Asia Pacific Allergy最新文献

Background: Dry nose (DN) can be commonly observed in rhinitis, which can be objectively diagnosed; but it is usually ignored.

Objective: The present work focused on analyzing clinical features, selecting biomarkers, and exploring the pathogenesis of DN.

Methods: The present prospective single-center study was carried out between July 1, 2023, and January 31, 2024. Consecutive patients with suspected rhinitis according to common symptoms, including rhinorrhea, nasal obstruction, itching, and sneezing, were recruited at the allergy-rhinology outpatient in our hospital. All subjects filled in the questionnaires during recruitment for recording demographic data. DN test devices were used to diagnose DN. Sponges were utilized for collecting nasal secretions, while serum-specific immunoglobulin levels were utilized to determine allergic status.

Results: Totally 1,323 chronic rhinitis patients were recruited, which included those with allergic rhinitis, idiopathic rhinitis (IR), local allergic rhinitis, and nonallergic rhinitis with eosinophilia syndrome. Of these participants, 8.6% were diagnosed with DN. The percentage of patients with DN and smokers remarkably increased in IR group. According to Qinling-Huaihe Line, 106 patients with DN (93.0%) were from Northern China. The IL-6 content in DN group apparently increased.

Conclusions: DN affects over 8% of patients with chronic rhinitis in China, most of whom are from Northern China. Most patients with DN smoke, accounting for the largest proportion of patients with IR. Mitogen-activated protein kinase pathways and associated cytokines are probably critical for the pathogenic mechanism underlying this nasal disease.

Background: Asthma is a chronic respiratory condition affecting 3,340 cases per 100,000 individuals globally. The significant global health burden of asthma necessitates the development and use of valid diagnostic tools for epidemiological purposes.

Objective: This study evaluated the diagnostic accuracy of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire among participants from the Singapore/Malaysia Cross-sequential Genetic Epidemiology Study (SMCGES).

Methods: Investigators administered the ISAAC survey questionnaire to SMCGES participants. Symptoms related to asthma were compared against diagnosed asthma, which was characterized by a questionnaire-reported history of asthma and exhibiting a positive skin prick reaction to allergen extracts from 2 dust mite species. Diagnostic accuracy was assessed via sensitivity (Se), specificity (Sp), positive and negative predictive values, and Youden's Index (J).

Results: This study analyzed data from 4,028 participants from Malaysia and 11,473 participants from Singapore. Asthma symptom prevalence differed between Malaysia and Singapore, with ever wheeze being the most prevalent in both populations. Diagnosed asthma was more prevalent in Singapore (17.3%, 95% confidence interval [CI]: 16.6-18.1%) than in Malaysia (9.7%, 95% CI: 8.8-10.7%). Ever wheeze showed the best diagnostic performance for diagnosed asthma in Malaysia (Se = 0.548, Sp = 0.831, J = 0.379) and Singapore (Se = 0.679, Sp = 0.888, J = 0.566). Combining symptoms or asthma medication usage improved accuracy slightly, with the most valid combinations being ever wheeze or exercise-induced wheeze in Malaysia (Se = 0.557, Sp = 0.824, J = 0.381) and usage of bronchodilators, beta-agonists, inhaled steroids, or leukotriene modifiers in Singapore (Se = 0.771, Sp = 0.871, J = 0.642).

Conclusion: The modified ISAAC questionnaire used by the SMCGES showed good Se and Sp for diagnosed asthma, especially when combining various symptom indicators or usages of different asthma medications. These findings substantiate the continued use of the ISAAC questionnaire as a valuable survey tool in epidemiological studies across diverse populations.

Background: Little is known in Japan about anaphylaxis management during an episode and after the episode to prevent recurrence.

Objective: This study aimed to clarify the reality of anaphylaxis management by surveying individuals who had experienced an anaphylactic episode and attended a medical institution after the episode.

Methods: A general consumer panel was used to identify individuals ≥16 years (or child ≤15 years) with a history of anaphylaxis. Data were collected on the use of an adrenaline autoinjector at the time of the episode, attendance at a medical institution during and after the episode, and prescribing patterns for the adrenaline autoinjector.

Results: Data were analyzed from 678 individuals (respondent [n = 552]; respondent on behalf of a child ≤15 years [n = 126]). Adrenaline autoinjector use at the time of the most recent anaphylactic episode was reported by approximately 7% of respondents, including by a subgroup with at least 2 previous anaphylactic episodes (n = 211). Only three-quarters of autoinjector users were prescribed another device at the medical institution they visited when anaphylaxis occurred. Among 349 respondents who visited a medical institution to prepare for recurrence, only 70 were prescribed another adrenaline autoinjector. Common reasons for nonprescription of another device were patients' lack of interest or physicians' lack of initiative.

