Frontiers in allergy最新文献

Background: Allergen Immunotherapy (AIT) is largely considered to be the only therapy that can provide relief from allergic rhinitis (AR).Although its effectiveness has been confirmed by the results of a large number of practical studies such as randomized controlled trials, it may in some cases have a poor or no response to treatment due to the development of resistance under the influence of certain risk factors. The purpose of this Meta-analysis was to examine the risk factors for AR resistance to AIT treatment.

Methods: A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and Cochrane Library from inception to August 2025. Study quality was assessed using the NOS scale, AHRQ criteria, and the GRADE framework. Statistical analyses, performed with R 4.5.0 and Stata 14, employed fixed-or random-effects models to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was explored via sensitivity analyses, and publication bias was evaluated using funnel plots with Begg and Egger tests.

Results: A total of 12 studies involving 2,552 patients were included in this Meta-analysis. The results suggest that the following factors may be associated with AR resistance to treatment with AIT. Gender: male (OR = 1.53, 95% CI: 1.08-2.18); Specific diagnostic antibody aspects: s-IgE/t-IgE ratio (OR = 1.09, 95% CI: 1.02-1.16), sIgE, sIgG4; For cytokines: IL-10, IL-35, TGF-beta, IFN-gamma; On blood parameters: Eosinophil; Immune Cell Aspects:TH2/CD4, TFH2/CD4, CD23 + BNSM, CD23 + BSM, TFR/CD4, TFR/TFH2; Clinical/personal characteristics: demographics, disease severity, allergen type, treatment details, treatment adherence, symptom control, lung function, airway inflammation, inflammatory markers, immunologic markers, imaging markers, environmental and behavioral factors. With respect to the heterogeneity analysis, the heterogeneity of the other analyses was relatively low, except for age and t-IgE levels, where there was significant heterogeneity.

Conclusion: The risk of developing resistance to AIT treatment for AR is closely associated with patient factors including gender, antibodies, cytokines, hematological parameters, clinical/personal characteristics, immune cells, and other indicators.

Systematic review registration: PROSPERO CRD420251154551.

Purpose: Skin prick test (SPT) and the level of serum-specific IgE (sIgE) antibodies to shrimp have low specificity in the diagnosis of shrimp allergy. Measurement of sIgE to tropomyosin is available as a test, but the accuracy remains controversial. This study aims to evaluate the diagnostic accuracy of sIgE measurement to tropomyosin in the diagnosis of shrimp allergy and compare the diagnostic performance to SPT and sIgE to shrimp.

Methods: Patients with a history of immediate reaction to shrimp allergy were recruited. All participants underwent SPT with commercial shrimp extract. Measurements of sIgE to shrimp and tropomyosin were carried out. An oral food challenge (OFC) with shrimp was performed to confirm the diagnosis.

Results: Fifty symptomatic patients (mean age 27.3 years) with suspected shrimp allergy were evaluated. OFC confirmed allergy in 13 (26%) patients. Diagnostic modalities offered distinct advantages and limitations. Tropomyosin sIgE (rPen a 1) yielded superior specificity (91.9%) at the cost of sensitivity (23.1%), while extract-based tests (SPT and shrimp sIgE) provided better sensitivity (46.2%-61.5%) but lacked specificity (43.2%-51.4%). Implementing a two-step algorithm-combining SPT with tropomyosin sIgE-successfully optimized specificity to 94.6%. Nevertheless, given the suboptimal predictive values across all methods (PPV 25%-50%; NPV 73%-77%), these tools alone cannot safely guide management, and OFC remains essential.

Conclusion: Measurements of sIgE to tropomyosin provided higher specificity and increased diagnostic efficiency than SPT and measurement of sIgE to shrimp for the diagnosis of shrimp allergy.

Olfactory perception plays a fundamental role in nutrition, emotional development, and social behavior, yet olfactory disorders (OD) in children remain largely underrecognized and understudied. This mini review summarizes current evidence and proposes a structured clinical approach for the evaluation and management of pediatric OD. Etiologies are diverse, encompassing congenital syndromes such as Kallmann and CHARGE, post-infectious and post-traumatic forms, inflammatory airway diseases, and structural or iatrogenic causes. Accurate diagnosis begins with a detailed medical history and comprehensive ENT examination, complemented by psychophysical olfactory testing adapted for pediatric populations. Although several validated tools exist-such as the Sniffin' Sticks, U-Sniff, Pediatric Smell Wheel, and pBOT-6-standardized age-specific protocols and normative data remain limited. Imaging techniques, particularly MRI, provide valuable insights into congenital and acquired abnormalities of the olfactory bulbs and tracts, while CT is reserved for sinonasal or bony pathology. Multidisciplinary collaboration among pediatricians, neurologists, endocrinologists, geneticists, and otolaryngologists is essential to achieve etiological precision. Management strategies depend on the underlying cause and include medical or surgical treatment for reversible conditions, intranasal corticosteroids for inflammatory diseases, and olfactory training for post-infectious or congenital forms. Regular follow-up with objective testing and family education supports recovery and long-term adaptation. Despite the scarcity of pediatric-specific evidence, this review highlights the need for awareness, early diagnosis, and individualized management of OD in children, proposing a practical diagnostic and therapeutic framework to guide clinical decision-making in everyday ENT practice. A structured search strategy was applied to summarize the currently available evidence and highlight practical implications for clinical care.

