Asia Pacific Allergy最新文献

Chronic rhinosinusitis with nasal polyp (CRSwNP) is a type 2 inflammatory disease frequently associated with asthma. Patients with CRSwNP are typically treated with endoscopic sinus surgery and oral corticosteroids. However, they often experience recurrence; in addition, oral corticosteroids have several adverse effects. CRSwNP is an important factor influencing asthma control, and total control of both CRSwNP and asthma is important for treatment. Dupilumab and mepolizumab, which are anti-interleukin (IL)-4R and anti-IL-5 monoclonal antibodies, respectively, have been approved for the treatment of severe asthma and CRSwNP. Here, we discuss the successful treatment of a patient with severe asthma comorbid with CRSwNP after switching from dupilumab and mepolizumab to tezepelumab. The patient was initially treated with high-dose inhaled corticosteroids/long-acting β2-agonist/long-acting muscarinic antagonist treatment, without success. Treatment with dupilumab improved asthma and CRSwNP; however, it later induced hypereosinophilia with exacerbated asthma. Although subsequent treatment with mepolizumab improved asthma, the nasal symptoms recurred. After attempting dupilumab treatment again, the nasal symptoms improved; however, the asthma symptoms worsened parallel with an increased eosinophil count. Finally, the antithymic stromal lymphopoietin monoclonal antibody tezepelumab, was selected for treatment; the worsening asthma symptoms then improved with the control of CRSwNP. This report illustrates the potential utility of tezepelumab for the treatment of asthma and CRSwNP. Tezepelumab therapy may enhance total control of comorbidities of both the upper and lower airways. Further studies are required to identify effective therapies for asthma and CRSwNP.

Background: Despite established criteria, diagnosing anaphylaxis remains challenging but critical for preventing future reactions. Fast-paced clinical settings, compounded by underrecording in electronic medical records (EMRs), increase the risk of dangerous re-exposures. Leveraging artificial intelligence through automated systems such as large language models (LLMs) offers a solution.

Objective: This study aims to assess the efficacy of artificial intelligence, specifically LLMs, in autonomously identifying anaphylaxis diagnoses from EMR text to enhance patient safety and optimize care delivery.

Methods: LLMs (GPT 3.5, 4, and 4 Turbo) analyzed 969 medical texts in Brazilian Portuguese, annotated as anaphylaxis-positive (48) or negative (921) by 3 expert physicians. A primary prompt simulated a general practitioner's role in reviewing medical narratives for anaphylaxis detection, with a secondary prompt incorporating World Allergy Organization (WAO) criteria. The experiments were conducted using 3 GPT configurations. The diagnostic suggestions of the LLM were compared to the physicians' diagnoses. Precision, sensitivity (recall), specificity, and accuracy values were calculated.

Results: Using the primary prompt, GPT 4 Turbo detected anaphylaxis cases with 90.6% precision, 100% sensitivity, 99.5% specificity, 99.5% accuracy, and a Cohen kappa coefficient of 0.95. The inclusion of WAO criteria slightly improved the performance of older models (GPT 3.5 + 4 configuration). However, for GPT 4 Turbo, additional information did not enhance precision.

Conclusion: The results highlight the potential of artificial intelligence, particularly LLMs, to automate anaphylaxis diagnosis, support healthcare professionals, and improve patient safety and care.

Background: Chronic spontaneous urticaria (CSU) is characterized by recurrent wheals lasting over 6 weeks, with various internal and external triggers implicated. Autoimmune progesterone dermatitis, a rare condition associated with cyclical urticaria in response to elevated progesterone levels, may overlap with CSU, particularly in women with menstrual cycle-related exacerbations.

Objective: To document and analyze the timing of urticaria episodes in relation to the menstrual cycle to better understand this phenomenon.

Methodology: This cross-sectional study was conducted at Omdurman Maternity Hospital and Omdurman Friendship Hospital in Sudan from January to June 2022. We included 75 women (ages 18-45) with CSU suspected to be linked to their menstrual cycle. Participants completed a structured questionnaire detailing demographic information, menstrual history, urticaria episodes, and associated symptoms.

