Allergologia et immunopathologia最新文献

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.

Objective: The aim of this study was to evaluate and compare the prevalence of comorbidities in asthmatic and non-asthmatic individuals and to compare groups based on sociodemographic variables.

Materials and methods: This cross-sectional study used data from the 2017 National Household Health Survey (NHHS), which included 6053 individuals aged 15 years and older. The sociodemographic characteristics, behavioral risk factors, and comorbidities of the study participants were analyzed and Pearson chi-squared tests were used to assess statistical significance, and multiple logistic regression analysis was conducted to evaluate the relationships.

Results: Of the 6053 participants, 518 had asthma; 40.4% were male and 59.6% were female, and 73.2% of the asthma patients and 58.3% of the non-asthmatic individuals were females (p < 0.001). Patients with asthma had a higher prevalence of at least one comorbidity compared to non-asthmatic individuals (p < 0.001). Disease-specific analyses in patients with asthma showed higher rates of hypertension (42.9% vs. 23.9%), hyperlipidemia (35.3% vs. 19.4%), diabetes (27.8% vs. 17.7%), Chronic Obstructive Pulmonary Disease (COPD) (29.7% vs. 2.6%), cardiovascular diseases (16.0% vs. 6.1%), and obesity (56.1% vs. 36.2%) (p < 0.001). In the multiple logistic regression analysis, asthma was 14.6 times more likely in individuals with COPD, 1.6 times more likely in obese individuals, and 1.7 times more likely in those with hyperlipidemia.

Conclusion: Patients with asthma have a higher prevalence of specific comorbidities with varying sociodemographic characteristics. Further research is needed to explore the causal relationships between asthma and these comorbidities to improve disease management strategies.

Background: Allergic rhinitis and allergic asthma are respiratory tract diseases predominantly triggered by allergens such as pollens, house dust mite, mold etc. The prevalence of respiratory allergens varies according to geographic location. Ragweed (Ambrosia artemisiifolia), a prevalent weed particularly in South America and Europe, is being investigated for its sensitization frequency in the Black Sea region of our country. This study aims to evaluate ragweed and other allergens associated with respiratory allergic diseases in this region and determine their disease frequency.

Materials and methods: A retrospective analysis was performed on patients diagnosed with allergic rhinitis, conjunctivitis, and asthma who attended the Immunology and Allergy outpatient clinic at Samsun Training and Research Hospital between 2017 and 2024. Data from 3,000 diagnosed patients were examined.

Results: Of the 3,000 patients, 2,124 (70%) were female and 876 (30%) were male. All patients were diagnosed with allergic rhinitis, while conjunctivitis was observed in 2,300 patients (76%), and asthma was diagnosed in 1,382 patients (46.6%). The most frequently detected allergen was house dust mite (75%). Ragweed pollen was identified as the most common cause of seasonal allergic rhinitis (15%). Moreover, ragweed pollen was found to be the allergen associated with the highest risk of asthma development (p-value: 6.69 × 10^-52).

Conclusion: Ragweed pollen allergy is common in our region, and the allergenicity load is high. The sensitization rate may increase over time. If the prevalence is determined accurately, appropriate preventive measures and treatments can be developed.

Peucedanum japonicum Thunberg is a perennial herbaceous plant of the genus Peucedanum that belongs to the Apiaceae family and is effective in improving inflammation, gout, and dizziness. However, the skin pruritus improvement effect and mechanism of action of Peucedanum japonicum Thunberg root extract (PJRE) have not yet been reported. We investigated the effects of PJRE on the regulation of pruritus and inflammatory responses in compound 48/80 (C48/80)-treated mice, phorbol 12-myristate 13-acetate (PMA)/A23187-induced human skin mast cells, and LPS-stimulated mouse macrophages. PJRE administration significantly inhibited scratching behavior, skin inflammatory cells, and mast cell infiltration in mice increased by C48/80. PJRE treatment also reduced the PMA/A23187-activated secretion of histamine, inflammatory cytokines, and interleukins via NF-κB activation in HMC-1 cells. PJRE treatment reduced LPS-stimulated secretion of inflammatory cytokines and expression of iNOS and COX-2 through phosphorylation of NF-κB, Akt, ERK1/2, and p38 MAPK in Raw 264.7 cells. PJRE treatment increases HO-1 expression in a concentration-dependent manner via NRF2 nuclear translocation. These results suggest that PJRE has therapeutic potential for alleviating atopic dermatitis-like skin symptoms, which is likely mediated by NF-κB as a transcription factor and Akt, ERK1/2, and p38 MAPK as upstream signaling molecules.

