Allergologia et immunopathologia最新文献

Wiskott-Aldrich Syndrome (WAS) is an X-linked immunodeficiency characterized by eczema, microthrombocytopenia, and recurrent infections. Immunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory disorder involving various organs. We present a 34-year-old male with WAS who developed cervical lymphadenopathy and parotid gland swelling. Initial biopsies were inconclusive and imaging suggested pleomorphic adenoma. Given the persistent cervical lymphadenopathy and the underlying immunodeficiency, lymphoma was also considered in the differential diagnosis. However, histopathological examination of excised salivary gland and lymph nodes revealed lymphoplasmacytic and eosinophilic infiltrates, numerous IgG4-positive plasma cells, storiform fibrosis, and obliterative phlebitis, consistent with IgG4-RD. The patient responded well to prednisone therapy. This case emphasizes the importance of considering IgG4-RD in the differential diagnosis of lymphoproliferative lesions in immunodeficient individuals and highlights the diagnostic value of histopathological evaluation in excisional tissue specimens. To our knowledge, this represents a rare coexistence of WAS and IgG4-RD not previously reported in the literature.

Objectives: Food allergy (FA) is a growing public health concern, imposing significant psychosocial burdens on families and necessitating strict allergen avoidance. The unpredictability of severe reactions is associated with increased anxiety, dietary restrictions, and reduced quality of life.

Methods: We conducted a cross-sectional study including 77 mothers of children (0-12 years) with FA and 71 mothers of healthy children. Participants completed the Spielberger State-Trait Anxiety Inventory (STAI), Zarit Caregiver Burden Scale (ZCBS), and European Health Impact Scale (EUROHIS-QOL). Statistical analyses compared anxiety, caregiver burden, and quality of life between groups and explored sociodemographic factors.

Results: Mothers in the FA group had significantly higher state anxiety (STAI-S) (P < 0.001) and ZCBS scores (P < 0.001) compared to controls. However, trait anxiety (STAI-T) did not differ significantly between groups (P = 0.508). Additionally, mothers of children with FA reported lower EUROHIS-QOL scores (P = 0.009). Low maternal educational levels (P = 0.005) and middle-range income levels ($500-1000/month, P = 0.027) were significantly associated with higher anxiety and caregiver burden. Cow's milk protein allergy (CMPA) specifically increased trait anxiety (P = 0.035) and reduced mothers' quality of life (P = 0.003). No significant associations were found between anxiety or caregiver burden and anaphylaxis or other allergenic triggers.

Conclusion: Food allergy significantly elevates maternal anxiety and caregiving burden, and reduces quality of life, especially in CMPA cases. Sociodemographic factors exacerbate these effects, highlighting the need for comprehensive, multidimensional interventions. Psychological support and broader public awareness initiatives may help alleviate adverse outcomes and improve caregiver well-being.

This letter offers constructive feedback of the study by Sağun et al. on changing allergen sensitivity in the COVID-19 pandemic. The data presented were very interesting concerning the changing rates of sensitization, but the authors neglected some important areas requiring further consideration. The study does not take into account whether or not enhanced sensitization had translated into more clinical allergic disease, thus putting restrictions on considering actual real-world implications. Lifestyle disruption and COVID-19 infection status have not been directly measured and analyzed as potential confounds. Also, the allergy clinic's patient focus raises concerns about selection bias. Stating these issues may help shape future inquiries in building a more comprehensive picture of how the pandemic has affected allergy risks and outcomes.

Background: Acute lung injury (ALI) is a critical clinical condition with high mortality, necessitating the development of more effective therapeutic strategies. Rho Guanine nucleotide dissociation inhibitor (GDP) beta (ARHGDIB) has been shown to exert protective effects against noxious stimuli in various disease models.

Objective: In this study, we investigated whether ARHGDIB knockdown had a protective effect on lipopolysaccharide (LPS)-induced injury in alveolar epithelial cells and elucidated its underlying molecular mechanisms.

