Asian Pacific journal of allergy and immunology最新文献

Background: Non-allergic eosinophilic asthma (NAEA) is a distinct subtype of asthma. However, the immune mechanisms associated with NAEA are not yet clearly understood.

Objective: To gain further insight into the pathogenesis of NAEA.

Methods: The proportion of innate lymphoid cells (ILCs) in the blood of patients with allergic eosinophilic asthma (AEA) and NAEA was evaluated. Eosinophilic asthma was defined when fractional exhaled nitric oxide measured at diagnosis (before initiating anti-asthma medications) was greater than 50 ppb. We evaluated the genome-wide gene expression profiles in peripheral blood mononuclear cells obtained at enrollment (in a stable state).

Results: A total of 57 participants were enrolled (10 healthy controls, 23 patients with NAEA, and 24 patients with AEA). We found that the type 1 ILC (ILC1) proportion significantly decreased, but the type 2 ILC (ILC2) and type 3 ILC (ILC3) proportions significantly increased in the blood of both patients with NAEA and those with AEA compared with healthy controls. However, there were no significant differences in the ILC1~3 proportions between NAEA and AEA patients. We also identified distinct biological pathways in patients with NAEA (anti-viral pathway) or AEA (IL-4 and IL-13 signaling and neutrophil degranulation pathways) based on co-expressed gene modules showing significant correlations with the ILC proportions.

Conclusion: ILC proportions in the blood did not differ between NAEA and AEA patients. However, different biological pathways were related to the ILC proportions in these patients. Our results provide further insight into eosinophilic airway inflammation in allergic and non-allergic patients.

Background: Exposure to air pollutants have been associated with exacerbations of atopic dermatitis (AD) symptoms, however, the role of each volatile organic compound (VOC) was rarely investigated.

Objective: This population-based study investigated associations between daily visits for AD at hospitals and exposure to each ambient air VOC in central-southern Taiwan.

Methods: The dependent variable with diagnostic code (ICD-9-CM code 691.8 and ICD-10-CM code L20) retrieved from National Health Insurance Research Database (NHIRD) from 2008/01/01 to 2018/12/31. Independent variables included one-day 75th-percentile value of each VOC and four meteorologic conditions retrieved from Taiwan Air Quality Monitoring Network Databases and four allergic diseases from NHIRD. This multivariable model was analyzed using both case-crossover study (adjusted odds ratio (AOR)) and Poisson model (adjusted relative risk (ARR)).

Results: Two study designs in total and each subgroup showed consistently significantly positive effects of each 12 ambient air VOC, especially highest in 1,3,5-trimethylbenzene and methylcyclohexane. The concentration of each 12 VOC was highly affected the total daily visits (AOR: 1.05-3.58, ARR: 1.03-3.74, P < 0.001), particularly highest for 1,3,5-trimethylbenzene (AOR = 3.58, ARR = 3.74, P < 0.001) and methylcyclohexane (AOR = 3.55, ARR = 2.13, P < 0.001). The results of each VOC were similarly positive in men and women. Children were the most vulnerable on the exposure to methylcyclohexane (AOR = 6.18, ARR = 2.35, P < 0.001), and 1,3,5-trimethylbenzene (AOR = 6.08, ARR = 4.62, P < 0.001). The results for older adults, adolescents, and younger adults were also significantly higher. In the analysis of five areas, mostly VOCs showed significantly higher effects using two methods. (Kappa = 0.44 vs 0.26).

Conclusion: 12 air VOCs can be considered as risk factors of daily visits for AD.

Background: House dust mite subcutaneous immunotherapy (HDM SCIT) is a therapeutic option for allergic rhinitis (AR) patients who are unable to properly manage symptoms with standard medications.

Objective: This study aimed to determine long-term efficacy and identify predictive factors in the clinical remission of AR patients who completed and discontinued HDM SCIT.

