Asia Pacific Allergy最新文献

In the past few decades, biomarkers have been successfully used for the diagnosis, treatment, and monitoring of disease. Taking together clinical, genetic, lifestyle, and information on relevant biomarkers, the therapy of diseases can be personalized to an individual. Several novel biomarkers have been recently reported for allergic diseases. However, to interpret the validity of biomarker data, the validation of their reliability, precision, and reproducibility is imperative. Once validated, they can be used in therapeutic product development and in clinical practice. Eosinophils are multifunctional leukocytes and major effector cells that play a crucial role in the immunological mechanisms of allergic disease. Measuring eosinophils has been the gold standard for treating and monitoring eosinophil-related diseases such as asthma, atopic dermatitis, and allergic rhinitis. However, eosinophil numbers/percentages yield little information about eosinophil activity. Eosinophil activation leads to the extracellular release of 4 granule proteins, with the most promising biomarker of the 4 being eosinophil-derived neurotoxin (EDN). EDN is more easily recovered from measuring instruments and cell surfaces than other eosinophil biomarkers because of its weaker electrical charge. EDN is known to be released from eosinophils at a greater efficiency, adding to its recoverability. It also has antiviral activity in respiratory infections associated with allergic disease development in early life (eg, respiratory syncytial virus and human rhinovirus infections in early childhood). EDN can be measured in several body fluids, including blood, urine, sputum, nasal secretions, and bronchoalveolar lavage. EDN is a stable biomarker utilized to precisely diagnose, treat, and monitor many eosinophil-related allergic diseases. This eosinophil granule protein may prove useful in precision medicine approaches and should always be considered as a useful tool for the clinician to give the best patient care possible.

There is a scarcity in both epidemiological studies and forecast models on the impact of air pollution on respiratory allergic responses in Malaysia. The quantification of baseline allows for an understanding of the severity of the impact and target areas for intervention. High-quality forecasts not only provide information for the assessment of potential outcomes but also the dissemination of public health warnings, such as the application of mobile-based early warning systems. There is a need for a data repository system that facilitates research on such studies. However, a call for more evidence should not put a pause on actions and future plans that will help reduce pollution emission and exposure to air pollutants as there are sufficient evidence to indicate that air pollutants impact health.

As the SARS-CoV-2-induced pandemic wanes, a substantial number of patients with acute Corona Virus-induced disease (COVID-19 continue to have symptoms for a prolonged time after initial infection. These patients are said to have postacute sequelae of COVID (PASC) or "long COVID". The underlying pathophysiology of this syndrome is poorly understood and likely quite heterogeneous. The role of persistent, possibly deviant inflammation as a major factor in comorbidity is suspected.

Objective: To review data that address the relative importance of inflammation in the pathophysiology spectrum of PASC and to address how this would impact diagnosis and approach to therapy in patients identified as having such inflammatory abnormalities.

Methods: A review of public databases, including PubMed, MeSH, NLM catalog, and clinical trial databases such as clinicaltrials.gov.

Results: The literature supports a prominent role for various forms and types of inflammation in the pathophysiologic spectrum of PASC. Such inflammation can be persistent ant CoV-2-specific responses, new onset autoimmune responses, or a loss of normal immunoregulation resulting in widespread, sustained inflammatory pathologies that can affect both broad constitutional symptoms (such as fatigue, neurocognitive dysfunction, and anxiety/depression) and organ-specific dysfunction and/or failure.

Conclusions: PASC is a significant clinical entity with similarities to and differences from other postviral syndromes. Significant research efforts are ongoing to better understand specific aberrant inflammatory pathways present in individual patients for the purpose of developing and implementing effective therapies and ultimately prophylaxis strategies to prevent the progression of COVID-19 as well as likely future viral illnesses and pandemics.

We report 2 patients who first developed cutaneous manifestations, followed by autoimmune phenomena, infections, and hypogammaglobulinemia. They were initially diagnosed with common variable immunodeficiency; however, the diagnosis was revised to cytotoxic T-lymphocyte antigen 4 haploinsufficiency after genetic and functional testing.

