Allergologia et immunopathologia最新文献

Background: Asthma is a chronic inflammatory disorder characterized by airway inflammation and hyperresponsiveness, significantly impacting children's quality of life. Despite optimal treatment, some children experience poor asthma control, partly attributed to circadian rhythm disturbances.

Objectives: This study aimed to evaluate circadian clock protein levels and their relationship with asthma control and sleep quality in children.

Methods: Patients with asthma aged 8-17 years and age-matched healthy controls were enrolled. Pulmonary function was assessed using spirometry, asthma control via the Asthma Control Test (ACT), and sleep quality using the Children's Sleep Habits Questionnaire (CSHQ). Serum circadian protein levels (BMAL1, CLOCK, CRY1, CRY2, PER1, and PER2) were quantified and compared between groups.

Results: Asthmatic children had significantly elevated levels of BMAL1, CLOCK, CRY1, PER1, and PER2 compared to controls (p<0.01); however, CRY2 was not significantly different. Poor sleep quality was associated with higher levels of BMAL1, PER1, and PER2 (p<0.01). Elevated circadian protein levels correlated with poorer asthma control and reduced pulmonary function (FEV1, FEV1/FVC, PEF; p<0.05). Individually, PER2 and BMAL1 showed the highest AUCs (~0.75), while a combined model of all proteins yielded an AUC of ~0.76, indicating complementary rather than singularly dominant contributions.

Conclusion: These exploratory findings support further evaluation of circadian proteins as biomarkers in pediatric asthma and warrant investigation of chronotherapy in appropriately designed trials, rather than justifying a specific dosing time at present. Circadian proteins, particularly PER2 and BMAL1, may serve as potential biomarkers and support precision-based chronotherapy in pediatric asthma management.

Drug-induced fever is a probably an under/misdiagnosed condition. The onset of drug-induced fever is highly variable among drugs and patients, usually occurring after 7-10 days of treatment, with rapid resolution after discontinuation. However, it sometimes appears at any time during treatment, even after stopping the drug. The estimated prevalence is 10%, and early diagnosis avoids hospitalizations, expensive treatments, and techniques, favoring the sustainability of the Health System. We report a 40-year-old woman diagnosed with Cystic Fibrosis and drug-induced fever due to trimethoprim-sulfamethoxazole. She was referred to the Allergy Department by the Pulmonology Department because of Pandoraea sputorum sputum colonization, which was only sensitive to TMP-SMX. After confirming the diagnosis and given the absence of therapeutic alternatives, obtaining informed consent, and informing her Pulmonology specialist, desensitization was decided upon, following the therapeutic scheme described in Table 1, using premedication with Acetaminophen and Prednisone to improve comfort and reaching a dose of 320/1600 mg in 8 days. This is a unique case of successful desensitization in TMP-SMX-induced fever in a young patient with Cystic Fibrosis. In summary, we believe that in Medicine, the most important thing is to individualize treatments based on each patient's needs and assessing risks and benefits.

Introduction: Climate change may influence patterns of allergic sensitization in children.

Objective: To compare the prevalence of aeroallergen sensitization in pediatric patients diagnosed with allergic rhinitis (AR) alone versus those diagnosed with both asthma and AR (asthma/AR).

Methods: A cross-sectional study was conducted at a teaching hospital. Medical records of children aged 2-17 years, diagnosed with AR or asthma between January 2020 and December 2023, and with at least one positive sensitization test, were reviewed. Descriptive statistical analyses were performed for all study variables.

Results: A total of 216 children were included (mean age, 8.4 years; 65.7% male), divided into two groups: AR (107 cases) and asthma/AR (109 cases). Overall, 45 patients (20.8%) were monosensitized, with no significant difference between groups (p = 0.364). House dust mites were the most frequent allergens in both groups (p = 0.992), followed by cockroach and cat epithelium. Among pollens, oak and ash were the most common, with no significant differences between groups (all p > 0.05).

Conclusion: Sensitization to house dust mites predominated in both AR and asthma/AR patients. These findings contribute to current knowledge of the major aeroallergens involved in allergic sensitization among children with respiratory diseases.

Progestogen hypersensitivity is a broad spectrum of disorders that may present with cutaneous manifestations such as urticaria and eczema-like lesions, as well as systemic symptoms including anaphylaxis. Anaphylaxis due to progestogen hypersensitivity is very rare but should be considered in cases of recurrent anaphylaxis, particularly in young female patients. The timing of symptoms is the leading hint, as endogenous progesterone-induced reactions typically occur during the luteal phase of the menstrual cycle. Exogenous progesterone exposure, such as through oral contraceptives or assisted reproductive technologies (e.g., in vitro fertilization), has also been reported to trigger similar reactions. Therapeutic options include systemic corticosteroids, antihistamine tablets to control symptoms, and antihormone agents aiming the ovulation suppression. In refractory patients who are unresponsive to medical therapy, surgical options such as oophorectomy may be considered. In this report, a case of progesterone-associated anaphylaxis, triggered by an intradermal progesterone test, is presented, and a successful symptom control was achieved through the high-dose omalizumab treatment. As an alternative treatment option, omalizumab can be safely used in cases of progestogen hypersensitivity, especially in young female patients planning pregnancy.

