Allergologia et immunopathologia最新文献

Background: Hypersensitivity reactions to drugs represent a significant and growing health concern worldwide, with the potential to cause severe and life-threatening outcomes. Accurate diagnosis of drug allergies is essential for effective patient management, particularly in differentiating true allergic reactions from other adverse drug reactions.

Objective: This study aimed to evaluate for the first time the Basophil Activation Test (BAT) using flow cytometry as a reliable diagnostic tool for immediate-type drug allergies in Tunisia.

Methods: This study included 35 BATs, conducted between November 2022 and December 2024. Only one patient underwent two separate BATs on different drugs. From each patient, venous blood was drawn and BAT was assessed using flow cytometry. Serial dilutions of suspected drugs, including antibiotics (e.g., amoxicillin and cefixime), non-steroidal anti-inflammatory drugs (e.g., mefenamic acid), and others, were tested. For each sample, basophils were incubated with the drug dilutions stained with antibodies marked with different fluorescents, such as CRTH2-FITC, CD3-PC7, CD203c-PE, and then analyzed on a Navios Ex flow cytometry.

Results: Of all the performed BATs, antibiotics represented the majority of tested drugs accounting for 56%. However, only three tests were positive, in favor of a type I hypersensitivity drug reaction.

Conclusion: By applying BAT in the Immunology Department of the Military Hospital of Tunisia, this study seeks to enhance diagnostic accuracy and contribute to personalized patient care.

Background: In order to prevent total elimination of wheat from their diet, we introduced a very-low-dose (VLD) oral food challenge (OFC) in patients with severe wheat allergy in 2019.

Objective: This study investigated the efficacy of starting VLD wheat intake for achieving full-dose OFC.

Material and methods: Patients with a history of overt allergic reactions to low-dose (LD; 80-mg wheat protein) wheat or lesser within 6 months and those with complete wheat elimination were included in the study. We retrospectively compared the proportion of passing a full-dose OFC (2650-mg wheat protein) between patients who underwent an LD OFC prior to 2019 (LD group) and those who underwent a VLD OFC (26.5-mg wheat protein) after 2019 (VLD group). The period for passing the full-dose OFC was evaluated using Kaplan-Meier survival analyses.

Results: We enrolled 200 and 58 patients in LD group and VLD group, respectively. The median age at OFC initiation was 2.1 (1.6-4.2) and 1.9 (1.4-3.6) years in LD group and VLD group, respectively. Wheat- and ω-5 gliadin-specific immunoglobulin E (IgE) levels were 25.2 (7.7-59.8) kUA/L and 2.5 (0.8-12.6) kUA/L, respectively, in the LD group and 21.9 (7.4-94.9) kUA/L and 3.3 (1.2-9.4) kUA/L, respectively, in the VLD group. Over 4 years, the LD group and VLD group passed the full-dose OFC at proportions of 50% and 75%, respectively, with a significant difference (Log-rank test, P < 0.01).

Conclusion: Starting VLD wheat intake may contribute to achieving a full-dose OFC in patients with severe wheat allergies.

Background: Allergic rhinitis (AR) is increasingly prevalent in China, yet allergen sensitization data in coastal subtropical cities such as Shenzhen remain scarce.

Objective: To investigate allergen distribution and demographic characteristics among AR patients in Shenzhen, China.

Methods: A retrospective analysis was conducted on 3351 AR patients from January to December 2022. Serum-specific immunoglobulin E (sIgE) levels were measured; values ≥0.35 kU/L were considered positive and graded into six levels. Allergen patterns were compared by gender, age (<14 vs. ≥14 years), and sIgE level.

Results: Clinic visits peaked in August. The most prevalent allergens were Blomia tropicalis (Bt), Dermatophagoides pteronyssinus (Dp), and Dermatophagoides farinae (Df). Other important indoor allergens included cockroach, dog dander, and cat dander. Leading outdoor allergens were Ambrosia artemisiifolia (ragweed), Chenopodium album/Amaranthus retroflexus, and Platanus/Fraxinus. Male patients showed higher sensitization to Dp and Df (P < 0.05). The sensitization proportions for leading allergens (Bt, Dp, and Df) declined with increasing age: compared with adolescents and adults (≥14 years), pediatric patients (<14 years) had significantly higher sensitization to indoor allergens, whereas the adolescent/adult group showed significantly higher sensitization to pollens and molds (P < 0.05). Dp and Df responses peaked at class 3, Bt and cat dander at class 2, and cockroach/dog dander/pollens/molds at class 1, with significant differences in sIgE levels among allergens (P < 0.05).