Conclusions: There is a clear need to raise awareness and educate patients, parents, caregivers, and healthcare providers about anaphylaxis management.

Background: Allergen sensitization patterns vary across regions; however, few studies have directly compared pediatric sensitization profiles between Japan and Taiwan.

Objective: This study aimed to compare allergen sensitization patterns in children from Japan and Taiwan using the multiple antigen simultaneous test (MAST) and latent class analysis (LCA).

Methods: A total of 217 Japanese and 166 Taiwanese children (aged 2-12 years) were enrolled. Based on responses to the International Study on Asthma and Allergy in Childhood questionnaire, participants were classified as either healthy or as having allergic rhinitis (AR), bronchial asthma (BA), or atopic dermatitis. Serum samples were analyzed using a commercial MAST kit available in Japan, and 20 allergens shared with the panel used in Taiwan were selected for analysis. Sensitization was defined as a lumicount value ≥2.78 (equivalent to class 2 or higher). LCA was conducted on the combined dataset, and the optimal number of latent classes was determined using the Akaike Information Criterion.

Results: LCA identified 4 latent classes: low-sensitized (LS), house dust mite-dominant (HDM-D), inhalant-sensitized (IH-S), and poly-sensitized (PS). The HDM-D class was more prevalent in Taiwan (50%) than in Japan (6.9%). In contrast, the IH-S and PS classes were more common in Japan (36.4% vs. 3% and 8.8% vs. 2.4%, respectively). AR and BA were primarily associated with HDM-D in Taiwan and with IH-S in Japan, which includes HDM and Japanese cedar pollen. HDM and crab sensitization were strongly correlated in Taiwan.

Conclusion: MAST combined with LCA reveals distinct regional sensitization profiles, suggesting divergent pathways in allergic disease development.

Background: The prevalence of allergic rhinitis (AR) has increased progressively over the past several years. One of the vital objectives of management of AR is to provide satisfactory symptom control that improves the patient's quality of life. Several classes of drugs, such as antihistamines, intranasal corticosteroids, decongestants, leukotriene receptor antagonists, and immunotherapy, have been developed over the past decades for more effective management of AR. Combinations of pharmacotherapies have also been advocated to treat AR.

Objective: To develop clinical practice-relevant consensus statements from experts in the field of otorhinolaryngology after giving due consideration to the real-world clinical dilemmas, current evidence, and preferences of both physicians and patients.

Methods: Expert otorhinolaryngologists (n = 61) from India were invited to develop the consensus statements based on the modified Delphi method.

Results: Several consensus statements were framed based on evidence from clinical trials and expert insights and experience. One crucial statement was regarding the additional subgrouping of patients with intermittent or persistent AR, or mild, moderate or severe AR into "sneeze-runners" (sneezing, anterior rhinorrhea, itchy nose, and itchy eyes; more sensitization to pollens) and "blockers" (severe nasal blockage and thick nasal mucus which often leads to postnasal drip and breathlessness; higher sensitization to polyvalent house dust, house dust mites and fungi) since they have distinct clinical profiles and different treatment approach. Another critical consensus was on the use of the fixed-dose combination of fluticasone furoate and oxymetazoline hydrochloride nasal spray for the persistent and moderate-severe blocker phenotype of AR.

Conclusion: This expert consensus will help physicians in their clinical practice and complement effective diagnosis and management of AR.

Non-IgE-mediated gastrointestinal food allergy is a hypersensitivity disorder that affects the gastrointestinal tract, operating independently of IgE. While eosinophilic inflammation has been implicated in the literature, its precise role in the pathophysiology of non-IgE-mediated gastrointestinal food allergy remains poorly understood. We report the first documented case of severe non-IgE-mediated gastrointestinal food allergy in which eosinophil infiltration, eosinophil extracellular traps, and Charcot-Lyden crystals were observed in the tissue. A 1-month-old female infant presented with fever, watery diarrhea, and poor weight gain associated with the ingestion of cow's milk-based formula. Despite transitioning to an extensively hydrolyzed formula, she developed necrotizing enterocolitis. Following a switch to an amino-acid-based infant formula, her abdominal symptoms resolved, and her weight gain normalized. However, 1 month later, bile-like vomiting led to the diagnosis of jejunal atresia, which was attributed to scarring from necrotizing enterocolitis. Surgical resection revealed histopathological findings of eosinophil infiltration, cytolytic eosinophil cell death (ETosis), extracellular traps, and Charcot-Lyden crystals. The necrotizing enterocolitis was ultimately diagnosed as a severe manifestation of non-IgE-mediated gastrointestinal food allergy triggered by cow's milk protein. After surgery, the patient resumed feeding with an amino-acid-based infant formula. During regular follow-up, she continued to gain weight well without any clinical symptoms while being fed an amino-acid-based infant formula. To our knowledge, this is the first report to identify a histopathological link between severe non-IgE-mediated gastrointestinal food allergy-related inflammation and eosinophil ETosis. This suggests a potential role of ETosis in the pathogenesis and its complications.