Introduction: Hereditary α-tryptasemia (HαT), defined by increased TPSAB1 copy number and elevated basal serum tryptase, is associated with mast cell (MC)-mediated symptoms. However, its role in gastrointestinal disease remains unclear. Because intestinal MCs express the non-IgE-dependent activation receptor MRGPRX2, we investigated whether MRGPRX2 expression and MC phenotypes are altered in individuals with HαT in the context of inflammatory bowel disease (IBD).

Methods: We genotyped 854 biobanked IBD samples to identify individuals with HαT. Spatial transcriptomic analysis was performed on descending colon tissue from individuals with HαT (n = 4) as well as tissue and severity matched non-HαT controls (n = 4). Small intestinal biopsies were additionally analyzed using mass cytometry (CyTOF) from HαT individuals (n = 5) and non-HαT controls (n = 9). Droplet digital PCR (ddPCR) was used to establish TPSAB1 copy number variant for HαT detection. Comparisons across groups were performed using Welch's t-test with effect sizes and 95% CI.

Results: Across complementary platforms, HαT was associated with increased gastrointestinal mast cell abundance and elevated expression of mast cell activation markers, including CD203c, LAMP-1, and SIGLEC8. Both spatial transcriptomics and ddPCR demonstrated significantly increased MRGPRX2 and SIGLEC8 transcript levels in IBD samples from individuals with HαT compared with matched non-HαT IBD controls.

Discussion: These findings suggest that enhanced MRGPRX2 expression and mast cell activation may contribute to gastrointestinal symptoms in individuals with HαT, particularly in the setting of IBD. As interest in precision immunogenetics grows, defining mast cell phenotypes linked to α-tryptase copy number may help refine diagnostic evaluation and identify patients who could benefit from emerging mast cell-targeted therapeutic strategies in the context of IBD.

Introduction: Asthma is a multifactorial disease influenced by genetic and environmental factors, including diet. The gut microbiome contributes to airway inflammation via the gut-lung axis, partly through production of short chain fatty acids (SCFAs) from bacterial fermentation of dietary fiber. We hypothesized that dietary fiber supplementation could modulate the gut microbiome and increase SCFAs in children with asthma.

Methods: This is a double-blind, placebo-controlled trial of children who were randomized to consume 12 g of soluble corn fiber (SCF) as a supplement to their usual daily diet (50% the recommended daily fiber intake) or placebo for 4-6 weeks (clinicaltrials.gov NCT03673618). Dietary surveys, asthma symptom questionnaires, fecal, blood and nasal samples were collected before and after the intervention period to quantify fiber intake, asthma control, nasal and gut microbiome, and serum short chain fatty acids (SCFAs).

Results: Of the 20 children enrolled, 15 completed the intervention with an average adherence rate of 83%. SCFA concentrations and gut microbiome changes varied by individual and treatment group. No significant differences in gut or nasal alpha or beta diversity were observed between groups post-intervention. However, differential abundance analysis showed a trend toward increased Bifidobacterium in the SCF group compared to placebo (ANCOM-BC p = 0.0004, FDR q = 0.073).

Discussion: Supplementation of 50% of recommended daily fiber intake had minimal impact on asthma symptoms, the microbiome, or SCFA levels. Future studies should consider higher fiber doses, different fiber types, or targeting individuals with low baseline fiber intake to account for observed variability in microbiome and SCFA responses.

Clinical trial registration: https://clinicaltrials.gov/study/NCT03673618, identifier NCT03673618.

Background: Biological therapies have improved the control of severe asthma. However, biological therapies are expensive. Therefore, the cost-effective use of these medications after achieving improved disease control warrants consideration.

Methods: This retrospective case series analyzed 69 adult patients with asthma who received biological therapies at our department between 2009 and 2023. Among them, 11 patients underwent dosing interval extension. We collected data on their clinical characteristics, asthma control status, and changes in clinical parameters after interval extension.