Methods: This study included 240 AR patients, who completed a three-year course of HDM SCIT at two tertiary hospitals and were currently being discontinued. We followed-up the patients to ask about their current symptoms and allergy medication. Clinical remission was defined by patients who no longer required daily intranasal steroid or oral antihistamine. We compared patients in clinical remission to those still taking medication.

Results: The enrolled patients had a median age of 21.0 (11.0-36.0) years at the time they began HDM SCIT. The clinical remission of AR was achieved in 174 (72.5%) patients. Starting HDM SCIT before the age of 15 and not having asthma were identified as significant and independent predictors of remission (aOR 4.44; 95%CI, 1.72-11.50; p-value 0.002, and 2.67, 95%CI 1.00-7.12; p-value 0.049), respectively, as determined by multivariate logistic regression analysis. There were no significant differences in HDM SCIT duration or sensitization patterns between patients in remission and those on medication after discontinuing HDM SCIT for at least one year.

Conclusion: HDM SCIT exhibited persistent long-term efficacy after treatment discontinuation. Starting HDM SCIT before the age of 15 and without asthma comorbidity might be predictors of AR remission with HDM SCIT.

Background: Concerns about new COVID-19 vaccines played a key role in vaccine hesitancy and hampered population uptake. Hong Kong initiated a Vaccine Allergy Safety Track (VAS-Track) program to assess potential COVID-19 vaccine-associated allergies. A 'Hub-and-Spoke' model of predominately non-specialists supported by the allergist hub was established to meet overwhelming demand despite limited specialists.

Objective: To assess the cost-effectiveness of VAS-Track as a pre- and post-vaccination assessment service for individuals potentially at high risk of COVID-19 vaccine-related allergy.

Methods: An individual-level decision-analytical model was constructed using data from VAS-Track participants supplemented by published estimates. Analyses were from a health service provider perspective over 12 months. We calculated the incremental cost-effectiveness ratio (ICER) to estimate the cost per quality-adjusted life years (QALYs) gained. Willingness-to-pay threshold was based on local GDP per capita (US$ 49,590). Sensitivity analyses examined robustness of findings.

Results: Cost-effectiveness varied widely across age groups. VAS-Track was cost-saving for older adults (dominant strategy for age ≥ 50) compared with standard practice across a range of sensitivity analyses. VAS-Track was not cost-effective for younger groups (age 18-49: ICER: US$ 410,914/QALY for pre-vaccination and US$ 213,786/QALY for post-vaccination assessments). Infection rate, cost of treating severe infection, and vaccination rate were most influential on cost-effectiveness estimates.

Conclusion: VAS-Track was cost-effective both as a pre- and post-vaccination assessment service for adults over 50. The 'Hub-and-Spoke' model using non-specialists with limited allergy specialist resources to provide vaccine allergy assessment services would provide high economic value compared with usual care for adults aged 50 and over.

Background: Visual analog scale (VAS) correlates well with total nasal symptom score (TNSS) but negatively correlates with peak nasal inspiratory flow (PNIF) in adults with allergic rhinitis (AR). Small children may not rate VAS properly and parents usually help assess their child's symptoms. Data on the correlations among parent-assessed VAS (P-VAS), VAS, TNSS, and PNIF in children with AR was limited.

Objective: To assess correlations among P-VAS, VAS, TNSS, and PNIF in children and adolescents with perennial AR (PAR).

Methods: Patients with PAR aged 6-18 years and their parents were instructed to record daily VAS, TNSS, PNIF, and P-VAS in an electronic diary for 8 weeks.

