Asian Pacific journal of allergy and immunology最新文献

Background: Immediate hypersensitivity reactions (IHRs) are commonly found in patients receiving paclitaxel. Effects of paclitaxel vary because of variable co-therapy or re-challenge with paclitaxel.

Objective: Our objective was to investigate the incidence, patterns, and risk factors for paclitaxel-related IHRs and management of IHRs in gynecologic malignancy patients.

Methods: This retrospective study was performed in gynecologic cancer patients receiving paclitaxel-based regimens at Siriraj hospital from January 2012 to December 2017.

Results: 416 subjects were included and received ranitidine 50 mg, dexamethasone 20 mg, ondansetron 16 mg intravenously and diphenhydramine 50 mg orally 30 minutes before starting chemotherapy. The incidence of IHRs was 17.79%. IHRs occurring on first exposure to paclitaxel was 81.1% and occurred within 30 minutes after starting paclitaxel. The most commonly found presentation of IHRs were skin reactions (86.5%). In multivariate analysis, age < 54.5 years, stage of cancer < 2, and leukocyte cell count < 7.735 × 109/L were significantly associated with IHRs. Seventy-two out of 74 patients that recovered from IHRs were reintroduced paclitaxel. Forty-seven patients (97.92%) of 48 patients with mild reactions were successfully reintroduced to paclitaxel after treatment with chlorpheniramine or other interventions.

Conclusions: The incidence of paclitaxel-related IHRs was about one in five. Skin reactions were the most commonly occurring reactions. Younger age, stage of cancer < 2, and leukocytes < 7.735 × 109/L were significant risk factors for IHRs. Patients with IHRs recovered without the use of dexamethasone and antihistamines before the reintroduction of paclitaxel.

Background: Burden of severe eosinophilic asthma (SEA) data in Asia are limited.

Objective: This retrospective, observational study characterized SEA epidemiology, healthcare resource use (HCRU) and costs for adult patients in Taiwan.

Methods: Data from Taichung Veterans General Hospital electronic medical record database, between 2013 to 2016, were extracted. Eligible general asthma patients were ≥ 18 years at index date, with ≥ 1 medical claim with an asthma diagnosis after the index date. Patients with SEA (meeting additional criteria: Global Initiative for Asthma Step 4/5 treatment guidelines [within 3 months preceding index date], ≥ 2 clinically significant exacerbations, and eosinophil counts ≥ 300 cells/μL [within 12 months preceding index date] or ≥ 150 cells/μL [on index date]) and SEA patients using high-dose inhaled corticosteroids (HD ICS) were also identified. Twelve months' pre-index data were used to evaluate exacerbation frequency, treatment patterns, HCRU, and costs (2016 US Dollars).

Results: Of 2,601 eligible general asthmatic patients, 162 (6.2%) met predefined criteria for SEA; of SEA patients, 72/162 (44.4%) had used HD ICS. SEA and HD ICS SEA patients experienced more clinically significant exacerbations than general asthma patients (1.6 ± 3.3 and 1.5 ± 2.6 vs 0.6 ± 2.0, p < 0.01). HD ICS SEA and SEA patients incurred at least 2-2.5-fold higher total asthma-related and all-cause costs than general asthma patients and had significantly greater HCRU.

Conclusions: Of eligible Taiwanese general asthma patients, 6.2% met predefined SEA criteria. Compared with general asthma patients, SEA and HD ICS SEA patients used more respiratory medications, experienced more exacerbations, and incurred greater HCRU and higher costs.

Background: Polycyclic aromatic hydrocarbons are one of the major pathogenic components in air pollution. Previous studies have demonstrated an association between air pollution and atopic dermatitis.

Objective: We sought to explore the relationship between polycyclic aromatic hydrocarbons exposure and adult atopic dermatitis.