Hereditary angioedema (HAE) is an uncommon disorder characterized clinically by recurrent episodes of nonitchy subcutaneous and/or submucosal swellings. The estimated prevalence of HAE is ~ 1: 10,000 to 1: 50,000. There are no prevalence data from India, however, estimates suggest that there are 27,000 to 135,000 patients with HAE in India at present. The majority of these, however, remain undiagnosed. Replacement of plasma-derived or recombinant C1-esterase inhibitor (C1-INH) protein, administered intravenously, is the treatment of choice during the management of acute episodes of angioedema (i.e., "on-demand treatment") and is also useful for short-term prophylaxis (STP) and long-term prophylaxis (LTP). This has been found to be effective and safe even in young children and during pregnancy. Until recently, none of the first-line treatment options were available for "on-demand treatment," STP or LTP in India. As a result, physicians had to use fresh frozen plasma for both "on-demand treatment" and STP. For LTP, attenuated androgens (danazol or stanozolol) and/or tranexamic acid were commonly used. These drugs have been reported to be useful for LTP but are associated with a significant risk of adverse effects. Intravenous pd-C1-INH, the first-line treatment option, is now available in India. However, because there is no universal health insurance, access to pd-C1-INH is a significant challenge. HAE Society of India has developed these consensus guidelines for India and other resource-constrained settings where plasma-derived C1-INH therapy is the only available first-line treatment option for the management of HAE and diagnostic facilities are limited. These guidelines have been developed because it may not be possible for all patients to access the recommended therapy and at the recommended doses as suggested by the international guidelines. Moreover, it may not be feasible to follow the evaluation algorithm suggested by the international guidelines.

Bronchiolitis is the most common seasonal viral respiratory disorder in infants. However, risk factors for the development of bronchiolitis, particularly during pregnancy, remain unclear.

Methods: A questionnaire was administered to the parents of the hospitalized infants with acute bronchiolitis to obtain information regarding patients' medical, family, and prenatal exposure history. Logistic regression with adjustment was performed to evaluate risk factors associated with bronchiolitis in the infants.

Results: Among the enrolled patients, 55 (36.7%) were diagnosed as having bronchiolitis, and the majority (89%) of the patients had moderate-to-severe bronchiolitis. The bronchiolitis group had lower C-reactive protein levels than did the control group. Fewer patients in the bronchiolitis group developed fever. However, hospital stays were longer in the bronchiolitis group than in the control group. Respiratory syncytial virus was the most detected virus (23/26, 88.6%) in the bronchiolitis group. Male sex (odds ratio [OR], 5.71; 95% confidence interval [CI], 2.02-16.12; P < 0.001), antibiotic usage during pregnancy (OR, 27.2; 95% CI, 1.12-660.84; P = 0.04), and viral infection (OR, 49.3; 95% CI, 9.01-270.26; P < 0.001) during the postnatal period were significantly associated with hospitalization for acute bronchiolitis in the infants. By contrast, pet exposure during the perinatal period was significantly and negatively associated with acute bronchiolitis (OR = 0.21, 95% CI = 0.07-0.69, P < 0.01).

Conclusion: Environmental exposures during pregnancy may affect respiratory health in offspring, and effective strategies should be developed to prevent bronchiolitis in early life.

We present hyperthyroidism with autoimmune thyroid disease, which developed a few weeks after the COVID-19 infection in a patient with no prior thyroid disease. Our case was described with clinical presentations, diagnostic tests, and subsequent patient management and compared to other similar reported cases. A 28-year-old female patient with no prior history of thyroid dysfunction developed hyperthyroidism 8 weeks after COVID-19 infection, confirmed by low thyroid stimulating hormone, high free thyroxine 4, and thyroid receptor antibody. She was treated and responded well to methimazole 20 mg in a few weeks. We searched the literature and found three other similar reported cases and compared those. The effects of COVID-19 infection on the immune system and the thyroid gland might explain the pathology of hyperthyroidism post-COVID-19 infection in this patient. This new-onset hyperthyroidism was found in a woman with mild symptoms and responded well to thiamazole and β-blockers.