The journal of allergy and clinical immunology. Global最新文献

{"title":"Global trends and modifiable risk factors for atopic dermatitis incidence: Insights from GBD 2021","authors":"Yi Xiao MD ,&nbsp;Yuxuan Chen MPH ,&nbsp;Xu Yao MD ,&nbsp;Xiang Chen PhD ,&nbsp;Juan Su MD ,&nbsp;Minxue Shen PhD","doi":"10.1016/j.jacig.2025.100532","DOIUrl":"10.1016/j.jacig.2025.100532","url":null,"abstract":"<div><h3>Background</h3><div>Global patterns in atopic dermatitis (AD) incidence and their associations with modifiable risk factors remain unclear.</div></div><div><h3>Objective</h3><div>We sought to analyze global trends in AD incidence and identify associated socioeconomic, environmental, and lifestyle factors contributing to its global disparities and epidemics.</div></div><div><h3>Methods</h3><div>Data on AD in 204 countries and territories from 1990 to 2021 were extracted from the Global Burden of Diseases Study 2021. Age-standardized incidence rates (ASIRs) were calculated by sex and region. Socioeconomic development was measured by the Sociodemographic Index, a composite indicator of income, education, and fertility. Modifiable risk factors—including high body mass index, low physical activity, air pollution, and unhealthy diets—were quantified using summary exposure values, reflecting the population-level exposure to each risk. Dietary risks included diet high in sugar-sweetened beverages, processed meat, and sodium, and low intake of whole grains. Relationships between ASIRs and summary exposure values were independently assessed using restricted cubic spline regression.</div></div><div><h3>Results</h3><div>In 2021, 16.0 million new cases of AD were recorded globally, with the highest ASIRs in high-income Asia Pacific (474.8 per 100,000 population) and Western Europe (421.7 per 100,000 population) geographically and higher ASIRs in women. AD incidence strongly increased with socioeconomic development. Among modifiable risk factors, high body mass index, low physical activity, and nitrogen dioxide pollution formed positive associations with AD risk. Diets rich in sugar-sweetened beverages, processed meat, and sodium and diet low in whole grains further increased the risk.</div></div><div><h3>Conclusions</h3><div>Global disparities in AD incidence trends are closely linked to socioeconomic development and modifiable risk factors, including obesity, air pollution, and unhealthy diets. Addressing these factors through targeted public health policies is essential to mitigating the global burden of AD, particularly in industrialized and rapidly developing regions.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 4","pages":"Article 100532"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of atmospheric particles washed away by eyewashes in Indonesia: The second report of the Jakarta study","authors":"Tatsuya Mimura MD, PhD ,&nbsp;Willitri A. Sunarya PhD ,&nbsp;Kazuhiro Tsuji PhD ,&nbsp;Eichi Uchio MD, PhD ,&nbsp;Kazumi Fukagawa MD, PhD ,&nbsp;Hiroshi Fujishima MD, PhD","doi":"10.1016/j.jacig.2025.100527","DOIUrl":"10.1016/j.jacig.2025.100527","url":null,"abstract":"<div><h3>Background</h3><div>Airborne particles from pollutants aggravate ocular and nasal symptoms.</div></div><div><h3>Objective</h3><div>We sought to investigate the effectiveness of eyewashing in removing airborne particles from the eyes and improving ocular and nasal symptoms in Jakarta.</div></div><div><h3>Methods</h3><div>Healthy volunteers were divided into car (n = 15) and motorcycle (n = 15) commuters. Both eyes were washed twice with commercial eyewash, then the number of particles in the washing solution was calculated using a microscope connected to a smartphone. Ocular and nasal symptoms before and after the first eyewash were scored using a modified Japanese Allergic Conjunctival Disease Quality-of-Life Questionnaire.