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

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The journal of allergy and clinical immunology. Global

Pub Date : 2026-01-01

引用次数: 0

The journal of allergy and clinical immunology. Global

Pub Date : 2026-01-01

引用次数: 0

The journal of allergy and clinical immunology. Global

Pub Date : 2026-01-01

引用次数: 0

The journal of allergy and clinical immunology. Global

Pub Date : 2026-01-01

引用次数: 0

Specialist physician perspectives on clinical decision support to address secondary vaccine hesitancy 专科医生对临床决策支持的观点，以解决二次疫苗犹豫

The journal of allergy and clinical immunology. Global

Pub Date : 2025-12-22 DOI: 10.1016/j.jacig.2025.100636

Anjali Nemorin MPH , Dylan T. Norton BA , Chloe V. Green MURP , Michelle S. Jerry BS , Alysse G. Wurcel MD, MS , Kimberly G. Blumenthal MD, MSc

Background

Vaccines are an evidence-based intervention that mitigates the impact of infections, yet many Americans indicate hesitancy toward receiving vaccines. One of the most common reasons for this is the potential for experiencing adverse reactions when receiving vaccines. The current literature shows that clinical decision support (CDS) tools have been utilized to improve vaccine coverage.

Objective

Our aim was to assess specialist physician experiences, practices, and levels of comfort with evaluating adverse and allergic reactions to vaccines, as well as with addressing secondary vaccine hesitancy, using CDS tools.

Methods

Researchers conducted 10 semistructured interviews with physicians in Mass General Brigham’s Infectious Diseases and Allergy/Immunology units. The interview guide consisted of 11 questions divided into 4 sections: vaccine conversations, vaccine allergies/reactions, CDS, and structural facilitators/barriers. The interview responses were evaluated by using rapid thematic analysis.

Results

Specialist physicians were generally comfortable talking to patients about vaccine hesitancy but were also open to CDS tools that effectively and efficiently contribute to improved conversations around secondary vaccine hesitancy to increase vaccine uptake. Desired CDS tool features include sharing educational visuals and videos with patients. The risks involve operational delays and lack of real-time data and accountability structures. Clinic modifications such as longer appointment times or group appointments were considered as other ways to help address vaccine hesitancy.

Conclusion

Specialist physicians expressed interest in using CDS tools to improve vaccine-related conversations with their patients. Future CDS tools must account for timely vaccine information and workflow efficiency issues. Future research should include generalist physicians, other health care team members, and patients.

疫苗是一种基于证据的干预措施，可以减轻感染的影响，但许多美国人表示对接种疫苗犹豫不决。最常见的原因之一是接种疫苗时可能出现不良反应。目前的文献显示，临床决策支持（CDS）工具已被用于提高疫苗覆盖率。目的：我们的目的是评估专科医生在使用CDS工具评估疫苗不良反应和过敏反应以及处理二次疫苗犹豫方面的经验、做法和舒适度。研究人员对麻省总医院布里格姆感染性疾病和过敏/免疫学部门的医生进行了10次半结构化访谈。访谈指南包括11个问题，分为4个部分：疫苗对话、疫苗过敏/反应、CDS和结构性促进因素/障碍。通过快速主题分析对访谈反应进行评估。结果专科医生通常愿意与患者谈论疫苗犹豫，但也对CDS工具持开放态度，这些工具有效且高效地有助于改善围绕二次疫苗犹豫的对话，以增加疫苗吸收率。期望的CDS工具功能包括与患者共享教育视觉和视频。风险包括操作延迟、缺乏实时数据和问责制结构。诊所的改变，如延长预约时间或团体预约，被认为是帮助解决疫苗犹豫的其他方法。专家医生表示有兴趣使用CDS工具来改善与患者的疫苗相关对话。未来的CDS工具必须考虑到及时的疫苗信息和工作流程效率问题。未来的研究应该包括全科医生、其他医疗团队成员和患者。