Introduction: Lipid transfer protein (LTP) allergy is the leading cause of food allergy and food anaphylaxis in adults in the Mediterranean region. Treatment options include avoidance of the implicated foods and specific sublingual peach immunotherapy (Pru p3 SLIT). This study aims to determine the effectiveness of Prup3 SLIT in patients with cofactor-induced and noncofactor-induced LTP syndrome, assessing the change in food tolerance before and after treatment.

Methods: We conducted a retrospective observational study of 23 patients diagnosed with LTP allergy who were treated with Pru p3 SLIT. To assess food tolerance before and after treatment, all patients underwent an oral challenge with unpeeled peach, as well as other foods to which they were allergic or sensitized.

Results: Fifty-five percent of patients were female, with a mean age of 25.8 years, 39% of whom were under 14 years of age. Thirteen percent were allergic only to pink fruits, 4.3% to nuts, 43.4% to two families, and 39.1% to more than two families of vegetables. Eighty-six percent of the reactions were systemic, including 47% anaphylaxis. After a mean of 2.7 years of treatment, 95.6% of the patients tolerated oral provocation with unpeeled peach and all foods to which they were allergic. However, none of the seven patients with cofactor-induced or cofactor-enhanced allergic reactions to food showed improved tolerance following Pru p3 SLIT.

Conclusion: Pru p3 SLIT can induce clinical remission of LTP food allergy in both adult and pediatric populations. However, it doesn´t resolve cofactor-triggered LTP reactions; therefore, patients with this profile should continue to avoid such triggers.

Objective: This study assessed the tolerance of a commercial, extensively hydrolyzed casein formula (eHCF), in a cohort of children with cow's milk protein allergy (CMPA) as a primary outcome, as well as its effect on growth outcomes.

Methods: Observational retrospective study of CMPA patients taking eHCF for at least 4 months. Patients were followed for three visits.

Results: A total of 61 evaluable pediatric patients with CMPA were included in the study. The patients had a follow-up period of 8.4 months, with a mean age of 3.1 ± 2.5 months at the first hospital visit, and 11.5 ± 5.3 months at the second follow-up visit. At the first hospital visit, the weight, height, and body mass index (BMI) were recorded as 5.6 ± 1.4 kg, 59.3 ± 6.1 cm, and 15.6 ± 1.7, respectively, increasing to 9.2 ± 1.5 kg, 73.9 ± 6.5 cm, and 16.9 ± 1.4 at the second follow-up visit. The mean Z-scores for weight-for-age (WAZ), height-for-age (HAZ), BMI for age (BAZ), and weight-for-height (WHZ) were -0.36 ± 0.95, -0.26 ± 1.00, -0.29 ± 1.05, and -0.22 ± 1.1, respectively, at the first hospital visit, and 0.09 ± 0.79, 0.05 ± 1.03, 0.10 ± 0.87, and 0.13 ± 0.85 at the second follow-up visit. The eHCF was well tolerated by 100% of patients with no immediate allergic or intestinal reactions recorded during the follow-up visits.

Conclusions: The participating physicians rated the tolerance of the eHCF as good in 100% of the patients (95% CI: 94.1-100). Over a follow-up period of 8.4 months, pediatric patients with CMPA consuming the eHCF showed anthropometric Z-scores WAZ, HAZ, BAZ, and WHZ between -1 and 1, within a range close to the mean of a standard normal distribution.

The diagnosis of IgE-mediated cow's milk allergy (CMA) involves serum-specific IgE (spIgE), skin prick tests (SPT), and the gold standard oral food challenge (OFC). SpIgE levels are measured using methods such as ImmunoCAP and IMMULITE, with most cutoff data derived from ImmunoCAP. This study aims to determine IMMULITE-specific cutoff values to predict OFC positivity. Patients diagnosed with CMA via OFC between 2019 and 2023 were retrospectively analyzed. Data on demographics, eosinophil counts, total and specific IgE levels, and SPT results were collected. OFC was conducted using yogurt, milk-based formula, or milk-containing muffins. SPTs were performed with commercial extracts (Lofarma®) and pasteurized milk using the prick-to-prick method. SpIgE levels were measured with the Siemens® IMMULITE 2000 Immunoassay System, with values ≥0.35 kU/L considered positive. The study included 50 OFC-positive patients (60% males) and 50 age- and clinically matched controls without objective OFC reactions. The median age at diagnosis was 6 months (IQR: 3-21), and 52% presented with atopic dermatitis. OFC reactions occurred with yogurt in 42 patients (84%), muffins in 6, and milk in 2; 26% of reactions were anaphylaxis. IMMULITE-derived cutoff values were 3.13 kU/L (AUC: 0.776, 72% sensitivity, 72% specificity) for cow's milk spIgE and 1.85 kU/L for casein. SPT enduration cutoffs were 4.25 mm for pasteurized milk and 3.5 mm for commercial extracts. This study provides critical IMMULITE-specific spIgE cutoffs to predict OFC outcomes, offering valuable reference ranges for clinical CMA diagnosis.