Background: Emulsion bathing has been commonly advised in the management of atopic dermatitis (AD) to maintain skin hydration and reduce the negative effects of soaps on the skin barrier. However, there is limited scientific evidence from randomized controlled trials to support their effectiveness.

Objectives: We aimed to compare the moisturizing effectiveness of 2 regimens: emulsion bathing combined with moisturization and moisturization after bathing with tap water only, in adults with AD.

Method: Thirty-nine adult patients with AD (aged 20-63 years) were recruited. The right and left forearms of each subject were randomly assigned to be immersed and washed for 3 minutes with either moisturizing bath oil (dual-therapy group) or tap water alone (monotherapy group), followed by air drying for 30 minutes. Subsequently, a moisturizer was applied to the tested skin areas. Stratum corneum hydration (SCH) and transepidermal water loss (TEWL) were measured using a GP Skin Pro device (Gpower, South Korea) at five time points: before washing (baseline), after washing and air drying for 30 min (postwash), and after moisturization at 0, 30 and 60 minutes.

Results: At the postwash time point, mean SCH levels in both groups decreased significantly; however, the mean SCH level of the dual-therapy group was significantly higher than that of the monotherapy group (20.9 ± 8.4 a.u. vs 14.4 ± 9.96 a.u., P = 0.006). Additionally, the mean TEWL level of the dual-therapy group was significantly lower than that of the monotherapy group (6.73 ± 2.7 g/m²/h vs 8.53 ± 3.1 g/m²/h, P = 0.009). After moisturizer application, both study groups demonstrated significant increases in SCH and decreases in TEWL levels. However, no significant differences in SCH and TEWL levels were observed between the 2 groups after moisturization at 0, 30, and 60 minutes.

Conclusion: Emulsion bathing helped prevent epidermal damage induced by bathing. However, the combination of emulsion bathing and moisturization did not show superiority over moisturization alone in improving skin hydration after bathing.

Background: While phenotyping assists in selecting the right biologic agent for severe asthma, the frequency of patients transitioning to a different biologic is also significant.

Objective: We sought to identify the factors that predict switching between biological agents.

Methods: The study involved 165 adults with severe asthma and included a 3-year follow-up period. Clinical and spirometric data were evaluated alongside the demographic characteristics of the patients. In addition to skin prick tests and specific immunoglobulin E (IgE) tests, eosinophil counts and total IgE measurements were assessed.

Results: The patient group comprised 124 female participants (75%); the average age was 48 ± 13 years. Over half of the patients had eosinophilic asthma (56%) and allergic asthma (52%). In the first-line treatment, 111 patients (68%) were started on omalizumab, 43 patients (26%) on mepolizumab, and 11 patients (6%) on benralizumab. A total of 37 patients required a change in their biologic treatment. The 2 key factors influencing this switch were the initial annual number of asthma attacks and the level of improvement in the asthma control test score assessed during the first evaluation after starting the biologic (odds ratio 2.23 [95% confidence interval: 1.49-3.33]; P < 0.001 and 0.42 [0.30-0.58]; P < 0.001, respectively).

Conclusion: Patients with higher annual attacks at baseline and lower responsiveness at the first postbiologic efficacy assessment can be useful in predicting switching status. However, further well-designed studies involving a larger number of patients and conducted over a longer term are needed to identify additional factors that could assist in selecting the most appropriate biologic.

While food allergies affect individuals across all age groups, oral immunotherapy (OIT) has been widely studied and implemented in pediatric populations. Here, we report a successful case of cow's milk (CM) OIT in a 60-year-old male with adult-onset cow milk allergy. The patient who was previously tolerated with CM initially presented with generalized pruritus, rash, dyspnea, urticaria, and dizziness occurring 4 hours after consuming milk-containing foods. The patient was positive on the skin prick test and for specific IgEs to milk (24.4 kU/L) and casein (31.2 kU/L). After diagnosis, CM OIT was initiated using bread containing milk protein. The protocol began with a 1/4 slice of milk bread (1.55 g of milk protein) and gradually increased to 1 full slice (6.2 g of milk protein) over the course of 4 years. Throughout the period, the patient's immunological markers consistently improved, with his CM-specific IgE level decreasing from 24.40 to 1.50 kU/L and his casein-specific IgE level decreasing from 31.20 to 2.24 kU/L. The patient successfully completed an oral food challenge with 190 mL of cow milk and currently maintains a daily consumption of 200 mL of CM without adverse reactions. This case demonstrates that CM OIT can be successfully implemented in elderly patients with adult-onset CM allergy. The clinical and immunological responses suggest that immune modulation remains possible even in older adults, suggesting potential therapeutic options for adult-onset food allergies.