Frontiers in allergy最新文献

[This corrects the article DOI: 10.3389/falgy.2025.1537501.].

Introduction: Individuals allergic to peanuts (PN) may show IgE cross-reactivity to tree nuts, especially walnuts (WN), which often complicates diagnosis. Vicilin-buried peptides (VBPs), short segments within the N-terminal vicilin leader sequence (LS), contribute to cross-reactivity due to their ubiquitous, highly conserved and stable α-hairpin structures. The binding patterns of cross-reactive IgE to linear and conformational epitopes of PN and WN LSs and constituent VBPs may serve as a model for understanding clinically symptomatic cross-reactivity.

Methods: Serum samples (n = 30) from primarily oral food challenge-positive individuals with PN allergy (PNA, 33%), WN allergy (WNA, 47%), and PN and WN allergies (PWA, 20%) were collected. These sera and a monoclonal IgE antibody (6D12) were examined for IgE binding with microarrays of overlapping peptides from native Ara h 1 LS [AH1LS, Ara h 1.0101 (26-84)] and recombinant Jug r 2 LS [JR2LS, Jug r 2.0101 (1-173)] and via direct and competitive inhibition ELISA with intact LSs and constituent VBPs from PN (AH1.1) and WN (JR2.1, JR2.2, JR2.3). A mixed model analysis assessed the contribution of IgE binding patterns to VBPs in relation to PNA, WNA, or PWA status.

Results: All three intact WN VBPs bound IgE at similar frequencies, with individual sera showing varying preferences for specific VBPs. AH1.1 was less recognized by WNA individuals but more frequently recognized by PNA and PWA subjects. WN VBPs were recognized by PNA sera samples at rates comparable to AH1.1. Our data indicates that each VBP can bind to one IgE molecule with high affinity. In a competitive inhibition ELISA, combining VBP competitors did not enhance inhibition compared to the dominant VBP, suggesting that both high- and low-affinity VBPs compete for the same monoclonal IgE in serum. This observation was mimicked by 6D12, a monoclonal IgE against JR2.1.

Discussion: Cross-reactivity among VBPs most likely arises from monoclonal IgE binding to α-hairpin structures and their overlapping linear amino acid sequences. The combination of linear and conformational IgE binding patterns enabled us to differentiate between the WNA, PNA, and PWA groups in this study and may assist us in using AH1LS and JR2LS to distinguish PN and WN allergies in the future.

Background: Across all age groups, asthma disproportionally affects inner-city underserved populations. Studies on the use of at-home spirometry and digital inhalers have limited real-world evaluation in pediatric asthma.

Objectives: In this prospective exploratory study, we assessed how an integrated digital rescue inhaler and at-home spirometer would affect proper inhaler use, medication adherence, and asthma outcomes using a minimalistic real-world approach.

Methods: In total, 21 pediatric patients with asthma (8-17 years of age) were asked to replace rescue medications with the ProAir Digihaler and perform at-home gamified spirometry daily. Lung function and questionnaires were obtained at baseline and at 3-4 months.

Results: The participants were mostly male (81%), Latino/Hispanic (71%), and obese (88th ±16 percentile). Proper rescue inhaler step identification by survey did not change, but inhalation technique based on digital inhaler flow measurements improved for all participants. At-home spirometry was sporadic and reported controller adherence did not change. Younger children (age 8-11) were more severe at baseline [Composite Asthma Severity Index (CASI) of 4.8] compared to older children (CASI of 2.9). For younger children, overall asthma control test scores increased by 3.1, CASI decreased by 0.70, and the Pediatric Quality of Life Inventory scores increased by 14 and 11 for participants and parents, respectively.

Conclusions: Proper rescue inhaler step identification by survey did not change, but actual inhalation technique based on digital inhaler flow measurements improved. At-home spirometry was sporadic and reported medication adherence did not change. Younger children used the spirometer more frequently and demonstrated improvements in asthma control, severity, and quality of life. These improvements were not observed in older children.

Objective: This study analyzes a case with a JAK1 (Janus Kinase 1) inhibitor was successfully employed to treat a patient with glucocorticoid-resistant acute severe urticaria (ASU), with the aim of improving clinical understanding of this condition.

Methods: A retrospective analysis was conducted on the clinical data, diagnosis, treatment, and prognosis of a patient with acute severe urticaria, who was admitted to the Allergy Department of Tangshan Workers' Hospital on March 10, 2025.

Results: The patient was a 50-year-old female who presented with widespread skin wheals and itching, along with a sensation of throat obstruction for two days. Upon admission, the patient had a body temperature of 38.5°C. Large, irregularly shaped wheals, up to 10 cm in diameter, were observed on the skin. These wheals were bright red with surrounding erythema and increased upon scratching. Laboratory tests indicated elevated levels of white blood cells (WBC), neutrophils percentage, neutrophils absolute value, total IgE, and interleukin-6 (IL-6). A diagnosis of acute severe urticaria was made. Prior to admission, the patient had been administered with betamethasone sodium phosphate, dexamethasone sodium phosphate, methylprednisolone succinate, diphenhydramine, and calcium gluconate at the emergency department without relief in wheals and itching. Upon admission, the patient was treated with glucocorticoids and JAK1 inhibitors, resulting in the complete regression of the rash and normalization of laboratory indicators.

Conclusion: This case suggests that JAK1 inhibitors can achieve satisfactory results in treating glucocorticoid-resistant acute severe urticaria.

Background: Allergy to animal epithelium is on the rise with an estimated 26% of European adults presenting to clinics for suspected inhalant allergy are sensitized to cats, and allergen avoidance measures are often difficult to implement and often ineffective.

