Allergy and asthma proceedings最新文献

Background: Common variable immunodeficiency (CVID) and selective immunoglobulin G (IgG) deficiency (sIgGD) are primary antibody deficiencies with divergent clinical trajectories. CVID is characterized by recurrent infections and systemic noninfectious complications, whereas sIgGD typically follows a milder course. Despite sharing clinical features such as recurrent infections, comparative data on complications and mortality remain limited, which hinders risk-stratified management. Objective: This study compared the prevalence, clinical impact, and mortality associated with noninfectious complications in CVID and sIgGD, and identified predictors of adverse outcomes to support risk-stratified management and examined clinical differences within the CVID group based on baseline serum IgM levels. Methods: A single-center retrospective cohort study (2018-2024) included 111 patients with CVID and 19 patients with sIgGD. Diagnostic criteria for CVID included hypogammaglobulinemia (IgG level < 400 mg/dL with low IgA/IgM), impaired vaccine responses, and exclusion of secondary causes. The sIgGD required isolated IgG deficiency with normal IgA/IgM and intact vaccine responses. Noninfectious complications, including organ-specific and systemic manifestations as well as bronchiectasis were evaluated. In patients with CVID, a predefined subgroup analysis was performed based on baseline serum IgM levels (normal versus <40 mg/dL). Multivariate logistic regression identified mortality predictors. Results: The patients with CVID exhibited significantly higher rates of recurrent sinopulmonary infections (70.3% versus 42.1%), bronchiectasis (46.8% versus 21.1%), and noninfectious complications (57.7% versus 31.6%), including autoimmune disorders such as hematologic manifestations (33.3% versus 10.5%). In the CVID group, the patients with low IgM levels exhibited a significantly higher prevalence of gastrointestinal involvement (24.0% versus 5.6%; p = 0.035). Bronchiectasis (odds ratio [OR] 5.22) and noninfectious complications (OR 7.95) independently predicted mortality in CVID. Male sex showed borderline risk. In contrast, no mortality was observed in the sIgGD cohort over the study period. Conclusion: CVID is associated with substantial noninfectious morbidity and mortality, which necessitates early identification and long-term monitoring. In contrast, sIgGD exhibits a milder clinical phenotype, although preventive care remains important. These findings support distinct management strategies and highlight the utility of clinical markers for risk stratification.

Background: Hypersensitivity reactions (HSR) to tumor necrosis factor α inhibitors (TNFi) can occur but data about skin testing in such reactions are limited. Objective: To evaluate skin testing in patients with HSRs to TNFi. Methods: A detailed review of demographics and clinical characteristics, features of index reactions, results of skin tests, and outcomes of desensitization protocols were obtained. Results: The cohort comprised 64 patients (women/men: 41/23). Treatment distribution included etanercept (n = 50 [78.1%]), adalimumab (n = 11 [17.2%]), and infliximab (n = 3 [4.7%]). HSRs were seen as an injection-site reaction (ISR) in 47 patients (73.4%), generalized urticaria in 8 patients (12.5%), and anaphylaxis in 3 patients (4.7%). Forty-four patients (44/64 [72%]) had positivity on skin tests as either skin-prick test (SPT) or intradermal test (IDT). Among other reaction types, the patients with ISRs exhibited the highest skin test positivity (p = 0.043). Among the 17 patients who underwent rapid subcutaneous or intravenous desensitization, 15 patients (88.2%) had positive skin test results, and all desensitization procedures were successfully completed, despite some experiencing local breakthrough reactions (BTR). Conclusion: This study, which includes the largest number of patients reported in the literature, highlights the important role of skin testing in diagnosing HSRs to TNFi. Notably, etanercept demonstrated the highest positivity rate. Successful completion of desensitization protocols despite some BTRs highlights the importance of desensitization in patients experiencing HSRs to these treatments.

Background: During pregnancy, the mother's gut microbiota is passed onto the baby and the baby's gut microbiota resembles the mother's. The bioactive peptides and microbial metabolites contained in fermented foods help the formation of healthy gut microbiota. Objective: The aim of this study was to investigate habits of consumption of homemade fermented milk and dairy products (FMP) during pregnancy by mothers of children with egg allergy. Methods: Mothers of children with egg allergy ages < 3 years (EA group [n = 93]) and age- and sex-matched healthy children (HC group [n = 77]) admitted to the pediatric allergy and immunology outpatient clinic between January 2023 and June 2023 were included in this case-control study. Data were collected by using the random sampling method. A sociodemographic form was used for the mother and child, and the frequency, amount, and variety of weekly consumption of FMPs (yogurt, cheese, tarhana, and kefir) during pregnancy were investigated. Results: The homemade FMPs during pregnancy of the mothers of the EA group were yogurt, tarhana, and cheese. The number of mothers in the EA group who consumed homemade yogurt (p = 0.049) and tarhana (p < 0.001) was lower than those in the HC group. Mothers in the EA group were also less likely to consume yogurt regularly (p = 0.036). Mothers in the EA group also consumed less homemade yogurt (p = 0.020), cheese (p = 0.001), and tarhana (p < 0.001) than those in the HC group. The diversity of homemade yogurt and cheese (p = 0.048); yogurt, cheese, and tarhana (p < 0.001) consumed during pregnancy was lower in the EA group compared with the HC group. Conclusion: Mothers of children with egg allergy exhibited lower frequencies, quantities, and varieties of homemade FMPs consumption during pregnancy. Consumption of homemade FMPs by mothers during pregnancy may protect against egg allergy in their children.

