Frontiers in allergy最新文献

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The bradykinin-forming cascade in anaphylaxis and ACE-inhibitor induced angioedema/airway obstruction 过敏性休克和 ACE 抑制剂诱发的血管性水肿/气道阻塞中的缓激肽形成级联反应

Frontiers in allergy

Pub Date : 2024-01-25 DOI: 10.3389/falgy.2024.1302605

Berhane Ghebrehiwet, K. Joseph, Allen P. Kaplan

Anaphylaxis is a potentially life-threatening multi-system allergic reaction to a biological trigger resulting in the release of potent inflammatory mediators from mast cells and basophils and causing symptoms in at least two organ systems that generally include skin, lungs, heart, or gastrointestinal tract in any combination. One exception is profound hypotension as an isolated symptom. There are two types of triggers of anaphylaxis: immunologic and non-Immunologic. Immunologic anaphylaxis is initiated when a foreign antigen directly binds to IgE expressed on mast cells or basophils and induces the release of histamine and other inflammatory substances resulting in vasodilation, vascular leakage, decreased peripheral vascular resistance, and heart muscle depression. If left untreated, death by shock (profound hypotension) or asphyxiation (airway obstruction) can occur. The non-immunologic pathway, on the other hand, can be initiated in many ways. A foreign substance can directly bind to receptors of mast cells and basophils leading to degranulation. There can be immune complex activation of the classical complement cascade with the release of anaphylatoxins C3a and C5a with subsequent recruitment of mast cells and basophils. Finally, hyperosmolar contrast agents can cause blood cell lysis, enzyme release, and complement activation, resulting in anaphylactoid (anaphylactic-like) symptoms. In this report we emphasize the recruitment of the bradykinin-forming cascade in mast cell dependent anaphylactic reactions as a potential mediator of severe hypotension, or airway compromise (asthma, laryngeal edema). We also consider airway obstruction due to inhibition of angiotensin converting enzyme with a diminished rate of endogenous bradykinin metabolism, leading not only to laryngeal edema, but massive tongue swelling with aspiration of secretions.

过敏性休克是一种可能危及生命的多系统过敏反应，由生物诱因导致肥大细胞和嗜碱性粒细胞释放强效炎症介质，并引起至少两个器官系统的症状，通常包括皮肤、肺部、心脏或胃肠道的任何组合。极度低血压是一个例外，它是一种孤立的症状。过敏性休克有两种诱因：免疫性和非免疫性。免疫性过敏性休克是指外来抗原直接与肥大细胞或嗜碱性粒细胞上表达的 IgE 结合，诱导释放组胺和其他炎症物质，导致血管扩张、血管渗漏、外周血管阻力下降和心肌抑制。如果不及时治疗，可能会因休克（严重低血压）或窒息（气道阻塞）而死亡。另一方面，非免疫途径可通过多种方式启动。外来物质可直接与肥大细胞和嗜碱性粒细胞的受体结合，导致脱颗粒。经典补体级联的免疫复合物可能会被激活，释放出 C3a 和 C5a 等无性毒素，随后肥大细胞和嗜碱性粒细胞会被招募。最后，高渗造影剂可导致血细胞溶解、酶释放和补体激活，从而引起过敏性休克（类过敏性休克）症状。在本报告中，我们强调在肥大细胞依赖性过敏反应中缓激肽形成级联的招募是严重低血压或气道损伤（哮喘、喉头水肿）的潜在介质。我们还认为，由于血管紧张素转换酶受到抑制，内源性缓激肽代谢率降低，导致气道阻塞，这不仅会引起喉头水肿，还会导致舌头肿胀并吸入分泌物。

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引用次数: 0

Phenotypes, endotypes and genotypes of atopic dermatitis and allergy in populations of African ancestry on the continent and diaspora 非洲大陆和散居地非洲裔人群特应性皮炎和过敏症的表型、内型和基因型

Frontiers in allergy

Pub Date : 2024-01-24 DOI: 10.3389/falgy.2023.1203304

N. Lunjani, T. Kerbelker, F. B. Mdletshe, C. Hlela, L. O’Mahony

Atopic dermatitis is a complex inflammatory condition characterized by synergist interactions between epidermal and immune related genotypes, skin barrier defects and immune dysregulation as well as microbial dysbiosis. Ethnicity-specific variations in clinical presentation, immune endotypes and genetic susceptibility have been described in diverse populations. We summarize available data with specific consideration of AD in populations of African ancestry. Some highlights include the observation of AD lesions on extensor surfaces, lichen planus-like AD, prurigo type AD and follicular AD in African populations. In addition, a consistent absence of dominant filaggrin gene defects has been reported. The detection of normal filaggrin protein content in AD skin implicates the contribution of alternative mechanisms in the pathogenesis of AD in African patients. Markedly high IgE has been described in paediatric and adult African AD. While Th2, Th22 and Th17 activation in African AD skin shares the same direction as with other populations, it has been noted that the magnitude of activation is dissimilar. Reduced Th17 cytokines have been observed in the circulation of moderate to severe paediatric AD.

