Frontiers in allergy最新文献

Crustacean allergy, a common food allergy triggered by immune reactions to proteins in shrimp, lobster, and crab, involves over ten identified allergenic proteins and can lead to severe symptoms, including anaphylaxis. Shellfish-allergic individuals are often sensitized to house dust mites (HDM), yet the specific interrelationships remain unclear. This study analyzed 93 seafood-allergic individuals and selected 54 subjects with positive skin prick tests and/or ImmunoCAP-measured specific IgE to crustaceans. Allergy Explorer 2 (ALEX2) testing was subsequently performed for these individuals. The most reactive mite allergens (in total over 81%), included Der p 1, Der p 2, Der p 23, Der f 1, Der f 2, Gly d 2, and Lep d 2. Der p 23 alone was identified in over 61% of crustacean allergic subjects. Anaphylaxis was reported in 11 subjects, correlating strongly with IgE sensitization to tropomyosin (63.6%), but also to Lep d 2 and Der p 23 (both 54.5%). These findings stress the complex sensitization patterns in crustacean-mite allergic individuals in the tropics, highlighting both tropomyosin and non-tropomyosin cross- and co-reactivity. The significant IgE reactivity to Der p 23 and arginine kinase suggests the need for enhanced diagnostic approaches and further investigation into the clinical implications of these sensitization patterns in crustacean and mite sensitised individuals for improved allergy management.

Background: Pediatric atopic dermatitis (AD) demonstrate significantly higher rates of both general behavioral problems and condition-specific maladaptive behaviors. These behavioral challenges often interfere with parental treatment adherence and compromise disease management effectiveness. The Eczema Behavior Checklist Extent Scale (EBC-ES), initially developed and validated in Australia, represents the first psychometric tool specifically designed to evaluate AD-specific behavioral problems in children. However, its cross-cultural applicability and validation in Chinese populations remain unexplored.

Objective: This study aimed to culturally adapt and validate the Chinese version of the EBC-ES for assessing AD-specific behavioral problems in pediatric patients across China.

Methods: The Chinese EBC-ES utilized Brislin's validated back-translation protocol for cultural adaptation. This cross-sectional study recruited 674 parents (mean age 35.5 ± 4.7 years, range 24-49) of 3-10-year-old children (mean 5.9 ± 1.8) with physician-diagnosed AD. The sample comprised 369 boys (54.7%) and 305 girls (45.3%). Participants completed the Chinese EBC-ES and the Eyberg Child Behavior Inventory-Intensity scale (ECBI-IS). Psychometric evaluation included exploratory and confirmatory factor analyses (EFA, CFA) to assess construct validity, content validity indices (CVI), internal consistency (Cronbach's α, McDonald's ω), split-half reliability, and test-retest reliability.

Results: The final 24-item Chinese EBC-ES demonstrated a stable three-factor structure (eigenvalues >1), accounting for 80.44% of the total variance. The Kaiser-Meyer-Olkin measure confirmed sampling adequacy (KMO = 0.942), and Bartlett's test supported factorability (χ² = 14,091.013; p < 0.001). CFA indicated excellent model fit: chi-square degree of freedom (χ²/df) = 2.855, root mean square error of approximation (RMSEA) = 0.075, standardized root mean square residual (SRMR) = 0.041. Comparative Fit Index (CFI) = 0.948, Tucker Lewis Index (TLI) = 0.942, Normed Fit Index (NFI) = 0.923, and Incremental Fit Index (IFI) = 0.948. The scale showed strong content validity (CVI = 0.96), high internal consistency (α=0.968, ω = 0.987), excellent test-retest reliability (r = 0.969), and satisfactory split-half reliability (r = 0.895).

Conclusion: The Chinese version of the EBC-ES demonstrates robust psychometric properties, confirming its reliability and validity for AD-specific child behavioral problems in both clinical practice and research settings within Chinese populations.

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.