Frontiers in allergy最新文献

Chronic rhinosinusitis with nasal polyps (CRSwNP), is a prevalent inflammatory airway disease associated with type 2 inflammation. When CRSwNP coexist with asthma, the condition is referred to as global air disease (GAD). People how lives with CRSwNP or GAD often report a high symptom burden, for example persistent nasal obstruction, impaired smell and taste, disturbed sleep, fatigue, and reduced well-being. While these burdens have been quantified through clinical outcomes and patient-reported outcome measures (PROMs), there is limited qualitative research exploring how these peoples experience living with CRSwNP or GAD in their daily lives. The aim of the study was to describe the impact of CRSwNP or GAD on patients' everyday lives before the initiation of biologic treatment.

Methods: A descriptive qualitative interview study was conducted with 13 patients diagnosed with CRSwNP or GAD. Semi-structured interviews were analyzed using qualitative content analyzed as described by Graneheim and Lundman, resulting in the identification of thematic categories reflecting participants' lived experiences.

Results: Five categories were identified: (1) feeling constantly unwell, like having a chronic cold, describing the persistent sense of ill health; (2) loss of senses disrupting everyday life, illustrating how impaired smell and taste influenced both social and practical activities; (3) illness leading to social isolation and emotional distress, highlighting psychological and relational consequences; (4) dependence on prednisolone-choosing between the lesser of two evils, reflecting the balance between temporary relief and side effects; and (5) Longing for a normal life, expressing high expectations of biologic therapy as a potential turning point.

Conclusion: This study showed that patients with CRSwNP or GAD experienced a substantial symptom burden, sensory loss, impaired work ability, and reduced social participation, all of which profoundly affected their daily lives. Many relied on prednisolone for temporary relief despite being aware of its serious side effects. The extensive impact of CRSwNP made participants hopeful that biologic therapy could provide more stable symptom control and help them regain a more "normal" life. CRSwNP or GAD is a multifaceted condition that affects patients' emotional, psychological, and social well-being. These findings highlight the importance of adopting a holistic treatment approach, including consideration of psychosocial support to address the broader consequences of the disease.

[This corrects the article DOI: 10.3389/falgy.2025.1740057.].

Background: Food allergy remains a serious public health concern associated with significantly lowered quality of life and the risk of potentially life-threatening allergic reactions. While oral immunotherapy (OIT) has consistently demonstrated efficacy in the desensitization of multi-food allergic patients, many patients undergoing such treatment are burdened by dose-related side effects that can hinder their compliance and the overall efficacy of OIT. Recent efforts to improve upon OIT have begun to evaluate the concomitant use of biologics such as omalizumab and dupilumab with OIT for their ability to selectively inhibit pathways involved in the underlying pathology of food allergy.

Methods: Herein, we detail the clinical trial design, rationale, and methods for a Phase 2 randomized, double-blind, placebo-controlled, multi-center study evaluating the safety and efficacy of omalizumab and/or dupilumab therapy in combination with participant-specific multi-food (mOIT) in patients aged 4-55 years, with multi-food allergy that includes peanut. In this two-arm superiority trial, participants will be randomized (5:5:1) to (1) omalizumab/placebo-dupilumab with mOIT (n = 50), (2) omalizumab/dupilumab with mOIT (n = 50), or (3) a mechanistic-only arm of placebo-omalizumab/dupilumab with mOIT (n = 10). Double-blind placebo-controlled food challenges (DBPCFCs) will be used to assess desensitization to ≥1,043 mg cumulative protein at Week 32, after which all treatment is to be discontinued. A follow-up assessment of sustained unresponsiveness via DBPCFCs will be conducted at Week 44.

Conclusion: This trial tests the hypothesis that adding dupilumab to omalizumab-facilitated mOIT will increase the likelihood of inducing sustained unresponsiveness and decrease mOIT-related adverse events.

Introduction: House dust mite (HDM) allergens are major triggers of IgE-mediated asthma in tropical regions, yet the role of cockroach allergens and their cross-reactivity with HDM remains unclear. Cross-reactivity among invertebrate allergens is a common challenge in daily practice, especially to define primary sensitizers and reactions of clinical relevance. Multiplexed arrays in molecular allergology constitute a useful tool for better detection and interpretation of cross-reactions.

Methods: We assessed specific IgE levels and skin prick test reactivity to the American cockroach and HDM allergens in cohorts of allergic and asthmatic patients from Cartagena, Colombia, using ImmunoCAP™, skin testing, and multiplex molecular allergology (ALEX2).