</div></div><div><h3>Results</h3><div>The number of particles obtained by eyewashing was significantly higher following the first wash than that following the second wash (36.2 ± 23.2 vs 11.5 ± 10.1, <em>P</em> &lt; .001). However, the number of particles did not significantly differ between motorcycle and car commuters for both the first (36.1 ± 23.5 vs 36.3 ± 22.9) and the second washes (13.1 ± 12.4 vs 9.9 ± 6.5). Eyewashing significantly improved total ocular (3.2 ± 3.6 vs 0.9 ± 1.3, <em>P</em> = .003) and nasal (1.2 ± 1.8 vs 0.3 ± 0.7, <em>P</em> = .017) symptom scores.</div></div><div><h3>Conclusions</h3><div>Both motorcycle and car commuters have many particles in their eyes. Eyewashing removes particles from the eye and improves subjective symptoms. Therefore, eyewashing may be effective in improving ocular symptoms in countries with severe air pollution.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 4","pages":"Article 100527"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seasonal variation in respiratory syncytial virus–specific IgG concentrations in Northern Plains American Indian children with asthma","authors":"Esther Erdei PhD ,&nbsp;Dara Torgerson PhD ,&nbsp;Rae O’Leary RN ,&nbsp;Melissa Spear PhD ,&nbsp;Jake Oxendine BS ,&nbsp;Matias Shedden BS ,&nbsp;Marcia O’Leary RN ,&nbsp;Kendra Enright RN ,&nbsp;Lyle G. Best MD","doi":"10.1016/j.jacig.2025.100560","DOIUrl":"10.1016/j.jacig.2025.100560","url":null,"abstract":"<div><h3>Background</h3><div>Exposure to respiratory syncytial virus (RSV) during childhood is nearly ubiquitous by age 2 years, and infants who develop severe RSV bronchiolitis are more likely to develop asthma later in life.</div></div><div><h3>Objective</h3><div>We sought to quantify IgG response to RSV infection in American Indian children with and without asthma and to investigate the environmental, clinical, and genetic factors that associate with varying response.</div></div><div><h3>Methods</h3><div>We compared immunologic response to previous RSV infection in 319 children with and without asthma from a Northern Plains American Indian community and investigated the role of environmental and genetic factors in levels of RSV-specific IgG.</div></div><div><h3>Results</h3><div>Overall, we found 73% of children to have high concentrations of RSV-specific IgG (&gt;40 IU/mL), which was associated with the absence of asthma (<em>P</em> = 2.6 × 10⁻⁴). Parents of children with asthma reported a higher clinical burden of RSV as compared with those of children without asthma, including previous diagnosis by a health care professional (35% vs 16%; <em>P</em> = 3.5 × 10⁻³) and previous hospitalization due to RSV (18% vs 7%; <em>P</em> = 2.9 × 10⁻⁴). Among RSV-exposed individuals, children with asthma had lower concentrations of RSV IgG as compared with those without asthma (mean, 117 vs 154 IU/mL; <em>P</em> = 7.1 × 10⁻⁴). However, this difference was unique to children recruited during the winter months when RSV is thought to circulate more broadly. Multivariate regression confirmed that the strongest predictor of RSV-specific IgG concentration was an asthma and RSV season interaction (<em>P</em> = 8.3 × 10⁻⁴). Among candidate genes, we identified a genetic association between an intronic variant in <em>IFNL4</em> and RSV-specific IgG concentration whereby the minor allele (A) was associated with higher concentration (rs12979860; <em>P</em> = 4.3 × 10⁻³).</div></div><div><h3>Conclusions</h3><div>Our findings suggest a seasonal difference in immunologic response to RSV infection that varies by asthma status and warrants further investigation.