Results: Among the 75 participants, 46.7% experienced urticaria exacerbation coinciding with menstruation, primarily within the first 3 days. Another 33.3% reported premenstrual urticaria, while 20% had postmenstrual symptoms. The majority exhibited classic urticarial wheals, with only 3.7% experiencing angioedema. Premenstrual urticaria was significantly associated with the 21 to 30 age group (P = 0.030). A majority had a history of allergic conditions, suggesting a predisposition to urticaria influenced by hormonal fluctuations.

Conclusion: This study highlights a significant association between the menstrual cycle and urticaria, suggesting that hormonal fluctuations play a key role in symptom exacerbation. These findings provide a basis for future research into the underlying mechanisms of hormonally influenced urticaria and the development of targeted therapeutic strategies, such as hormonal modulation or individualized treatment plans for affected patients.

Allergic reactions to general anesthetics, though rare, can lead to severe complications. Genetic predisposition and prior allergic history are key risk factors, but the exact mechanisms remain under investigation. Effective preventive measures, such as pretesting and alternative drug selection, are essential to minimizing risks. The study aims to review the factors and processes underlying the development of allergic reactions to general anesthetics. As part of the study, a literature that contained data on patients undergoing general anesthesia was analyzed to identify cases of allergic reactions and their most probable causes. Available data on genetic factors and the previous allergic status of patients, which may affect the risk of developing an allergic reaction, were addressed. The results of the study showed that the development of allergic reactions during general anesthesia is an infrequent phenomenon, but cases of varying severity (from skin manifestations to anaphylaxis) occur. The analysis identified that genetic factors and a previous allergic status of a patient significantly increase the risk of developing allergies. The study also showed that the mechanisms of allergic reactions include both IgE-dependent and IgE-independent pathways, which requires a comprehensive approach to diagnosis. Furthermore, the study determined that several cases of allergic reactions during general anesthesia occurred due to the lack of preventive measures, including pretesting and sensitivity to anesthetic and the use of alternative drugs for patients at high risk of developing allergic reactions. The findings highlight the importance of collaboration among anesthetists, allergists, and surgeons to reduce the risk of allergy and ensure maximum patient safety. The data obtained can significantly impact the development of new protocols for managing allergic reactions and improving preoperative diagnostic methods for patients.

Background: Coconut (Cocos nucifera) is a fruit belonging to the Arecaceae plant family. It is not a common allergen and literature on it is limited. Currently, there is a lack of data on coconut allergy in Asia, despite it being a fruit commonly used as a food ingredient in tropical Southeast Asia.

Objective: In this study, we aimed to describe the demographics, clinical features, and natural history of Singaporean children with IgE-mediated coconut allergy.

Methods: A retrospective review was conducted for children diagnosed with coconut allergy in a tertiary pediatric hospital in Singapore between 2017 and 2022.

Results: The diagnosis of coconut allergy was made in 41 patients based on convincing history of IgE-mediated allergic reaction and a positive test (prick-to-prick test to coconut water, coconut flesh, and/or specific immunoglobulin E). The median age at first reaction was 20 months (range: 6-96 months) with most reacting on first ingestion (80.5%). Majority presented with cutaneous reactions (90.2%). Anaphylaxis occurred in 9.8%, with all involving cutaneous and respiratory systems. Most reacted to coconut milk (34.1%). Majority (82.9%) had another food allergy and a personal history of atopy (90.2%). Median duration of follow-up was 35 months (range: 3-109). Only 1 of the 41 patients reported natural tolerance at 76 months.

Conclusions: Although a relatively uncommon food allergy, coconut allergy is a significant problem as anaphylaxis occurs in 1 in 10 and appears to be a persistent allergy.

Background: Among the different endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP), eosinophilic CRSwNP (ECRSwNP) exhibits more severe symptoms and a higher rate of recurrence compared with noneosinophilic CRSwNP (non-ECRSwNP), as well as distinct metabolic alterations. Hence, early identification of metabolic alterations in polyps is crucial for the prediction and selection of personalized treatment for patients with CRSwNP, especially ECRSwNP. However, clinical practice faces a deficiency in readily accessible and expedited predictive diagnostics of metabolic changes.

