Allergologia et immunopathologia最新文献

Purpose: We aimed to investigate allergic sensitization and associated factors in pediatric patients with selective immunoglobulin A deficiency (SIgAD) and to evaluate differences between allergic and nonallergic groups.

Methods: We analyzed 110 patients (aged 4-18 years) diagnosed with SIgAD at Çam and Sakura City Hospitals, Istanbul, between 2021 and 2024. Their demographic, clinical, and laboratory data were assessed.

Results: Allergic sensitization was detected in 62.7% of patients. Patients with allergic sensitization, family history of allergic diseases, eosinophilia, and elevated total immunoglobulin E (IgE) levels were significantly higher (P < 0.05). Immunglobulin M (IgM) levels were higher in the allergic group (P = 0.01), and they had lower neutrophil counts (P = 0.03). Allergic sensitization was lower in patients with autoimmune diseases (P = 0.03). In 60% of the patients, the main reason for presentation was recurrent infection.

Conclusion: Allergic sensitization with SIgAD is associated with genetic and immunological factors. A family history of allergic disease, eosinophilia, and elevated total IgE levels are important markers for the development of allergy. These findings highlight the need to closely monitor allergies in people with SIgAD.

Background: Asthma is a chronic respiratory disease with complex pathogenesis. Some studies suggest that certain trace metals may be associated with asthma. However, the relationship between serum copper (Cu) and childhood asthma remains unclear. This meta-analysis evaluates the association between Cu and childhood asthma.

Methods: Studies of multiple databases were searched from inception to 2024. We recorded the standardized mean difference (SMD), 95% confidence intervals (CIs), and other data. The analysis was performed using Stata 18.0 software. Two independent reviewers appraised methodological quality using the Newcastle-Ottawa Scale. Sensitivity analysis was used to test robustness. To evaluate publication bias, we used Begg's funnel plots and Egger's regression test.

Results: A total of 11 studies with a combined 1006 participants were included. There was no significant difference in the level of serum Cu between children with asthma cases and controls (SMD = -0.032, 95% CI: -0.291-0.228, P = 0.811). There was significant heterogeneity among the studies (I² = 73.5%, P < 0.0001). Subgroup analysis demonstrated that heterogeneity was not caused by the continent of origin, publication year, sample size, detection methods, and the mean age of participants. No publication bias was found.

Conclusion: There is no statistically significant association between serum Cu levels and childhood asthma. Further research, particularly large-scale prospective cohort studies, is needed to clarify this relationship.

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.