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 4","pages":"Article 100560"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aims and scope","authors":"","doi":"10.1016/S2772-8293(25)00187-0","DOIUrl":"10.1016/S2772-8293(25)00187-0","url":null,"abstract":"","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 4","pages":"Article 100586"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145473485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reported penicillin allergy in Israel: Clinical outcomes and antibiotic costs in a nationwide population-based cohort study","authors":"Shirley Shapiro Ben David MD ,&nbsp;Avner Kantor MA ,&nbsp;Beatriz Hemo PhD ,&nbsp;Swetlana Donskoi RN, BSN, MMedSc ,&nbsp;Sharon Baruch-Gez MSc ,&nbsp;Daniella Rahamim-Cohen MD ,&nbsp;Na’ama Shamir-Stein MA ,&nbsp;Edna Bar-Rason MBA, MSc ,&nbsp;Alon Y. Hershko MD, PhD","doi":"10.1016/j.jacig.2025.100565","DOIUrl":"10.1016/j.jacig.2025.100565","url":null,"abstract":"<div><h3>Background</h3><div>Penicillin allergy (PA) is the most documented drug allergy and is overdiagnosed. Data on medical aspects and expenditure outcomes of PA in the outpatient setting are important for planning delabeling programs.</div></div><div><h3>Objective</h3><div>We sought to characterize the features of PA on a nationwide level and associated burden on the health care system.</div></div><div><h3>Methods</h3><div>This is a retrospective, matched cohort study conducted on members of a single health maintenance organization. Medical records of those with documented PA in 2022 were compared with those of matched subjects without allergy based on age group, sex, ethnicity, socioeconomic status, and comorbidities. Outcomes included physician encounters, hospitalizations, death events, antibiotic purchases, and costs.</div></div><div><h3>Results</h3><div>From a database of 2,602,110 individuals, 96,675 (3.7%) subjects with documented PA were included. Most were females (63.3%), mean age 47.3 ± 22 years, and had medium to high socioeconomic status (85.6%). PA was associated with more encounters with primary care physicians (odds ratio [OR], 1.42; 95% CI, 1.38-1.46; <em>P</em> &lt; .001), pediatricians (OR, 1.1; 95% CI, 1.07-1.14; <em>P</em> &lt; .001), and secondary care physicians (OR, 1.21; 95% CI, 1.19-1.24; <em>P</em> &lt; .001), and increased hospitalizations (OR, 1.12; 95% CI, 1.07-1.17; <em>P</em> &lt; .001). Death events were similar in both groups. PA was associated with increased antibiotic purchases per patient (average, 0.93 ± 1.79 vs 0.8 ± 1.58; <em>P</em> &lt; .001) at higher costs (8.91 USD vs 6.03 USD, <em>P</em> &lt; .01). It exhibited increased use of clindamycin (OR, 5.66; 95% CI, 5.38-5.95; <em>P</em> &lt; .001), macrolides (OR, 4.20; 95% CI, 4.08-4.32; <em>P</em> &lt; .001), and quinolones (OR, 1.50; 95% CI, 1.44-1.55; <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Reported PA is associated with an increased burden on health care resources but not increased mortality. PA delabeling strategies should improve antibiotic use and costs.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 4","pages":"Article 100565"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and safety of algorithm for treating pregnant women with syphilis and history of immediate allergy to penicillin","authors":"Bruna Gehlen MD,&nbsp;André Feodrippe MD,&nbsp;Juliana Fóes Bianchini Garcia MD, PhD,&nbsp;Marcelo Vivolo Aun MD, PhD,&nbsp;Jorge Kalil MD, PhD,&nbsp;Pedro Giavina-Bianchi MD, PhD","doi":"10.1016/j.jacig.2025.100572","DOIUrl":"10.1016/j.jacig.2025.100572","url":null,"abstract":"<div><h3>Background</h3><div>Penicillin is the only proven effective treatment for pregnant women with syphilis.</div></div><div><h3>Objective</h3><div>We evaluated the efficacy and safety of an algorithm to guide reexposure to penicillin in pregnant women with syphilis and a history of allergy to the drug; and identified predictive biomarkers for successful desensitization.</div></div><div><h3>Methods</h3><div>By using risk stratification, pregnant women with syphilis and a history of immediate hypersensitivity reaction to penicillin were reexposed to the drug through rapid desensitization or drug provocation test. Patients with a high-risk clinical history for anaphylaxis or positive skin test result underwent desensitization.