Asian Pacific journal of allergy and immunology最新文献

Background: Misdiagnosed vaccine-related "allergies" lead to unnecessary vaccine deferrals and incomplete vaccinations, leaving patients unprotected against COVID-19. To overcome limitations and queues for Allergist assessment, the "VAS-Track" pathway was developed to evaluate patients via a multi-disciplinary triage model including nurses, non-specialists, and Allergists.

Objective: We assessed the effectiveness and safety of VAS-Track and evaluate its real-world impact in terms of vaccination rates and COVID-19 protection.

Methods: Patients referred to VAS-Track between September 2021 and March 2022 were recruited. Subgroup analysis was performed with prospective pre- and post-clinic antibody levels.

Results: Nurse-assisted screening identified 10,412 (76%) referrals as inappropriate. 369 patients were assessed by VAS-Track. Overall, 100% of patients were recommended to complete vaccination and 332 (90%) completed their primary series. No patients reported any significant allergic reactions following subsequent vaccination. Vaccination completion rates between patients seen by non-specialists and additional Allergist review were similar (90% vs. 89%, p = 0.617). Vaccination rates were higher among patients with prior history of immediate-type reactions (odds ratio: 2.43, p = 0.025). Subgroup analysis revealed that only 20% (56/284) of patients had seropositive COVID-19 neutralizing antibody levels (≥ 15 AU/mL) prior to VAS-Track, which increased to 92% after vaccine completion (pre-clinic antibody level 6.0 ± 13.5 AU/mL vs. post-clinic antibody level 778.8 ± 337.4 AU/mL, p > 0.001).

Conclusions: A multi-disciplinary allergy team was able to streamline our COVID-19 VAS services, enabling almost all patients to complete their primary series, significantly boosting antibody levels and real-world COVID-19 protection. We propose similar multidisciplinary models to be further utilized, especially in the settings with limited allergy services.

Background: The efficacy of rupatadine for the treatment of AR has been confirmed in numerous clinical studies, however there are very few studies on asian patients.

Objective: To assess the safety and efficacy of rupatadine fumarate in the treatment of Korean perennial allergic rhinitis (PAR) patients.

Methods: A multicenter, double-blind, randomized, placebo-controlled, comparative study of rupatadine fumarate and bepotastine besilate was conducted. Each group was administered rupatadine, bepotastine or placebo for 4 weeks. Primary parameters for efficacy included morning and evening symptom reduction from baseline at 4 weeks. Treatment safety and tolerability were evaluated according to a self-reported incidence and type of adverse events at each follow up visit.

Results: Rupatadine showed a significant reduction in symptoms at morning and evening evaluations, in both 5TSS (-5.69, P < 0.0006) and 4NTSS (-4.74, P < 0.0015) compared to placebo. There was a significant reduction from baseline for 5TSS (-65.4%, P = 0.002) and 4NTSS (-63.7%, P = 0.003) with rupatadine compared with placebo. At evening evaluations, there were significant reductions of 5TSS (-63.2%, P = 0.009) and 4NTSS (-61.6%, P = 0.013) for the rupatadine group. Compared with bepotastine, rupatadine showed greater reduction in the morning symptoms at 4 weeks. When individual symptoms were assessed with 12-hour reflective mean daily symptom score, rupatadine showed better efficacy than placebo in sneezing (P = 0.016) and rhinorrhea (P = 0.097). The rate of adverse events showed no statistical significance.

Conclusions: Rupatadine is a safe and effective treatment option for Korean PAR patients and possibly a better choice over bepotastine for controlling morning symptom.

Background: Nowadays, moisturizers contain non-steroidal anti-inflammatory agents that help for treatment of atopic dermatitis (AD). Defensil® (black currant seed oil, sunflower oil, and balloon vine), a new anti-inflammatory, obtained from plant extracts, remain had a few studies for AD.

Objective: To compare the effectiveness of moisturizer containing 3% Defensil®, 5% dexpanthenol and ceramide (LDC) with 5% urea cream in childhood AD treatment.

Methods: Thirty-eight patients with diagnosis of atopic dermatitis by UK working party's criteria were recruited in randomized, controlled, double-blinded 4-week study. The patients were received with twice-daily application of LDC cream on one side of the body and 5% urea cream on the opposite side. The clinical severity was assessed by modified scoring of atopic dermatitis (SCORAD). Median time to remission was analyzed by survival analysis.

Results: Thirty-seven out of 38 patients accomplished the protocol. The clinical SCORAD significantly improved from baseline in both groups (p < 0.001) after 2 and 4 weeks. Furthermore, the LDC group significantly reduced severity of disease better than the 5% urea group (P = 0.043). The mean difference SCORAD scores were -13.83 (±1.83) and -13.04 (±3.22) respectively. Stratum corneum hydration (SCH) was enhanced from baseline in both groups (p < 0.001) but no statistically significant difference between both groups. Median time to remission had no statistically significant difference (P = 0.697).

