Asian Pacific journal of allergy and immunology最新文献

Background: Limited data exist regarding recurrent chronic spontaneous urticaria (RCSU) following complete disease remission.

Objective: This study investigated the clinical characteristics and factors associated with RCSU.

Methods: We retrospectively reviewed data from chronic spontaneous urticaria (CSU) patients who actively visited the Urticaria Center of Reference and Excellence, Siriraj Hospital, between January 2021 and December 2023. Medical records were analyzed through May 2024. The RCSU was defined as a new CSU episode occurring after a 6-month symptom-free period without treatment.

Results: Among 179 CSU patients, 19 (10.6%) developed RCSU. These patients had a mean age of 40 (SD 14.9) years, with a female predominance. The mean time to RCSU recurrence was 1.96 (SD 2.05) years. The UAS7 and medication scores were not significantly different between the recurrence and nonrecurrence groups (P = 0.675, P = 0.77). Multivariate analysis revealed that a shorter disease remission time from the first episode onset (< 3 years) was significantly associated with RCSU (odds ratio 5.13, 95%CI 1.83-14.29; P = 0.002).

Conclusions: The RCSU rate was 10.6%. The time to disease remission from the first episode onset significantly associated with RCSU. Several clinical characteristics may corelate with the recurrence: younger age at onset, the presence of angioedema, chronic inducible urticaria comorbidity, systemic corticosteroid use, and positive antinuclear antibody status.

Background: Cytokine-induced killer (CIK) cells are a heterogeneous group of immune cells that exert potent MHC-unrestricted cytotoxicity toward various cancer cells in both solid and hematological malignancies.

Objective: The purposes of this study were to compare the expansion and characteristics of cytokine-induced killer cells between a standard culture method and a gas-permeable culture method and to develop a clinical-scale expansion protocol for cytokine-induced killer cells using a gas-permeable culture method.

Methods: We compared the absolute cell number, fold change, cell subsets, activation markers, cytokine concentrations, and cytotoxicity toward myeloid leukemia cell lines between cytokine-induced killer cells expanded using two different culture methods. Then, we determined the ability to achieve clinical-scale expansion of cytokine-induced killer cells using the gas-permeable culture method.

Results: Cytokine-induced killer cells in the gas-permeable culture method group exhibited significantly better expansion but maintained similar cell subsets, activation markers, and cytotoxicity to those in the standard culture method group. In addition, we successfully manufactured cytokine-induced killer cells for clinical use using the gas-permeable culture method. We also showed the clinical efficacy of allogeneic cytokine-induced killer cells produced by the gas-permeable culture method in a patient with acute myeloid leukemia that relapsed after allogeneic hematopoietic stem cell transplantation. This patient maintained ongoing disease remission for 2 years with minimal side effects after cytokine-induced killer cell infusion.

Conclusions: We successfully developed a simple and effective protocol for the ex vivo expansion of cytokine-induced killer cells using the gas-permeable culture method for clinical application.

Background: The concept of heterologous vaccination against SARS-CoV-2 infection has been adopted in Thailand with limited data on the induction of humoral and cellular immunity, particularly the CoronaVac/ChAdOx-1 (CoVac/ChAd) regimen in the elderly.

Objective: In this study, the immune responses of the elderly induced by heterologous CoVac/ChAd and homologous ChAdOx-1 (ChAd/ChAd) vaccinations were demonstrated.

Methods: A prospective observational study involving healthy participants aged ≥ 60 years who received heterologous CoVac/ChAd or homologous ChAd/ChAd vaccination was conducted. Surrogate neutralizing antibody (NAb) and T-cell responses against the SARS-CoV-2 wild type (WT) and variants of concern were determined at pre and post vaccinations.

Results: At 4 and 12 weeks after heterologous or homologous vaccination, the NAb levels against WT, Alpha, Beta, and Delta variants between each group were not significantly different, except for significant lower NAb against the Beta variant in heterologous group at 12 weeks after vaccination. The NAb against the Omicron at 4 weeks post-vaccination were below the cutoff level for antibody detection in both groups. However, higher spike-specific CD4 T cell producing IFN-γ and TNF-α in the heterologous than the homologous vaccination were observed. Insignificant difference of cellular immune responses to spike-peptides of Alpha, Beta, and Delta variants and their WT homologues was demonstrated.

Conclusions: In the elderly, heterologous CoVac/ChAd vaccination could induce NAb response against the WT and non-Omicron variants not different from the homologous ChAd/ChAd vaccination. Both regimens could not give adequate NAb of the Omicron strain. The heterologous vaccination, however, induced higher spike-specific Th1 cell response.

