Asia Pacific Allergy最新文献

Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction that can be triggered by food, drugs, or venom. Anaphylaxis to toothpaste, a generally well-tolerated household product, is rare. In this report, we describe a rare case of anaphylaxis in a child triggered by mint-containing toothpaste. The case involves a 9-year-old boy with a history of allergic rhinoconjunctivitis, who initially experienced localized lip pruritus from toothpaste, which progressed to systemic anaphylaxis secondary to mint allergy. Mint allergy is rarely reported, with most documented cases involving type IV hypersensitivity reactions, resulting in cheilitis. This case highlights the need for clinicians to be aware that allergic reactions, including anaphylaxis, to toothpaste are possible. A thorough review of all product ingredients is essential to ensure accurate diagnosis and appropriate management.

Australia has the highest prevalence worldwide of tick-induced allergies (mammalian meat and tick allergy/anaphylaxis). Inappropriate tick removal techniques are known to trigger tick anaphylaxis. This study aimed to ascertain the evidence for the effectiveness of tick removal methods and their relationship to the outcomes of tick-induced allergies and tick-borne illnesses. The design involved is a systematic literature review. Scopus, Embase, and Medline were searched (September 20, 2023) for studies of tick removal techniques and for outcomes of tick-induced allergic reactions and tick-borne illnesses. Two reviewers reviewed abstracts and full texts. Included studies were appraised (Joanna Briggs Institute critical appraisal tools), and data were extracted, tabulated, and evaluated. Six studies investigated a relevant outcome, all of low or moderate quality. Tick-killing in situ before removal resulted in allergic reactions in only 3/61 patients and no anaphylaxis. 23/28 who presented to the Emergency Department following removal with tweezers had allergic reactions (one anaphylaxis). When those with known tick anaphylaxis killed ticks in situ before removal there was no subsequent anaphylactic reaction. A significant decrease in disease transmission and/or seropositivity (B. burgdorferi and/or R. conorii) was shown with crushing ticks or gentle pressure before removal with fine-tipped forceps, forceps alone, and surgical tweezers. Manipulation before removal with tweezers made no difference to B. burgdorferi seropositivity. Few studies worldwide have examined outcomes of tick removal techniques. Tick-killing in situ reduces recurrent tick anaphylaxis in Australians. Early removal with forceps may be effective where tick-borne disease is of greater concern. Further studies of tick-killing in situ focusing upon disease transmission should be prioritized.

Background: Oral allergy syndrome (OAS) is an immediate allergic reaction triggered by specific foods, often linked to pollen-food allergy syndrome (PFAS). With the increasing prevalence of pollinosis in Japan, especially among younger populations, OAS and PFAS are expected to rise. However, few studies have investigated their prevalence in pediatric populations, particularly in relation to different families of causative foods.

Objective: In this study, we examined the comparative prevalences of oral symptoms suggestive of OAS based on survey data from parents of a general population of children attending elementary and junior high schools, focusing on the differences between causative food families.

Methods: We conducted a questionnaire-based survey among parents of 6,853 elementary and junior high school students in Omihachiman, Japan. Oral symptom was identified based on reported oral symptoms following the consumption of specific raw fruits and vegetables. Data were analyzed using trend analysis and multivariable logistic regression.

Results: Among 4,991 respondents (72.8%), 12.4% had oral symptoms. Prevalence was significantly higher in females than in males (14.4% vs. 10.4%). Older age groups showed higher prevalence trends, except for Cucurbitaceae (melon/watermelon). Actinidiaceae (kiwi) and Bromeliaceae (pineapple) had significantly higher prevalence in females, while Cucurbitaceae (melon/watermelon) showed no sex differences. No significant sex differences were observed in cases requiring avoidance.

Conclusion: This study provides the first prevalence estimates of oral symptoms suggestive of OAS by sex, age, and causative food family in Japanese children. These findings contribute to improved diagnosis, treatment, and prevention strategies for pediatric OAS and PFAS.