Conclusions: The effectiveness of LDC cream is better than 5% urea cream for improving clinical atopic dermatitis. It was suggested that moisturizer containing LDC could be used for the treatment of mild-to-moderate childhood atopic dermatitis.

Background: Despite the high incidence of spondyloarthritis (SpA) as an extra-intestinal manifestation of Crohn's disease (CD), the immunopathogenesis of CD-associated SpA remains largely unknown.

Objective: We tried to explore molecular mechanisms accounting for the development of CD-associated SpA in a patient successfully treated with infliximab.

Methods: Peripheral blood mononuclear cells (PBMCs) before infliximab treatment were stimulated with Toll-like receptor (TLR) ligands to measure pro-inflammatory cytokine responses. Endoscopic biopsy samples before and after infliximab treatment were subjected to quantitative polymerase chain reaction.

Results: PBMCs from this CD-associated SpA patient exhibited higher production of pro-inflammatory cytokines upon stimulation with TLR ligands than PBMCs from healthy controls. Induction of remission by infliximab was associated with the downregulation of pro-inflammatory cytokine responses in the small intestinal mucosa, which is continually exposed to TLR ligands.

Conclusions: Excessive pro-inflammatory cytokine responses to TLR ligands might underlie the immunopathogenesis of CD-associated SpA.

Background: : Despite the reported clinical effectiveness of house dust mite (HDM) sublingual immunotherapy (SLIT) in pediatric patients, the risk of treatment remains unclear in pediatric patients with allergic asthma.

Objective: To show a risk of adverse drug reactions (ADRs) in pediatric patient with allergic asthma during the initiation period of HDM SLIT.

Methods: We retrospectively analyzed the clinical data of pediatric patients aged ≤ 15 years who initiated allergen immunotherapy (AIT) with the SQ HDM SLIT-tablet for allergic rhinitis between February 2017 and September 2019. Asthma severity at baseline and ADRs during the first 4 weeks of the treatment were determined for each subject.

Results: In our study population (n = 217; median age, 8.4 years), 99 patients (45.6%) were classified as having asthma. One hundred and one patients (46.5%) in the whole cohort experienced ADRs during the first 4 weeks of therapy, but a major gap in the frequency of ADRs was not observed between an asthma group and a non-asthma group.

Conclusions: The SQ HDM SLIT-tablet was well tolerated in pediatric patients with controlled HDM-driven allergic asthma. HDM-SLIT is an option to treat their allergic rhinitis without excessive concern for its ADRs.

Chronic cough is a common clinical condition requiring comprehensive assessment. This review employs a symptom-focused approach, prioritizing the presenting symptom of "chronic cough" to mirror real-world clinical practice. Ten key questions regarding the investigations in the uncertain areas were systematically addressed based on the PICO framework and applying the GRADE system for evidence synthesis to provide the strength of recommendation and quality of evidence for key questions. Practical diagrams were developed to facilitate clinical decision-making. The initial evaluation involves screening for red flag signs requiring urgent attention, followed by a detailed history-taking and physical examination. A chest radiograph is recommended as the first-line investigation. The primary objective of the initial evaluation is to identify the cause and initiate appropriate treatment. If history and physical examination prove insufficient for a definitive diagnosis, referral to a specialist is advised for further specific testing. The recommendations on specific testing include fractional exhaled nitric oxide for cough variant asthma, nasal endoscopy or digital endoscopy (optional) for upper airway cough syndrome, paranasal sinus computed tomography (CT) for chronic rhinosinusitis, and laryngoscopy for hoarseness. Spirometry is for the diagnosis of obstructive airway diseases, and peak flow variability or bronchial challenge tests are complements particularly if asthma is suspected. Gastroesophageal reflux (GERD) investigations are for patients with chronic cough without typical GERD symptoms. Sinus radiographs and chest CT are not routinely recommended. Our guideline distinguishes itself by prioritizing a symptom-based clinical evaluation to guide clinicians toward the most probable diagnosis, streamlining the diagnostic process.

Background: Increased numbers of circulating microparticles (MPs) have long been documented in thalassemia and are considered as a contributing factor in developing the thromboembolic events (TEEs), which are associated with endothelial dysfunction. Indeed, the cellular and molecular mechanisms by which MPs and endothelial cells interact and their consequences remain poorly investigated.

Objective: The present study aims to compare the biological effects of MPs obtained from healthy subjects and β-thalassemia/HbE patients on endothelial pro-inflammatory responses.