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引用次数: 0

Rising trends in infant ER encounters for food-induced allergic reactions in the era of early allergenic food introduction 在早期过敏性食物引入时代，婴儿ER遭遇食物引起的过敏反应的上升趋势

The journal of allergy and clinical immunology. Global

Pub Date : 2025-12-22 DOI: 10.1016/j.jacig.2025.100637

Aaron Chin MD , Ali Doroudchi MD , Derek C. Pham BS , Nicholas J. Jackson PhD, MPH , Maria I. Garcia-Lloret MD

Background

Allergic reactions to food are a leading cause of pediatric emergency room (ER) visits. National guidelines now recommend early introduction of allergenic foods; however, whether these changes have affected ER encounters remains poorly understood.

Objective

Our aim was to observe trends in ER encounters for food-induced reactions (FIRs), including food-induced anaphylaxis (FIA), among children aged 0 to 5 years between 2013 and 2024.

Methods

We performed a retrospective analysis of ER visits at the University of California Los Angeles from 2013 to 2024. FIRs were identified by using International Classification of Diseases codes and stratified by age (0-1 vs 2-5 years). Logistic regression assessed annual trends. Multivariate logistic regression was used to compare postguideline years (2022-2024) with preguideline years (2013-2016), adjusting for clinical and demographic variables.

Results

Of 67,059 ER visits, 350 FIRs and 182 FIA visits were identified. FIR and FIA annual rates increased significantly over time in infants aged 0 to 1 years (odds ratio [OR] = 1.15 [P = .005] and OR = 1.27 [P = .002]). In children aged 2 to 5 years old, neither FIR nor FIA rates increased. Refractory anaphylactic reactions did not change in either group. In multivariate analysis, infants in the postguideline period had more than twice the odds of a FIR during the preguideline years (OR = 2.21 [95% CI = 1.37-3.55]), whereas no change was observed in the 2- to 5-year age group (OR = 0.82 [95% CI = 0.55-1.2]).

Conclusion

ER visits for food reactions have continued to rise at a steady rate over time among infants. These findings underscore the need for additional research on adoption, parental guidance, and long-term impact of early allergen introduction.

食物过敏反应是儿童急诊室就诊的主要原因。国家指南现在建议尽早引入致敏食物；然而，这些变化是否影响了急诊就诊仍然知之甚少。我们的目的是观察2013年至2024年间0至5岁儿童因食物引起的反应（FIRs）（包括食物引起的过敏反应（FIA））而遭遇ER的趋势。方法回顾性分析2013年至2024年加州大学洛杉矶分校急诊室就诊情况。首先采用国际疾病分类代码进行鉴定，并按年龄（0-1岁vs 2-5岁）分层。Logistic回归评估了年度趋势。采用多变量logistic回归比较指南后年份（2022-2024年）和指南前年份（2013-2016年），调整临床和人口统计学变量。结果67059例急诊就诊中，有350例FIRs和182例FIA就诊。随着时间的推移，0 ~ 1岁婴儿的FIR和FIA年发病率显著增加（比值比[OR] = 1.15 [P = 0.005]和OR = 1.27 [P = 0.002]）。在2至5岁的儿童中，FIR和FIA率均未增加。两组患者的难治性过敏反应均未发生变化。在多变量分析中，指南后时期的婴儿在指南前年份发生FIR的几率是指南前年份的两倍多（OR = 2.21 [95% CI = 1.37-3.55]），而2- 5岁年龄组没有变化（OR = 0.82 [95% CI = 0.55-1.2]）。随着时间的推移，婴儿因食物反应而就诊的人数持续稳定上升。这些发现强调了对收养、父母指导和早期引入过敏原的长期影响进行进一步研究的必要性。

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引用次数: 0

Potential for gradual tolerance acquisition in egg yolk–induced FPIES: A case series 在蛋黄诱导的FPIES中逐渐获得耐受性的潜力：一个病例系列

The journal of allergy and clinical immunology. Global

Pub Date : 2025-12-20 DOI: 10.1016/j.jacig.2025.100635

Tomoaki Kunitsu MD , Kana Hamanaka MD , Midori Tagaya MD , Kazuo Nonomura MD, PhD

Background

Food protein–induced enterocolitis syndrome (FPIES) caused by egg yolk is increasingly recognized in Japan, yet the optimal timing for oral food challenge (OFC) and the process of tolerance acquisition remain unclear.

