Allergy, Asthma & Immunology Research最新文献

Ocular allergy encompasses a heterogeneous group of diseases with overlapping clinical features and complex immunopathological mechanisms. This often creates challenges in classification and, consequently, in optimizing patient management. The nomenclature published in 2023 by the European Academy of Allergy and Clinical Immunology (EAACI) addresses these issues by redefining these conditions and linking clinical phenotypes and environmental modifiers to underlying types of hypersensitivity. This framework enhances diagnostic precision and supports mechanism-guided management. This article applies the EAACI approach based on hypersensitivity types to ocular allergy. The examples addressed include seasonal and perennial allergic conjunctivitis, driven mainly by type I and IV hypersensitivity reactions; vernal and atopic keratoconjunctivitis, involving mixed type I, IVb and IVa pathways; giant papillary conjunctivitis, a tissue-driven type V reaction; and contact blepharoconjunctivitis, a type IVa delayed hypersensitivity reaction with additional components. Distinct endotypes-such as local or acute allergic conjunctivitis, dupilumab-induced ocular disease, and vernal keratoconjunctivitis/atopic keratoconjunctivitis overlap-further illustrate heterogeneity, with the ocular surface microbiome emerging as a modifier. Diagnostics are increasingly aligning with mechanisms, and the EAACI framework translates this complexity into a mechanism-indexed map; this supports the selection of responders for targeted interventions while minimizing overtreatment.

The diagnosis of asthma in children is challenging due to limitations of conventional spirometry, which primarily assesses large airway function and requires considerable patient effort. Terminal expiration volume (TEV)/forced expiratory volume in 3 seconds (FEV3) has been proposed as a new metric that may help assess small airway dysfunction, where TEV represents the volume difference between FEV3 and forced expiratory volume in 1 seconds (FEV1) and reflects terminal expiratory airflow. We aimed to evaluate the bronchodilator response (BDR) of TEV/FEV3 (BDR-TEV/FEV3) as an index reflecting variable small airway obstruction in children. This retrospective study included 1,199 children who underwent both spirometry and bronchial provocation testing for asthma at a tertiary hospital between January 2017 and December 2019. BDR-TEV/FEV3 was compared according to asthma status and severity. The findings were verified using an external validation group (n = 105). We also explored the association between BDR-TEV/FEV3 and established indices of airway inflammation. BDR-TEV/FEV3 was significantly higher in children with asthma than in those without asthma (3.74% vs. 1.81%, P < 0.001) and showed a stepwise increment with asthma severity (P for trend < 0.001). Moreover, BDR-TEV/FEV3 showed a positive correlation with changes in airflow limitation markers, impulse oscillometry parameters, and inflammatory markers such as eosinophil count and fractional exhaled nitric oxide. The change in TEV/FEV3 after bronchodilator inhalation significantly differed between asthmatic and non-asthmatic children and across asthma severity groups. BDR-TEV/FEV3 may be used as a parameter to assess the reversibility of small airway obstruction in children with asthma.

Purpose: Antibiotic-related drug eruption is a common cutaneous adverse reaction in pediatric populations. However, its incidence and risk factor remain unclear. This study investigated the incidence of drug eruptions in pediatrics and its association with antibiotic exposure to identify potential risk factors.

Methods: Using the Health Insurance Review and Assessment Service-Pediatric Patient Sample database (2009-2019), we conducted a retrospective nationwide cohort study involving 6,699,010 pediatric patients. Drug eruptions were identified based on administrative claims data using the International Classification of Diseases, 10th Revision codes L27.0 and L27.1. The incidence was compared between antibiotic-exposed and unexposed groups.

Results: We analyzed 4,107,522 patients in the antibiotic-exposed group and 2,591,488 patients in the antibiotic-unexposed group. The overall incidence of drug eruptions was 10.84 per 10,000 person-years, with higher rates in the antibiotic-exposed group than in the antibiotic-unexposed group (14.59 vs. 4.89 per 10,000 person-years, Log rank P < 0.001). Any exposure to antibiotics significantly increased drug eruption risk (adjusted hazard ratio, 2.86; 95% confidence interval, 2.27-3.60). The risk of drug eruption was higher among pediatric patients who used multiple antibiotics than in those with single antibiotic use. The association remained consistent across age groups and was robust in sensitivity analyses, including extended follow-ups and inpatient-only outcomes.

Conclusions: Antibiotic exposure increases the risk of drug eruption in pediatric populations, particularly with multiple antibiotic use. Careful consideration is needed when prescribing antibiotics to children, especially in combination therapy.

Purpose: To examine the association between the risk of obstructive sleep apnea (OSA) and atopic dermatitis (AD), in addition to the dose-response relationship between the risk of OSA and the prevalence of AD.

