Frontiers in allergy最新文献

Purpose: To present a rare, to our knowledge previously undescribed, case of successful AFRS management using stapokibart (CM310).

Patients and methods: The laboratory, immunological, symptom scores and imaging datas before and after stapokibart treatment were evaluated to determine the effect of stapokibart on AFRS.

Results: After four weeks of treatment, the patient showed significant clinical improvement, including a marked reduction in nasal polyp size and the near-complete return of normal olfaction. By week 16, lab tests confirmed a substantial drop in eosinophils and IgE, and a follow-up CT scan showed complete resolution of sinus inflammation. The patient reported high satisfaction due to a major improvement in quality of life.

Conclusion: This pioneering case demonstrates that stapokibart, a novel anti-IL-4Rα antibody, is a promising and effective treatment for refractory AFRS, showing a rapid onset of action and sustained control of type 2 inflammation.

Background: The relationship between chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and type 2 inflammation has led to the use of biologic treatment for uncontrolled cases. As biologic treatment remains a relatively new approach for CRSwNP, systematic assessment and collection of high-quality, real-world data are crucial. This study established the national Global Airways registry to collect longitudinal data over a period of 12 months for patients with CRSwNP treated with biological therapies according to criteria established by the Danish Health Authority.

Methods: All participating sites conducted systematic assessments of patients with CRSwNP referred for initiation of biologic treatment. Clinical and patient-reported outcome data were collected at baseline and after 6 and 12 months of treatment and were entered in real-time into the Global Airways registry. Comparisons were performed between patients eligible or not eligible for biologic therapy and between pre- and post-treatment timepoints.

Results: A total of 513 patients were enrolled between November 2022 and December 2024, with 310 receiving treatments with biologics (mepolizumab or dupilumab). Mean [standard deviation (SD)] age in the treatment group was 49.7 (14) years and 66% were male. The median number of previous endoscopic sinus surgeries was 2 (range 1-16). Baseline mean (SD) scores were as follows: Nasal Polyp Score (NPS) 4.8 (1.7); Sinonasal Outcome Test (SNOT)-22 68.7 (18.7); Visual Analog Scale (VAS) CRS 84.1 (16); and Sniffin' Sticks-16 (SST-16) score 4.8 (3). Asthma was present in 204 (66%) patients, with a mean (SD) Asthma Control Questionnaire (ACQ)-5 score of 2.1 (1.5). Among patients with available data at both 6 and 12 months (n = 160), mean SNOT-22 scores improved from 68 to 29 and 24, NPS from 5.1 to 3.0 and 2.4, SST-16 from 4.7 to 9.2 and 10.0, and ACQ-5 from 2.3 to 1.0 and 0.8 (all p < 0.001).

Conclusions: The Global Airways registry was an effective working tool that ensured collection of important real-world data when moving from surgery to biologics. Furthermore, the registry demonstrated the sustained effectiveness of biologic therapy in patients with refractory CRSwNP and provided a robust foundation for defining CRS phenotypes and advancing targeted treatment strategies.

Chronic spontaneous urticaria (CSU) is a clinically heterogeneous, mast cell-driven inflammatory disease in which disease expression, treatment response, and resistance are determined by distinct but overlapping immunopathogenic mechanisms. Growing evidence supports the existence of two principal molecular endotypes: type I (autoallergic) CSU, mediated by autoreactive IgE antibodies against self-antigens such as thyroid peroxidase and interleukin-24, and type IIb (autoimmune) CSU, characterized by IgG (and less frequently IgA or IgM) autoantibodies directed against IgE or its high-affinity receptor FcεRI. These endotypes differ substantially in biomarker profiles, clinical severity, and therapeutic responsiveness. Patients with type I CSU typically exhibit elevated total IgE levels, allergic comorbidities, and rapid, robust responses to omalizumab, whereas those with type IIb CSU more often present with low IgE, positive autologous serum skin test or basophil activation assays, thyroid autoantibodies, eosinopenia, basopenia, and delayed or insufficient responses to anti-IgE therapy. Importantly, accumulating data indicate that strict dichotomous classification is insufficient, as many patients display concurrent IgE- and IgG-mediated autoreactivity, supporting the concept of an immunological continuum summarized under the broader framework of "autoreactivity." Beyond immunoglobulin-driven mechanisms, eosinophils, basophils, complement activation, and coagulation pathways critically contribute to disease amplification and treatment refractoriness. Biomarkers such as total IgE, anti-thyroid antibodies, eosinophil and basophil counts, C-reactive protein, and functional assays including ASST and BAT enable pragmatic endotype stratification and prediction of therapeutic outcomes. Integrating molecular endotypes with clinical phenotypes provides a rational basis for personalized management, allowing earlier identification of likely non-responders, optimization of omalizumab dosing, and timely consideration of alternative or emerging targeted therapies. This evolving endotype-guided approach represents a key step toward precision medicine in CSU.