Methods: We prospectively recruited 23 adult patients with atopic dermatitis and 11 healthy controls. Plasma levels of inflammatory cytokines were determined using enzyme-linked immunosorbent assay. Expression levels of aryl hydrocarbon receptor, which mediates the effect of polycyclic aromatic hydrocarbons, and cytokines in peripheral blood nuclear cells (PBMCs) were measured using reverse transcription polymerase chain reaction. Urine levels of 16 polycyclic aromatic hydrocarbon metabolites were determined by gas chromatography- tandem mass spectrometry.

Results: Patients with atopic dermatitis had lower levels of interleukin (IL)-5 and IL-23, and lower PBMC messenger RNA expression levels of interferon-> than the healthy controls. Plasma levels of IL-22 were moderately and positively associated with the SCORAD index. Creatinine-corrected urine levels of 9-hydroxyfluorene and 2-hydroxyphenanthrene were elevated in the atopic dermatitis group. However the difference was not statistically significant after Bonferroni correction.

Conclusions: Our results demonstrated that the polycyclic aromatic hydrocarbons fluorene and phenanthrene are potentially associated with the pathogenesis of atopic dermatitis in adults.

Background: Interferon (IFN)-γ and interleukin (IL)-4 are considered to be important factors to regulate immune responses. Although the effects of IFN-γ or IL-4 on macrophage functions are well established, their cooperative action is not fully understood.

Objective: Inducible nitric oxide synthase (iNOS) or arginase (Arg)-1 is a representative marker of M1 or M2 macrophages and plays a role in the acceleration or suppression of inflammatory responses. In the present study, we examined the effect of simultaneous treatment with IFN-γ and IL-4 on macrophage expression of iNOS and Arg-1 using the murine macrophage cell line RAW264.7.

Methods: Protein production and mRNA expression of iNOS and Arg-1 were measured using immunoblotting and reverse transcription-polymerase chain reaction. Cell surface expression of CD86 and programmed death ligand (PD-L) 2 was analyzed using flow cytometry.

Results: IFN-γ or IL-4 increased iNOS or Arg-1 protein production, respectively. Of note, IL-4 combined with IFN-γ synergistically increased Arg-1 protein production, whereas IL-4 inhibited IFN-γ-induced iNOS production. This phenomenon was consistent with the mRNA levels. In addition, IL-4 combined with IFN-γ synergistically increased cell surface expression of PD-L2, which is involved in T cell suppression, whereas IL-4 completely inhibited IFN-γ-induced expression of CD86, which is responsible for T cell activation.

Conclusions: In the present study, we found the synergy of IFN-γ and IL-4 in Arg-1 and PD-L2 expression. Thus, macrophages highly expressing Arg-1 and PD-L2 may be induced by both IFN-γ and IL-4 at the inflammatory site, and might play a role in the regulation of inflammatory immune responses.

Background: The possible myelosuppression side effect of Trimethoprim-Sulfamethoxazole (TMP-SMX) on primary immune deficiency (PID) patients has not been established yet.

Objective: Identify if the PID patients are at higher risk of developing myelosuppression secondary to the use of TMPSMX.

Methods: Retrospective, three groups study, of PID patients (on and off TMP-SMX prophylaxis) and urinary tract infection (UTI) patients received prophylaxis TMP-SMX. Data about CBC results (WBC, ANC, Lymphocytes, RBC, Hemoglobin, and Platelet counts) at baseline, first, and maximum myelosuppression observed during the period of TMP-SMX administration were collected.

Results: A total of 122 patients were included in this study (41 PID patients on TMP-SMX prophylaxis, 45 PID patients not on TMP-SMX prophylaxis, and 36 UTI patients on prophylaxis TMP-SMX). There are significant differences noticed in the percentage of patients who developed clinical myelosuppression (i.e. less than normal value for age) in ANC (39.0% vs. 8.9% vs. 16.7%, p = 0.002), RBC (36.6% vs. 13.3% vs. 13.9%, p = 0.014), WBC (41.5% vs. 13.3% vs. 13.9%, p = 0.003), and platelet (24.4% vs. 15.6% vs. 2.8%, p = 0.028) in group 1, 2, and 3, respectively. Significant difference in myelosuppression between the groups was most likely due to the combination of TMP-SMX effect on PID patients rather than the disease or the drug itself.