Methods: This study analyzed data from 15,095 participants aged ≥ 40 years who were part of the 2019-2022 Korea National Health and Nutrition Examination Survey (KNHANES). AD was assessed using self-reported questionnaires, and the risk of OSA was determined using the STOP-BANG score. Demographic distributions were analyzed by using χ² tests, whereas adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression analysis. The weighted prevalence of AD and 95% CIs were calculated to account for the complex sampling design of KNHANES.

Results: Multivariable logistic regression revealed a significant association between OSA risk and AD, with an OR of 2.159 (95% CI, 1.456-3.202). The weighted prevalence of AD increased with higher OSA risk, from 1.43% in the low-risk group to 1.74% in the intermediate-risk group, and 2.17% in the high-risk group (P value for trend = 0.013).

Conclusions: OSA risk was significantly associated with AD prevalence, having a dose-response relationship. Given the observed associations, incorporating OSA management into clinical strategies may warrant further investigation as a potential avenue for mitigating AD-related risk.

Purpose: Biologic therapies have revolutionized the management of severe asthma (SA), yet the variability in patient responses necessitates identification/verification of predictive biomarkers. Siglec-8, a sialic acid-binding immunoglobulin-like lectin 8 selectively that is expressed on eosinophils, could serve as a biomarker for predicting responsiveness to biologics in patients with SA. It is necessary to evaluate the predictive value of baseline serum Siglec-8 levels compared to other parameters, including blood eosinophil counts, in determining clinical responses to anti-interleukin 5 (IL-5) therapies in patients with SA.

Methods: This study included 68 patients with SA from the Precision Medicine Intervention in Severe Asthma study, who had initiated anti-IL-5 therapies and whose baseline serum Siglec-8 levels were measured. Clinical outcomes were assessed at 6 and 12 months following treatment. Excellent responders were defined as patients with zero exacerbations during follow-up. Multivariable logistic regression and receiver operating characteristic curve analyses were performed to compare the predictive performance of serum Siglec-8 levels versus that of other parameters.

Results: Data from 29 patients treated with mepolizumab and 39 patients treated with reslizumab were analyzed. Baseline serum Siglec-8 levels showed a trend toward better diagnostic performance compared to blood eosinophil counts for predicting 6- and 12-month clinical responses (area under the curve, 0.931 vs. 0.836; P = 0.08 for 6-month responders; and 0.811 vs. 0.628, P = 0.05 for 12-month excellent responders). Additionally, the ratio of serum Siglec-8 levels to blood eosinophil counts significantly increased after 6 months of anti-IL-5 therapy (P < 0.001).

Conclusions: Baseline serum Siglec-8 levels showed a trend toward better predictive performance than other parameters for predicting 6- and 12-month responses to anti-IL-5 therapies in patients with SA. These findings suggest that Siglec-8 may have the potential as a biomarker for guiding treatment decisions, although further validation in larger, prospective studies is warranted.

Trial registration: ClinicalTrials.gov Identifier: NCT05164939.

Tree nut (TN) and seed allergies have become increasingly recognized as important global health concerns, paralleling rising consumption driven by dietary trends. These allergies are often severe, typically develop in childhood, and may persist throughout life. Recent population-based studies show rising prevalence, particularly for TNs and sesame, with substantial regional variability. Clinical outcomes are strongly influenced by the underlying sensitization profile: storage proteins and lipid transfer proteins are associated with systemic reactions and anaphylaxis, whereas sensitization to pathogenesis-related group 10 and profilins usually results in milder manifestations including pollen-food syndrome. Co-sensitization among TNs and seeds occurs frequently; however, clinical co-allergy is observed to a lesser degree, with the highest overlap reported between cashew-pistachio and walnut-pecan. Advances in diagnosis, including component-resolved diagnostics and the basophil activation test, improve discrimination between clinical allergy and asymptomatic sensitization or mild localized reactions, and help minimize the need for oral food challenges. Acute management aligns with standard principles for immunoglobulin E-mediated food allergy, with prompt intramuscular epinephrine being the first-line treatment for anaphylaxis. Long-term management emphasizes accurate allergen identification, pragmatic dietary recommendation that supports inclusion of tolerated nuts, and preparedness with epinephrine for accidental exposure. Emerging data support the use of oral immunotherapy for selected TNs and sesame, with promising desensitization rates. Regulatory progress in allergen labeling and targeted education in high-risk settings, such as schools, restaurants, and air travel, are essential for prevention. Further studies are required to clarify natural history, to optimize immunotherapy, and to refine management for better supporting affected individuals across the lifespan.

Purpose: This study aimed to assess the current prevalence of allergic rhinitis (AR) among Korean children based on a 2022 nationwide survey and to analyze long-term trends from 1995 to 2022.

