Asian Pacific journal of allergy and immunology最新文献

Background: Asthma is a heterogeneous disease with diverse and poorly defined phenotypes, especially in children.

Objective: We aimed to classify childhood asthma phenotypes using unsupervised cluster analysis based on type 2 (T2) biomarkers and to evaluate their clinical characteristics and outcomes.

Methods: We retrospectively analyzed 614 pediatric patients. Hierarchical clustering was performed using four variables: age, absolute eosinophil count (AEC), eosinophil cationic protein (ECP), and total immunoglobulin E (IgE). Clinical characteristics and two-year clinical outcomes were compared across clusters. The effect of age was examined using Analysis of Covariance (ANCOVA) and age-tertile subgroup analyses.

Results: Three distinct clusters were identified. Cluster 2, the T2-high asthma group (n = 157; median age: 8.0 years), was characterized by male predominance (69.4%), the highest levels of T2 biomarkers (AEC, ECP, IgE, FeNO; all P < 0.001), airway hyperresponsiveness (BDR, P = 0.024; PC20, P < 0.001), and reduced lung function (FEV1, P = 0.002). In contrast, Cluster 1 (n = 252; median age: 4.0 years) showed the highest exacerbation and steroid use rates but relatively low T2 biomarker levels. Cluster 3 (n = 205; median age: 12.0 years) had moderate T2 levels and the lowest exacerbation burden. After adjusting for age, Cluster 2 maintained 4-6 folds higher T2 biomarker levels compared to other clusters (all P <0.001). These cluster-specific differences were not observed in the age tertile subgroup analysis.

Conclusions: The identified school-age T2-high cluster in childhood asthma exhibits distinct immunological and clinical phenotypes, characterized by high airway hyperresponsiveness, atopic features, and decreased lung function.

Background: Dermatophagoides pteronyssinus and D. farinae are major indoor allergens. Raw materials derived from these house dust mites (HDMs) are used to produce allergen extracts. The stability of these materials is influenced by storage form and conditions, which can affect protein integrity.

Objective: To compare storage formats and conditions for maintaining physicochemical stability of HDM raw materials.

Methods: Pure mite bodies (PMBs), prepared in fresh frozen and lyophilized forms, were stored at -80°C, -20°C, and 25°C. Over a 12-month period, samples were assessed for total protein and major allergens (Der p 1 and Der f 1) using ELISA. Protein integrity was analyzed by SDS-PAGE. Accelerated stability testing at 25°C for up to 14 days was also performed.

Results: Storage at -80°C best preserved total protein and Group 1 allergen content over 12 months. At -20°C, moderate declines were observed, with D. farinae showing greater reductions than D. pteronyssinus. Lyophilized samples were generally more stable than fresh-frozen ones at -20C°. Accelerated testing at 25°C caused marked losses over 14 days.

Conclusions: Ultra-low temperature storage (-80°C) remains optimal for preserving physicochemical stability of HDM raw materials. Lyophilization with -20°C storage is a promising, context-dependent option; however, in the absence of residual-moisture and immunological data, these findings should be interpreted as preliminary and limited to raw-material handling.

Background: Accurate diagnosis of IgE-mediated allergic diseases is crucial for effective management. This study compared the diagnostic performance of two multiplex allergy assays-AllergyChip and ALEX2-by measuring IgE reactivity to 31 inhalant allergens in serum from 90 participants.

Objective: To compare the diagnostic performance of AllergyChip with ALEX2 as reference method for specific IgE detection.

Methods: Agreement between the assays was evaluated by calculating overall (OPA), positive (PPA), and negative percentage agreement (NPA). Cohen's kappa measured agreement beyond chance. ROC analysis evaluated AllergyChip's ability to discriminate between positive and negative sIgE results. Spearman's correlation assessed concordance between sIgE classes, and Bland-Altman analysis evaluated quantitative agreement.

Results: AllergyChip showed substantial agreement with ALEX2 (OPA 88%, Cohen's kappa 0.792). ROC analysis showed excellent discrimination (AUC 0.891). Spearman's correlation (Rs 0.792) indicated strong agreement. However, AllergyChip had PPA below 70% for nine allergens, notably 0% for Phl p 12 and 30% for Bet v 2.

Conclusions: AllergyChip performs well in detecting IgE to inhalant allergens and may be a viable alternative assay. However, its lower sensitivity for certain allergens suggests it should complement, rather than replace, ALEX2, particularly in cost-sensitive settings. Further studies are needed to confirm these findings and improve accuracy in multiplex allergy diagnostics.

Background: Eosinophilic asthma is a severe phenotype in pediatrics, often refractory to conventional therapy. Biologic agents targeting Type 2 inflammatory pathway are increasingly used in children and adolescents.

Objective: To evaluate the efficacy and safety of omalizumab, mepolizumab, benralizumab, and dupilumab in pediatric eosinophilic asthma.