Results: Cockroach sensitization was present in 29%-40% of patients but elicited significantly lower IgE responses and smaller skin test wheals compared with HDM. Most cockroach-sensitized individuals were cosensitized to HDM, with limited recognition of cockroach molecular components. Mean specific IgE levels to cockroach were 2.1 kU/L ranging from 0.1 to 25.8 kU/L. The majority of patients had IgE levels in Class 1 (0.35-0.70 kU/L) or Class 2 (0.70-3.5 kU/L). In the ALEX2 array, most cockroach-sensitized patients (by skin tests) did not recognize the Periplaneta americana extract (Per a) or other cockroach allergens in the array, and instead they recognized HDM allergens and the extracts of crustaceans and mollusks. Only one patient recognized the Per a extract, cockroach tropomyosin (Per a 7), and tropomyosins in HDM (Blo t 10, Der p 10), shrimp (Pen m 1), and Anisakis simplex (Ani s 3) together with other allergens in crustaceans and mollusks. Interestingly, IgE reactivity to cross-reactive allergens like arginine kinase, myosin light chain, and sarcoplasmic calcium-binding protein was not detected. Cockroach sensitization was not associated with worsened asthma control or lung function but correlated with higher shrimp-specific IgE in patients reporting shellfish allergy.

Discussion: HDM allergens induce stronger IgE responses than cockroach in this tropical population, indicating HDM as the primary sensitizer. Cockroach sensitization often reflects cross-reactivity and requires careful clinical evaluation to determine its relevance.

Atopic dermatitis (AD) is an inflammatory skin condition associated with chronic itch and inflammation in both humans and animals. While this disease depends upon various immune cell types, the precise role and kinetics of neutrophils remain elusive, particularly in relevant large-animal models. Given a recent report suggesting the involvement of neutrophils in a mouse model, we aimed to characterize the temporal presence and infiltration of these cells in a canine model of house dust mite (HDM)-induced AD. AD was induced in canines via HDM exposure, and skin biopsies were analyzed over a time course (0-96 h) using standard H&E staining and specific immunofluorescent (IF) staining for canine neutrophils. Our results showed general cellular infiltration with the H&E method, while IF further confirmed detectable neutrophil immunoreactivity starting between 24 and 96 h post-challenge in atopic skin. Quantitation demonstrated a significant increase in neutrophil infiltration (cells/mm²) in atopic skin at 48 h following HDM exposure compared to baseline (p = 0.041). Collectively, our data confirms time-dependent infiltration of neutrophils into the skin of the canine AD model following allergen challenge, supporting the hypothesis that this previously overlooked immune cell may play a role in the acute phase of AD pathogenesis and sensitization.

Over the past decade, chronic rhinosinusitis (CRS) management has undergone substantial transformation, shifting from conventional symptom-focused treatments to precision medicine strategies grounded on molecular insights. The introduction of biologic agents has significantly changed the therapeutic landscape for CRS with nasal polyps (CRSwNP), directly addressing key inflammatory pathways and leading to marked reductions in nasal polyp burden, overall disease impact, and corticosteroid use. Concerns regarding long-term effectiveness, financial burden, and accessibility remain unresolved. Advances in the understanding of the mechanisms underlying CRS are paving the way for the development of novel therapeutic strategies, with increasing attention now also being directed toward the phenotype without nasal polyps (CRSsNP), which currently lacks targeted therapies. Despite progress in pharmacologic therapies, surgery remains a fundamental treatment option, with ongoing efforts to standardize surgical approaches and evaluate novel techniques. Optimizing the integration of surgical and medical therapies while expanding access to novel treatments represents a key future goal in CRS care. This review aims to guide researchers and clinicians through the evolving landscape of CRS management, covering the latest evidence on established and emerging therapies, offering practical insights into endotyping, and highlighting important considerations for the management of severe or refractory cases.

Background: Research on the combination of biologics with rush immunotherapy (RIT) remains scarce, particularly regarding safety and efficacy data in pediatric and hypersensitive populations undergoing rapid desensitization or concurrent biologic therapy. Furthermore, regarding RIT, it remains unclear which patients can effectively reduce the occurrence of adverse reactions when combined with biologics, and which patients fail to achieve such a reduction with this combination therapy.

Methods: This retrospective study analyzed 202 patients with mite-induced allergic asthma (2018-2024) receiving RIT alone (n = 133) or omalizumab-pretreated RIT (RIT + Omb-pre, n = 69). Stratified analyses were conducted based on age, mite sIgE levels, total IgE(T-IgE) levels, and sIgE to T-IgE ratios. Outcomes included systemic adverse reaction (SR) rates, RIT completion rates, improvements in clinical parameters following omalizumab intervention, and 1-year follow-up efficacy across subgroups.

Results: Both regimens were well tolerated, with no grade ≥3 SRs observed. Compared to RIT alone, RIT + Omb-pre significantly reduced SR incidence (p < 0.05) and showed a trend toward higher target peak concentration completion rates (p = 0.054). Age-stratified analysis revealed higher SR risks in children/teenager patients vs. adults. Subgroup analyses further demonstrated that SR incidence correlated positively with mite sIgE levels and sIgE/T-IgE ratio (p < 0.05), but not with T-IgE. Patients with low-risk biomarkers (sIgE grades 1-2 and sIgE/T-IgE <10%) exhibited minimal SR incidence unaffected by omalizumab, whereas high-risk subgroups (sIgE grades 3-6 and sIgE/T-IgE ≥10%) showed significantly elevated SR incidence, which was markedly mitigated by omalizumab (p < 0.05).Subgroup with sIgE/T-IgE ratios >16% achieved substantially greater improvements in ACQ scores and daily medication burden compared to those with ratios <16% during the 12-month intervention. Furthermore, this study reaffirmed the age-dependent efficacy correlation, with pediatric patients demonstrating superior therapeutic outcomes to adult patients.