Objective

Our aim was to investigate the clinical outcomes of early OFC (performed 90-120 days after the last symptomatic episode) in children with egg yolk–induced FPIES, with a focus on identifying a potential transitional tolerance phase.

Methods

We conducted a retrospective analysis of a case series of 3 patients with egg yolk–induced FPIES who underwent early OFC. Subsequent ingestion outcomes and clinical symptoms were analyzed.

Results

All 3 patients had negative OFC results but experienced mild gastrointestinal symptoms such as persistent diarrhea or recurrent vomiting during repeated ingestion at home. These features suggested a transitional tolerance phase. Full tolerance was achieved within 6 to 7 months in all cases.

Conclusion

Early OFC may be conducted at a time that is suboptimal for reliable confirmation of tolerance. A negative OFC result does not necessarily indicate acquisition of full tolerance. Clinicians should be aware of a transitional phase during which symptoms may recur despite initial OFC success. Continued ingestion and close monitoring are essential to confirm full tolerance.

背景：在日本，蛋黄引起的食物蛋白性小肠结肠炎综合征（FPIES）越来越被认识到，但口服食物挑战（OFC）的最佳时机和耐受性获得过程仍不清楚。我们的目的是研究蛋黄诱导的FPIES儿童早期OFC（在最后一次症状发作后90-120天进行）的临床结果，重点是确定潜在的过渡耐受期。方法回顾性分析了3例早期OFC的蛋黄性FPIES患者。分析随后的摄入结果和临床症状。结果3例患者均为OFC阴性，但在家中反复服用时出现持续腹泻或反复呕吐等轻微胃肠道症状。这些特征表明存在过渡耐受阶段。所有病例均在6 - 7个月内完全耐受。结论早期OFC可能不是可靠确认耐受性的最佳时间。OFC阴性结果并不一定表明获得了完全耐受。临床医生应该意识到一个过渡阶段，在这个阶段，尽管最初的OFC成功，但症状可能会复发。持续摄入和密切监测对于确认完全耐受至关重要。

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引用次数: 0

Prospective study of basophil activation test in suspected perioperative transfusion anaphylaxis 怀疑围手术期输血过敏反应的嗜碱性粒细胞激活试验的前瞻性研究

The journal of allergy and clinical immunology. Global

Pub Date : 2025-12-20 DOI: 10.1016/j.jacig.2025.100634

Yasuhiro Amano MD, PhD , Tasuku Fujii MD, PhD , Natsumi Kameyama MHS , Takahiro Tamura MD, PhD

Background

Identifying the causative blood product in cases of suspected perioperative transfusion anaphylaxis is challenging because no confirmatory skin tests exist, and few blood-based diagnostic tests are available, potentially resulting in underreporting. Although recent studies have demonstrated the utility of the basophil activation test (BAT) for examining the causative relationship between allergic reactions and blood product transfusion, its applicability in suspected perioperative transfusion anaphylaxis remains unknown.

Objective

We aimed to assess the utility of the BAT for suspected perioperative transfusion anaphylaxis cases and calculated the incidence of perioperative transfusion anaphylaxis.

Methods

We prospectively performed BATs using blood products from patients with suspected transfusion anaphylaxis undergoing general anesthesia at a single hospital over 4 years. Transfusion anaphylaxis was confirmed on the basis of a positive BAT and hypersensitivity score.

Results

The hypersensitivity clinical scores in all 11 patients were >8 points. BATs of blood products revealed 6 patients (55%) with positive results and dose–response curves with increasing concentrations of one blood product. These findings confirmed the diagnosis of transfusion anaphylaxis. The overall incidence of perioperative anaphylaxis due to blood products was 1/2,230, 19-fold higher than that in the 6th National Audit Project survey. The highest incidence was associated with fresh frozen plasma (1/670; 95% confidence interval, 1/2,061-1/287), followed by platelet concentrate (1/1,292; 95% confidence interval, 1/51,031-1/232).