Background: Bee venom (BV) hypersensitivity can be severe and potentially life-threatening. Beekeepers heavily exposed to bee stings and are thus at a high-risk group. The data on bee sting reactions among beekeepers in Thailand is limited.

Objective: To determine the prevalence, clinical and immunological characteristics, and the knowledge of BV hypersensitivity in Thai beekeepers.

Methods: A self-reported questionnaire survey about BV reactions in beekeepers were conducted. Further blood test for immunological parameters: serum BV-specific IgE (BV sIgE), phospholipase A2-specific IgE (Api m1 sIgE), and BV-specific IgG4 (BV sIgG4) were compared between non-allergic beekeepers, patients with a history of bee sting anaphylaxis and the non-allergic control group.

Results: A total of 202 out of 447 questionnaires (response rate 45%) were returned. The median age was 46.7 years. Systemic reactions were documented in 6.4%. Younger than 45 years was found to be a factor associated with systemic reactions (OR, 4.35; 95% CI, 1.16-16.31). The BV sIgE and Api m1 sIgE were significantly higher in the anaphylaxis group (p = 0.001). The median of BV sIgG4 was significantly higher in non-allergic beekeepers (p = 0.001). For the knowledge of BV hypersensitivity, 56.4% recognized that BV hypersensitivity could be fatal but only 6% knew about epinephrine auto-injector device.

Conclusions: The prevalence of systemic reactions after stings among Thai beekeepers was not high, which might be due to the tolerance induced by natural exposure via sIgG4. The level of knowledge of BV hypersensitivity among beekeepers was insufficient, more education must be provided.

Background: Hypersensitivity reaction to vaccines has been reported to occur in 5 per 100,000 doses. Although hypersensitivity reactions can occur to either the active vaccine component or other components such as excipients, outcome data from skin testing and provocation remains limited.

Objective: To evaluate the role of skin testing and vaccine provocation in patients with an allergy label to vaccine.

Methods: This is a single centre, prospective study between March 2021 and November 2021 of adults with known allergy to non-COVID vaccine. All participants underwent skin prick testing (SPT) and intradermal testing (IDT) to vaccine and excipients. A subset of patients with negative skin testing underwent graded vaccine provocation.

Results: A total of 264 adults were evaluated. The most common index vaccine reactions were nonspecific rash (47.7%), angioedema (32.2%) and itch (25.0%). All patients had negative SPT to vaccines and excipients. Thirty patients (11.4%) had positive IDT to Hepatitis A, Hepatitis B, Human Papilloma Virus (HPV), Influenza, Measles-Mumps-Rubella (MMR), Pneumococcal, Rabies, Diphteria, Tetanus and Pertussis (DTaP). Out of 234 patients with negative IDT, 32 patients (12.1%) underwent vaccine provocation. Three patients (9.4%) developed reaction to influenza and MMR vaccine. One patient required systemic corticosteroids, one required antihistamine, and another patient did not require any treatment. None required admission or attendance at emergency department.

Conclusions: The majority of allergy labels to vaccine are inaccurate based on low skin test positivity and low reaction rates on vaccine provocation. Vaccine provocation is safe. Excipients are unlikely to be the main cause of hypersensitivity reactions in vaccines.

Background: Ocular Myasthenia Gravis (OMG) is an autoimmune disease which causes ptosis, diplopia, or both. There is very limited information on the presenting symptoms, treatment trends, factors influencing generalization, and treatment outcome in Thai populations.

Objective: To investigate characteristics of the presenting symptoms, associated factors for conversion to Generalized-MG (GMG), and treatment outcome in OMG patients.

Methods: We analyzed data from patients diagnosed with OMG between January 2015 and December 2020 at Rajavithi Hospital, Thailand. We investigated disease generalization in time-to-event analysis and compared factors associated with disease generalization using a Cox-proportional-hazards model.

Results: Of the 155 consecutive patients, 106 (68.4%) were female and their mean (SD) age was 49.3 years (15.51). There were 123 (79.35%) and 32 (20.6%) patients in the remained OMG and GMG groups respectively. Ptosis was the presenting symptom in 147 (94.8%) patients, diplopia alone was found in 8 (5.2%), and both symptoms were present in 53 (34.2%) patients. GMG patients had a higher proportion of combined ptosis and diplopia (p = 0.01), and positive AChR-Antibody test (p = 0.013). Overall, 32 (20.65%) patients converted to GMG, mostly in the first 48 months. Multivariate Cox-proportional-hazard model identified positive AChR-Ab test as a risk factor for generalization (HR, 5.32, 95% CI; 1.02-27.84).