Results: 2387 records from 46 patients (56.5% male) were obtained. VAS and P-VAS showed a strong correlation (rs = 0.82, p < 0.001). Moderate correlations were found between VAS vs TNSS (rs = 0.53, p < 0.001) and between P-VAS vs TNSS (rs = 0.48, p < 0.001). There was a weak negative correlation between PNIF vs VAS, PNIF vs TNSS, and PNIF vs P-VAS (rs = -0.20, rs = -0.22, rs = -0.18, p < 0.001 respectively). In addition, a weak negative correlation was found between nasal congestion and PNIF (rs = -0.26, p < 0.001). The overall inter-rater agreement between VAS and TNSS was fair (Kappa = 0.37, p < 0.001). Higher inter-rater agreement was found in moderate-severe than in the mild PAR group (Kappa = 0.50 vs 0.17) and in adolescents than in the children group (Kappa = 0.44 vs 0.26).

Conclusion: In small children, P-VAS was a reliable tool to assess nasal symptoms. Both subjective and objective measurements provided complementary information for symptom monitoring in patients with AR.

Hereditary angioedema (HAE) is a rare hereditary disorder characterized by episodic swelling and life-threatening airway obstruction caused by laryngeal angioedema. In most HAE patients, reduced level of serum C1-Inhibitor (type-I-HAE) or presence of aberrant C1-Inhibitor (type-II-HAE) result in the lost of regulation of the complementary system and contact activation system with downstream over-activation of bradykinin - the chief mediator leading to angioedema. Type-III HAE (HAE-nl-C1INH) is rare without deficient or dysfunction of C1-Inhibitor, often with genetic aberrant related to the contact activation system. The prevalence of HAE in the population is estimated at 1 in 50,000 individuals, often with early onset, but due to the heterogeneity of the disease, there is frequently a significant delay in diagnosis. Recently, better awareness by physicians, more access to diagnostic tools, better management and prophylaxis has decreased morbidity and mortality. A focus in HAE patient care shift from management of attacks with on-demand medication, to use of prophylaxis to reduce attacks has improved the overall quality of life of patients with HAE. One area in HAE research that has not been emphasized is the long-term consequence of C1-INH deficiency in HAE patients, other than the typical manifestations of HAE, as evidence have emerged linking this disorder with increased risk of cardiovascular diseases, auto-immune disorders, and malignancy. This review aims to gather the current knowledge and evidence of potential consequence of C1-Inhibitor deficiency in HAE aside from angioedema with emphasis in the improvement of long-term care and overall quality of life for HAE patients.

Background: The appropriate COVID-19 booster vaccine following inactivated or adenoviral vector COVID-19 vaccination is unclear.

Objective: To investigate the immunogenicity of four COVID-19 booster vaccines.

Methods: We prospectively enrolled healthy adults who received a two-dose CoronaVac or ChAdOx1 8-12 weeks earlier and allocated them to receive one of the following booster vaccine: inactivated (BBIBP-CorV), ChAdOx1 or mRNA (BNT162b2 at full [30 μg] and half [15 μg] dose) vaccines. We determined the reactogenicity and the humoral (anti-receptor binding domain IgG (anti-RBD-IgG), neutralizing antibodies (nAb) against Delta, Beta and Omicron variants) and cellular immunity measuring by interferon gamma (IFN-γ) responses post-booster. AR patients.

Results: Among the 352 participants (179 CoronaVac and 173 ChAdOx1 participants), 285 (81%) were female, and median age was 39 (IQR: 31-47) years. Two weeks post-booster, both 30 μg- and 15 μg- BNT162b2 induced the highest anti-RBD IgG concentration (BAU/mL); Coronavac-prime: 30 μg-BNT162b2, 5152.2 (95%CI 4491.7-5909.8); 15 μg-BNT162b2, 3981.1 (3397.2-4665.4); ChAdOx1, 1358.0 (1141.8-1615.1); BBIBP-CorV, 154.6 (92.11-259.47); ChAdOx1-prime: 30 μg-BNT162b2, 2363.8 (2005.6-2786.1; 15 μg-BNT162b2, 1961.9 (1624.6-2369.1); ChAdOx1, 246.4 (199.6-304.2); BBIBP-CorV, 128.1 (93.5-175.4). Similarly, both 30 μg- and 15 μg- BNT162b2 boosting induced the highest nAb titers against Beta, Delta and Omicron BA.1 variants and highest T-cell response at 2 weeks after boosting. While all BNT162b2 or heterologous ChAdOx1-boosted participants had nAb against Omicron, these were < 50% for BBIBP-CorV and 75% for homologous ChAdOx1-boosted participants. There was significant decrease in nAb ( > 4-fold) at 16-20 weeks post booster for all groups.