Conclusions

The BAT may help identify causative blood products in suspected perioperative transfusion anaphylaxis cases. Moreover, perioperative anaphylaxis may occur more frequently than previously reported.

背景：在疑似围手术期输血过敏反应的病例中，确定致病血液制品具有挑战性，因为没有确证性皮肤试验，而且很少有基于血液的诊断试验，这可能导致少报。尽管最近的研究已经证明了嗜碱性粒细胞激活试验（BAT）在检查过敏反应和血液制品输血之间的因果关系方面的效用，但其在疑似围手术期输血过敏反应中的适用性仍不清楚。目的评估BAT在围手术期输血过敏反应疑似病例中的应用价值，并计算围手术期输血过敏反应的发生率。方法前瞻性地对一家医院4年以上全麻疑似输血过敏反应患者的血液制品进行BATs。输血过敏反应在BAT阳性和超敏反应评分的基础上得到证实。结果11例患者超敏反应临床评分均为8分。血液制品的BATs结果显示6例患者（55%）呈阳性，且随一种血液制品浓度的增加呈剂量-反应曲线。这些结果证实了输血过敏反应的诊断。围手术期血液制品过敏反应总发生率为1/ 2230，比第六次审计工程调查高19倍。发病率最高的是新鲜冷冻血浆（1/670,95%可信区间为1/2,061-1/287），其次是浓缩血小板（1/1,292,95%可信区间为1/51,031-1/232）。结论在疑似围手术期输血过敏反应病例中，BAT可帮助鉴别致病血液制品。此外，围手术期过敏反应的发生可能比以前报道的更频繁。

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引用次数: 0

Real-world impact of mepolizumab on pediatric and adolescent patients with severe asthma mepolizumab对儿童和青少年严重哮喘患者的实际影响

The journal of allergy and clinical immunology. Global

Pub Date : 2025-12-20 DOI: 10.1016/j.jacig.2025.100638

Michelle L. Hernandez MD , Tom Corbridge MD , François Laliberté MA , Malena Mahendran MSc , Annalise Hilts BA , Kaixin Zhang MSc , Arijita Deb PhD

Background

Real-world evidence on the effectiveness of mepolizumab in children and adolescents with severe asthma (SA) is limited.

Objective

We sought to evaluate mepolizumab’s impact on the clinical and health care resource utilization (HCRU) burden of SA in children and adolescents.

Methods

A retrospective study (GSK ID: 218952) was conducted of US administrative claims for patients aged 6-17 years with SA who initiated mepolizumab (from October 1, 2016, to June 30, 2023), had continuous health plan enrollment for ≥12 months pre- and post-mepolizumab initiation, and had ≥1 additional mepolizumab dispensings/administrations ≤6 months from initiation. Rate ratios from Poisson regression models were used to compare asthma exacerbations, oral corticosteroid (OCS) dispensings and bursts, short-acting β₂-agonist (SABA) canister use, and HCRU per patient-year (PPY) pre- and post-mepolizumab; risk ratios from log-binomial regression models compared proportions of patients with ≥1 OCS dispensings and ≥1 SABA canister dispensings between periods.

Results

Of 580 patients, 47% were aged 6-11 years and 53% were aged 12-17 years. Mean OCS dispensings PPY decreased by 24% (P < .001) pre- versus post-mepolizumab initiation. Mean overall asthma exacerbations and OCS bursts PPY decreased by 34% and 29% (P < .001 each), respectively. The proportions of patients with ≥1 OCS dispensings and those using ≥1 SABA canisters decreased by 16% (P < .001) and 3% (P = .039), respectively. Asthma-related HCRU PPY decreased by 23% for inpatient visits (P = .031), 15% for emergency department visits (P = .021), and 26% for outpatient visits (P < .001).