Conclusions: The conversion rate to GMG in our study was 20.65%. The presence of AChR-Ab was identified as a risk factor for generalization of the disease; therefore, patients with OMG should be advised to test for AChR-Ab for both diagnosis and prognosis purpose.

Chronic spontaneous urticaria (CSU), characterized by recurrent wheals and/or angioedema persisting for more than 6 weeks, represents a substantial clinical challenge. Although international guidelines endorse second-generation H1-antihistamines (sgAHs) as first-line therapy, up to 50% of patients remain refractory even at quadruple doses, significantly compromising quality of life and mental well-being. Notably, standardized guidelines for managing H1 antihistamine-resistant CSU are currently lacking. To address this gap, we aimed to develop an evidence-based clinical practice guideline for the diagnosis, assessment, and step-wise treatment of H1 antihistamine-resistant CSU. A multidisciplinary panel conducted a systematic literature review and through multiple rounds of group discussions, both offline and online, to draft recommendations. Evidence was graded using the Oxford CEBM 2011 system and recommendations assigned GRADE strengths. This guideline provides a standardized, personalized treatment algorithm for H1 antihistamine-resistant CSU, aiming to improve clinical efficacy, reduce socioeconomic burden, and direct future research toward validating novel agents such as JAK inhibitors and optimizing long-term outcomes.

Background: Sweat allergy is frequently observed in patients with cholinergic urticaria (CholU) and atopic dermatitis (AD), yet data from high-sweating, tropical regions are scarce. The autologous sweat skin test (ASwST) is considered the reference diagnostic assay, but protocols differ.

Objective: To determine the prevalence of sweat allergy-assessed by the ASwST-in patients with CholU and AD in a tropical setting, and to evaluate concordance between the testing methods.

Methods: In this cross-sectional pilot study, 29 CholU patients, 41 AD patients, and 20 healthy controls underwent intradermal injection of filtered autologous sweat at 20 μL and 50 μL. Skin responses were assessed via wheal and flare formation. Positivity rate of sweat allergy using ASwST, clinical correlates, and inter-volume agreement were calculated.

Results: ASwST was positive in 8/29 CholU patients (27.6%) and 11/41 AD patients (26.8%); all controls were negative. In AD, positivity occurred across disease-severity strata. Overall inter-volume agreement reached 80%: 51/70 tests (72.9%) were negative for both volumes, and 5/70 (7.1%) were concordantly positive. The remaining 14/70 cases (20.0%) reacted only at 50 μL, yielding a significantly higher positivity rate than 20 μL (27.1% vs 7.1%, P = 0.001).

Conclusions: In tropical Thailand, ASwST identified sweat allergy in approximately 25% of CholU and AD patients, lower than many temperate-zone reports. Either injection volume is acceptable; however, 50 μL increases diagnostic yield without compromising specificity. Larger, multicenter studies should clarify whether ambient heat, humidity, or cutaneous microbiota modulate sweat-allergy.

Background: Melioidosis is an infectious disease caused by Burkholderia pseudomallei. In infected mice, IFN-γ can provide protection against B. pseudomallei infection. Invariant Natural Killer T (iNKT) cells are a subpopulation of T lymphocytes, activated by recognition of glycolipid ligands such as α-Galactosylceramide presented by CD1d, produce and secrete several cytokines, including IFN-γ and IL-4. The response of iNKT cells in human melioidosis was then investigated.

Objective: To determine the iNKT cells response in human melioidosis.

Methods: The number of human iNKT cells and its activation states were investigated in sepsis melioidosis patients compared with healthy controls using flow cytometry. The iNKT cells activation was confirmed in vitro using heatkilled B. pseudomallei with normal peripheral blood mononuclear cells. The components induced iNKT cell were also determined using different concentration of B. pseudomallei lipopolysaccharide (LPS), heat-killed B. pseudomallei treated with or without DNase, RNase, or proteinase.

Results: The number of human iNKT cells was significantly lower while the percentage of activated iNKT cells was higher in sepsis melioidosis when compared to control. In addition, B. pseudomallei can stimulate human iNKT cells in vitro. Heat-killed B. pseudomallei could activate iNKT cells but not relate to nucleic acid, proteins, or LPS.

Conclusions: We found for the first time that the iNKT cells were activated during B. pseudomallei infection in human. However, the roles and the mechanism of iNKT cells during early state of infection needed to be further investigated.

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.