United States Pharmacopeia (USP), a nonprofit organization that sets safety standards for food, medicine and supplements updated its Chapter 797 standards for the preparation of allergy immunotherapy vials in November 2023. These guidelines impacted facility and personnel qualifications, workflow, and laboratory documentation. We hypothesized adhering to regulations may be financially difficult for allergy practices. To comply, offices must either use mail order prescription facilities or allocate financial resources to purchase a Primary Engineering Control (PEC) Hood, a device used to protect against airborne contaminants, or build-out an Allergenic Extract Compounding Area (AECA), a room specialized for compounding allergens. We performed a comparative analysis to determine financial feasibility of these three scenarios with the support of a Public Service Enterprise Group (PSEG) grant. Of these three options prescription sets were most costly, followed by PEC Hood and AECA. For both PEC Hood and AECA, costs were recouped by the third week of operation. In conclusion, for long term operation, the AECA would be most feasible for small private practice outpatient clinics in regard to overall cost and estimated revenue.

The increasing availability of biologic therapies for allergic diseases has highlighted the need for more precise, mechanism-based patient selection. Traditional approaches based on disease phenotypes often fall short in predicting therapeutic response. Escalating healthcare costs together with questions about the efficacy of the current management of allergic diseases prompt to a shift toward endotype-driven and biomarker-guided strategies. This review explores the role of endotypes, defined by distinct immunologic, molecular, or cellular mechanisms, in guiding the use of targeted biologics in asthma and in chronic rhinosinusitis with nasal polyps. Endotype classification based on the type 1, type 2 and type 3 immune response is critical for selecting biologics targeting the IgE, IL-5, IL-4/IL-13, or TSLP pathways. The endotype-driven approach in allergic diseases has tremendous potential if incorporated into comprehensive care pathways, with endotype identification playing a key role in the management decision tree, with improved outcomes and greater patient satisfaction. To this purpose this review provides decision algorithms for the endotype-guided approach at the point of care and discusses the unmet needs with potential practical solutions to support a personalized precision approach.

Eczema is an inflammatory skin condition that affects individuals of all ages worldwide. Patients may develop various forms of eczema, including atopic dermatitis, contact dermatitis, which is often associated with an allergic response to various stimuli, dyshidrotic eczema which develops on the palms and soles, asteatotic dermatitis that predominantly occurs in elderly patients, nummular eczema characterized by its cylindrical shape lesions and seborrheic dermatitis often located on patient's scalps, back, face and chest. Extensive studies have been conducted on atopic dermatitis, however, limited information such as their etiology, effect on the immune system and potential treatments are available on the other types of eczema. The socioeconomic impacts of eczema include the cost of conventional treatments such as corticosteroids, immunosuppressive agents and phototherapy, expenses related to specialists' consultation and the effect on work and school productivity. The impact of atopic dermatitis on patients' quality of life, social functioning and individual healthcare expenses has been extensively studied in other countries but remains underreported in South Africa. Reports have estimated the annual direct and indirect costs in Australia, the United Kingdom and the United States, however reports are limited for South Africa. This study aimed to provide information on the different types of eczema's etiology, their respective socioeconomic impact in South Africa in correlation to the above mentioned inflated yearly cost, and conventional, targeted and alternative treatments commercially available. Several knowledge gaps were identified in this study, including the limited availability of information on asteatotic dermatitis, dyshidrotic dermatitis and nummular eczema, the effect most commercially available treatments have on other eczema subtypes and an in-depth review of the socioeconomic impact of eczema within the African continent.

Introduction: Chronic urticaria (CU) is a common, burdensome mast cell-mediated skin disease. However, little is known about physician estimation of the disease prevalence and clinical impact. This study assessed physicians' perceptions of CU and compared them with data from peer-reviewed literature.

Methods: We conducted a cross-sectional, questionnaire-based study distributed worldwide via UCARE (Urticaria Centers of Reference and Excellence) network to 198 UCAREs and forwarded to GPs (general practitioners). Questionnaire data was analyzed using SPSS and subgroup analysis was performed using appropriate non-parametric statistical tests depending on the number of comparison groups and the distribution of the data.