Results: At the time of dosing interval extension, the mean patient age was 62.1 years, with 5 female patients. Omalizumab was used in five cases, benralizumab in five, and dupilumab in one. The dosing intervals were extended by 1.5 to 2 times. The median duration from the initiation of biologics to interval extension was 7.0 months, with 6 patients undergoing extension within the first 7 months. One year after extension, asthma exacerbation occurred in only one patient receiving omalizumab. The frequency of exacerbations and the proportion of patients receiving oral corticosteroids (OCS) were decreased. The median ACT score remained at 25, while the median daily OCS dose decreased from 5.0 mg to 4.0 mg (prednisolone equivalent). The median % predicted FEV₁ changed from 84.9% to 78.3%.

Conclusions: For patients whose asthma control improves after initiating biological therapy, extending the dosing interval may be a feasible treatment option. Given the retrospective, single-center design and small sample size, these findings are exploratory and generate hypotheses that require validation in larger, prospective studies.

Background: Severe pediatric asthma is a heterogeneous, high-burden disease marked by variable corticosteroid responsiveness, frequent exacerbations, and substantial impairment in quality of life. Advances in airway immunobiology, particularly the delineation of type-2 (T2) pathways (IgE, IL-5, IL-4/IL-13) and epithelial alarmins, have enabled the development of targeted biologic therapies for biomarker-defined patient subgroups.

Objective: To synthesize current evidence on the efficacy and safety of biologic therapies for severe pediatric asthma and to translate biomarker-driven selection into practical clinical guidance, while outlining emerging therapeutic directions.

Summary of findings: Targeted biologics, anti-IgE (omalizumab), anti-IL-5/IL-5Rα (mepolizumab, benralizumab; pediatric data for reslizumab remain limited), anti-IL-4Rα (dupilumab), and anti-TSLP (tezepelumab) improve disease control, reduce severe exacerbations, and enable steroid-sparing in appropriately selected children. Benefits are greatest in T2-high profiles, particularly with elevated blood eosinophils and/or fractional exhaled nitric oxide (FeNO), while tezepelumab shows efficacy across biomarker strata. Lung-function gains are modest to moderate but clinically meaningful. Persisting gaps include optimal treatment duration, stopping rules, long-term safety, cost, and equitable access.

Conclusions: Biologic therapies have reshaped the care of severe pediatric asthma, operationalizing precision medicine through immunologic endotyping and biomarker-guided selection. Priorities now include standardized definitions of response and remission, robust long-term safety data, and strategies to ensure equitable access across diverse pediatric populations.

Dupilumab is a fully human monoclonal antibody directed against the interleukin-4 receptor subunit α, the common chain of the IL-4 and IL-13 receptors. Dupilumab has been demonstrated to be highly effective in the treatment of severe atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyps. Despite the favorable tolerability of dupilumab, several publications and reviews have reported various adverse events, including conjunctivitis, keratitis, and face and neck treatment-resistant dermatitis, which reduce patients' quality of life and may necessitate the cancellation of therapy. The current standard of care for severe chronic diseases involves a collaborative approach between the patient and their physician. The majority of patients who respond well to this type of systemic atopic dermatitis (AtD) therapy are reluctant to interrupt dupilumab treatment due to the previously mentioned adverse events. The combination of dupilumab and anti-IgE therapy (omalizumab) may be beneficial for individuals who undergo dupilumab treatment for AtD and experience severe adverse events.

Introduction: Seasonal allergic rhinitis (SAR) patients often use homeopathy for symptom relief. The HOMEOSAR trial, a randomized, placebo-controlled, triple-blind multicenter study, included a qualitative sub-study to assess feasibility. This sub-study specifically examined the feasibility of the study, focusing in particular on two mechanism-rich domains-the therapeutic relationship and study organization-with special attention to study procedures, physician-patient relationships, organizational aspects, and interactions with the study team.

Methods: Semi-structured interviews with trial participants were conducted 6-8 weeks after baseline, corresponding to 2-4 weeks after study intervention ended. Data were coded, categorized, and analyzed using qualitative content analysis, both inductively from the material and deductively based on study aims. MAXQDA® software was used to support analysis.

Results: Fifteen patients (mean age 43 years; range 20-67; 11 male) participated in the qualitative study (n = 8 standardized homeopathy, n = 2 individualized homeopathy, n = 5 placebo). They were recruited from nine study centers in Berlin. Results of the qualitative sub-study indicate the overall feasibility of the HOMEOSAR trial. Patients highlighted the empathetic and professional relationships with physicians and the supportive contact with the study team. While the documentation was seen as well-structured and clear, it was also described as time-consuming.

Conclusion: Findings of this qualitative study provide design-level recommendations (e.g., upfront communication of consultation length, digital diaries with free-text, tracked medication shipping, single contact point) for RCT studies. Beyond the specific homeopathy study context, these findings offer important methodological insights for designing patient-centered RCTs in complex intervention settings not only in the field of Complementary and Integrative Medicine.