Frontiers in allergy最新文献

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.

Background: Social phobia and asthma pose threats to the health of adolescents at the psychological and physical levels, respectively. The aim of this study was to explore the association between social phobia and asthma in this population.

Methods: A total of 337 adolescent asthma patients and 337 adolescent controls were included. Social phobia status was assessed using the Mini Social Phobia Inventory (Mini-SPIN) and the Social Anxiety Scale for Children (SASC). The ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC), the percentage of forced expiratory volume in 1 s to its predicted value (FEV1%pred), peak expiratory flow, and peripheral levels of plasma eosinophil, immunoglobulin E (IgE), leukotriene, and histamine were also measured. Multivariate logistic or linear regression analyses were used to evaluate the associations between social phobia-related variables and asthma-related variables.

Results: Elevated scores on the Mini-SPIN and SASC scales were associated with an increased risk of asthma in adolescents (both P < 0.001). This association remained consistent among adolescents with new-onset asthma (both P < 0.001) and those experiencing asthma recurrence in adolescence following a childhood asthma history (both P < 0.001). Meanwhile, higher scores on both scales correlated with decreased FEV1/FVC (both P < 0.001) and FEV1%pred (P = 0.001 and P = 0.002, respectively) and elevated leukotriene levels (P < 0.001 and P = 0.001, respectively). However, neither scale showed an association with plasma eosinophil, IgE, or histamine levels.

Conclusion: Among adolescents, there was a significant association between social phobia and asthma.

Allergic rhinitis (AR) is a complex, multifactorial condition that continues to pose significant clinical and public health challenges, despite the availability of established therapeutic strategies. It significantly contributes to a lower quality of life by causing sleep issues, mental fatigue, and a decline in productivity. A thorough grasp of AR is crucial to enhancing diagnosis and treatment results because of its pervasive effects and ongoing management gaps. This review covers a wide range of topics, such as classification schemes, historical perception, and physical consequences of AR. It talks about the etiological elements that influence the pathophysiology of the illness and sheds light on the immune systems at play. By critically examining current diagnostic limitations and barriers to early intervention, this review underscores the necessity for improved clinical awareness and patient education. Additionally, the paper assesses the variety of existing treatment options, ranging from allergy immunotherapy to pharmaceutical interventions, and investigates breakthroughs in the treatment of AR, including phytotherapy and innovative therapeutic techniques. Trends in patient preferences and clinical uptake are noted, along with the market's evolution for AR treatments. Furthermore, current clinical studies for possible pharmacotherapies are examined, highlighting the significance of continued innovation in the treatment of AR. The review's conclusion makes recommendations for enhancing clinical practice, public health initiatives, and patient outcomes as well as future research directions. By highlighting the necessity of improved clinical awareness and intervention techniques, this thorough analysis seeks to offer a comprehensive understanding of AR and its management.

Thymic stromal lymphopoietin (TSLP), IL-33, and IL-25 are epithelial-derived proinflammatory alarmin cytokines that drive inflammatory airway diseases such as asthma and chronic obstructive pulmonary disease (COPD). Targeted inhibition of these proteins has demonstrated varying degrees of efficacy in patients with asthma and COPD. As the biology of inflammatory respiratory disease is complex, combination approaches that directly inhibit multiple targets may provide deeper efficacy in a broader patient population. Here, we review the biology of alarmins and the development landscape for monotherapies and multispecific alarmin inhibitors.

Introduction: Allergic asthma affects over 300 million people globally, characterized by a type 2 immune response to allergens like house dust mite (HDM). This includes eosinophilia, IgE production, and symptoms such as bronchial hyperresponsiveness. Human milk oligosaccharides (HMOS), ingested by breastfed infants, have immunomodulatory effects and may help prevent allergic diseases, like asthma.

Methods: This study investigates the effects of two sialylated HMOS, 3'-sialyllactose (3'SL) and 6'-sialyllactose (6'SL), in a murine model of HDM-induced allergic asthma. Male BALB/c mice (6-7 weeks old) were fed an AIN93G diet with or without 0.1% or 0.5% 3'SL or 6'SL from 2 weeks before HDM sensitization until sacrifice. Airway hyperresponsiveness was measured after the final HDM challenge, and broncho-alveolar lavage fluid (BALF) and lung tissue were collected for analysis.

Results: Dietary 0.5% 3'SL, 0.1% 6'SL, or 0.5% 6'SL prevented methacholine-induced airway hyperresponsiveness in HDM-challenged mice compared to control diet. Mice fed the 0.5% 3'SL diet had elevated SCFA levels in cecum content. Both 3'SL and 6'SL groups showed reduced HDM-induced macrophage influx in BALF. Mice on 3'SL diets had lower total inflammatory cell influx, while those on 0.5% 6'SL had increased eosinophils in BALF, associated with higher IL33, TNFα, CCL5, IFNγ levels, and reduced regulatory T cells. The 3'SL diets also prevented increases in HDM-specific IgE and mMCP1 in serum.

Conclusion: Dietary 3'SL and 6'SL showed dose-dependent, differential clinical and immunological outcomes in HDM-sensitized mice. Both 0.5% 3'SL, 0.1% 6'SL, and 0.5% 6'SL reduced airway hyperresponsiveness. However, 0.5% 6'SL increased eosinophilic inflammation, while 3'SL protected against HDM-induced sensitization and asthma development.