Methods: Real-world, retrospective study to evaluate the effectiveness and safety of subcutaneous immunotherapy (SCIT) with depigmented, polymerized cat epithelium extract (Dpg-pol-cat) in adult patients with moderate to severe allergic rhinitis/rhinoconjunctivitis with or without controlled asthma due to cat epithelium sensitization. The primary endpoint was to evaluate the effectiveness of SCIT with Dpg-pol-cat under real-life conditions, as measured by improvement in health-related quality of life (HRQoL) using the validated ESPRINT-15 questionnaire 24 months after treatment initiation.

Results: The study included 28 patients. The median age was 35 years and the median duration of treatment with Dpg-pol-cat was 21.8 months. All patients had a 1-day rush build-up schedule. Significant and sustained improvements in all domains of the ESPRINT-15 questionnaire were observed from month 6 to month 24 of treatment, as well as in reduction of rescue medication use and better asthma control. Specific IgG4 levels increased significantly after 24 months of SCIT, although no significant change was observed in mean anti-Fel d 1 IgG4 levels. Most adverse reactions were local and mild, with systemic reactions, all grade <2 according to the 2010 World Allergy Organization grading system, occurring mainly during the build-up phase.

Conclusions: SCIT with Dpg-pol-cat proved to be effective with an excellent safety profile in this real-world study, making it a good treatment option for patients with rhinitis/rhinoconjunctivitis and asthma due to allergy to cat epithelium.

Background: Air pollution, including particulate matter smaller than 10 (PM₁₀) and 2.5 (PM_2.5) µm, increases the risk for heart and lung diseases, including asthma, but has not been extensively studied as a possible etiology in eosinophilic esophagitis (EoE). We aimed to estimate the associations between exposure to PM_2.5 or PM₁₀ and EoE.

Methods: In this case-control study, using a large national pathology database of esophageal biopsies, EoE cases were defined by having biopsies with ≥15 eosinophils per high-powered field in the absence of other histopathologic causes. Controls were all other patients with esophageal biopsies. Patient residential addresses were geocoded and exposure to PM_2.5 and PM₁₀ were estimated using National Emissions Inventory data at the county level for a 5-year period including the biopsy. We estimated the odds ratios (OR) for EoE as a function of PM_2.5 or PM₁₀ exposure in tons emitted per year air using mixed logistic regression models adjusted for individual- and census tract-level characteristics.

Results: Among 12,062 EoE cases and 229,397 non-EoE controls, the unadjusted OR for PM_2.5 was 1.12 (0.99-1.25) and the adjusted OR was 1.10 (95% CI, 0.99-1.23). The unadjusted OR for PM₁₀ was 1.04 (1.00-1.07) and the adjusted odds ratio was 1.02 (95% CI, 0.99-1.06).

Discussion: Exposure to higher levels of PM₂₅ and PM₁₀ was modestly associated with EoE case status but the association was attenuated by adjusting for potential confounders. The findings suggest any etiologic role for these particulates in EoE would be of small magnitude.

[This corrects the article DOI: 10.3389/falgy.2025.1631479.].

Background: Introducing baked egg into the diet of children with hen's egg allergy (HEA) has been shown to potentially accelerate the development of tolerance to non-heated egg. However, there is no standardized egg ladder (EL) protocol, and different scientific societies across countries recommend varying versions. This study aims to assess the efficacy and safety of the four-step EL (4-EL) compared with the five-step EL (5-EL) in children with IgE-mediated HEA.

Methods: We will perform an open-label randomized trial with two-parallel arms in two departments if the same academic hospital. A total of 84 children with IgE-mediated HEA will be allocated in 1:1 ratio to introduce hen's egg allergy into their diet according to either 4-EL or 5-EL with 4-week break period between subsequent steps. Oral food challenge (OFC) with tested products at each subsequent step of the EL will be conducted in hospital settings. The primary outcome will be the percentage of children with tolerance to non-heated hen's egg proteins defined as non-allergic reaction to raw hen's egg (0.5-1 egg, depending on the age of the patient) during the last OFC; measured at the end of the 18-week observation period for the 4-EL and 24-week observation period for the 5-EL. Secondary outcomes will include the percentage of children with negative OFC to each EL step; the percentage of children with anaphylaxis (including the percentage of those who were treated with epinephrine); the percentage of children with exacerbation of atopic dermatitis; growth; compliance; and quality of life of the caregivers and parents anxiety about adverse events during their child's OFC.

Discussion: This rigorously designed RCT will provide evidence on the efficacy and safety of the 4-EL in children with IgE-mediated HEA. The findings will inform guideline development groups and further confirmatory trials.

Trial registration number: NCT07040111, date of registration: 27 June 2025.

Background: Netherton syndrome (NS) is a rare, autosomal recessive disease resulting from a mutation in the pathogenic variants in the Kazal type 5 (SPINK5) gene. In recent years, the targeted treatment of biological agents has increasingly emerged as a focal point of research.

Case reports: We reported a 4-month-old child and 19-year-old female, both presenting with symptoms including erythema, scaling, and recurring episodes. Subsequently, genetic testing identified a defective SPINK5 gene, leading to a diagnosis of NS. The child received treatment with dupilumab, while the 19-year-old woman alternated between using dupilumab and secukinumab. Both patients had swift and enduring enhancement of skin lesions during the follow-up period.

Conclusion: NS is an uncommon and frequently misdiagnosed hereditary dermatological disease. The management strategies for this condition are diverse, and no consensus exists. We implemented various biologic regimens for distinct patients, all demonstrating favorable outcomes and satisfactory tolerance. Besides, monitoring and evaluating the long-term safety of biologics in combination is essential.