Asian Pacific journal of allergy and immunology最新文献

Background: Asian carps, a popular freshwater fish globally, are valued for their flavor and serve as a crucial protein source, especially for infants. However, grass carp parvalbumin is highly allergenic, surpassing the allergenicity of fish like salmon and cod. The allergenic potential of parvalbumin in other Asian carps remains unknown, underscoring the need for allergen identification to improve the precision of fish allergy diagnosis and treatment.

Objective: To identify all parvalbumin homologs in Asian carps and investigate the role of gene divergence in allergenic homolog formation.

Methods: Three annotated genomes of Asian carp, including grass carp, black carp and bighead carp, were constructed using a hybrid assembly approach. Through sequence homology at the genomic level, all the homologs of major fish allergens were identified. Bioinformatics tools were then employed to reveal the gene structures, expression levels, and protein conformations of parvalbumin.

Results: Grass carp genome analysis showed nine parvalbumin homologs, with Cid_PV2 most similar to Cten i 1. Bighead and black carp genomes had ten homologs, including potentially allergenic Mpi_PV7 and Hno_PV7. Tissue-specific expression patterns revealed alternative usage of parvalbumin homologs. Gene duplication events expanded parvalbumin copies in bony fish, with two gene clusters identified in Asian carp genomes.

Conclusion: All the homologs of Asian carps' parvalbumin were accurately identified and gene divergence contributed to the formation of allergenic homologs. Together with a comprehensive gene sequence profile of carps' parvalbumin, those could be applied to achieve a more precise clinical diagnostic test.

Background: Infants with cow's milk protein allergy (CMPA) are at risk for nutrient inadequacy and impaired growth.

Objective: To evaluate the effect of a new amino acid-based formula (nAAF) compared with commercial amino acid-based formula (cAAF) on growth and protein status of cow's milk protein (CMP)-allergic infants and to compare their growth with those of healthy infants.

Methods: Infants less than 6 months of age with CMPA were enrolled in the nAAF or cAAF groups. Healthy infants fed breast milk (BM) or infant formula (IF) were controls. They remained on their formula/milk until day 28 of the study. Anthropometric evaluation was performed at birth, day 0 and day 28 of the study and calculated to z-scores of weight-for-age (WAZ), length-for-age (LAZ) and head circumference-for-age (HAZ). Plasma amino acids, albumin, urea nitrogen, and creatinine were assessed for infants with CMPA on day 0 and day 28.

Results: The nAAF and cAAF groups did not differ in increases in WAZ [regression coefficient (95%CI): 0.088 (-0.619, 0.796), p = 0.791], LAZ [0.045 (-0.789, 0.880, p = 0.909], and HAZ [-0.645 (-2.082, 0.793), p = 0.337] between day 0 and day 28. The increases in WAZ and LAZ during 28 days in the nAAF group did not differ from the controls. The changes in the blood chemistry values, except albumin, were not different between CMPA groups.

Conclusions: The nAAF, similar to the cAAF, supports growth and protein status for infants with CMPA, and it might be used as a substitute for the cAAF.

Background: Cow's milk allergy (CMA) is one of the most common food allergies in young children. As improved diagnostic tools, allergic tests are inconsistent and limited in predicting anaphylaxis.

Objective: To explore risk factors for anaphylaxis and to determine practical cut-offs for allergic tests in predicting anaphylaxis.

Methods: This is a prospective cohort study. Children with IgE-mediated CMA were enrolled and divided into three groups (Group 1: non-anaphylaxis; Group 2: GRADE I anaphylaxis; Group 3: GRADE II-IV anaphylaxis that warranted epinephrine). Prick-to-prick tests (PTPs) using fresh cow's milk (CM) were performed. Serum specific IgE (sIgE) against CM and its components, including casein, alpha-lactalbumin, beta-lactoglobulin, and bovine serum albumin were measured. The 90% and 95% positive predictive value (PPV) decision points for predicting anaphylaxis were determined. Potential predictors of anaphylaxis were evaluated in logistic regression models.

Results: This study included 134 CMA patients with a median age of 14.4 months. The sensitization rate to any CM component was 89%. Group 3 was more likely to be sensitized to multiple CM components and have higher sIgE levels. The 95% PPV diagnostic decision points of casein-sIgE in predicting anaphylaxis was 13.0 kUA/L. For GRADE II-IV anaphylaxis, casein-sIgE ≥ 54.9 kUA/L could provide a PPV of 88.9%. The elevated casein-sIgE level (OR 14.0, P=0.025) and complicating respiratory allergic diseases (OR 4.8, P=0.022) were independent risk factors for GRADE II-IV anaphylaxis.

Conclusion: High casein-sIgE levels are strongly associated with CM anaphylaxis. Detection of casein-sIgE may offer an additional value for the prediction of CM anaphylaxis.