</div></div><div><h3>Results</h3><div>The study included 127 patients. Forty-nine (38.6%) had high-risk clinical history for anaphylaxis and were desensitized, while 78 (61.4%) were at low risk and with negative skin test results underwent challenge. Skin test results were positive in 7.9% of all patients. These patients underwent desensitization, and 40% experienced a reaction. There was an association between positive skin test results and reaction during desensitization (<em>P</em> &gt; .0001). Seventy-eight patients (61.4%) considered to be at low risk were challenged, with only 3 (3.8%) experiencing a reaction. The risk stratification algorithm evaluated in this study demonstrated high efficacy (99.2%) and safety (92.1%) in guiding penicillin reintroduction.</div></div><div><h3>Conclusion</h3><div>Our algorithm for managing immediate reactions to penicillin is effective and safe. Skin testing identifies patients at higher risk for reactions. This study enables the identification of pregnant women with a history of high risk for immediate hypersensitivity to penicillin, allowing for safe desensitization treatment, or can offer low-risk pregnant women the option to delabel the allergy through a provocation test.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 4","pages":"Article 100572"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145264783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accelerated Hymenoptera testing in pediatric patients","authors":"Elizabeth S. Brunner MD,&nbsp;Jeffrey M. Chambliss MD,&nbsp;Timothy G. Chow MD","doi":"10.1016/j.jacig.2025.100570","DOIUrl":"10.1016/j.jacig.2025.100570","url":null,"abstract":"<div><h3>Background</h3><div>Skin testing is an important component of evaluating Hymenoptera sensitization in patients presenting with a suspected Hymenoptera systemic reaction. Accelerated skin testing protocols have been reported in adults, but they have not been evaluated in children.</div></div><div><h3>Objective</h3><div>Our aim was to assess the safety of an accelerated Hymenoptera testing protocol in the evaluation of Hymenoptera venom hypersensitivity systemic reactions in pediatric patients.</div></div><div><h3>Methods</h3><div>A retrospective chart review of pediatric patients evaluated for Hymenoptera venom allergy at an academic allergy clinic from January 2017 through December 2024 was conducted. The children included in the study had a history consistent with a systemic reaction, as determined by a board-certified allergist to a sting and completed Hymenoptera allergy testing. The variables collected included demographic factors, age at initial reaction, age at skin testing, comorbid atopy, Mueller severity score reaction grade, reagents and concentrations used for skin testing, and skin testing results.</div></div><div><h3>Results</h3><div>A total of 61 patients were included. Of those patients, 80% presented with systemic reactions having a Mueller grade of 2 to 4. The median age at initial sting reaction was 5 years (interquartile range 2.75-8 years), and the median age at skin testing was 6 years (interquartile range 3-8 years). In all, 36 patients underwent accelerated intradermal testing (12 for flying Hymenoptera allergy, 24 for fire ant allergy); there were no adverse events or systemic reactions to testing.</div></div><div><h3>Conclusion</h3><div>Our findings provide initial evidence suggesting that an accelerated Hymenoptera skin testing protocol is safe in the pediatric population and encouraging subsequent larger, multicenter studies evaluating the safety of this diagnostic approach.