Methods: A nationwide cross-sectional study was conducted in 2022, involving 12,558 children aged 6-13 years from randomly selected elementary and middle schools across Korea. The AR prevalence and risk factors were assessed using the modified International Study of Asthma and Allergies in Childhood Questionnaire. The data were compared with epidemiological surveys conducted in 1995, 2000, and 2010 to evaluate long-term trends.

Results: The prevalence rates of AR symptoms during the last 12 months were 45.2%, 48.2%, and 47.8%, respectively, in children aged 6-7, 9-10, and 12-13 years, respectively. Among children aged 6-7 years, the prevalence of AR symptoms showed a long-term upward trend, rising from 29.9% in 1995 to 26.0% in 2000, 43.6% in 2010, and 45.2% in 2022 (P < 0.001). Among children aged 12-13 years, the prevalence rates also increased steadily, from 26.7% in 1995 to 31.0% in 2000, 42.7% in 2010, and 47.8% in 2022 (P < 0.001). A parental history of allergic disease and a diagnosis of atopic dermatitis were risk factors for AR symptoms during the last 12 months across all study populations from both the 2010 and 2022 surveys. Antibiotic use during infancy and male sex were significant contributors to AR development in children aged 6-7 years, whereas female sex was a significant risk factor in adolescents aged 12-13 years in 2022.

Conclusions: The prevalence of AR among Korean children has increased over the past few decades, highlighting the importance of continuous surveillance and preventive measures. Identifying modifiable risk factors, such as early-life exposure and environmental influences, is crucial for developing targeted intervention strategies.

Purpose: Insulin resistance, a central feature of metabolic syndrome, has been associated with asthma exacerbations. However, the role of metabolic markers, specifically the triglyceride-glucose body mass index (TyG-BMI), in predicting asthma exacerbations is not fully explored. This study explored the predictive value of the TyG-BMI, a biomarker of metabolic syndrome and insulin resistance, in the risk of asthma exacerbations.

Methods: This single-center prospective cohort study enrolled 484 patients with stable asthma between March and October of 2023. The study employed K-means clustering analysis to categorize patients according to TyG-BMI. The primary endpoint was the first occurrence of asthma exacerbation during one year of follow-up. Additionally, weighted quantile sum regression was performed to quantify the contribution of fasting triglycerides (TGs), fasting blood glucose, and BMI to the TyG-BMI, aiming to provide a more comprehensive explanation.

Results: Of the 484 patients who met the study criteria, 359 experienced exacerbations during the study period. The fully adjusted model showed an odds ratio of 10.65 (95% confidence interval, 2.51-45.25) for patients with higher TyG-BMI levels. Restricted cubic spline analysis revealed a threshold effect at the TyG-BMI of 215, beyond which the asthma exacerbation rate increased significantly. Weight assignment analysis indicated that TG was the primary contributor to the TyG-BMI.

Conclusions: The TyG-BMI is an independent risk factor for asthma exacerbation, highlighting its potential utility in identifying high-risk patients and guiding personalized interventions.

Allergic rhinitis (AR) significantly impairs quality of life and often necessitates combination therapies for optimal symptom control. This study aimed to evaluate the efficacy of montelukast-antihistamine combination therapy in patients with AR by using a network meta-analysis. A comprehensive search was conducted using PubMed, Embase, MEDLINE, Scopus, the Cochrane Library, and Google Scholar up to April 2025. The treatment strategies included montelukast alone, antihistamine monotherapies (loratadine, desloratadine, levocetirizine, and fexofenadine), their respective combinations with montelukast, including bilastine. Outcomes included daytime and nighttime symptom scores, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and individual symptoms. Both pairwise and network meta-analyses were conducted. Thirty studies (4,486 patients) were included. Montelukast combinations with desloratadine (standardized mean difference [SMD] = -0.51), levocetirizine (SMD = -0.44), and loratadine (SMD = -0.31) significantly improved daytime nasal symptoms compared to montelukast alone. Only montelukast-levocetirizine improved nighttime symptoms (SMD = -0.21) and RQLQ (SMD = -0.48). The combinations with desloratadine or levocetirizine were superior for nasal obstruction, sneezing, and itching, while nasal discharge improved only with montelukast-levocetirizine. No treatment significantly improved eye symptoms. Surface under the cumulative ranking curve rankings generally favored combination therapies, though trends varied by outcome. Desloratadine monotherapy ranked highest for nasal itching. Although some comparisons require cautious interpretation, montelukast-based combination therapy demonstrated greater efficacy than monotherapy for multiple AR symptoms. These results highlight the importance of selecting therapeutic strategies based on the predominant symptom profile of individual patients.