Methods: MPs isolated from plasma by two-step centrifugation from 10 healthy donors, 19 splenectomized and 30 non-splenectomized β-thalassemia/HbE patients were first characterized for their cellular origins, then counted and incubated with primary human umbilical vein endothelial cells (HUVECs). Internalization of MPs into HUVECs and their induction on endothelial cell activation and pro-inflammatory responses were determined.

Results: MPs either from healthy or β-thalassemia/HbE patients could become internalized into endothelial cells, but unlike MPs from healthy donors and non-splenectomized patients, MPs from splenectomized patients were the most active and induced the 2-fold up-regulation of pro-inflammatory genes, IL1B, CXCL8, and CCL2 and 4-fold increase in interleukin-1β. In addition, MPs from both healthy subjects and splenectomized patients at 106/ml failed to trigger the secretion of endothelial IL-6 and IL-8 while higher MP concentration at 5 × 10⁶/ml significantly induced this secretion.

Conclusions: Plasma MPs isolated from splenectomized β-thalassemia/HbE patients are capable of triggering pro-inflammatory responses from endothelial cells reflected at both gene and protein levels.

This part reviews the management of chronic cough and proposes a management algorithm. Despite proven improvements in quality of life following chronic cough treatment, a clear understanding of the disease and the evidence for the efficacy of some treatments remain vague. Eight key questions regarding the treatment in the uncertain areas were systematically addressed based on the PICO framework and applying the GRADE system for evidence synthesis to provide the strength of recommendation and quality of evidence for key questions, with narrative components for the description of other chronic cough treatment including non-pharmacological therapy. Practical diagrams were developed to facilitate clinical decision-making on treatment. Our guideline introduces the concept of the cough management process for guiding practitioners to assess chronic cough using a holistic approach.

Background: Intranasal corticosteroid (INCS) remains the primary treatment for allergic rhinitis (AR). Understanding adherence, safety concerns and sensory preferences is crucial for optimal care.

Objective: This review aims to determine medication adherence, sensory attributes and adverse effects of INCS in AR patients.

Methods: A systematic search of PubMed, Web of Science, Scopus, and Cochrane database was conducted for English articles published from 2004 to 2023. Eligibility includes clinical trials and observational studies with adult patients (18 years old or older) receiving INCS for AR (both intermittent and persistent).

Results: Thirty-one studies with 10,582 patients, comprising 10 cross-sectional studies and 21 randomized controlled trials (RCT) were included. Adherence rates ranged from 28% to 87%, with an average of 55.8%. Forgetfulness was the primary reason for non-adherence (63.1-77.8%), followed by adverse events (26.4-61.5%) and fear of adverse events (3.8-31.5%). Scent (38%), taste (28.5%), or aftertaste (24.3%) were the main differentiators for sensory attribute, with varying levels of intensity and preferences for each INCS. Common adverse events encompass epistaxis, nasal dryness/irritation, headache and nasopharyngitis. A meta-analysis of eight RCT detected no significant difference in adverse events between the INCS and control groups (risk ratio 1.05; 95% confidence interval, 0.88-1.24; p = 0.61).

Conclusions: The findings of this review indicate that medication adherence to INCS is not optimal, with non-adherence mostly attributed to forgetfulness, preferences for sensory attributes, and unpleasant effects associated with INCS. The underlying factors should be addressed as part of a multimodal strategy to improve adherence.

Background: Inhaled corticosteroids (ICS) are the first-line therapy for pediatric asthma. However, very few studies have developed simple tools for predicting treatment outcomes in pediatric asthma.

Objective: This study aimed to construct a predictive model for poor asthma control in children after 6 months of ICS therapy.

Methods: This retrospective study included children with asthma, aged 6-15 years, who received ICS with complete follow-up for 6 months. The potential factors associated with poor asthma control were also assessed. Poor control was considered if the child had partial or uncontrolled symptoms according to the Global Initiative for Asthma guidelines.

Results: Among the 165 eligible children, 33 (20%) had poor symptom control. The factors associated with poor control were a history of more than four exacerbations in the 12 months before ICS treatment (odds ratio [OR], 3.39 [1.06, 10.83]), the presence of moderate to severe allergic rhinitis symptoms at the 6-month follow-up visit (OR, 21.93 [2.97, 162.05]), and poor adherence to asthma medications (OR, 4.16 [1.32, 13.12]). By incorporating these factors, a model for predicting poorly controlled asthma was constructed and converted into a nomogram with a total score of 200, with prediction risk ranging from 0 to 100%. The area under the receiver operating characteristic curve of the developed model was 0.737, indicating a moderate performance level.

Conclusions: We developed a predictive tool for poor asthma control. The model has a good discriminatory ability and is simple to use, which could facilitate the individualized management of children with asthma.