Conclusions

Mepolizumab initiation was associated with significant reductions in asthma exacerbations, OCS and SABA use, and HCRU in children and adolescents with SA, demonstrating real-world clinical benefit.

现实世界关于mepolizumab治疗儿童和青少年严重哮喘（SA）有效性的证据有限。目的：我们试图评估mepolizumab对儿童和青少年SA临床和卫生保健资源利用（HCRU）负担的影响。方法回顾性研究（GSK ID: 218952）对6-17岁SA患者的美国行政索赔进行了研究，这些患者接受美宝珠单抗治疗（2016年10月1日至2023年6月30日），在美宝珠单抗治疗前和治疗后连续参加健康计划≥12个月，并且在美宝珠单抗治疗后≤6个月有≥1个额外的美宝珠单抗配药/给药。来自泊松回归模型的比率用于比较哮喘加重、口服皮质类固醇（OCS）配药和爆发、短效β2激动剂（SABA）罐使用和mepolizumab前后每患者年HCRU (PPY)；对数二项回归模型的风险比比较了在不同时期使用≥1个OCS配药和≥1个SABA罐配药的患者比例。结果580例患者中，6 ~ 11岁占47%，12 ~ 17岁占53%。平均OCS配药PPY在mepolizumab开始前与开始后下降24% （P < .001）。平均总体哮喘加重和OCS发作PPY分别下降34%和29% （P < 0.001）。使用≥1个OCS分配器和使用≥1个SABA分配器的患者比例分别下降了16% （P < 0.001）和3% （P = 0.039）。与哮喘相关的HCRU PPY在住院患者中下降23% (P = 0.031)，在急诊科中下降15% (P = 0.021)，在门诊中下降26% （P < 0.001）。结论：smepolizumab起始治疗与儿童和青少年SA患者哮喘加重、OCS和SABA使用以及HCRU的显著降低相关，显示出现实世界的临床益处。

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引用次数: 0

Identification of predictive factors for clinical remission and comparison of 3 definitions in Japanese patients with severe asthma treated with biologics 日本重度哮喘生物制剂治疗患者临床缓解的预测因素及3种定义的比较

The journal of allergy and clinical immunology. Global

Pub Date : 2025-12-17 DOI: 10.1016/j.jacig.2025.100629

Takanori Numata MD, PhD, Susumu Saito MD, Keitaro Okuda MD, PhD, Hanae Miyagawa MD, PhD, Masahiro Yoshida MD, PhD, Daisuke Takekoshi MD, Saburo Ito MD, PhD, Shunsuke Minagawa MD, PhD, Takeo Ishikawa MD, Hiromichi Hara MD, PhD, Jun Araya MD, PhD

Background

The definition and predictive factors of clinical remission (CR) in patients with severe asthma are unclear.

Objective

We sought to elucidate the remission rate among patients and predictive factors and concordance rates of CR among 3 definitions.

Methods

From July 2009 to November 2024 at Jikei University Hospital, 126 patients who received treatment with biologics for ≥ 12 months were evaluated retrospectively.

Results

Biologics was given to 40 men and 86 women for ≥ 12 months. Initially, 34, 42, 27, 21, and 2 patients received omalizumab, mepolizumab, benralizumab, dupilumab, and tezepelumab, respectively. After treatment, among all patients, the following criteria were achieved: asthma control test score of ≥ 23 in 32% of patients, no exacerbations in 62%, no oral corticosteroid maintenance use in 72%, and pulmonary function optimization in 94%. The percentage of patients with CR according to the 2 Japanese definitions, 1 with 3 criteria excluding pulmonary function and 1 with 4 criteria including pulmonary function, was 25% and 24%, respectively. The percentage of patients who met the other definition of CR with 4 criteria, ie, an asthma control test score ≥ 20, no oral corticosteroid use, no exacerbations, and %FEV₁ ≥ 80% of the predicted value, was 23%. The concordance rate among the 3 definitions was 83% to 99% (κ = 0.52-0.98). Predictive factors for CR were male sex, age at initiation of biologics, and eosinophilic chronic rhinosinusitis according to multivariate logistic regression analysis.

