Asia Pacific Allergy最新文献

Neuromyelitis optica is a rare, inflammatory autoimmune disease of the central nervous system. Tocilizumab is a humanized monoclonal antibody, which targets the inhibition of the interleukin-6 receptor, a mediator with an important role in the pathophysiological mechanism of neuromyelitis optica. Hypersensitivity reactions to tocilizumab are rare, but similar to other biological drugs can elicit a hypersensitivity reaction. The authors present a case of a 50-year-old female patient, with a neuromyelitis optica, with a severe reaction at the 6th cycle of treatment. The patient was referred to Drug Allergy Consultation, where she underwent tocilizumab skin tests: intradermal test 1/1,000 with a positive result. The patient was then proposed for drug desensitization, and, to date, the patient has undergone 22 desensitization cycles, all of which were uneventful. This case emphasizes the importance of trying to phenotype the hypersensitivity reactions to monoclonal antibodies, and therefore invest in an allergy workup to make the best decision for our patients.

Background: Hereditary angioedema (HAE) is characterized by unpredictable acute attacks that impair the patient's quality of life (QoL) not only due to the impact on functional abilities caused by edema but also due to pain and other symptoms, including fatigue, nausea, and vomiting.

Objectives: QoL studies in patients with HAE have not been carried out in the Indian subcontinent. Hence, we carried out this study to assess the QoL and to identify factors associated with impaired QoL in patients with HAE.

Methods: This was a cross-sectional observational study carried out in confirmed cases of HAE, aged >18 years, using angioedema QoL score and angioedema control test.

Results: We enrolled 135 patients with HAE (aged 18-80 years) with a mean age of 40.93 years. We observed that the QoL directly correlates with angioedema control and is also affected by other factors such as gender, duration of follow-up, and the frequency of episodes. Genitalia swelling, positive family history, and presence of mortality due to HAE in the family also significantly impact the QoL of patients with HAE. In addition, patients with type 1 HAE reported a poorer QoL as compared to patients with type 2 HAE.

Conclusion: We report the QoL of patients with HAE from settings where none of the first-line medications are available. Results of the study suggest that disease control is the most important factor that influences the QoL.

Background: In response to the continual increase in the prevalence of pediatric allergic diseases in the Philippines, the Philippine Society of Allergy, Asthma, and Immunology (PSAAI) and the Philippine Society of Pediatric Gastroenterology, Hepatology, and Nutrition (PSPGHAN) have published guidelines on the dietary prevention of allergic diseases in children.

Objective: This guideline aims to update the previous guideline recommendations for clinicians on the use of dietary interventions for the prevention of allergic disease in children.

Methods: Following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach specified in the Department of Health Manual for Clinical Practice Guidelines development, we systematically searched for and appraised clinical practice guidelines and systematic reviews on topics formulated and prioritized by a Steering Committee, which comprised of members of the PSAAI and PSPGHAN. In the absence of an existing systematic review, a de novo systematic review was conducted. A multisectoral consensus panel reviewed the evidence summaries and formulated recommendations through a formal consensus method.

Results and conclusion: The recommendations made by the consensus panel were based on the available evidence on the benefits and harm of the intervention, as well as the cost, feasibility, acceptability, and availability. Several research gaps exist, resulting in low levels of certainty of evidence on most dietary recommendations for the prevention of pediatric allergic diseases.

Background: Surgery and oral corticosteroids are recommended therapies for chronic rhinosinusitis with nasal polyps (CRSwNP) patients who are nonresponsive to intranasal corticosteroid treatment.

Objective: This study aimed to compare the effectiveness of these 2 treatments in terms of improving sinus-related symptoms, enhancing quality of life, and economic costs and duration costs.

Methods: This prospective study enrolled CRSwNP patients. All participants were instructed to complete the 22-item Sino-Nasal Outcome Test (SNOT-22), visual analog scale, and 36-item short-form (SF-36) questionnaire at baseline and 3 months after treatment. The nasal polyp score (NPS) was assessed via endoscopic examination. Additionally, patients were requested to maintain records of economic direct costs, other indirect costs, and duration costs throughout the 3-month period and to report them during each follow-up visit.

Results: A total of 40 patients who underwent surgery or received oral corticosteroids were enrolled in this study. After 3 months of treatment, significant improvements were observed between baseline and 3 months after treatment in the NPS, total SNOT-22 score, and nasal congestion, runny nose, facial pain, olfactory function, and overall symptoms measured. Only headache and sleep order were improved in the surgery group. Both physical functioning and general health, as measured by the SF-36, improved after both treatments, and the role-physical, bodily pain, and social functioning domains of the SF-36 improved only in the surgery group. The changes in the NPS, nasal congestion, runny nose, olfactory function, and sleep disorders in the surgery group were greater than those in the oral corticosteroid group (P values = 0.0003, 0.0092, 0.0258, 0.0284, and 0.0164, respectively). Changes in the total SNOT-22 score and SF-36 subscores were not different between the 2 treatment groups. The direct economic costs and duration costs of surgical treatment were 4.5 times and 17.0 times higher, respectively, than those of oral corticosteroid treatment.

Conclusions: Both surgical and oral corticosteroid treatments effectively improved clinical symptoms and quality of life in patients with CRSwNP. Patients who underwent surgery exhibited greater improvements in sinus-related symptoms. Nevertheless, oral corticosteroid treatment presented notable advantages in terms of economic cost and duration cost of disease-related care.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) pathogenesis might be impacted by autophagy. Nevertheless, autophagy-related gene utilization as a disease indicator about the course of CRSwNP has yet to be elucidated.