特应性皮炎是一种复杂的炎症，其特点是表皮和免疫相关基因型、皮肤屏障缺陷和免疫调节失调以及微生物菌群失调之间的协同作用。在不同的人群中，临床表现、免疫内型和遗传易感性都存在种族特异性差异。我们总结了现有数据，并特别考虑了非洲裔人群中的先天性痴呆症。其中一些亮点包括在非洲人群中观察到的伸肌表面 AD 病变、扁平苔藓样 AD、瘙痒型 AD 和毛囊性 AD。此外，据报道，非洲人中始终没有显性丝胶蛋白基因缺陷。在 AD 皮肤中检测到正常的丝胶蛋白含量表明，非洲患者 AD 的发病机制中存在其他机制。在非洲裔 AD 儿童和成人中，IgE 明显偏高。虽然非洲裔 AD 皮肤中 Th2、Th22 和 Th17 的活化方向与其他人群相同，但活化程度却不同。在中度至重度儿童 AD 的血液循环中观察到 Th17 细胞因子减少。

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引用次数: 0

Clinical utility of and correlation between Sniffin' Sticks and TIB smell identification test (TIBSIT) among Hong Kong Chinese with or without chronic rhinosinusitis 在患有或未患有慢性鼻炎的香港华人中，嗅探棒与TIB气味鉴定测试（TIBSIT）的临床实用性及其相关性

Frontiers in allergy

Pub Date : 2024-01-24 DOI: 10.3389/falgy.2024.1292342

H. W. Mak, Shi Yeung Ho, J. C. Wong, V. Chiang, Elaine Lee, Jackie S. H. Yim, Birgitta Y. H. Wong, Philip H Li

Olfactory dysfunction (OD) is common among patients with chronic rhinosinusitis (CRS). Validated and culturally specific tests, such as the “Sniffin’ Sticks” test (SST) and the TIB Smell Identification Test (TIBSIT), are crucial for the diagnosis and monitoring of OD. However, they have not been utilised in Hong Kong Chinese and their correlations are unknown.Twelve CRS patients and twenty healthy volunteers were prospectively recruited from a joint allergy-otorhinolaryngology clinic in Hong Kong and performed both SST and TIBSIT. Demographics, baseline characteristics and all test results were compared and analysed.Patients with CRS demonstrated significantly lower test scores than healthy controls (all p < 0.001). Significant and strong correlations were observed between all composite and subtest scores, particularly between the composite SST and TIBSIT scores (ρ = 0.789, p < 0.001). Multivariate analysis demonstrated that the presence of CRS and increasing age were significantly associated with OD.Both SST and TIBSIT are useful olfactory tests and are strongly correlated among Hong Kong Chinese. We advocate that either test can be used for measuring OD among CRS patients.

嗅觉功能障碍（OD）在慢性鼻炎（CRS）患者中很常见。经过验证且具有文化特异性的测试，如 "嗅棒 "测试（SST）和TIB气味识别测试（TIBSIT），对于诊断和监测嗅觉障碍至关重要。我们从香港一家过敏-耳鼻喉科联合诊所招募了 12 名 CRS 患者和 20 名健康志愿者，对他们进行了 SST 和 TIBSIT 测试。对人口统计学、基线特征和所有测试结果进行了比较和分析。CRS 患者的测试得分明显低于健康对照组（所有 P < 0.001）。在所有综合和分项测试得分之间，尤其是在 SST 和 TIBSIT 综合得分之间，观察到了显著的强相关性（ρ = 0.789，p < 0.001）。多变量分析表明，CRS 的存在和年龄的增加与 OD 显著相关。我们认为这两种测试均可用于测量 CRS 患者的 OD。

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引用次数: 0

Case Report: A family history of peanut allergy and hereditary alpha-tryptasemia 病例报告：花生过敏和遗传性α-色氨酸血症家族史