Results: In total, 234 participants from 46 countries completed the survey [54.3% female, median age: 48.5, interquartile range (IQR) 38.3-58.0 years]. Median age of disease onset reported for chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU) was 30.0 and 25.0 years, respectively. Median estimated prevalence of CU in adult and pediatric patients was 2.5% and 1.0%, respectively. The most affected aspects of patient life, estimated by physicians, were sleep (CSU), physical activities (CIndU), and mental status (CSU, CIndU). Physicians working at UCARE (78.9% (183/232) vs. non-UCARE (21.1% (49/232) sites differed in their estimation of adult CU prevalence (median: 2.0% vs. 4.5%, p < 0.001), proportion of adult CSU patients among CU patients (median: 70.0% vs. 60.0%, p = 0.027), and proportion of CSU patients with severe impact (median: 50.0% vs. 30.0%, p = 0.042). When asked how confident participants were in their estimations regarding CU prevalence and burden, UCARE experts reported significantly higher median confidence compared to other physicians.

Conclusion: Although physicians' estimations of CU prevalence and burden generally align with literature data, non-UCARE physicians may underestimate the burden and overestimate the prevalence. This might affect CU management in primary care potentially leading to a less effective treatment and underscores the need for increased urticaria awareness among non-UCARE physicians via publications, masterclasses, webinars, or other educational initiatives.

Chronic spontaneous urticaria (CSU) is a common immune-mediated skin disorder characterized by spontaneous wheals, angioedema, or both, persisting for more than six weeks. Its pathogenesis is multifactorial, involving mast cell and basophil activation, autoimmunity and dysregulation of inflammatory and coagulation pathway. Current treatment guidelines recommended a stepwise algorithm beginning with second-generation H1-antihistamines (sgAH1) at standard doses (which can be increased up to fourfold if needed) before progressing to omalizumab (OMA). Nevertheless, a considerable proportion of patients remain unresponsive, highlighting the need for reliable predictors of treatment response to enable personalized care. This narrative review summarizes the current evidence on demographic, clinical, serological, and cellular biomarkers that may predict outcomes with sgAH1and OMA. Favorable sgAH1 response has been associated with shorter disease duration, low baseline UAS7 scores, and absence of angioedema. In contrast, high disease activity, inducible urticaria, elevated CRP or IL-6 levels, and hematological features such as increased neutrophil-to-lymphocyte ratio, basopenia, eosinopenia, and markers of coagulation activation (e.g., D-dimer, fibrinogen) are linked to resistance. Regarding OMA, predictors of good response include high total IgE levels, elevated basophil FcεRI expression, and reduction in IL-31 and D-dimer during treatment. Poor response correlates with advanced age, high BMI, comorbid autoimmune diseases, low total IgE (<40-50 IU/ml), positivity for ANA or anti-TPO antibodies, and activation markers such as CD203c. Functional test like the autologous serum skin test (ASST), basophil activation test (BAT), and histamine release assays offer additional stratification value. Composite immunological signatures integrating multiple biomarkers hold promise for guiding therapeutic decisions and improving prediction accuracy. Implementing validated markers could enable earlier identification of difficult-to-treat patients, faster disease control and more targeted therapy, advancing precision medicine in CSU.

Continuous exposure to textile dyes can result in potential health risks, such as inflammatory and allergic responses. We investigated immunotoxicity, and epithelial responses induced by Disperse Blue 1, 124, 79.1, and 183 when in co-culture with swine peripheral blood mononuclear cells (PBMCs), intestinal porcine epithelial cells (IPEC), and human epidermal skin scaffolds. PBMC cytokine production (IFN-γ and TNF-α), cell viability, IPEC gene expression profiles (by Nanostring analysis) and histopathology of human epidermis were evaluated. Disperse Blue 124 strongly increased pro-inflammatory cytokines without significant cytotoxicity, suggesting high sensitization potential. Contrarily, Disperse Blue 1 exhibited high cytotoxicity despite moderate cytokine production. Nanostring analysis revealed prominent epithelial inflammation (CCL20 upregulation) and compromised barrier integrity (CLDN-4) with Blue 1 and Blue 124, but not Blue 79.1 and 183. Histopathology further confirmed epidermal damage, with Blue 1 and 124. Therefore, dye-induced effects correlated with chemical structure, molecular weight, hydrophobicity, and functional groups, supporting the hypothesis that structural properties influence toxicity and absorption.