Conclusion: Dust mites, especially Bt, are the primary source of allergens affecting AR patients in Shenzhen. Sensitization patterns differ by age, gender, and sIgE levels, highlighting the importance of region-specific allergen surveillance and personalized AR management.

Background: Hereditary angioedema (HAE) is a genetic disorder characterized by recurrent, spontaneous, and sometimes life-threatening episodes of swelling. Attacks of angioedema that negatively impact quality of life can occur anywhere in the body. The chronic and unpredictable course of the disease can also affect mental health, sleep quality, and sexual life.

Objective: This study aimed to investigate sexual function, sleep quality, and related factors in HAE patients.

Material and methods: In all, 40 patients diagnosed with type 1 and type 2 HAE were followed up in the Immunology and Allergy Clinic, and 40 healthy controls were included in the study. Participants completed the Arizona Sexual Experience Scale (ASEX), Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HADS).

Results: The patient group had significantly higher ASEX and PSQI scores compared to the healthy control group. In the patient group, ASEX scores showed a significant positive correlation with HADS-Depression (HADS-D) and HADS-Anxiety (HADS-A) scores. It was shown that as frequency of monthly attacks in patients increased, both HADS-D and HADS-A scores increased, and with increase in HADS-D scores, sleep efficiency decreased. Furthermore, a strong positive correlation was shown between HADS-A scores and PSQI scores. Longer disease duration, history of genital attacks, and decreased sleep quality were found to be significantly correlated with sexual dysfunction.

Conclusion: The results supported our hypothesis that sexual life and sleep quality are more affected in this patient group than known previously. It is expected that evaluating sexual life, sleep quality, and general well-being in the routine follow-up of these patients may contribute to disease control.

Poppy seeds are increasingly used for flavoring, for example, in cakes, bread, and fruit salads, and it is gaining popularity globally. Most case reports of poppy seed allergy are in children. Ingestion of cake, in which ground poppy seed is used, is mostly associated with anaphylactic reactions. Reactions may occur even with minimal amounts or traces. In sera of patients allergic to poppy seeds, four IgE-reactive poppy seed proteins were identified. Cross allergy with sesame and buckwheat are reported. Cross-reaction is described with nuts (cashew and walnut), wheat, rye flour, buckwheat, rice, and kiwi. Although rare, allergy to poppy seed is often rapid, generalized, and potentially life-threatening and, therefore, should be considered in allergic work-up. Therapy of poppy seed allergy/anaphylaxis is based on an elimination diet. However, oral desensitization could be hypothesized in some high-risk allergic patients, according to other reports of oral desensitization in seed anaphylaxis.

The aim of this study was to evaluate the nutritional status, especially calcium deficiency, of breastfeeding mothers of infants diagnosed with cow's milk food protein-induced allergic proctocolitis (FPIAP) on an elimination diet and to investigate the relationship between daily calcium intake and body composition of these mothers. Our prospective cohort study included 86 patients with cow's milk protein allergy (CMPA) and their mothers on an elimination diet. The mother's body fat, muscle, and water percentages were measured with the Bioelectrical Impedance Method (Tanita MC-580). All mothers were administered a diet containing an average of 2000 kcal (kilocalorie), 1000 mg of calcium, and 400 units per day of vitamin D. The final measurements were repeated 1 month later and the results of the first and second assessments were compared. The mean age of the patients included in the study was 3.8 ± 1.8 months, and the M/F (male to female) ratio was 18/17. In all, 54.3% of the patients had only CMPA, while 45.7% had multiple food allergies, including milk. A comparison of the mother's body measurements before and after the diet showed a significant decrease in fat but with an increase in calcium levels. In contrast, muscle and water ratios did not change (p < 0.001, p = 0.332, p = 0.189). Despite the recommendation of a 2000 kcal per day diet, the second evaluation found that calorie, fat, and protein ratios were significantly reduced (p = < 0.001, p = 0.011, p = 0.009, p < 0.05, respectively). The metabolic health of breastfeeding mothers who follow an elimination diet for CMPA is affected even with dietician support.