Consumption of an amino acid-based formula (AAF) with added synbiotics [short-chain oligofructose and long-chain inulin (scFOS/lcFOS, 9:1 ratio) and Bifidobacterium breve M-16V] (AAF-S) beneficially impacts the gut microbiome of infants with cow's milk allergy (CMA). We assessed the effect of consuming AAF with or without synbiotics by children with CMA for 12 months on their fecal (branched) short-chain fatty acids (SCFA/BCFA) concentrations, and on gut barrier and inflammation markers (Netherlands Trial Register NTR3725). Feces and saliva were collected from 161 children (≤13 months) with IgE-mediated CMA at baseline, 6 and 12 months after enrollment, and at 24 and 36 months follow-up. Fecal SCFA and BCFA were analyzed by gas chromatography, and gut barrier and inflammation markers were measured in saliva/feces by ELISA or ImmunoCAP. At 6 months, children receiving AAF-S had significantly lower fecal propionate, valerate and BCFA concentrations compared to children consuming AAF. The percentage of propionate from the total 6 SCFA/BCFA (acetate + butyrate + propionate + valerate + isobutyrate + isovalerate) was significantly lower, while the percentage of acetate from the total 6 SCFA/BCFA was significantly higher in the AAF-S group. There were no significant differences between groups in fecal concentrations of butyrate at 6 months, nor in SCFA or BCFA at baseline and after 12, 24 or 36 months. Intestinal inflammation and barrier markers did not differ between groups. Addition of synbiotics to AAF brings concentrations of key fecal microbial metabolites more in line with patterns observed in healthy breastfed infants. The effects on SCFA and BCFA concentrations were transient and only seen at 6 months.

Asthma is a heterogeneous condition influenced by multiple clinical and biological factors, and obesity has emerged as a major modifier that worsens symptoms and increases the risk of exacerbations. This review aimed to examine the mechanisms by which obesity contributes to reduced responsiveness to corticosteroids, which remain the cornerstone of guideline-based asthma management. We reviewed evidence from clinical and experimental studies describing how adipose tissue dysfunction, chronic low-grade inflammation, oxidative stress, and systemic comorbidities alter glucocorticoid receptor signalling and downstream pathways. Particular attention was given to immune mechanisms such as neutrophilic inflammation and interleukin-17 signalling, as well as metabolic disturbances including hyperleptinaemia and vitamin D deficiency. We also considered the role of lifestyle factors, such as physical inactivity and dietary patterns, in sustaining corticosteroid insensitivity. Based on these insights, we evaluated both established and emerging therapeutic strategies, including weight loss, structured exercise, dietary modification, and drug repurposing with agents such as metformin, low-dose theophylline, and glucagon-like peptide-1 receptor agonists. A comprehensive synthesis of these findings highlights the need for integrated lifestyle and pharmacological interventions, and provides a framework for the development of targeted treatments to improve outcomes in patients with obesity-associated, corticosteroid-insensitive asthma.

Background: Childhood asthma is common and associated with extensive racial, ethnic and socioeconomic healthcare inequities and health disparities. Approximately 50% of children with asthma are insured by Medicaid in the U.S. and states have increasingly implemented Accountable Care Organization (ACO) models in their Medicaid programs, but little is known about the effects of ACOs on pediatric asthma quality of care, utilization, and disparities. Seventeen new ACOs were implemented in Massachusetts in 2018. Delivery System Reform Incentive Payments were provided to ACOs that could be used to improve outcomes for chronic diseases, such as asthma, through quality measures, enhanced care coordination, and community health worker staffing. This qualitative study explored caregiver experiences with pediatric asthma care for their Medicaid-insured child following ACO implementation in Massachusetts.

Methods: Semi-structured virtual interviews were conducted with caregivers of Medicaid-insured children with asthma in Massachusetts between July 1-December 31, 2023. Purposive sampling aimed to include a range of participant and practice characteristics. The overarching theoretical framework was an adaptation of the Framework of Asthma Disparities, and data were analyzed using rapid qualitative analytic methods.

Results: Of the 26 participants, 96% were female; 23% identified as Black and 39% as Hispanic. Key themes included: (1) Perceived lack of changes in asthma care related to Medicaid ACO implementation; (2) Insurance coverage influences on asthma care; (3) Perceptions of asthma management in primary care; (4) Perceptions of asthma specialist care; (5) Influence of health related social needs on pediatric asthma care and outcomes; and (6) Suggestions for improving pediatric asthma care in Medicaid ACOs. Continuity of care, communication, and asthma education were prominent subthemes.

Conclusions: Medicaid ACOs efforts to transform care delivery through increased resources and improved infrastructure for care coordination and other aspects of care may not have had a substantial influence on asthma care for children in early years of implementation, addressing a gap in knowledge about mixed-age ACOs' effects on pediatric populations. Participants' perceptions of the importance of care continuity, specialty access, and education may warrant further exploration in general and in the context of Medicaid ACO effects on asthma care for children at high risk for asthma disparities.