Methods: We systematically searched eight databases to March 31, 2025 (PROSPERO: CRD420251017602). Eligible studies were randomized controlled or controlled observational trials in patients 1≤8 years. Outcomes included lung function, asthma control, quality of life (QoL), and adverse events (AEs).

Results: Twenty-two studies (n = 2,468) were included. Biologics significantly improved predicted FEV1 (SMD = 0.97, 95%CI: 0.38-1.57), asthma control also improved (SMD = 2.84, 95%CI: 1.40-4.28), as did quality of life (SMD = 1.72, 95%CI: 0.39-3.05). Overall AEs were more frequent (OR 1.48, 95%CI 1.22-1.81), but serious AEs were rare and not increased. Evidence was strongest for omalizumab; data for other biologics remain limited.

Conclusions: Biologic therapies are associated with improvements in clinical outcomes in children and adolescents with eosinophilic asthma, with an increased incidence of predominantly mild adverse events. However, the current evidence is largely driven by studies of omalizumab, and data for other biologics remain limited in pediatric populations. Further long-term and comparative studies are warranted to better define the efficacy and safety profiles of individual biologic agents.

Background: Allergic asthma in children significantly impacts quality of life, and immunotherapy, including subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT), has emerged as an effective treatment. However, their comparative immunological mechanisms remain unclear.

Objective: This study aimed to compare the effects of SCIT and SLIT on immune response in children with allergic asthma and to explore their underlying immunological mechanisms.

Methods: A total of 86 children aged 5-12 years with allergic asthma who visited Hangzhou Children's Hospital were prospectively enrolled and randomly assigned to three groups: inhaled corticosteroids (ICS) group (n = 30), SCIT group (n = 30), and SLIT group (n = 26). Clinical and immunological parameters-including Childhood Asthma Control Test (C-ACT) scores, forced expiratory volume in the first second percentage (FEV1%), Th17, Treg cells, and serum levels of IL-17, IL-9, IL-10-were assessed before treatment and after one year.

Results: After treatment, all three groups showed significant improvements in C-ACT scores and FEV1% compared to baseline (all p < 0.05). The SCIT and SLIT groups demonstrated greater improvements than the ICS group (all p < 0.05), with no significant differences between the SCIT and SLIT groups (p > 0.05). In terms of immune markers, significant differences were observed in all parameters before and after treatment in the SCIT and SLIT groups (all p < 0.05), while Treg levels in the ICS group remained unchanged (p > 0.05). No statistically significant differences in immune markers were found among the three groups post-treatment (all p >0.05).

Conclusions: Both SCIT and SLIT, when combined with ICS, offer superior efficacy compared to ICS monotherapy. The comparable immunological changes observed in SCIT and SLIT suggest a shared mechanism of immune tolerance, potentially mediated through Treg cell induction.

Background: Bullous systemic lupus erythematosus (BSLE) is a rare autoimmune blistering disorder occurring in association with systemic lupus erythematosus (SLE). Owing to its rarity, current knowledge remains limited, particularly in Southeast Asian populations.

Objective: This study retrospectively evaluated the clinical, histopathologic, immunofluorescence, and serologic features of BSLE, together with a review of the existing literature.

Methods: This review included patients diagnosed with BSLE at Siriraj Hospital, Mahidol University, between 2003 and 2024.

Results: Among 9,055 patients with cutaneous lupus erythematosus, 12 were identified as having BSLE (incidence 0.13%). The median age was 39.5 years with equal sex distribution. Most patients (75%) presented with BSLE at the time of SLE diagnosis, while others developed it later. Lesions appeared on sun-exposed and non-sun-exposed areas, mainly the extremities, and mucosal involvement occurred in 33.3%. Direct immunofluorescence most frequently demonstrated immunoglobulin (Ig) G deposition (91.7%), followed by complement 3 (83.3%), IgM (75%), and IgA (50%), typically with linear and/or granular deposition of IgG and C3 along the basement membrane zone. Antinuclear antibodies were present in all patients. Systemic involvement was common (75%), most frequently affecting the kidneys (66.7%), followed by hematologic abnormalities (58.3%). Owing to disease severity, most patients required treatment with systemic corticosteroids in combination with immunosuppressive agents rather than dapsone alone to achieve disease control.

Conclusions: This study and literature review highlight that, although BSLE is an uncommon cutaneous manifestation of SLE, it is strongly associated with systemic involvement, particularly renal and hematologic disease, which often necessitates treatment with immunosuppressive agents.

Background: The commercial wheat extract for skin prick test (SPT) provides less sensitivity to predict wheat allergy, compared to in-house gliadin extracts. SPT is a preferred method to study extract stability as it is the aim of developing extract. The role of cell degranulation assay, a functional assay with the same mechanism as SPT, is not widely used to determine extract stability.

Objective: To study the stability of in-house gliadin extracts stored at different periods, by using protein analysis, SPT and degranulation assay of humanized rat basophilic-leukemia (RBL-SX38) cells.

Methods: Patients with a history of wheat allergy and positive SPT to wheat, were recruited. The gliadin extracts stored for 1, 6, 9, and 12 months at 2-8°C were used in SDS-PAGE, SPT and cell degranulation assay. The cell degranulation was determined by β-hexosaminidase release. AR patients.