Frontiers in allergy

Pub Date : 2024-01-23 DOI: 10.3389/falgy.2023.1322117

Yannick Chantran, Hélène Renaudin, Michel Arock, Tamazoust Guiddir, A. Nemni

Hereditary alpha-tryptasemia (HαT) is associated with elevated basal serum tryptase (bST) and is associated with a higher risk of severe anaphylactic reactions in patients with clonal mast cell disorders or IgE-mediated Hymenoptera venom-induced anaphylaxis. The consequence of this genetic trait remains to be determined in other allergic diseases and food allergy in particular.Here, we describe three cases of peanut allergy among siblings from a single family of four: two of them were associated with HαT, and the third one was associated with the tryptase wild-type genotype.TPSAB1/TPSB2 genotypes were determined by digital PCR. After the case description, we provided a review of the literature regarding bST levels and tryptase genotypes in anaphylaxis, with a particular focus on food allergy.Compared to the sibling with the conventional tryptase genotype, the two siblings with HαT presented a lower peanut threshold at the initial oral food challenge, higher peanut skin prick test reactivity, higher levels of specific IgE to peanut, Ara h 2, and Ara h 6, and a lower IgG4/IgE ratio after 10 years of oral immunotherapy.The tryptase genotype and HαT status might modify the clinical presentation and biological features of food allergy.

遗传性α-胰蛋白酶血症（HαT）与基础血清胰蛋白酶（bST）升高有关，并与患有克隆肥大细胞疾病或 IgE 介导的膜翅目昆虫毒液诱发过敏性休克的患者发生严重过敏反应的风险较高有关。在这里，我们描述了一个四口之家的三例花生过敏病例：其中两例与 HαT 有关，第三例与胰蛋白酶野生型基因型有关。TPSAB1/TPSB2 基因型是通过数字 PCR 测定的。在对病例进行描述后，我们回顾了有关过敏性休克的 bST 水平和胰蛋白酶基因型的文献，尤其是有关食物过敏的文献。与传统胰蛋白酶基因型的兄弟姐妹相比，HαT 基因型的两个兄弟姐妹在初次口服食物挑战时的花生阈值较低，花生皮肤点刺试验反应性较高，花生、Ara h 2 和 Ara h 6 特异性 IgE 水平较高，口服免疫疗法 10 年后的 IgG4/IgE 比率较低。

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引用次数: 0

Feasibility of a drug allergy registry-based excipient allergy database and call for universal mandatory drug ingredient disclosure: the case of PEG 基于药物过敏登记处的辅料过敏数据库的可行性以及呼吁普遍强制披露药物成分：PEG 案例

Frontiers in allergy

Pub Date : 2024-01-16 DOI: 10.3389/falgy.2023.1331036

Andy Ka Chun Kan, Valerie Chiang, Chinmoy Saha, E. Au, P. Li

Excipient allergy is a rare, but potentially lethal, form of drug allergy. Diagnosing excipient allergy remains difficult in regions without mandatory drug ingredient disclosure and is a significant barrier to drug safety.To investigate the feasibility of a drug allergy registry-based excipient database to identify potential excipient culprits in patients with history of drug allergy, using polyethylene glycol (PEG) as an example.An excipient registry was created by compiling the excipient lists pertaining to all available formulations of the top 50 most reported drug allergy culprits in Hong Kong. Availability of excipient information, and its relationship with total number of formulations of individual drugs were analysed. All formulations were checked for the presence or absence of PEG.Complete excipient information was available for 36.5% (729/2,000) of all formulations of the top 50 reported drug allergy culprits in Hong Kong. The number of formulations for each drug was associated with proportion of available excipient information (ρ = 0.466, p = 0.001). Out of 729 formulations, 109 (15.0%) and 620 (85.0%) were confirmed to contain and not contain PEG, respectively. Excipient information was not available for the other 1,271 (63.6%) formulations. We were unable to confirm the presence or absence of PEG in any of the top 50 drug allergy culprits in Hong Kong.In countries without mandatory drug ingredient disclosure, excipient databases are unlikely able to identify potential excipient allergy in drug allergy patients. Legislations to enforce mandatory and universal ingredient disclosure are urgently needed.