Euglena, a microalga with photosynthetic capabilities, has become increasingly popular in Japan as a health food and supplement owing to its rich nutrient profile. However, their potential to cause allergic reactions remains largely unknown. We report the first case of anaphylaxis induced by euglena in a 48-year-old Japanese woman with a history of urticaria and oral allergy syndrome. She had been consuming a Euglena-containing supplement for nearly a decade, increasing her intake in the 3 months preceding her initial visit. She experienced recurrent anaphylactic episodes, including urticaria, abdominal pain, palpitations, and vomiting. Diagnostic tests, including histamine release and skin-prick tests, confirmed an immediate allergic reaction to Euglena. Following discontinuation of the Euglena-containing supplement, her symptoms resolved completely. As the consumption of Euglena-based products continues to increase, the possibility of Euglena-induced allergic reactions should be considered, and further research into its allergenic components is necessary.

We present an interesting case that demonstrated that delayed beta-lactam hypersensitivity can be lost, as demonstrated by both the initial skin test and challenge, and gained, as proven by a repeat delayed skin test positivity 4 weeks after the initial evaluation in this case. We postulate that positivity over the intradermal site following the completion of prolonged challenge occurs due to the priming and resensitization of circulating T cells and the homing of these drug-specific T cells to the skin (sites of intradermal testing) where the penicillin antigens are still present. Of note, post-inflammatory hyperpigmentation following skin tests is rare, as typical wheals and flare reactions associated with skin testing resolve completely. Thus, we postulate that the postinflammatory hyperpigmentation that is seen in this case may be representative of T cell mechanisms similar to that of a fixed drug eruption.

Cow's milk allergy (CMA) is a common pediatric food allergy that can cause significant nutritional and quality-of-life challenges. Severe cases, characterized by high milk-specific IgE levels and a history of anaphylaxis, rarely develop natural tolerance. Oral immunotherapy (OIT) is generally avoided in such high-risk patients due to the risk of serious allergic reactions, leaving strict avoidance as the standard treatment. However, prolonged avoidance may delay tolerance acquisition and increase psychosocial burden. We report a female patient with severe CMA and multiple food allergies who underwent a carefully tailored, ultra-low-dose OIT over 10 years. At treatment initiation, her milk-specific IgE was >100 kUA/L, and an oral challenge with 1.1 mL of milk induced anaphylaxis. The OIT protocol started with a dose well below her reaction threshold and increased gradually, resulting in no serious adverse events. Over time, she achieved tolerance to 200 mL of pure milk and resumed unrestricted consumption of milk and other previously avoided foods such as egg and wheat. This is the first report of successful long-term ultra-low-dose OIT in a highly sensitized child with severe CMA, showing that slow, cautious escalation can safely induce unrestricted intake even in patients previously deemed unsuitable for OIT. Given the limitations of biologics and emergency care availability worldwide, this low-risk, home-based protocol using locally available foods offers a feasible and affordable approach for managing severe food allergies globally. Such individualized, sustained OIT may improve long-term outcomes and quality of life for children with severe food allergies.

Nasal cytology (NC) has evolved into a standardized and clinically relevant diagnostic tool in rhinology, capable of characterizing the cellular patterns of allergic and nonallergic rhinitis, infectious rhinitis, and chronic rhinosinusitis with nasal polyps (CRSwNP). Through minimally invasive sampling and simple staining techniques, NC identifies distinct endotypes-such as nonallergic rhinitis with neutrophilic, nonallergic rhinitis with eosinophilis, nonallergic rhinitis with mast cell, and nonallergic rhinitis with eosinophils and mast cells-overcoming the limitations of conventional classifications and enabling targeted therapies. It also plays a decisive role in diagnosing overlapping rhinitis, a frequent cause of treatment failure. In CRSwNP, NC has contributed to defining the eosinophil-mast cell endotype and to developing the Clinical-Cytological Grading (CCG) and the Prognostic Index of Relapse (PIR), both correlating with disease severity and recurrence risk, while also aiding in the selection of candidates for biologic therapies. Its complementarity with histopathology has highlighted the importance of mast cells-often overlooked with standard hematoxylin-eosin staining-in the most severe disease phenotypes. Technological innovations, including artificial intelligence-assisted cell recognition, digital microscopy, phase-contrast analysis, and the nasal fern test, are enhancing diagnostic accuracy and reproducibility. Teaching remains essential, with hands-on training at the microscope under the guidance of expert tutors integrated into residency programs in otolaryngology, allergology, and pediatrics to ensure skill transfer and the incorporation of NC into clinical practice. Beyond morphology, NC bridges microscopic evidence with macroscopic clinical decisions, establishing itself as a cornerstone of precision medicine for upper airway diseases and as an indispensable tool in the rhinology and allergy clinic.