Background: Allergy immunotherapy is a proven treatment for allergic rhinitis and asthma with the potential to modify the natural history of these disorders. Considerable advances have been seen in the past 15 years since publication of the third update of the Allergen Immunotherapy Practice Parameter. Objective: The aim was to understand new developments that pertain to subcutaneous immunotherapy and sublingual immunotherapy (SLIT). Methods: New evidence related to advances related to efficacy and safety of allergy immunotherapy are presented as well as unmet needs and future directions. Results: Most new evidence has come from large double-blind placebo controlled trials of SLIT tablets, which better define efficacy and safety in patients with allergic rhinitis, allergic asthma, and atopic dermatitis. More evidence has emerged that identifies risk factors for anaphylaxis to subcutaneous injections and approaches to mitigate risk. Conclusion: Two modalities of allergy immunotherapy are available to allergy specialists. Both SLIT and subcutaneous immunotherapy have near equivalent efficacy, but SLIT has a superior safety profile, allowing self-administration.

Background: Hypersensitivity reactions, including anaphylaxis, have been increasingly reported with quinolones. Objective: To characterize the association of different quinolones with anaphylaxis reports in the FDA Adverse Event Reporting System (FAERS) data base. Methods: We searched the FAERS data base for anaphylactic reaction reports (between 2015 and 2024) associated with the three commonly used fluoroquinolones in the United States, viz., levofloxacin, ciprofloxacin, and moxifloxacin. The reporting odds ratio (ROR) was used to assess disproportional reports of anaphylaxis among the individual fluoroquinolones and between the fluoroquinolones and all medications within the data base. Results: We identified 941 anaphylaxis reports (ciprofloxacin, 390; levofloxacin, 299; and moxifloxacin, 252) of 89,351 adverse reactions reported for all fluoroquinolones between 2015 and 2024. There were disproportionally higher reports of anaphylaxis among fluoroquinolones compared with all medications within the data base (ROR 4.56 [95% confidence interval {CI}, 4.28-4.87]) but lower relative to that of amoxicillin (ROR 0.19 [95% CI, 0.17-0.20]). Within the fluoroquinolones, moxifloxacin was associated with the highest disproportionality signal for anaphylaxis relative to all other medications (ROR 8.65 [95% CI, 7.63-9.80]) and relative to all fluoroquinolones (ROR 1.90 [95% CI, 1.65-2.18]), whereas levofloxacin was associated with a disproportionally lower signal when compared with all other fluoroquinolones (ROR 0.77 [95% CI, 0.67-0.88]). The disproportionally higher anaphylaxis report associated with moxifloxacin was especially pronounced among women (ROR 2.11 [95% CI, 1.78-2.49]) and elderly individuals (ROR 2.74 [95% CI, 2.15-3.48]). Conclusion: Moxifloxacin is associated with relatively higher anaphylaxis reports when compared with all other quinolones, especially among female and elderly individuals.

We present the case of a 9-year-old girl with a medical history of growth hormone deficiency, Hashimoto's thyroiditis, failure to thrive, and eosinophilic colitis, and with a new progressive rash. The rash began as erythematous, pruritic papules, which gradually spread and evolved into larger, well-circumscribed plaques. Despite treatment with topical corticosteroids and broad antifungal therapy, the rash persisted without improvement. The patient reported no systemic symptoms. On examination, she was well appearing and afebrile, with normal vital signs. Dermatologic findings included erythematous, pruritic plaques on the abdomen, perioral area, and lower extremities. No lymphadenopathy or other abnormalities were noted. After a more thorough evaluation, an unexpected diagnosis was made. This case highlights the clinical challenge of diagnosing dermatologic conditions in pediatric patients with complex medical histories. Although the presentation was suggestive of atopic dermatitis, the morphology and distribution of the lesions, along with resistance to standard therapy, raised concerns for alternative diagnoses. This case underscores the importance of maintaining a broad differential diagnosis when managing chronic or atypical skin eruptions, particularly in patients with multisystem involvement or a history of autoimmune conditions.