Objective: This study aimed to assess the capacity of 15(S)-hydroxyeicosatetraenoic acid (15(S)-HETE) concentrations in nasal secretions to classify endotypes and predict the recurrence of CRSwNP.

Methods: Levels of 15(S)-HETE in nasal secretions were measured via enzyme-linked immunosorbent assay (ELISA) in 57 patients with ECRSwNP and 49 patients with non-ECRSwNP. The expression and distribution of ALOX15 were assessed by immunohistochemical staining. In addition, multivariate logistic regression analysis was conducted to identify predictive factors for polyp recurrence. The optimal cutoff value was determined as the point on the receiver operating characteristic (ROC) curve with the maximum Youden Index.

Results: The concentration of 15(S)-HETE in nasal secretions was significantly higher in the ECRSwNP group (median [interquartile range (IQR)]: 294.34 ng/mL [83.23-701.34 ng/mL]) than in the non-ECRSwNP group (median [IQR]: 100.19 ng/mL [25.53-207.25 ng/mL]) (P < 0.0001). Furthermore, it was positively correlated with the eosinophil counts and percentage in nasal polyp tissue (r = 0.620, P < 0.001 and r = 0.487, P < 0.001, respectively). Multivariate logistic regression analysis showed that 15(S)-HETE in nasal secretions was a risk factor for the recurrence of CRSwNP (odds ratio = 1.004, 95% confidence interval = 1.001-1.008, P = 0.022), and the ROC curve showed a predictive value for recurrence of CRSwNP (area under the curve = 0.890, P < 0.001).

Conclusion: 15(S)-HETE in nasal secretions, as measured by ELISA, can serve as a reliable and alternative indicator for identifying ECRSwNP and predicting CRSwNP recurrence.

Background: Mounting evidence supports the efficacy of sublingual immunotherapy (SLIT) due to its favorable safety profile and convenience. However, there is limited research comparing the efficacy and safety of SLIT between adults and children.

Objective: The aim of this prospective study is to contribute additional corroborative findings by evaluating the efficacy and safety of a SLIT vaccine formulated with Artemisia annua extracts in children and adult patients with seasonal allergic rhinoconjunctivitis (SARC).

Methods: SARC patients (n = 75, SLIT group: 49, control group: 26) allergic to Artemisia were treated with a standardized SLIT or symptomatic drug following the end of the grass pollen season in 2022. Evaluation of the efficacy of SLIT during the peak pollen phase (PPP) in 2023 was based on combined scores of medication and rhinoconjunctivitis symptom (CSMRS) and visual analog scale (VAS). Tolerability assessment was based on the incidence of local or systemic reactions.

Results: Compared with the control group, the SLIT group showed significant improvement in CSMRS after 1 year of treatment with Artemisia annua-SLIT (P < 0.001). Besides, Artemisia annua-SLIT significantly reduced VAS to a greater level from baseline (P < 0.001) than pharmacotherapy (P < 0.01) at the PPP in 2023. Meanwhile, our observations revealed no significant differences in CSMRS or VAS between the monosensitized group (n = 14) and polysensitized group (n = 35), as well as between the <18 age group and ≥18 age group within the SLIT cohort in terms of clinical efficacy (P > 0.05). No severe systemic adverse events (AEs) were reported. Overall, 20/49 patients experienced mild to moderate treatment-related adverse events (TRAEs) following Artemisia annua-SLIT. In the <18 age group, 20% of patients (3/15) experienced TRAEs, while in the ≥18 age group, 50% of patients (17/34) experienced TRAEs.

Conclusion: For patients suffering from SARC, Artemisia annua-SLIT demonstrates significant therapeutic efficacy and an excellent safety profile. Notably, we have provided the first evidence that the efficacy of Artemisia annua-SLIT is consistent across both adult and pediatric populations.