Conclusions: Primary immune deficiency (PID) patients are at higher risk of developing myelosuppression secondary to TMP-SMX prophylaxis (especially ANC) comparing to immune-competent patients or other PID patients who did not receive prophylactic TMP-SMX. Future larger prospective study is required to confirm this association.

Background: Cytokine-induced killer (CIK) cells are ex-vivo expanded T cells which present a phenotype of both T and Natural Killer cell properties.

Objective: To compare the proliferation and functional properties of human CIK cells cultured in three cell culture plasticwares.

Methods: The number and viability of CIK cells were monitored. The expression of surface markers (CD3 and CD56), TH1 cytokines (IFN-γ and TNF-α), and cytolytic granules (granzyme B and perforin) were determined by flow cytometry.

Results: The number of CIK cells cultured in a static bag was highest compared to those in a petri dish and gas-permeable flask. However, CIK cells cultured in all plasticwares similarity expressed surface marker, TH1 cytokines, and cytolytic granules.

Conclusions: Considering safety, efficacy, and cost, a static bag is the best plasticware for culturing CIK cells.

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: Unintentional exposure is common in children with food allergies.

Objective: To assess the benefits of newly developed food allergy application.

Methods: Caregivers of children with confirmed immediate reactions to food were enrolled to use the "Kinchew" application for one month. Kinchew provides the detail of food allergens after typing the name of specific food in the chat box. Then, the app provides the product image and detail of food allergens. Kinchew also has a menu for recording food diaries and videos on managing food allergies. Kinchew users were asked to assess their confidence in dealing with food allergies assessed by the questionnaire using 5 points Likert scale. The number of patients who experienced allergic reactions from unintentional food exposure was recorded after using Kinchew.

Results: Seventy caregivers were enrolled. Wheat was the most common causative food in 67% of the participants. All participants used Kinchew with a total use of 1,754 times, classified as food items searching 1080 times (62%), and recorded their food diary 674 times (38%). The number of patients who experienced allergic reactions from unintentional exposure significantly decreased from 61 (87%) to 31 (44%), p < 0.001.The user's confidence in choosing food improved significantly compared to the baseline score. In the subgroup analysis of the type of causative food, a significant improvement in confidence in food choosing was demonstrated in wheat and multiple food allergy groups.

Conclusions: Well-designed food allergy mobile applications could improve caregivers' confidence in dealing with food allergies and reduce unintentional food exposure.

Background: Henoch-Schönlein purpura (HSP), the most typical kind of pediatric vasculitis, can also affect adults. Over the last 10 years, research has been increasing on improvements in HSP diagnosis, physiopathology, symptoms, and therapy. Joint involvement is highly frequent in this condition; however, it typically undergoes spontaneous resolution and does not lead to long-term complications.

Objective: To provide a deeper understanding of the constituting pathogenic mechanisms and clinical presentation of articular involvement, focusing on the effect of neutrophil activation on systemic small vessels.

Methods: This literature review utilized a systematic search of academic databases, employing specific keywords to select recent peer-reviewed articles and scholarly sources on the topic.

Results: The manifestations of joint involvement in HSP can vary in severity and frequency. Non-steroidal anti-inflammatory medications or acetaminophen are considered the first-line treatment for joint pain; however, corticosteroids may help achieve quick remission. In cases where standard treatment fails or manifestations persist, immunosuppressive drugs like rituximab, methotrexate, cyclophosphamide, or azathioprine have been used.

Conclusions: While it tends to resolve without lasting joint damage, accurate diagnosis and appropriate management are crucial to ensure optimal patient outcomes.