Objective: This investigation aimed at discovering pivotal molecules related to autophagy to identify potential treatment targets for CRSwNP.

Methods: The dataset GSE136825 was obtained via the Gene Expression Omnibus (GEO) database, and afterward, differentially expressed genes (DEGs) analysis linked to autophagy was employed via the R software. A comprehensive examination of autophagy-related DEGs was conducted using functional analytic techniques. The utilization of the protein-protein interaction (PPI) network facilitated hub gene identification. Quantitative real-time polymerase chain reaction (qRT-PCR), western blot, and immunohistochemistry staining techniques were performed to validate the expression levels of the central genes in clinical samples. Correlation analysis was performed to examine the correlation between hub genes and disease severity parameters.

Results: A comprehensive set of 86 autophagy-related DEGs were discovered. The functional enrichment analysis of autophagy-related DEGs revealed the identification of enrichment terms involved with the autophagy process. The results obtained from the PPI analysis suggest that there was interaction among the autophagy-related genes. The qRT-PCR, immunohistochemistry staining, and western blot techniques yielded results, demonstrated that CXCR4, HMOX1, and SPP1 expression levels in CRSwNP agreed with the bioinformatics analysis of the dataset. Furthermore, a favorable association between CXCR4, HMOX1, and SPP1 expression levels with illness severity indicators was found.

Conclusion: Bioinformatics analysis yielded 86 autophagy-related DEGs in CRSwNP. CXCR4, HMOX1, and SPP1 regulation of autophagy has been confirmed in CRSwNP progression and pathogenesis.

Background: Eosinophil inflammation often persists in the airways of severe asthmatics, even under treatment with high-dose inhaled corticosteroids. Biologics for various type 2 cytokines have been recently developed for corticosteroid-resistant, eosinophil-dominant, severe asthma. However, it is unclear whether these biologics act directly on eosinophils.

Objective: In this study, we examined whether various type 2 cytokines targeted by biologics can directly modify the functions of eosinophils obtained from the peripheral blood of healthy individuals.

Methods: Peripheral eosinophils of healthy subjects were purified by conventional negative-depletion methods using anti-CD16 beads to avoid the priming effect (i.e., stimulation in vitro) to the maximum extent possible. Eosinophils were stimulated with interleukin (IL)-4, IL-5, IL-13, or thymic stromal lymphopoietin (TSLP), and eosinophil adhesiveness to recombinant human-intercellular adhesion molecule (ICAM)-1 was evaluated by eosinophil peroxidase assays. The effect of these cytokines on eosinophil superoxide anion (O₂ ^-) generation was evaluated by the superoxide dismutase-inhibitable reduction of cytochrome C. To determine whether eosinophil degranulation was induced, the concentration of eosinophil-derived neurotoxin (EDN) in the supernatant was measured using enzyme-linked immuno sorbent assay.

Results: As reported previously, at 100 pM, IL-5 increased eosinophil adhesiveness to ICAM-1, O₂ ^- generation, and EDN release. Conversely, at concentrations up to 10 nM, IL-4, IL-13, and TSLP did not induce eosinophil adhesiveness, O₂ ^- generation, or EDN release.

Conclusion: Type 2 cytokines other than IL-5 do not directly affect the functions of eosinophils from healthy individuals when used at clinical concentrations. These findings suggest that eosinophils play little, or no, direct role in the effects of anti-IL-4 receptor α or anti-TSLP antibody on severe asthma.

The presence of atopic dermatitis (AD) and mycosis fungoides (MF) presents diagnostic challenges due to their shared clinical features. AD, a chronic skin disorder characterized by pruritic and inflamed lesions, shares these features with MF, which is the most common cutaneous T-cell lymphoma. A 19-year-old male, who had a history of childhood AD, developed eczema-like lesions on his forearms, neck, and head. Initially, allergic contact dermatitis was suspected due to his occupational metal exposure. However, despite treatment with topical therapies, his condition worsened, requiring 3 cycles of oral corticotherapy. Notably, his lesions appeared atypically, affecting areas such as the scalp and nonflexural regions. Histopathological examination played a crucial role in the diagnostic process. While the initial biopsy suggested parapsoriasis, a second scalp biopsy confirmed MF. Despite their clinical similarities, AD and MF require distinct diagnostic approaches. This case emphasizes the need to consider MF as a diagnostic possibility, even in individuals with a history of AD. Early MF diagnosis enables tailored treatment, including topical therapies and narrowband ultraviolet B phototherapy. A multidisciplinary approach, advanced techniques such as immunophenotyping, and early identification are essential for providing optimal patient care. The shared clinical features of AD and MF suggest potential common mechanisms, underscoring the need for further research to enhance treatment strategies and patient care.

A 43-year-old male presented with pruritic nodular lesions in the red dye area of his leg tattoo, which developed 4 weeks after its application. Patch tests were performed using a standard series, and the inks used by the tattooist were tested semi-open. Tests identified a sensitization to 2 inks containing an azo-organic dye (Pigment Red 170), diketopyrrolopyrrole (Pigment Red 254), and copper phthalocyanine (Pigment Blue 15). Histopathological findings suggested a pseudolymphoid reaction, likely driven by T-cell hypersensitivity to the red pigments. Although the utility of patch testing in the assessment of tattoo reactions is not consensual, it can be useful in identifying the offending inks, helping to guide future tattoo choices and prevent recurrences. Patch testing including the suspected ink should not be disregarded from the diagnostic workup.