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 4","pages":"Article 100570"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145264782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and sensitization of pollen–food allergy syndrome among adolescents in Tokyo","authors":"Tomoyuki Kiguchi MD ,&nbsp;Tomoki Yaguchi MD ,&nbsp;Tatsuki Fukuie MD, PhD ,&nbsp;Yukihiro Ohya MD, PhD ,&nbsp;Kiwako Yamamoto-Hanada MD, PhD","doi":"10.1016/j.jacig.2025.100561","DOIUrl":"10.1016/j.jacig.2025.100561","url":null,"abstract":"<div><h3>Background</h3><div>Allergic rhinitis and pollen sensitization typically increase with age; however, longitudinal data on the prevalence of pollen–food allergy syndrome (PFAS) among Japanese adolescents are limited.</div></div><div><h3>Objective</h3><div>We assessed the prevalence, causal foods, and sensitization status of PFAS among 17-year-olds and explored its association with comorbid allergic conditions.</div></div><div><h3>Methods</h3><div>This study was conducted as part of the Tokyo Child Health, Disease, and Development Research, a prospective birth cohort study involving the general population. Adolescents aged 17 (range, 16-18) years participated in a cross-sectional survey that included a medical history and health questionnaire, alongside serum IgE testing by ImmunoCAP ISAC. Statistical analyses were performed by descriptive statistics.</div></div><div><h3>Results</h3><div>Among 458 participants, 54.4% had current pollen allergy and 11.2% had PFAS. The most common causal foods were apples (45.1%), kiwis (41.2%), and pineapples (39.2%). Sensitization rates were high for Cry j 1 (96.1%), Bet v 1 (70.6%), Mal d 1 (64.7%), and Pru p 1 (62.7%). Additionally, 43.1% of adolescents with PFAS had a history of atopic dermatitis, suggesting a link between PFAS and the concept of the allergic march. Rhinitis symptoms peaked in spring, with 79.8% reporting symptoms, particularly in March and April.</div></div><div><h3>Conclusion</h3><div>This study examined the prevalence and sensitization status of PFAS among Japanese adolescents. PFAS was common in those with pollen allergies and was associated with atopic dermatitis, supporting the allergic march hypothesis. Apples, kiwis, and pineapples were the most frequently implicated foods. These findings underscore the importance of recognizing PFAS in managing adolescent allergic conditions.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 4","pages":"Article 100561"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Egg desensitization is achieved effectively and safely through a low maintenance dose protocol","authors":"Diana Toscano-Rivero MD ,&nbsp;Nofar Kimchi MD ,&nbsp;Wei Zhao BSc ,&nbsp;Jana Abi-Rafeh BSc ,&nbsp;Danbing Ke PhD ,&nbsp;Duncan Lejtenyi MSc ,&nbsp;Liane Beaudette RN ,&nbsp;Christine McCusker MD ,&nbsp;Bruce D. Mazer MD ,&nbsp;Moshe Ben-Shoshan MD","doi":"10.1016/j.jacig.2025.100547","DOIUrl":"10.1016/j.jacig.2025.100547","url":null,"abstract":"<div><h3>Background</h3><div>Egg allergy is a common IgE-mediated food allergy in children. Oral immunotherapy (OIT) reduces allergic reactions via gradual allergen exposure. Although high maintenance doses (1-6 g egg protein) are often used, they carry higher risks of adverse reactions. Evidence on the safety and effectiveness of lower-dose egg OIT (E-OIT) remains limited.</div></div><div><h3>Objective</h3><div>We sought to determine whether a low dose of 300 mg E-OIT is safe and effective for desensitization.</div></div><div><h3>Methods</h3><div>Twenty-two participants were recruited from the Montreal Children’s Hospital; 20 were randomized to an immediate-treatment group or an observation group (egg avoidance for 1 year before OIT). Cumulative tolerated dose (CTD), Gal d 1– and Gal d 2–specific IgE (sIgE) and –specific IgG4 (sIgG4), and skin prick test responses were measured at baseline, postescalation, and maintenance. Adverse events were recorded throughout the study.