Conclusions

The 2 Japanese definitions, with 3 and 4 criteria, respectively, were highly concordant.

背景重度哮喘患者临床缓解（CR）的定义和预测因素尚不清楚。目的探讨3种定义的患者缓解率、预测因素及CR的符合率。方法回顾性分析2009年7月~ 2024年11月济庆大学附属医院126例接受生物制剂治疗≥12个月的患者。结果男性40例，女性86例，用药时间≥12个月。最初，分别有34例、42例、27例、21例和2例患者接受了omalizumab、mepolizumab、benralizumab、dupilumab和tezepelumab。治疗后，所有患者均达到以下标准：32%的患者哮喘控制测试得分≥23分，62%的患者无加重，72%的患者未使用口服皮质类固醇维持治疗，94%的患者肺功能优化。根据2个日本定义，1个有3个标准不包括肺功能，1个有4个标准包括肺功能，CR患者的百分比分别为25%和24%。符合其他4项标准的CR定义的患者比例为23%，即哮喘控制测试得分≥20，未使用口服皮质类固醇，无恶化，%FEV1≥预测值的80%。3种定义的一致性为83% ~ 99% （κ = 0.52 ~ 0.98）。多因素logistic回归分析显示，CR的预测因素为男性、开始使用生物制剂的年龄和嗜酸性慢性鼻窦炎。结论两种日语定义具有高度一致性，分别有3个标准和4个标准。

{"title":"Identification of predictive factors for clinical remission and comparison of 3 definitions in Japanese patients with severe asthma treated with biologics","authors":"Takanori Numata MD, PhD, Susumu Saito MD, Keitaro Okuda MD, PhD, Hanae Miyagawa MD, PhD, Masahiro Yoshida MD, PhD, Daisuke Takekoshi MD, Saburo Ito MD, PhD, Shunsuke Minagawa MD, PhD, Takeo Ishikawa MD, Hiromichi Hara MD, PhD, Jun Araya MD, PhD","doi":"10.1016/j.jacig.2025.100629","DOIUrl":"10.1016/j.jacig.2025.100629","url":null,"abstract":"<div><h3>Background</h3><div>The definition and predictive factors of clinical remission (CR) in patients with severe asthma are unclear.</div></div><div><h3>Objective</h3><div>We sought to elucidate the remission rate among patients and predictive factors and concordance rates of CR among 3 definitions.</div></div><div><h3>Methods</h3><div>From July 2009 to November 2024 at Jikei University Hospital, 126 patients who received treatment with biologics for ≥ 12 months were evaluated retrospectively.</div></div><div><h3>Results</h3><div>Biologics was given to 40 men and 86 women for ≥ 12 months. Initially, 34, 42, 27, 21, and 2 patients received omalizumab, mepolizumab, benralizumab, dupilumab, and tezepelumab, respectively. After treatment, among all patients, the following criteria were achieved: asthma control test score of ≥ 23 in 32% of patients, no exacerbations in 62%, no oral corticosteroid maintenance use in 72%, and pulmonary function optimization in 94%. The percentage of patients with CR according to the 2 Japanese definitions, 1 with 3 criteria excluding pulmonary function and 1 with 4 criteria including pulmonary function, was 25% and 24%, respectively. The percentage of patients who met the other definition of CR with 4 criteria, ie, an asthma control test score ≥ 20, no oral corticosteroid use, no exacerbations, and %FEV<sub>1</sub> ≥ 80% of the predicted value, was 23%. The concordance rate among the 3 definitions was 83% to 99% (κ = 0.52-0.98). Predictive factors for CR were male sex, age at initiation of biologics, and eosinophilic chronic rhinosinusitis according to multivariate logistic regression analysis.</div></div><div><h3>Conclusions</h3><div>The 2 Japanese definitions, with 3 and 4 criteria, respectively, were highly concordant.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"5 2","pages":"Article 100629"},"PeriodicalIF":0.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926972","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}

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