辅料过敏是一种罕见但可能致命的药物过敏形式。以聚乙二醇（PEG）为例，研究基于药物过敏登记处的辅料数据库的可行性，以确定有药物过敏史的患者中潜在的辅料元凶。通过汇编香港报告最多的前 50 种药物过敏元凶的所有可用制剂的辅料清单，建立了辅料登记处。分析了辅料信息的可用性及其与个别药物配方总数的关系。在香港报告的药物过敏元凶前 50 名的所有配方中，36.5%（729/2,000）可提供完整的辅料信息。每种药物的配方数量与可获得辅料信息的比例相关（ρ = 0.466，p = 0.001）。在 729 种制剂中，分别有 109 种（15.0%）和 620 种（85.0%）被证实含有或不含 PEG。其他 1,271 种制剂（63.6%）没有辅料信息。在没有强制披露药物成分的国家，辅料数据库不太可能识别出药物过敏患者的潜在辅料过敏。因此，亟需立法强制和普遍公开药物成分。

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引用次数: 0

Corrigendum: Approach for delabeling beta-lactam allergy in children. 更正：儿童对β-内酰胺过敏的脱标方法。

Frontiers in allergy

Pub Date : 2024-01-12 eCollection Date: 2023-01-01 DOI: 10.3389/falgy.2023.1361973

R Sáenz de Santa María, G Bogas, M Labella, A Ariza, M Salas, I Doña, M J Torres

[This corrects the article DOI: 10.3389/falgy.2023.1298335.].

[此处更正了文章 DOI：10.3389/falgy.2023.1298335]。

引用次数: 0

Depressive symptoms are related to asthma control but not self-management among rural adolescents. 抑郁症状与哮喘控制有关，但与农村青少年的自我管理无关。

Frontiers in allergy

Pub Date : 2024-01-11 eCollection Date: 2023-01-01 DOI: 10.3389/falgy.2023.1271791

Neha B Patel, Amarilis Céspedes, Jianfang Liu, Jean-Marie Bruzzese

Background: Depression, a relevant comorbidity with asthma, has been reported to be associated with asthma morbidity. Asthma self-management is essential to asthma control and may be negatively impacted by depression. We examined these associations in rural adolescents, a group with relatively high asthma morbidity and depressive symptoms, a population often ignored in asthma research.

Methods: We used baseline data from a randomized trial of an asthma intervention for adolescents in rural South Carolina (n = 197). Adolescents completed the Center for Epidemiological Studies-Depression (CES-D), three indices of asthma self-management (the Asthma Prevention Index, the Asthma Management Index and the Asthma Self-Efficacy Index), and the Asthma Control Test (ACT). Poisson and linear regression tested associations between depression, self-management, and asthma control. The models controlled for demographic variables and included school as a fixed effect.

Results: Most participants (mean age = 16.3 ± 1.2 years) self-identified as female (68.5%) and Black (62.43%). The mean CES-D score was 19.7 ± 10.3, with 61.4% of participants at risk for depression. The depressive symptoms were significantly related to asthma control [β = -0.085, 95% confidence interval (CI) = -0.14 to -0.03] but not to prevention [relative risk (RR) = 1.00, 95% CI = 0.99-1.01], management (RR = 1.00, 95% CI = 0.99-1.01), or self-efficacy (β = -0.002, 95% CI = -0.01 to 0.01).

Conclusions: In this sample of rural adolescents, as depressive symptoms increased, asthma control declined. Depressive symptoms were not associated with asthma self-management, suggesting that the aspects of self-management we assessed are not an avenue by which depression impacts asthma control. Additional research is needed to further understand the relationship between depressive symptoms, asthma self-management, and control.

背景：抑郁症是哮喘的一种相关合并症，据报道与哮喘发病率有关。哮喘自我管理对哮喘控制至关重要，而抑郁症可能会对哮喘自我管理产生负面影响。农村青少年是哮喘发病率和抑郁症状相对较高的群体，在哮喘研究中往往被忽视：我们使用了南卡罗来纳州农村青少年哮喘干预随机试验的基线数据（n = 197）。青少年填写了流行病学研究中心抑郁（CES-D）、哮喘自我管理的三个指数（哮喘预防指数、哮喘管理指数和哮喘自我效能指数）以及哮喘控制测试（ACT）。泊松回归和线性回归测试了抑郁、自我管理和哮喘控制之间的关联。这些模型控制了人口统计学变量，并将学校作为固定效应：大多数参与者（平均年龄 = 16.3 ± 1.2 岁）自我认同为女性（68.5%）和黑人（62.43%）。平均 CES-D 得分为 19.7 ± 10.3，61.4% 的参与者有抑郁风险。抑郁症状与哮喘控制明显相关[β = -0.085，95% 置信区间 (CI) = -0.14 to -0.03]，但与预防[相对风险 (RR) = 1.00，95% CI = 0.99-1.01]、管理（RR = 1.00，95% CI = 0.99-1.01）或自我效能（β = -0.002，95% CI = -0.01 to 0.01）无关：在这一农村青少年样本中，随着抑郁症状的增加，哮喘控制率也在下降。抑郁症状与哮喘自我管理无关，这表明我们评估的自我管理方面并不是抑郁症影响哮喘控制的途径。要进一步了解抑郁症状、哮喘自我管理和控制之间的关系，还需要进行更多的研究。

