables, plant aerobiology, air pollution exposure and a host of other factors that individually have been implicated in the inception and/or exacerbation of allergic disease like asthma and allergic rhinitis. It is unknown how climate change will impact allergic disease prevalence and morbidity in the future.

Recent findings: Pollen seasons are lengthening with variable effects on pollen peak concentrations and allergenicity. Air pollution exposure is linked with enhance susceptibility to allergic inflammation induced by pollen and with enhanced susceptibility to infection with a morbidity/mortality from respiratory viruses, including SARS-CoV-2. The available literature largely supports the association between climate change and three of the most salient factors for allergic respiratory disease prevalence and morbidity: changes in allergen exposure, pollution exposure, and viral respiratory infection. More research is needed to understand the complex interactions between these factors and individual-level variables that influence disease susceptibility.

Purpose of review: As an ex-vivo test of allergic effector cell activation, basophil activation testing (BAT) to allergen enables quantification of the in-vivo IgE-mediated allergic response. BAT thus holds promise in the diagnosis and monitoring of peanut and tree nut allergies. Recent systematic analyses and expert recommendations support a role for BAT in the diagnosis of peanut and tree nut allergy.

Recent findings: Diagnostic cut-offs for BAT in peanut and tree nut allergy have been identified. Consistently, BAT can discriminate with high sensitivity and specificity between allergy and tolerance when measured against oral food challenges. Furthermore, the utilization of BAT has can increase the sensitivity and specificity of peanut allergy and tree nut allergy diagnosis, both alone and in conjunction with specific IgE testing and skin prick testing. BAT is a promising tool in the diagnosis of peanut and tree nut allergy.

Purpose of review: This review explores the emerging role of T cell exhaustion in allergic diseases and allergen immunotherapy (AIT). It aims to synthesize current knowledge on the mechanisms of T cell exhaustion, evaluate its potential involvement in allergic inflammation, and assess its implications as a novel biomarker for predicting and monitoring AIT efficacy.

Recent findings: Recent studies highlight that T cell exhaustion, characterized by co-expression of inhibitory receptors (e.g., PD-1, CTLA-4, TIM-3), diminished cytokine production, and altered transcriptional profiles, may suppress type 2 inflammation in allergic diseases. In allergic asthma, exhausted CD4 + T cells exhibit upregulated inhibitory receptors, correlating with reduced IgE levels and airway hyperreactivity. During AIT, prolonged high-dose allergen exposure drives allergen-specific Th2 and T follicular helper (Tfh) cell exhaustion, potentially contributing to immune tolerance. Notably, clinical improvements in AIT correlate with depletion of allergen-specific Th2 cells and persistent expression of exhaustion markers (e.g., PD-1, CTLA-4) during maintenance phases. Blockade of inhibitory receptors (e.g., PD-1) enhances T cell activation, underscoring their dual regulatory role in allergy. T cell exhaustion represents a double-edged sword in allergy: it may dampen pathological inflammation in allergic diseases while serving as a mechanism for AIT-induced tolerance. The co-expression of inhibitory receptors on allergen-specific T cells emerges as a promising biomarker for AIT efficacy. Future research should clarify the transcriptional and metabolic drivers of exhaustion in allergy, validate its role across diverse allergic conditions, and optimize strategies to harness T cell exhaustion for durable immune tolerance. These insights could revolutionize therapeutic approaches and biomarker development in allergy management.

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.