Allergic rhinitis (AR) is a prevalent inflammatory condition of the nasal mucosa, characterized by rhinorrhea, nasal congestion, sneezing, and itching. Among these symptoms, rhinorrhea and nasal congestion are the most common complaints of AR patients. By blocking acetylcholine binding with muscarinic (M) receptors, intranasal anticholinergics have been recommended by guidelines as an "add-on" or second-line therapy to control rhinorrhea in patients with AR. Bencycloquidium bromide is a highly selective M1/M3 receptor antagonist that can reduce excessive mucus secretion and suppress type 2 inflammation in AR, while also demonstrating efficacy in alleviating overall nasal symptoms. In this consensus, we systematically review the role of acetylcholine and M receptors in AR pathogenesis, the key findings from clinical trials on intranasal anticholinergics for AR management and the evidence-based recommendations from experts in Allergy and Rhinology, hoping to guide physicians in the standardized and precise use of intranasal anticholinergics for AR patients.

Background: Allergic diseases, including asthma, allergic rhinitis (AR), and atopic dermatitis (AD), affect nearly 20% of the global population and are influenced by complex immune mechanisms. The COVID-19 pandemic, driven by SARS-CoV-2 and its evolving variants, has reshaped clinical and immunological landscapes. Previous evidence regarding the interaction between COVID-19 and allergic diseases remains inconsistent, necessitating large-scale real-world investigations.

Objective: This study aimed to investigate the association between COVID-19 infection and the subsequent development of allergic diseases (AD, AR, and asthma) in pediatric populations, while exploring subgroup variations and testing robustness through sensitivity analyses.

Methods: We performed a retrospective cohort study using TriNetX electronic health records from 56 U.S. healthcare facilities. Children <18 years with ≥2 visits and Polymerase chain reaction (PCR) testing (2020-2022) were included, excluding those with prior allergic disease. COVID-19 was defined by ICD-10 U07.1 and RNA positivity. Propensity score matching (1:1) balanced baseline characteristics. The primary outcome was the incident allergic disease within 1 year, assessed using Cox models; subgroup and sensitivity analyses tested robustness.

Results: After matching, 412,017 patients were included in each cohort (COVID-19 vs non-COVID-19). Children with COVID-19 exhibited a significantly higher risk of developing allergic diseases (Hazard ratio (HR) = 1.211, 95% confidence interval [CI]: 1.189-1.235; P < 0.001). Elevated risks were observed across all categories: AD (HR = 1.179, 95% CI: 1.140-1.219), asthma (HR = 1.252, 95% CI: 1.216-1.290), and AR (HR = 1.223, 95% CI: 1.188-1.259). Kaplan-Meier curves demonstrated consistently higher cumulative incidence in the COVID-19 cohort. Subgroup analyses stratified by sex, age, and race yielded concordant results, while sensitivity analyses-including competing risks, extended follow-up to 2-3 years, stricter visit definitions, and exclusion of vaccinated individuals-confirmed robustness.

Conclusion: COVID-19 infection was linked to a higher risk of allergic diseases in children, suggesting postviral immune dysregulation and microbiome changes as possible mechanisms. Further studies are needed to clarify causality and guide prevention and management.