Background: Fish is one of the common causes of food allergy and there is limited literature about fish allergy in Singapore.

Objective: We aimed to describe the demographics, clinical features, and natural history of children with IgE-mediated fish allergy.

Methods: A retrospective review was conducted for children diagnosed with fish allergy in a tertiary pediatric hospital in Singapore between 2015 and 2020.

Results: The diagnosis of fish allergy was made in 108 patients based on a convincing history of IgE-mediated allergic reaction and a positive skin prick test. The median age at first reaction was 12 months (range 6-168) with most reacting on first ingestion (62.0%). The most common fish causing reactions were threadfin (48.1%), salmon (33.3%) and cod (31.5%). Majority presented with cutaneous symptoms (97.2%). Anaphylaxis occurred in 6.5%. Five were mono-sensitized (4.6%), 77 were oligo-sensitized (71.3%) and 26 were polysensitized (24.1%). Most can tolerate another species of fish (75.9%), most commonly salmon (37.0%), tuna (24.1%) and cod (22.2%). Median duration of follow up was 24 months (range 0-176). Twenty-eight out of 108 children (25.9%) acquired natural tolerance to index fish at a median age of 60 months (range 18-159).

Conclusions: Most children with fish allergy can tolerate at least one other species of fish and resolution of fish allergy is possible. Thus, it is important to follow-up with an allergist to evaluate which fish species can be included in their diet to avoid unnecessary dietary restrictions.

Background: Food allergy (FA) has been reported in one-third of children with moderate-to-severe atopic dermatitis (AD).

Objective: To identify factor associated with food allergy among preschool children with AD, and to compare AD resolution between preschool children with and without FA.

Methods: A cross-sectional study using database registry and questionnaire interview was conducted at Siriraj Hospital(Bangkok, Thailand) during 2022, and physician-diagnosed AD children aged ≤ 6 years were enrolled.

Results: A total of 110 children (60.9% male, median age: 2.3 years) were included. Of those, 53 and 57 children had AD with and without FA, respectively. Very early-onset AD (≤ 3 months) and moderate-to-severe AD at onset were reported in 43.9% and 26.3% of AD without FA, and in 35.8% and 45.3% of AD with FA, respectively. The most commonly reported FAs were hen's egg, cow's milk, and wheat. Moderate-to-severe AD at onset was found significant associated with FA (aOR: 2.50; p = 0.037). Thirty-one (28.2%) patients experienced completed resolution of AD by 5 years of age. Of those, 19 had AD without FA, and 12 had AD with FA (p = 0.213). The median age at AD resolution was 18 months and 22.5 months in the without and with FA groups, respectively. AD with FA showed a strong trend toward a significantly longer duration to achieving AD resolution after adjusting for onset and severity of AD (aHR: 0.46, p = 0.050).

Conclusion: Preschool AD children with FA were found to have significantly greater AD severity at AD onset and a longer duration to AD resolution compared to AD children without FA.

Background: Hen's egg (HE) is a major food allergen in children. Oral immunotherapy (OIT) has emerged as a promising therapeutic option for hen's egg allergy (HEA), but the precise immunological mechanisms underlying HE-OIT are not fully understood.

Objective: We aimed to investigate the systemic immune phenotype in children with HEA and to examine transcriptomic changes during HE-OIT.

Methods: We enrolled 16 children, aged between 3 and 12 years, diagnosed with HEA (median age, 4.5 years). Peripheral blood mononuclear cells were collected before the initiation of HE-OIT and after the completion of the build-up phase. The transcriptomics of the samples were analyzed using single-cell RNA sequencing.

Results: All eight patients (8/8) whose blood samples were collected after the build-up phase achieved desensitization to 60 g of boiled HE white (6.0 g of HE proteins). Following the OIT build-up phase, significant reductions in total CD4+ T cells and early activated CD4+ T cell were observed (P = 0.001 and 0.045, respectively), while the frequencies of late activated CD4+ T cells and fully activated CD8+ T cells were increased (P = 0.019 and 0.038, respectively). Clonal analysis revealed proliferation within the late activated CD8+ T cell subset following OIT, indicative of the exhausted state of CD8+ T cells. Additionally, the population of regulatory T cells with abundant IKZF2 expression was significantly increased after the OIT build-up phase.

Conclusions: HE-OIT was associated with systemic immune cell transcriptomic changes, suggesting that its efficacy derives from these immune alterations.

Background: Allergic rhinitis (AR) is defined as an inflammatory disease of the nose. Nasal corticosteroids (NCS) are one of the most effective drugs used in AR treatment.

Objective: One of the most important issues in the treatment of AR is patient adherence to NCS. We aimed to evaluate the adherence and attitude of patients with AR to NCS treatment.

Methods: One hundred four patients who were prescribed NCS for AR at any time and who used NCS during the study period were included in the study. Morisky Medical Adherence Scale-8 (MMAS-8) was performed on the patients to determine their treatment adherence.

