Spices and herbs are widely used for their flavor and therapeutic properties. This narrative review explores current evidence on spice and herb allergies in children, using a scoping approach to synthesize data from case reports, clinical, immunologic, molecular studies, regulatory sources, and previous reviews. Selected adult cases were included for context. Spice and herb allergies are increasingly recognized in children, with symptoms ranging from mild oral reactions to anaphylaxis. The most frequently implicated spices include mustard, celery, coriander, fennel, cumin, anise, pepper, and herbs from the Lamiaceae-family such as mint, oregano, and sage. Both IgE- and non-IgE-mediated mechanisms are involved, with cross-reactivity to pollens (birch and mugwort) being common. Diagnosis remains challenging due to limited standardized tests; oral food challenge is the gold standard. Management relies on strict allergen avoidance and emergency preparedness. Improved clinical awareness, diagnostic tools, and clearer labeling-especially regarding hidden allergens-are crucial for effective care.
Since its initial description ten years ago, numerous studies have contributed to a better understanding of the role of hereditary alpha-tryptasemia (HαT) in the diagnosis and management of patients with clonal mast cell activation disorders (cMCADs). These studies have highlighted the high prevalence of HαT among cMCADs patients, the associated elevation in baseline serum tryptase levels-which can influence both diagnosis and disease monitoring-and distinct clinical features, notably an increased risk of severe anaphylaxis. As a result, screening for HαT has become an integral part of the diagnostic work-up in patients with cMCADs. However, several key questions remain unresolved: Why is HαT more prevalent among cMCADs patients? How can we accurately distinguish between HαT and cMCADs during the diagnostic process? And how does the presence of this genetic trait influence the clinical management of cMCADs? In this article, we present the position and clinical approach of the French National Reference Center for Mastocytosis (CEREMAST).
Biologics targeting interleukin-17 (IL-17) are widely used for moderate to severe psoriasis with great efficiency. Nonetheless, their usage has sporadically resulted in paradoxical reactions, such as eczema, sarcoidosis-like eruptions, alopecia areata, and pyoderma gangrenosum. Here, we report a case of temporary facial eczema to secukinumab with a score of 5 on the Naranjo scale, which suggests a probable drug side effect. The patient was a 32-year-old Chinese male with a history of chronic plaque psoriasis for 5 years. He was previously treated with topical steroids, calcipotriol, narrowband ultraviolet B phototherapy, and oral traditional Chinese medicine intermittently since 2020. In January of 2025, his psoriasis exacerbated and was not well controlled. The patient underwent an initial regimen of 300 mg secukinumab once weekly for 4 weeks, with significant psoriasis area and severity index (PASI) improvement, and was scheduled to continue maintenance therapy on a regimen of every 4 weeks. However, in the seventh week of the secukinumab treatment course, the patient's face developed diffuse, swollen, erythematous patches that had almost coalesced into sheets. The surface is smooth, without scales, blisters, or exudation, and accompanied by mild itching. Lab tests show elevated alanine aminotransferase (ALT) at 83.2 U/L (normal range: 9-50 U/L), slightly increased direct bilirubin at 8.48 μmol/L (normal range: 0-8.0 μmol/L). Other lab tests showed no significant abnormalities. After oral compound glycyrrhizin, olopatadine hydrochloride, triprolidine hydrochloride, and topical pimecrolimus for a week, his facial lesions were completely cleared. Liver function tests normalized following a 2-week course of polyenphosphatidylcholine. The patient delayed secukinumab administration by 2 weeks and continued 300 mg secukinumab administration on a regimen of every 4 weeks. No recurrence of similar rash or other adverse effects was observed during the subsequent follow-up period over 5 months. It is concluded that eczema could be induced temporarily by secukinumab, and maybe continued application.
Background: Although biologic therapies have transformed the management of severe asthma, reliable blood-based markers to measure treatment response and predict residual exacerbation risk remain limited. The aim of this study was evaluating routine hematologic indices as predictors of disease control and exacerbations after biologic therapy.
Methods: A cohort study included 107 patients with severe asthma were assessed before and after one year of initiating biologics. Asthma control was measured with the Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ-6); exacerbations were prospectively recorded. Complete blood counts were obtained at both time-points.
Results: patients with severe asthma were predominantly middle-aged, obese, non-smoking women with poorly controlled asthma and elevated eosinophil counts. Biologic therapy resulted in a significant reduction in median blood eosinophil count, halving it from 480 to 240 cells/µl (p < 0.001). Smaller but statistically significant decreases were also observed in total leukocyte count and neutrophil count (both p = 0.02), leading to a marked increase in the neutrophil-to-eosinophil ratio (NER, p < 0.001). Post-treatment, higher neutrophil counts and NER correlated with poorer asthma control, while elevated neutrophils, monocytes, and NER were significantly associated with exacerbations. Logistic regression confirmed monocytes (OR 1.03, P = 0.01) and NER (OR 1.07, P = 0.04) as independent predictors of exacerbation, with ROC analysis showing their significant discriminative ability (AUC 0.64-0.66). Depending on the clinical objective to rule out or confirm exacerbation risk, specific cutoffs for NER (>3.97) and monocytes (>435/µl) offered high sensitivity (∼92%), or high cutoffs for NER (>50.65) and monocytes (>755/µl) offered high specificity (∼91%).
Conclusion: Biologic therapy significantly reduced eosinophils and altered NER in severe asthma. Prominently, elevated post-treatment neutrophils, monocytes, and particularly a higher NER, were significant predictors of poorer asthma control and increased exacerbation risk, offering clinically useful biomarkers for personalized management.
Background: Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires rapid identification and intervention. Predicting individuals at risk remains a clinical challenge due to its multifactorial nature and variable presentation.