Material and methods: Mouse alveolar epithelial cells that were isolated from the lung of a 5-month-old female mouse (MLE-12) were treated with LPS, followed by ARHGDIB knockdown and overexpression of protein kinase A (PKA)-activated catalytic subunit β (PRKACB). Oxidative stress and apoptosis were assessed, while inflammatory cytokine levels were quantified using enzyme-linked immunosorbent serologic assays. Autophagy and PRKACB/nuclear factor kappa B (NF-κB) pathway activation was evaluated by Western blot analysis. Results: LPS upregulated ARHGDIB expression in alveolar epithelial cells. Silencing ARHGDIB significantly reduced oxidative stress inflammation, and promoted autophagy in LPS-treated MLE-12 cells. ARHGDIB knockdown modulated the PRKACB/NF-κB signaling pathway, thereby promoting autophagy and alleviating LPS-induced cellular injury.

Conclusion: This regulatory mechanism significantly reduced oxidative stress and inflammatory responses in alveolar epithelial cells, highlighting the protective role of ARHGDIB silencing in LPS-induced lung injury.

Objective: The aim of this study was to assess the association between allergic reactions after COVID-19 vaccination and the history of high-risk allergy, individual predisposing factors such as age and gender, and COVID-19 vaccine type.

Materials and methods: This retrospective cohort study included 234 adult patients (18 years old and above) who underwent a COVID-19 vaccine allergy test up until February 2023 in a Clinic of Allergy and Clinical Immunology in the University Clinical Center of Kosovo. All patients suspected of allergy underwent skin testing: SPT (skin prick test) and IDT (intradermal test) using either an mRNA (ribonucleic messenger acid) vaccine (BNT162b2, Pfizer-BioNTech) and/or an adenoviral vector vaccine (AZD1222, AstraZeneca). Subsequent immunization was administered under careful medical observation.

Results: Among the 234 patients with a high-risk allergy profile, several potential risk factors were identified, including a history of multiple allergies, previous anaphylaxis, and/or drug allergies. In our cohort, food allergies were reported by 20 patients (8.5%) and multiple drug allergies were reported by 118 patients (50.4%). Due to the retrospective nature of the study, we cannot establish causality. Therefore, older age and receipt of the Pfizer-BioNTech vaccine were found to be associated with increased allergic reactions after COVID-19 vaccination, while male gender was associated with decreased risk. Although previous allergic manifestations were common among those with reactions, they were not significantly associated with increased risk after adjustment for confounders. The absence of a control group consisting of vaccinated individuals without a high-risk allergy history limits the generalizability of our findings.

Conclusions: Immediate allergic reactions to COVID-19 vaccines are rare but can be severe and reoccur. Findings suggest that gender and age-specific factors may influence the response to the vaccine. Nevertheless, COVID-19 vaccines remain a critical tool in preventing severe disease and controlling the ongoing pandemic.

Introduction: Adverse reactions to iodinated contrast media (ICM) are very common due to its widespread use. Despite the fact that overall incidence of hypersensitivity reactions (HSRs) to ICM is low, the risk of severe outcomes needs a careful patient evaluation and management.

Methods: We conducted a retrospective epidemiological study that included patients referred to our Allergy Unit for suspected allergy to ICM in whom we carried out a protocolized allergic study based on skin and drug provocation tests (DPT).

Results: A total of 108 patients were tested and allergy to ICM was confirmed in 29 (26.9%) and assumed in 9 (8.3%). All these patients tolerated DPT with alternative ICM. The most frequently involved contrasts in confirmed HSR were iodixanol and iohexol, and iopromida was the best tolerated. Out of a total of 125 DPT, we obtained 26 positive results with only two systemic reactions (mild).

Conclusion: In most of the patients in our sample, allergy to ICM was ruled out, and in allergic patients, tolerance to an alternative ICM was established. Our protocol is safe and allows patients to receive ICM in the future.