Results: The scores of the MMAS-8 were below 6 in 55% of the patients, and the adherence of the patients to the NCS treatment was low. The adherence of the patients to NCS treatment was good in only 19% of the patients. As the duration of the disease increased, the adherence of the patients to the treatment decreased (p = 0.001). Patients who benefited from allergen immunotherapy had statistically significantly higher MMAS-8 scores than those who did not (p = 0.015). As expected, drug adherence was statistically significantly lower in patients with drug-related adverse effects (p = 0.01). Sixty percent of the patients had received NCS training, and MMAS-8 scores were significantly higher in those who received training (p = 0.023).

Conclusion: Inadequate drug adherence is a challenging problem in the treatment of AR. Frequent evaluation of patients' drug adherence and drug use techniques in daily practice is important for the follow-up and treatment of the disease.

Objective: We aimed to overview clinical characteristics of FPIAP with the results of diagnostic tools like APT, SPT and fecal calprotectin levels and the factors associated with tolerance development.

Methods: All patients diagnosed FPIAP at the outpatient clinic between January 2015 and January 2019 were enrolled retrospectively. Data about clinical characteristics, APT or SPT results, fecal calprotectin levels, suspected triggering foods, diet and tolerance status were obtained from the hospital database program and analyzed.

Results: 169 infants with F/M ratio 78/91 were enrolled. The mean age of the study population was 3.68 months (1-35 months, mean age 3.68 ± 4.33). APT was performed 137 of the participants and 126 (92%) of them were positive to at least one food allergens, 14 (48.2%) patients had positivity to at least one of the food allergens on SPT. Specific IgE were done in 90 patients and 12 (13.3%) revealed positive results. Two groups of patients developing tolerance before and after 18 months of age were evaluated; mucoid diarrhea, family history allergic diseases, cow's milk sensitivity and multiple allergen triggers were statistically significant risk factors for delayed tolerance according to univariate logistic analysis. However, none of these factors were revealed statistical significance in multivariate logistic analysis.

Conclusions: Our study revealed that APT may be a useful tool for programming the elimination diet in breastfeeding mothers. SPT, specific IgE and fecal calprotectin are not necessary for FPIAP management. Multivariate regression analysis showed that none of the evaluated parameters had statistically significant relationship with the tolerance development.

Background: Atopic dermatitis (AD) and food allergy (FA) often originate early in life. Gut microbiota interactions with the host immune system influence allergy development, yet the distinct gut microbiome and functional profiles in individuals with AD, FA, or both AD+FA remain underexplored.

Objective: We investigated microbial colonization and proteomic profiles in infants with AD, FA, and AD+FA compared to age- and sex-matched controls from the Allergy Development in Early Life and Associated Factors in the Thai Birth Cohort (ALICE).

Methods: Gut microbiomes from stool samples were analyzed using 16S sequencing, and proteomic analysis was conducted by liquid chromatography-tandem mass spectrometry.

Results: The study included 16 AD, 5 FA, 5 AD+FA subjects, and 26 controls. AD+FA group exhibited the most severe dysbiosis. Enrichment of proteins involved in methionine biosynthesis in Bifidobacterium scardovii and high Erysipelotrichaceae colonization suggest a link to high-fat diets, known to reduce intestinal short-chain fatty acid and serotonin levels, contributing to allergies. Erysipelotrichaceae in AD+FA groups also expressed proteins related to histidine degradation. Low Bifidobacteriaceae levels were noted in FA and AD+FA, with more pathogenic strains colonized. Increased Bacteroidaceae in FA and AD+FA and Enterobacteriaceae in FA were detected. Pathways involving vitamin B1, a ligand for proliferator-activated receptor-γ (PPAR-γ) from Enterobacteriaceae could promote TH2 cells, type 2 innate lymphoid cells, and M2 macrophages, likely contribute to allergic inflammation.

Conclusions: AD+FA phenotype exhibited the most distinctive gut microbiome alterations, highlighting unique dysbiosis patterns. Microbiome biosynthesis pathways involving metabolism of methionine, histidine, serotonin, and vitamin B1 point to new targets for modifying or treating AD and FA.

This review focuses on the updated knowledge of atopic dermatitis (AD) through collaboration between the Dermatological Society of Thailand, the Allergy, Asthma, and Immunology Association of Thailand, and the Pediatric Dermatological Society of Thailand. As AD is a chronic condition that significantly impacts quality of life and affects a large population worldwide, this review aims to provide an updated overview of the disease, including its prevalence, pathogenesis, diagnosis, and current treatment strategies. Continuous updates in that knowledge, especially the treatment guidelines, are necessary to provide proper management for both general practitioners and specialists who care for patients with AD. This also helps establish standards and improve the management of AD.