Objective: To develop and evaluate explainable machine learning models that predict the risk of anaphylaxis using routinely collected clinical data.
Methods: We analysed a matched case-control dataset derived from anonymised electronic health records. After applying chi-squared-based feature selection, we trained multiple classification algorithms-including logistic regression, decision trees, random forests, XGBoost, and a stacking ensemble. Model performance was evaluated using AUC, sensitivity, specificity, precision, and F1-score. SHAP values were used to assess model explainability.
Results: The best-performing model achieved an AUC of 0.79, demonstrating high discrimination and balanced sensitivity/specificity. Key predictors included healthcare utilisation patterns, age, socioeconomic proxy (copayment level), and specific diagnostic codes related to allergic conditions.
Conclusion: This study demonstrates the potential of interpretable machine learning approaches to support the early identification of individuals at high risk of anaphylaxis. These tools can enhance clinical risk stratification and inform preventive strategies in routine practice.
Background: The epithelial barrier serves as the body's first line of defense between the host immune system and the external environment. Evidence confirms that epithelial barrier damage is an initial event in the pathogenesis of allergic respiratory diseases, during which the barrier exhibits a dual "Janus-faced" role.
Methods: This review synthesizes current literature to explore the molecular and cellular mechanisms underlying epithelial barrier dysfunction, including dysregulation of tight junctions, aberrant immune signaling, and release of pro-inflammatory alarmins. We also evaluate contemporary diagnostic technologies for assessing the epithelial barrier and analyze current therapeutic strategies aimed at its restoration.
Results: An intact respiratory epithelial barrier effectively defends against allergens and pathogens. When compromised, it exacerbates inflammatory responses through the release of alarmins. Advances in omics-based profiling and advanced imaging now enable precise assessment of barrier integrity. Therapeutically, innovative strategies-including immunomodulators, biologics, and novel agents targeting epithelial repair pathways-offer promising avenues for restoring barrier function and controlling inflammation.
Conclusion: Real-time and effective diagnosis of epithelial barrier integrity, coupled with therapeutic strategies targeting the barrier, are pivotal for achieving long-term disease control in asthma, allergic rhinitis, and related conditions. Future research should focus on barrier-centric integrated approaches to bridge fundamental scientific discoveries with clinical applications.
Introduction: Allergic rhinitis (AR) is a systemic respiratory condition that is associated with a considerable humanistic burden and is frequently underdiagnosed. Despite the known effects of AR on individual patient well-being, the wider impact of AR on the UK healthcare system remains poorly defined. We aimed to compare healthcare resource use (HCRU) posed by this disease across different age groups between patients who were diagnosed in primary care only vs. those who have a secondary care diagnosis.
Methods: In this retrospective, observational study, patients with an AR record (AR diagnosis) and patients with a record of presenting with AR symptoms but no previous AR diagnosis (AR presentation) in the UK between 2009 and 2019 were defined from primary care and secondary care databases. Patients in the AR diagnosis cohort were further categorized based on whether they had a diagnostic code in primary care only, or any relevant diagnostic code(s) in secondary care for allergist or Ear, Nose, and Throat (ENT) services referrals. Key outcomes included specialist referrals, general practitioner (GP) visits, respiratory-related hospitalizations, GP-prescribed AR-related prescriptions, and coincident asthma.
Results: A total of 3,344,716 patients were defined as presenting signs of AR and 677,771 patients were defined as having an AR diagnosis between 2009 and 2019. Only 11.7% of the AR presentation group received ≥1 referral to an allergist or ENT, and most patients in the AR diagnosis group received a diagnosis in primary care only (89.3%). Compared to their HCRU before diagnosis, patients diagnosed with AR experienced an increase in mean GP visits [7.5-10.0 per patient per year (PPPY)], respiratory-related hospitalizations (5.5-7.1 PPPY), and AR-related medications (mean 8.8-15.0 PPPY). Patients with at least one diagnostic code in secondary care generally reported higher HCRU post-diagnosis than those in primary care. The incidence rate of asthma was lower after AR diagnosis compared to before, with a shorter interval between the onset of asthma and the diagnosis of AR.
Conclusion: Patients with AR impose a greater burden on the UK healthcare system following their diagnosis, especially those who require follow-up from respiratory specialists.
Introduction: Allergen immunotherapy (AIT) is an effective and safe treatment; however, it is not recommended in consensus guidelines for severe allergic asthma patients. As AIT has been shown to be capable of modifying the course of the disease, it should be considered a concomitant treatment for specific asthma patients. This study aimed to define the profile of patients with severe allergic asthma who are most likely to benefit from AIT.
Methods: A conjoint analysis approach was adopted to comprehensively assess the importance of clinical attributes in therapeutic decision-making. A scientific committee selected the main attributes to be considered: lung function, clinical control of allergic asthma, current main treatment and etiological confirmation of moderate to severe allergic asthma. Using the fractional factorial analysis technique, 8 eligible patient profiles for AIT were defined. Participant allergists, by means of a questionnaire, classified the profiles in order of preference, mimicking the comprehensive assessment performed in clinical practice.
Results: 91 allergists from Spain and Portugal with experience in asthma and AIT participated in the study. Allergists gave greater importance to the clinical control of allergic asthma (relative importance of 51.6%), followed by preserved lung function (relative importance of 25.0%), thus confirming that the most important criterion was good control of the underlying asthmatic condition.
Conclusions: The expert allergists endorse the use of AIT in the management of moderate to severe allergic asthma in patients with appropriate clinical characteristics. Additional studies to further investigate the safety and effectiveness of this new therapeutic approach would be of interest.
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