Penicillin allergy is the most commonly reported drug allergy, often leading to unnecessary avoidance of beta-lactam antibiotics, increased use of alternative broad-spectrum antibiotics, and higher healthcare costs. However, studies indicate that over 90% of penicillin allergy labels are erroneous. This study presents real-world data from a penicillin allergy delabeling program conducted at the Special Hospital for Pulmonary Diseases in Zagreb, Croatia. A total of 132 adult patients with a reported beta-lactam allergy were evaluated with a stepwise diagnostic protocol, including medical history review, skin tests, specific IgE, and drug provocation tests. Five patients were delabeled directly, while 127 underwent diagnostic testing. Among 121 participants who completed the protocol, penicillin allergy was confirmed in 13 (10.74%) patients, and the label was retained in an additional 3 patients because of high-risk history, resulting in an overall confirmed allergy rate of 13.2%. The negative predictive values for STs were 99.07% and 94.39% for immediate and delayed reactions, respectively, while the NPV of sIgE for immediate reactions was 100%. No severe reactions occurred during the diagnostic process. Hundred and five out of one hundred and thirty two (79.5%) patients were safely delabeled. These findings confirm the safety and effectiveness of PAD programs in outpatient settings and highlight the potential for improving antibiotic stewardship by reducing unnecessary beta-lactam avoidance.

Objective: The aim of this study was to evaluate whether fluoroquinolone antibiotics, which are structurally distinct from penicillins, can be safely prescribed as alternatives for patients with a history of immediate-type hypersensitivity reactions (HSRs) to penicillin in the absence of multidrug allergy and without the need for provocation testing.

Methods: We conducted a retrospective analysis of the medical records of patients who presented to the Erciyes University Adult Immunology and Allergy Outpatient Clinic with a documented history of penicillin allergy between 2015 and 2024. Inclusion criteria for immediate hypersensitivity to penicillin included at least one of the following: (1) a history of at least two separate immediate HSRs to the same penicillin; or (2) positive results from penicillin G/V (Penicillin G and Penicillin V) serum-specific immunoglobulin E (SsIgE) and/or skin prick testing. Patients who met these criteria and subsequently underwent oral provocation testing with fluoroquinolone antibiotics were included in the study.

Results: This study included 76 patients (72% female, mean age: 45.63 ± 11.76 years), 47.4% of whom had comorbid allergic diseases. The diagnosis was primarily based on clinical history (80%), while the remainder were confirmed by SsIgE testing, skin tests, or drug provocation. A history of urticaria-angioedema was reported in 59.2% of the patients, while 40.8% had a history of anaphylaxis. Following oral provocation testing with fluoroquinolones, only two patients (2.6%) developed mild, self-limited urticaria or angioedema, without systemic involvement.

Conclusions: Our study demonstrates a low positive rate (2.6%) for fluoroquinolone oral provocation testing among patients with penicillin allergy. These findings suggest that fluoroquinolones may be a viable and safe alternative in patients with a confirmed penicillin hypersensitivity and no history of multidrug allergy, and may be considered without prior provocation testing in selected cases.

Background and objectives: Health literacy (HL) is essential for managing chronic conditions such as inborn errors of immunity (IEI). Limited HL may lead to poor clinical outcomes and inefficient healthcare use; however, HL among IEI patients remains underexplored. The aim of this study was to evaluate HL levels in adult IEI patients using the Turkish Health Literacy Scale (TSOY-32) and to identify associated sociodemographic factors.

Materials and methods: This cross-sectional study included 27 adult IEI patients receiving regular immunoglobulin therapy at an allergy and immunology clinic. Participants completed the TSOY-32 via face-to-face interviews. The scale assessed HL across two dimensions-Treatment and Services (TS) and Disease Prevention/Health Promotion (DP/HP)-and four information processing stages. Sociodemographic data were also collected.

Results: According to the TSOY-32 general index, 44.4% of patients had inadequate or problematic HL. Significant associations were observed between HL levels (particularly in the DP/HP dimension) and age, gender, education, and marital status. Younger adults (18-34 years) showed higher HL than those aged 35 and older and married participants had lower HL than singles. Although HL improved with education, no significant link was found between educational level and overall HL. Economic status had a positive but nonsignificant relationship with HL.

Conclusion: A significant proportion of IEI patients had limited HL, which may negatively impact treatment adherence. Tailored educational interventions that take into account patients' HL levels (e.g., simplified visual materials, brief in-clinic education, digital tools) could help enhance self-management. Larger studies are warranted to clarify the determinants of HL and improve care in this population.