Allergen immunotherapy (AIT) is an evidence-based therapy for allergic rhinitis and allergic asthma. AIT is largely recognized as the only causal treatment of allergic diseases that targets the underlying pathophysiology and may have a disease-modifying effect in addition to the antisymptomatic effect. Carbamylated monomeric allergoids (CMAs) are chemically modified allergens with reduced IgE-binding activity (reduced allergenicity) but full immunogenicity. The carbamylation process allows them to be much smaller than other modified allergens, making them ideal for sublingual immunotherapy (SLIT), and reduced allergenicity makes them safe and well tolerated. CMAs have several advantages over other SLIT products: smaller size for easier absorption through mucosa, greater resistance to proteolytic degradation, greater bioavailability, and reduced allergenicity with full immunogenicity. The tablet form allows for accurate dosing and compliance is easy to monitor. Safety is an especially important consideration when treating conditions in pediatric populations, as is patient compliance. This review focused on the efficacy, safety, and clinical application of monomeric allergoid SLIT for allergic disease in children and its suitability as an alternative to subcutaneous immunotherapy.

Background: Allergic diseases are a growing health concern, with house dust mites being a prevalent allergen linked to various allergies. Rush subcutaneous immunotherapy (RIT) achieves maintenance dose rapidly but carries higher risks than conventional immunotherapy (CIT). The combination of Omalizumab with allergen immunotherapy (AIT) has been shown to improve AIT safety. This study investigates the safety of RIT combined with anti-immunoglobulin E (IgE) pretreatment.

Methods: This retrospective analysis compared patients with allergic rhinitis and/or allergic asthma sensitive to dust mites who underwent RIT with anti-IgE pretreatment versus CIT at our facility from July 2022 to January 2024. We collected and analyzed demographic data, adverse events, and baseline metrics including visual analog scale scores, daily medication scores, allergic blood test outcomes, and lung function parameters.

Results: Our study enrolled 50 patients in the RIT group and 60 in the CIT group. The RIT group demonstrated superior safety, with significantly fewer local adverse reactions during the up-dosing phase compared with CIT (P < 0.01). While systemic reactions were analogous between groups, the RIT group had a lower incidence of respiratory symptoms (P < 0.05). Logistic regression analysis established a predictive model for systemic reactions during up-dosing phase, with receiver operating characteristic analysis indicating its predictive accuracy exceeded that of individual factors (area under the curve = 0.815).

Conclusion: RIT combined with anti-IgE pretreatment demonstrated low systemic adverse reaction rates and high safety. A combined visual analogue scale scores (VASs) and maximal mid-expiratory flow at 25%-75% prediction model was more accurate in forecasting systemic reactions than individual factor. Further research is required to determine its clinical utility.

Background: The effectiveness of the Dermatology Life Quality Index (DLQI), translated into Kazakh, for assessing the quality of life of patients with atopic dermatitis (AD) in Kazakhstan, has not yet been evaluated.

Objective: The aim of the study is to assess the reliability and validity of the Kazakh language DLQI as a tool for assessing the quality of life of patients with AD.

Methods: This multicenter study involved 883 adult patients of the Kazakh population diagnosed with AD. To assess the quality of life of AD patients, the DLQI questionnaire translated into Kazakh was used.

Results: The reliability (Cronbach α) of the Kazakh version DLQI questionnaire was -0.924. The average DLQI score for the sample was 10.7 ± 8.2. Nearly 53.8% of patients had mild AD and 35.3% had moderate AD. According to the DLQI questionnaire, the average score increases with rising body mass index: patients who are overweight (11.9 ± 8.5) and those with obesity of the first degree (13.1 ± 9.0) have scores indicating a significant impact of the skin disease on their quality of life, whereas patients with normal weight (10.2 ± 8.0) or underweight (7.9 ± 7.4) experienced a more moderate effect, P = 0.001. Relapses 2 times a year (12.2 ± 8.5) and 3 or more times a year (12.6 ± 8.7) worsened the quality of life relatively more than relapses 1 time per year, P = 0.001. Smoking and alcohol consumption affected the deterioration in the quality of life of patients with AD (P ≤ 0.05). The quality of life of patients with AD in remission according to the DLQI scale was higher, P = 0.001.

Conclusion: The results demonstrate that the Kazakh language version of the DLQI is a reliable and valid tool for measuring the impact of AD on quality of life. Its applicability in research and clinical settings underscores its versatility. The study underscores the significance of clinical and demographic characteristics, along with the quality of life, for an accurate assessment of disease severity and effective treatment.