Conclusions: Heterologous boosting with BNT162b2 following CoronaVac or ChAdOx1 primary series is most immunogenic. Additional studies are needed to verify the clinical efficacy and persistence of immunity following half-dose BNT162b2.

Background: Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disease caused by a complex hypersensitivity reaction to colonization of the airways with various fungi. ABPA caused by Alternaria alternata, other than Aspergillus spp., is named Allergic bronchopulmonary mycosis (ABPM).

Objective: To describe the first case of ABPM caused by Alternaria alternata in East Asia.

Methods: Case report.

Results: A 58-year-old female visited our hospital due to an abnormal chest x-ray, following chest computed tomography (CT) revealed consolidation in the left lower lobe. On laboratory finding, eosinophil count and total IgE level were high. The skin prick test and specific IgE for Alternaria alternata were positive. After diagnosis of ABPM, the patient was treated with prednisolone without antifungal agents, and her chest image was much improved.

Conclusions: Aspergillus is most common etiology of allergic pulmonary disease, however, Alternaria should be considered even though positive culture of Aspergillus spp.

Mpox, the zoonotic disease caused by Monkeypox virus (MPXV), is currently a global health emergency. This review (Part I) aims to provide insights into the virus life cycle, epidemiology, host immune responses, and immune evasion mechanisms. Mpox symptoms is similar to smallpox but with lower mortality rates and lower transmissibility. In the past, the virus has been endemic in Central (Clade I) and West (Clade II) African countries. The first outbreak in outside Africa is reported in the United States in 2003. A multi-country outbreak across all continents occurred in 2022, predominantly driven by Clade II. Recently, the emergence of Clade Ib with sustained person-to-person transmission characteristic in the 2023-2024 outbreaks has raised significant public health concerns. Its apparent capacity for rapid spread and potential for causing severe disease highlight the need for enhanced surveillance, especially in regions not traditionally affected by Mpox. Immune responses induced by MPXV infection in humans and animal models provide the insights into the key step in which the host immune response recognizes and responds to the infection. The sophisticated immune evasion strategy by MPXV at both innate and adaptive arms also emerges that are useful for vaccine-based control measures. Taken together, understanding MPXV life cycle, epidemiology and immune response will facilitate better control, limit viral spread, and provide important insights for vaccine development.

Background: The COVID-19 situation in Maldives have evolved since the epidemic began in March 2020 with unprecedented increase in cases since mid-July 2019 with over 8000 cases at the end of August 2020.

Objective: The aim of the sero-epidemiological investigation is to obtain a sense of the population exposure to the SARS-CoV-2 by measuring the seroprevalence of antibodies to COVID-19 in the general population.

Methods: A population-based, age-stratified prospective method was employed to find out the key epidemiological and serologic characteristics of COVID-19 virus in this study.

Results: The results showed that seroprevalence in the population was 13%. The factors that were associated with antibody results included age (OR: 4.0, CI: 1.7-9.0), nationality (OR: 12.9, CI: 8.3-19.7), being diagnosed for COVID-19 (OR: 24.7, CI: 15.9-38.4) and having symptoms of COVID-19 (OR: 2.0, CI: 1.5-2.8). There was a gradual decrease in the antibody levels from 19 days to 250 days. The mean duration of the presence of antibodies in this study was found to be 124 days.

Conclusions: While the seroprevalence provides a measure that can be used to predict community transmission risk of the disease, the extent of functional immunity provided by antibody titres is still not clear. It is acknowledged that other mechanisms of protection such as T cell mediated immunity will play an important role in providing individual protection.