Conclusions: Regarding the safety of dust mite rush immunotherapy for allergic asthma, Omalizumab significantly reduces the incidence of SRs in high-risk populations (sIgE grades 3-6 and sIgE/T-IgE ≥10%), whereas it demonstrates limited efficacy in low-risk subgroups (sIgE grades 1-2 and sIgE/T-IgE <10%).

Objective: We hypothesized that intestinal barrier impairment is a key pathophysiological feature in AD and that the degree of baseline barrier dysfunction, reflected by serum D-lactate levels, predicts the clinical response to Washed Microbiota Transplantation (WMT). This study aimed to test these hypotheses by investigating the association between intestinal barrier biomarkers and AD severity, and their correlation with WMT outcomes.

Methods: We compared intestinal barrier biomarkers (D-lactate, endotoxin, and diamine oxidase) between 24 AD patients and 23 healthy donors. Additionally, we evaluated the clinical outcomes of 14 AD patients who underwent WMT therapy.

Results: AD patients exhibited significantly elevated intestinal barrier biomarkers compared to healthy donors (p < 0.01). Following WMT, significant improvements were observed in SCORAD, EASI, and NRS scores (p < 0.05). In exploratory, uncorrected analyses, baseline D-lactate levels showed a significant negative correlation with improvements in SCORAD (R = -0.738, p = 0.037) and NRS scores (R = -0.650, p = 0.012), suggesting that higher pre-treatment levels might predict greater symptom relief. Microbiota analysis revealed a increase in Acidaminococcus and decreases in Ruminococcus_gnavus_group, Flavonifractor, and Norank_f_Oscillospiraceae following WMT.

Conclusion: This study confirms significant intestinal barrier dysfunction in AD and demonstrates the potential clinical efficacy of WMT. The strong, uncorrected correlations suggest that pre-treatment D-lactate level warrants further investigation as a candidate biomarker for predicting WMT response. The clinical benefits occurred alongside a restructuring of the gut microbiota.

Rationale: Shrimp (Litopenaeus vannamei) allergies (SA) can result in allergic reactions ranging from life threatening severe anaphylaxis to oral allergy syndrome. SA may pose lifestyle restrictions on daily life and interfere with social relationships and school performance, but this has not been thoroughly investigated. We examined the QoL in SA adults and caregivers.

Methods: A QoL online questionnaire adapted from the validated Food Allergy Quality of Life Questionnaire (FAQLQ) was administered between September 30, 2023-July 15, 2024 to adults and caregivers of at least one SA child. Descriptive statistics, Wilcoxon rank sum test, and Fisher exact test were used to determine QoL and desire for treatment in SA subjects. Comparisons were made between SA adults with and without children with SA.

Results: Eighty-six participants completed the survey. Sixty-four (74%) SA adults did not have SA children, and 6 (7%) were SA adults with SA children. Eighty-one percent of SA adults found SA at least moderately to extremely troublesome, and 83% felt other people underestimated problems caused by SA. Seventy percent of SA adults were interested/very interested in a treatment and, of those interested, 47% wanted treatment to enable eating a serving size of shrimp. The small cohort of SA adults with a SA child may have been more likely to have concerns about allergic reaction compared to SA adults without a SA child. [OR, 4.4 (CI, 1-21)].

Conclusions: SA adults report impaired QoL and a desire for treatment to eat a serving size of shrimp. The majority of SA people have impaired QoL.

Background: Up to 30% of chronic spontaneous urticaria (CSU) patients and 24% of children with CSU may have an NSAIDs-exacerbated cutaneous disease (NECD). Some vegetables and fruits are rich in salicylate. Salicylates in food can exacerbate symptoms in CSU patients.

Aim: Our aim is to investigate the effect of a low salicylate diet on urticaria severity, quality of life, blood salicylate level and urine arachidonic acid pathway metabolites.

Methods: Patients followed a fourweek low salicylate diet. Chronic urticaria quality of life questionnaire (CU-Q2oL) and 4 Days-Urticaria Activity Scores (UAS4) were recorded and blood and urine samples were collected at baseline and after the low salicylate diet. Urine Leukotriene-E4, Prostaglandin-E2, Prostaglandin-F2α, Thromboxane-A2, and creatinine levels were measured via ELISA. Blood salicylate level was determined by LC-MS/MS.

Results: A total of 36 CSU patients were included in the study. The CU-Q2oL scores significantly decreased from 33.7 to 20.7 (p < 0.001) and the UAS4 significantly decreased from 14 to 8 (p < 0.001) after low salicylate diet when compared to baseline (low scores mean less complaints). The blood salicylate level was significantly lower after the low salicylate diet compared to the baseline (p = 0.042). However, there was no significant effect of the diet on urinary LTE4, PGDE2, PGDF2α and TXA2 levels.

Conclusion: Our findings suggest that a low salicylate diet may help to reduce the severity of urticaria and improve quality of life by lowering blood salicylate levels. However, the diet had no impact on urinary LTE4, PGDE2, PGDF2α, and TXA2 levels.