Atopic diseases are characterized by intense inflammation. There are increasing studies examining the relationship between atopic diseases and hematological parameters and indirect markers of inflammation, such as neutrophil-to-lymphocyte ratio (NLR), eosinophil-to-lymphocyte ratio (ELR), and platelet-to-lymphocyte ratio (PLR). The aim of this study was to investigate these parameters in patients with asthma, allergic rhinitis, and atopic dermatitis. The study was conducted retrospectively and cross-sectionally. The study group consisted of 172 patients (53 with asthma, 93 with allergic rhinitis, and 26 with atopic dermatitis) and 105 controls. There were no age or gender differences between patients and controls. When all atopic patients were compared to controls, ELR (P < 0.001), eosinophil count (P < 0.0019), and WBC (P < 0.05) were significantly higher in the patient group. When patient groups were compared independently, ELR (P < 0.001), eosinophil count (P < 0.001), and WBC (P < 0.05) were higher in asthmatic patients than in controls. In allergic rhinitis patients, ELR (P < 0.001) and eosinophil count (P < 0.001) were higher than in controls. In patients with atopic dermatitis, ELR (P < 0.001), eosinophil count (P > 0.001), WBC (P = 0.0019), and, additionally, NLR (P < 0.001) and PLR (P < 0.05) were higher than in controls. NLR and PLR were significantly higher in patients with atopic dermatitis than in controls, in patients with asthma and in patients with allergic rhinitis. Among all hemogram parameters, only ELR and eosinophil count stand out as markers that may be useful in the diagnosis of atopic diseases. NLR and PLR may be useful in the differential diagnosis of AD among atopic patients.

Background: Allergic bronchopulmonary aspergillosis (ABPA) and allergic bronchopulmonary mycosis (ABPM) are hypersensitivity disorders characterized by fungal colonization of the airways and exaggerated Th2-mediated immune responses. Despite corticosteroids being the cornerstone of treatment, adverse effects, relapses, and steroid dependence necessitate adjunctive antifungal and biologic therapies. This study aimed to evaluate clinical, functional, and immunologic responses to different treatment combinations in patients with ABPA or ABPM.

Methods: This retrospective, multicenter, cross-sectional study included 70 patients diagnosed with ABPA (n = 54) or ABPM (n = 16) at two tertiary chest disease centers between 2016 and 2023. Patients were grouped according to systemic corticosteroid (SS) use (SS-using vs non-SS) and further subdivided based on treatment composition (antifungal ± biologic therapy vs antifungal alone). Changes in FEV₁ (Forced Expiratory Volume in 1 second), Asthma Control Test (ACT) scores, total serum IgE, and peripheral blood eosinophil count (PBEC) before and after treatment were analyzed.

Results: In the SS-using group, combination therapy with antifungal ± biologic agents produced significant improvements in FEV₁ (mL and %) and ACT scores, along with substantial reductions in total IgE and PBEC levels (all P < 0.05). Antifungal monotherapy yielded significant reductions in immunologic parameters but no functional improvement. In the non-SS group, changes were minimal across most parameters, except for a modest reduction in total IgE within the antifungal ± biologic subgroup. The most comprehensive clinical and immunologic responses were observed in patients treated with corticosteroids combined with antifungal and biologic therapy.

Conclusion: SS remain the primary therapeutic modality for ABPA, but the addition of antifungal and biologic agents enhances both immunologic and functional recovery. A precision-based, stepwise treatment model-initiating with corticosteroids, followed by antifungal therapy, and incorporating targeted biologics-may optimize long-term outcomes, minimize steroid exposure, and promote sustained remission in ABPA and ABPM.

Objective: Bee stings, a prevalent issue globally, trigger severe allergic reactions and significantly impact physical health. However, their effects on psychologic well-being and quality of life, especially across seasons, are less understood. This study evaluates the impact of bee sting allergies on anxiety, somatization, and quality of life in children, with a focus on seasonal differences.

Methods: Conducted at the Medical Faculty of Erciyes University, this prospective study involved 106 children aged 6-18 years-53 with bee sting allergies and 53 healthy controls. Assessments using the Screen for Child Anxiety-Related Disorders (SCARED), Children's Somatization Inventory-24 (CSI-24), and Pediatric Quality of Life Inventory (PedsQL) were performed in winter and spring.

Results: Children with bee sting allergies exhibited significantly higher anxiety and somatization compared to controls, with lower quality of life scores in physical, emotional, and academic domains. Seasonal variations showed increased anxiety in spring, with fluctuating somatization and quality of life indicators, although these changes were not statistically significant.

Conclusion: Bee sting allergies significantly affect children's anxiety, somatization, and quality of life, with seasonal changes exacerbating these impacts. Targeted interventions are needed to address these challenges, particularly during peak allergen periods.