Human proteinase 3 (hPR3) is a lysosomal enzyme of the serine protease type. In autoimmune vasculitis, autoantibodies to hPR3 appear to have a role in the inception of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), where this protein is the main autoantigen. Indeed, patients with antibodies against hPR3 have more severe symptoms, relapses, and resistance to immunosuppressive therapies, supporting an important role for this autoantigen in the pathophysiology and severity of AAV. In this review, we describe what is known about the role of hPR3 in pathophysiology, diagnosis of AAV, and some perspectives on its treatment.

The diagnosis of chronic granulomatous disease (CGD), a congenital immunodeficiency affecting phagocyte function, remains a challenge for patients in Latin America. It is well established that dihydrorhodamine (DHR) flow cytometry is the most commonly used screening assay; however, few pediatric immunology centers in Brazil perform this test. This study reports data from a routine diagnostic workup for CGD conducted at a Brazilian children's hospital. A three-year prospective study was performed, enrolling children with clinical features suggestive of immunodeficiency who were screened using DHR. Sanger sequencing of the NCF1 (neutrophil cytosolic factor 1) and CYBB (cytochrome b-245, beta chain) genes was conducted in children with two consecutive abnormal DHR results. A total of 255 patients-62% males-with a median age of 3.2 years (range: 1 month-17.8 years) were evaluated. Six patients (2.4%) had abnormal DHR tests, and four of them (1.6%) received a definitive diagnosis of CGD. Most children presented with pneumonia and/or abscesses during the first year of life as the clinical manifestation of CGD. Two of the four diagnosed patients were receiving continuous antibiotics and two underwent transplantation. Pathogenic variants were identified in NCF1 (three cases) and CYBB (one case). The hospital-based diagnostic workup for CGD identified approximately one new case per 60 tested patients, indicating a high frequency of the disease in the study population. This approach may represent a valuable strategy for identifying new pediatric CGD cases in resource-limited settings.

Background: One of the most important points in the treatment of food allergies is the avoidance of the culprit allergen. This study aimed to determine whether the training given by a dietitian to mothers of children with IgE-mediated food allergies increased the habit of reading food labels.

Methods: Mothers of children with IgE-mediated food allergies were trained on reading food labels by a dietitian. Then, the mothers' food label reading habits were measured with a questionnaire form at 3-month intervals before and after the training.

Results: The study included 56 children with IgE-mediated food allergies and their mothers. Thirty-four (60.7%) of the patients were males. The median age was 10 (min-max = 1-52) months. The most common food allergen was eggs, and this allergy was detected in 31 (55.3%) of the patients. The most common systemic involvement was skin, which was seen in all patients (100.0%). Fifty-six mothers of children with IgE-mediated food allergies participated in the study (Median age: 30 years, min-max = 20-45). There were statistically significant differences between the pre- and post-training groups in terms of the answers to the question "What are the things that affect you the most when buying food?" as "Label information on food packaging," "Do you look at the product label when purchasing food?" as "yes," "If your answer is "yes," "Which food group do you look at?" as "milk and dairy products or eggs and products," and "What do you pay attention to on food labels?" as "allergen information" (P = 0.001,0.001, 0.001,0.001, and 0.001, respectively).

Conclusion: This study concluded that providing training by a dietitian on how to read food labels to mothers of children with IgE-mediated food allergies increases mothers' awareness of reading the labels.

Background: The increasing prevalence of asthma necessitates consideration of modifiable asthma risk factors, such as sedentary lifestyle, overweight/obesity, and environmental tobacco smoke (ETS) exposure. The aim of this study was to analyze the relationship between asthma symptoms and the risk factors in young adolescents.

Methods: This cross-sectional study, as part of the Global Asthma Network (GAN) Phase I project, used standardized questionnaires based on ISAAC (International Study of Asthma and Allergies in Childhood) Phase I and Phase III questionnaires. In Gjilan, Kosovo, self-reported data from 1200 school children aged 13-14 years were collected.

Results: Overweight (BMI [body mass index] > 25 kg/m²) had a statistically significant association with asthma symptoms (p < 0.05), particularly with disturbed sleep due to wheezing (OR [odds ratio] = 3.93 [95% CI [confidence interval]: 1.27-12.12]) and the reported wheezing by females during or after exercise. Sedentary lifestyle (≥ 3 hours/day on a computer/television) was found to be associated with wheezing (OR = 1.89 [95% CI: 1.34-2.66]) and the diagnosis of asthma. ETS exposure was significantly associated with wheezing during or after exercise (OR = 1.67 [95% CI: 1.15-2.42]) and coughing at night (OR = 1.67 [95% CI: 1.19-2.33]).

Conclusion: The findings support the importance of sedentary lifestyle, obesity, and ETS exposure as asthma risk factors in young adolescents experiencing asthma symptoms. Future public health interventions should take these modifiable risk factors into account, especially in urban locations, in order to alleviate asthma morbidity.