Introduction: House dust and storage mites are allergens associated with allergic rhinitis and asthma. Oral mite anaphylaxis manifests after ingesting contaminated flour with mites. We present the case of a 13-year-old child who developed anaphylaxis after consuming pizza.

Case presentation: A 13-year-old boy presented with respiratory distress after consuming pepperoni pizza, which he had previously tolerated. Skin prick and specific IgE test results revealed sensitization to house dust and storage mites. He passed an oral food challenge (OFC) for pepperoni pizza.

Discussion: Anaphylaxis to foods contaminated by mites (also known as "pancake syndrome") is often overlooked. In this case, the diagnosis was supported by the skin prick tests and specific IgE, although the flour used for pizza preparation could not be tested. The patient passed an OFC using ingredients from a different source.

Conclusion: Oral mite anaphylaxis is an unusual presentation that must be considered when other possible food allergy triggers have been excluded and the patient is sensitized to mites.

Alzheimer's disease (AD) and nonalcoholic fatty liver disease (NAFLD) are both prominent public health concerns owing to their increasing prevalence and burden on healthcare systems. The interconnected genetic and immunological mechanisms that may cause both of these diseases are poorly understood. This study used broad gene expression datasets to identify similar molecular markers and immunological profiles in AD and NAFLD and evaluate their potential. Using the Gene Expression Omnibus (GEO) database, mRNA expression profiles from patients with AD and NAFLD were analyzed alongside control samples to identify differentially expressed genes (DEGs). Systems biology approaches, including LASSO regression and multivariate logistic regression models, were used to further refine the significance of DEGs. The diagnostic potential of the key genes was evaluated using receiver operating characteristic (ROC) curves, and the immune cell environment was quantified using the Immune Cell Abundance Identifier (ImmuCellAI). We identified 11,278 DEGs, with 3551 upregulated and 7857 downregulated genes. S100A8, CXCL9, and ST8SIA3 have emerged as significant biomarkers of both AD and NAFLD. ROC analysis substantiated the diagnostic value of these markers. Additionally, distinct patterns of immune cell populations have been observed in AD and NAFLD, highlighting potential targets for immunomodulatory therapy. This study elucidates shared molecular and immune mechanisms in AD and NAFLD, offering insights into the pathophysiological underpinnings that could inform the development of novel diagnostic and therapeutic strategies. S100A8, CXCL9, and ST8SIA3 are potential candidates for future clinical application. Further investigation into these genetic discoveries and their immune system effects may lead to a unified strategy for treating these complicated disorders.

Background: Proton pump inhibitors (PPIs) are identified to cause immediate hypersensitivity reactions and cross-reactivity among them. In this study, we aimed to describe the clinical features of immediate-type hypersensitivity reactions caused by PPIs, the results of drug tests performed with PPIs, and the cross-reactivity between PPIs. There are immediate hypersensitivity reactions with PPIs and there may be cross-reactivity between PPIs. In this study, we aimed to describe the clinical features of immediate-type hypersensitivity reactions caused by PPIs, the results of drug tests performed with PPIs and the cross-reactivity between PPIs.

Methods: Adult patients who described an immediate hypersensitivity reaction to PPIs between March 1, 2017 and March 1, 2023 were evaluated.

Results: Of the 47 patients included in the study, 89.4% were females, and the suspected PPI in 68% of the patients was lansoprazole. Anaphylaxis accounted for 72.3% of reactions, and the most common reaction was grade 2 (42.6%) according to Ring Messmer. Those who had two or more reactions to the same or different PPI were 51.1% of patients. A positivity rate of 43.8% was observed in the skin prick test with the suspected drug, 33.3% in the intradermal test, and 100% in the provocation test. There is varying potential for cross-reactivity among five different PPIs.

Conclusions: İmmediate hypersensitivity reactions are observed among PPIs, particularly to lansoprazole, with the majority of reactions being anaphylaxis. Multiple life-threatening reactions can be prevented by increasing awareness of allergies to PPIs. Cross-reactivities among PPIs are variable, and further studies are needed to elucidate cross-reactivity with PPIs.