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引用次数: 0

Pilot study on the use of basophil activation tests and skin tests for the prevention of allergic transfusion reactions 关于使用嗜碱性粒细胞活化试验和皮试预防过敏性输血反应的试点研究

Frontiers in allergy

Pub Date : 2024-01-08 DOI: 10.3389/falgy.2023.1328227

Philippe Akiki, L. Dedeken, Alina Ferster, Virginie Doyen, Gwendy Dupire, Carole Nagant, Julie Smet, Nathalie Ghorra, Isabelle Ruth, Maïlis Lauwers, Valery Daubie, Francis Corazza, H. El Kenz

Management of severe allergic transfusion reactions (ATR) is challenging. In this study, we investigate the usefulness of skin tests and basophil activation tests (BAT) in chronically transfused patients for the prevention of future ATR.BAT and skin tests were carried with the supernatant of red blood cell (RBC) units for a sickle-cell disease patient under chronic exchange transfusion who has presented a severe ATR, in order to prevent potential future ATR. If the results for both BAT and skin tests were negative, the RBC units could be transfused to the patient. If either one of the results was positive, the tested RBC unit was discarded for the patient.192 RBC units were tested with both tests. The level of results concordance between the two tests was 95%. Out of the 169 negative units with both tests, 118 units were transfused to the patient for which he presented no ATR.In our study, combining both BAT and skin tests was associated with a good negative predictive value since we were able to safely transfuse our patient. Further studies are still necessary to confirm this result but this pilot study indicates that skin tests and BAT might help prevent ATR. When BAT is not available, skin tests may also be useful in preventing ATR.

严重过敏性输血反应（ATR）的处理极具挑战性。在这项研究中，我们调查了皮肤测试和嗜碱性粒细胞活化测试（BAT）在长期输血患者中的应用，以预防未来的输血过敏反应。如果 BAT 和皮试结果均为阴性，则可向患者输注红细胞单位。如果其中一项检测结果呈阳性，则该患者将放弃接受检测的红细胞单位192。两种检测结果的一致性为 95%。在我们的研究中，结合 BAT 和皮试具有良好的阴性预测价值，因为我们能够安全地为患者输血。仍需进一步研究来证实这一结果，但这项试点研究表明，皮试和 BAT 可能有助于预防 ATR。在无法使用 BAT 的情况下，皮试也可能有助于预防 ATR。

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引用次数: 0

Editorial: IgE mediated and non IgE mediated cow’s milk protein allergy 社论：IgE 介导和非 IgE 介导的牛奶蛋白过敏症

Frontiers in allergy

Pub Date : 2024-01-08 DOI: 10.3389/falgy.2023.1354711

Rita Nocerino

引用次数: 0

Allergen immunotherapy in China 中国的过敏原免疫疗法

Frontiers in allergy

Pub Date : 2024-01-08 DOI: 10.3389/falgy.2023.1324844

Yaqi Yang, Wen-jing Li, R. Zhu

Allergen immunotherapy (AIT) is an etiological treatment strategy that involves administering escalating doses of clinically relevant allergens to desensitize the immune system. It has shown encouraging results in reducing allergy symptoms and enhancing patients' quality of life. In this review, we offer a thorough overview of AIT in China, examining its efficacy, safety, current practices, and prospects. We further underscore the progress made in AIT research and clinical applications, as well as the distinct challenges and opportunities that China faces in this area.

过敏原免疫疗法（AIT）是一种病因学治疗策略，它是指给患者注射逐渐增加剂量的临床相关过敏原，使免疫系统脱敏。它在减轻过敏症状和提高患者生活质量方面取得了令人鼓舞的效果。在这篇综述中，我们全面概述了 AIT 在中国的发展情况，探讨了其疗效、安全性、当前实践和前景。我们进一步强调了 AIT 研究和临床应用所取得的进展，以及中国在这一领域所面临的独特挑战和机遇。

引用次数: 0

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