Background: Food allergy (FA) is a prevalent condition in the United States that can cause anaphylaxis. FA cases are becoming increasingly concerning in the United States, with rising trends in the pediatric population. However, increases have not been proportional across racial and/or ethnic groups, with studies that show rapid increases in minority populations. Objective: Due to this trend, we investigated if FA prevalence increased in patients at Texas Children's Hospital (TCH) based on race and gender. Methods: We retrospectively compared patients at TCH between the years 2013 and 2015 (time frame 1) and 2016 and 2018 (time frame 2). Patient FA history was diagnosed via medical diagnosis codes. Patients were stratified by gender and five race categories: Asian, black/African American (AA), Hispanic/Latino, non-Hispanic white, and "other." The prevalence of an FA was calculated by dividing the number of patients with an FA by the total number of patients seen at TCH within a given race, gender, and time frame. The χ² test was used, and two-sided p-values of <0.05 were considered statistically significant. Results: The prevalence of an FA at TCH significantly increased within each race and gender except for patients who self-reported as "other" race. Asian patients had the highest increase in FAs among all the races between the two time frames. Black/AA American patients also had a clinically significant increase, with FA prevalence increased by 1.5 times from time frame 1 to 2. The prevalence increased more for male patients (0.43%) than for female patients (0.28%). The increase for male patients was similar to the increase for blacks (0.46%). Conclusion: FA prevalence increased for all race and gender subcohorts except for those who identified as "other" race, with clinically significant increases noted in males, Asian, and black/AA populations. This increase in FA prevalence suggests that there may be children of specific racial or ethnic groups who are at an increased risk of developing an FA.

Background: The ACAAI//AAAAI Joint Task Force on Practice Parameters periodically develops updated guidance based on all available evidence. Methods: This review summarizes advances in diagnosis and management of insect sting allergy from published practice parameters, and developments under review for the 2026 update. Results: Changes in the species and distribution of stinging insects in the US may be due to migration and invasion. Overall prevalence has not changed, but fatalities from insect sting allergy increased 50% in 30 years. Diagnostic evaluation includes both skin and serum immunoglobulinE testing although positive predictive value is dependent on the history. Evaluation may include venom component testing. Mastocytosis and hereditary alpha tryptasemia must be considered in many cases; testing for baseline serum tryptase is now routine. Testing for c-KIT gene mutation in peripheral blood and tryptase genotype are important supplemental tests. The risk of beta blockers and angiotensin converting enzyme inhibitors is relatively low in most cases, and they are not contraindicated during venom immunotherapy (VIT). VIT is indicated in high-risk patients (30-70% risk of anaphylaxis), but is not required in those with cutaneous reactions (3-10% risk of anaphylaxis). VIT can be safely initiated with rush regimens. Recurrent systemic reactions are rare, and may require omalizumab treatment (off-label). VIT can be discontinued after 5 years in most patients, but extended or indefinite VIT (often at 12-week intervals) is recommended in patients with known high-risk factors or where stopping would cause markedly impaired quality of life. Conclusion: Continued research has refined our clinical approach to patients with concerns about stinging insect hypersensitivity.

Background: This study evaluates the lymphocyte-eosinophil to neutrophil-monocyte ratio (LENMR) as a novel inflammatory indicator of the exacerbation risk in adults with asthma. Methods: This cross-sectional study included 1344 adults with asthma from the 2007-2012 cycles of the National Health and Nutrition Examination Survey. The association between LENMR and asthma exacerbations was evaluated by using multivariable logistic regression with progressive adjustment for confounders. Subgroup analyses were conducted to assess the consistency of associations. Restricted cubic spline and threshold effect models were used to explore potential nonlinear relationships. Results: A higher LENMR was significantly associated with an increased risk of asthma exacerbations. In the fully adjusted model, the participants in the highest quartile had a 77% higher odds of exacerbation compared with the lowest quartile (odds ratio 1.77 [95% confidence interval, 1.19-2.65]; p = 0.007). Associations were consistent across subgroups. Restricted cubic spline analysis revealed a significant nonlinear relationship, with a threshold effect identified at LENMR = 0.31. Conclusion: An elevated LENMR is positively associated with asthma exacerbations under specific thresholds.

Background: Drug provocation tests (DPT) are the criterion standard method for diagnosing nonsteroidal anti-inflammatory drugs (NSAID) and paracetamol hypersensitivity reactions in children. However, there is no consensus in the literature with regard to the duration of DPTs. Objective: The objective was to compare the negative predictive values (NPV) of single- and 2-day DPTs for NSAID and paracetamol hypersensitivity diagnosis in pediatric patients. Methods: We retrospectively evaluated children (ages 1-18 years) with a history of NSAID and paracetamol hypersensitivity. The patients were categorized into two groups based on drug provocation duration: short (single-day test) and extended (test continued on the second day at home). Patients with negative DPT results for the suspected agent were contacted to determine whether they reused the drug and, if so, whether there was a reaction. The NPVs of the DPTs performed for both groups were calculated. Results: The DPT results of 104 patients (53.8% boys) were negative for 116 suspected agents: 67 (57.7%) tested with short DPT and 49 (42.2%) with extended DPT. No significant differences in age, sex, reaction type, or comorbidities were observed between the two groups. In the follow-up, 114 DPTs were performed for 102 patients, of whom 93 used the suspected drug(s) after the tests but none developed a reaction. The NPV was the same for both groups: 100%. Conclusion: To the best of our knowledge, this is the first study to compare the NPVs of single- and 2-day DPTs for children who present with suspected NSAID and paracetamol hypersensitivity. Our results indicate that both approaches have the same NPV and suggest that single-day DPT is sufficient to exclude suspicion of NSAID and paracetamol hypersensitivity in children.