</div></div><div><h3>Results</h3><div>At baseline, CTD did not differ between groups (treatment: median, 14.1 mg; observation: 20.1 mg; <em>P</em> = 1). After 1 year of egg avoidance, CTD in the observation group remained low (32.3 mg; <em>P</em> = .06). Following E-OIT, the treatment group showed a significant increase in CTD to 2000 mg at postescalation (<em>P</em> = .004) and 6000 mg at the exit double-blind, placebo-controlled food challenge (<em>P</em> = .009). The observation group, after crossover, reached 1000 mg postescalation (<em>P</em> = .02) and 5000 mg at exit (<em>P</em> = .04). Adverse reactions occurred in 15.6% of 5971 doses, mostly mild. Skin prick test wheal diameters decreased significantly (<em>P</em> &lt; .001); s-IgE levels declined whereas s-IgG4 levels increased (<em>P</em> &lt; .001), and sIgG4/sIgE ratios improved. No significant clinical or immunologic changes occurred during the observation period.</div></div><div><h3>Conclusions</h3><div>Targeting a low maintenance dose of 300 mg E-OIT produces significant clinical and immunologic changes in individuals with egg allergy while maintaining low risk of adverse reactions.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 4","pages":"Article 100547"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guideline-based asthma treatment in Asia: Insights from a robust time-in-state model","authors":"Laura Huey Mien Lim MSc ,&nbsp;Yah Ru Juang BSc ,&nbsp;Mei Fong Liew MBBS, MRCP, MMed ,&nbsp;Ming Ren Toh MD ,&nbsp;Gerald Xuan Zhong Ng BSc ,&nbsp;Yvonne Qi Feng Wong BSc ,&nbsp;Juntian Wu MPH ,&nbsp;Wei Qiang See MPH ,&nbsp;Narayanan Ragavendran MBA ,&nbsp;Sean Shao Wei Lam PhD ,&nbsp;Anthony Chau Ang Yii MB, BChir, MA, MRCP ,&nbsp;David Hsien Yung Tan MBBS, MMed, FCFP, MBA ,&nbsp;Zafar Zafari MSc, PhD ,&nbsp;Mariko Siyue Koh MD ,&nbsp;Wenjia Chen PhD","doi":"10.1016/j.jacig.2025.100531","DOIUrl":"10.1016/j.jacig.2025.100531","url":null,"abstract":"<div><h3>Background</h3><div>The landscape of guideline-based asthma treatment in Asia remains unclear.</div></div><div><h3>Objective</h3><div>Leveraging current evidence, we predicted the long-term economic impact of guideline-based asthma treatment in Asian countries, using Singapore as a case study.</div></div><div><h3>Methods</h3><div>We systematically reviewed evidence between 2014 and 2024 on asthma prevalence, adherence to inhaled corticosteroid (ICS) with or without long-acting β-agonist (LABA), and frequency of short-acting β-agonist (SABA) use in Asian asthma populations. We developed a time-in-state model for the joint impact of ICS/ICS-LABA adherence and SABA use on the economic and humanistic burden of uncontrolled asthma during 2024 to 2043. Accordingly, we projected 20-year total direct costs, indirect costs, and quality-adjusted life-years (QALYs) lost associated with uncontrolled asthma in Singapore and assessed the varied impact of guideline-based asthma treatment.</div></div><div><h3>Results</h3><div>Among 28 Asia-based, population-level studies, asthma prevalence was 1% to 12% in adults and 2% to 14% in children. ICS/ICS-LABA adherence, reported in only 3 countries, ranged from 10% to 90%; average SABA use was 2.5 to 6.4 canisters/year. In Singapore, under current trends of ICS/ICS-LABA adherence and SABA use, the 20-year burden of uncontrolled asthma is SGD$2.772 billion in direct costs, SGD$5.670 billion in indirect costs, and 58,872 QALYs lost. Optimizing guideline-based treatment nationwide (ICS/ICS-LABA medication possession ratio = 0.8, SABA use = 1 canister/year) reduces 20-year direct costs, indirect costs, and QALYs lost by 27.7%, 23.8%, and 28.8%, respectively.</div></div><div><h3>Conclusions</h3><div>Population-based evidence on guideline-based asthma treatment in Asia is limited. Population-level modeling of its economic impact, using minimal key evidence, revealed substantial reduction in societal economic and humanistic burden in Asian countries such as Singapore.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 4","pages":"Article 100531"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}