Results: Forty children were recruited. The gliadin extract stored for 9 and 12 months provided lighter protein bands than 1 and 6 months. However, the wheal diameters from SPT using extracts stored at different periods, were not significantly different (p = 0.09). There were also no significant differences of the β-hexosaminidase released using 0.1 and 1 μg/mL of gliadin extracts stored at different periods (p > 0.05). The 10 μg/mL of gliadin extracts stored at longer periods, significantly stimulated higher β-hexosaminidase release (p = 0.01). The extracts were sterile at all storage times.

Conclusions: To determine the stability of in-house gliadin extracts, SPT or cell degranulation assay provided additional information to SDS-PAGE. The extracts were stable for up to 12 months.

Recurrent respiratory papillomatosis (RRP) is caused by human papillomavirus (HPV) types 6 and 11. Juvenile-onset RRP (JoRRP), typically acquired during birth, and adult-onset RRP (AoRRP), commonly associated with sexual transmission, are both predominantly caused by HPV-6, followed by HPV-11. HPV-11 infection, more frequent in children, is associated with more severe disease, increased risk of tracheobronchial and pulmonary spread, and, rarely, RRP-related mortality. Local immune tolerance within the airway mucosa is thought to impair clearance of HPV-6/11-infected cells, resulting in persistent infection and recurrent papilloma growth. Surgical debulking remains the cornerstone of management; however, JoRRP requires substantially more procedures than AoRRP (4-8 vs 1-2 per year), leading to cumulative morbidity, including vocal fold scarring, anterior commissure webbing, glottic or subglottic stenosis, and pulmonary dissemination. Defective innate immune activation and impaired HPV-specific cellular immunity contribute to viral persistence, with the papilloma microenvironment characterized by ineffective antiviral T-cell responses. To reduce surgical burden, immunotherapeutic strategies targeting HPV-6/11 antigens have been developed. Three platforms have advanced into phase 1-2 clinical trials: a gorilla adenoviral vector (gAdeno)-based therapy, a DNA plasmid vaccine, both encoding HPV-6/HPV-11 E6/E7 oncoproteins, and a Modified Vaccinia Ankara (MVA)-based bovine papillomavirus E2 vaccine. These approaches aim to elicit robust E6/E7-specific cellular immunity, particularly CD8+ T-cell responses, to overcome local immune tolerance and eradicate HPV-infected cells. The gAdeno-based therapy is the first FDA-approved immunotherapy for RRP; however, with annual treatment costs exceeding USD 300,000, ensuring equitable access remains a critical challenge.

Background: Food allergy affects the patient's quality of life (QoL) and leads to anxiety and depression. In addition to routine treatment, QoL evaluation should also be performed in patients with food allergies. The validated Food Allergy Quality of Life Questionnaire - Adult Form (FAQLQ-AF) and Food Allergy Independent Measure - Adult Form (FAIM-AF) have been well accepted and available in many languages.

Objective: Translate FAQLQ-AF and FAIM-AF into Thai and perform reliability and validity tests in Thai adult patients with food allergies.

Methods: The translation process was performed according to the ISPOR Task Force for Translation and Cultural Adaptation. Participants 18 years or older and with physician-diagnosed food allergies were included in the study. Thai versions of FAQLQ-AF and FAIM-AF were administered to participants at baseline and after two weeks. The intraclass correlation coefficient and Cronbach's α coefficient were evaluated to demonstrate both questionnaires' test-retest reliability and internal consistency.

Results: The study included 104 participants. The Thai version of FAQLQ-AF and FAIM-AF demonstrated good reliability, with intraclass correlation coefficients of 0.83 (95%CI 0.76, 0.88) and 0.85 (95%CI 0.79, 0.90), respectively. The validity was excellent, with Cronbach's α coefficient of 0.91 and 0.92, respectively. Both questionnaires were moderately correlated (r = 0.69, P < 0.001), but poorly correlated with the 36-Item Short Form Survey, which is usually used to evaluate general health status.

Conclusions: To evaluate the QoL in adult patients with food allergies, the Thai versions of FAQLQ-AF and FAIM-AF are valid, reliable, and more suitable than the general questionnaire.

Background: Exposure to environmental pollutants has been associated with an increased risk of respiratory and allergic diseases.

Objective: To describe the interactions between common pollutants and the immune system and their association with allergic diseases.

Methods: A systematic literature review was conducted using PubMed, Clinical Key, Redalyc, MEDLINE, and SciELO for studies published between 2018 and 2024.

Results: Evidence shows that pollutants such as PM2.5 , PM10 , NO2 , CO, and ozone trigger oxidative stress, inflammatory responses, and epithelial damage, facilitating allergic sensitization, asthma, rhinitis, and dermatitis.

Conclusions: Exposure to environmental pollutants plays a key role in the development and exacerbation of allergic diseases, highlighting the need for preventive measures.