Asian Pacific journal of allergy and immunology最新文献

Background: The Angioedema Control Test (AECT) is a questionnaire that monitors disease control in patients with angioedema, with a recall period of 4 weeks (AECT-4wk) or 3 months (AECT-3mo).

Objective: This study investigated the psychometric properties of a Thai version of the AECT.

Methods: Of 54 patients, 46, 5, 2, and 1 had recurrent angioedema with chronic spontaneous urticaria, hereditary angioedema, idiopathic histaminergic angioedema, and acquired angioedema due to C1 esterase inhibitor deficiency, respectively. The AECT, Angioedema Activity Score (AAS), Dermatology Life Quality Index (DLQI), Angioedema Quality of Life Questionnaire (AE-QoL), and anchors for disease control (numeric rating scale [NRS] and patient global assessment-Likert scale [PatGA-LS]) were used. The patients rated the efficacy of their treatment.

Results: Fifty-four and 47 patients completed the AECT-4wk and AECT-3mo, respectively. Both AECT versions showed significant correlations with disease activity (AAS, r = 0.6-0.8), disease control (NRS and PatGA-LS, r = 0.7-0.9), and quality of life impairment (DLQI and AE-QoL, r = 0.6-0.8). Higher correlations were found for the AECT-4wk than for the AECT-3mo. Excellent internal consistency (alpha = 0.98 and 0.97, respectively) and intraclass correlation (0.96 and 0.94, respectively) were found. A cutoff ≥ 10 was confirmed to identify patients with well-controlled disease for both AECT versions (AUCs = 0.89 and 0.97).

Conclusions: The Thai version of the AECT is a valid and reliable tool for clinical practice. Due to the shorter recall period, the AECT-4wk may be more accurate than, and preferable to, the AECT-3mo. A cutoff ≥ 10 should be used to identify patients with well-controlled disease.

Delayed pressure urticaria (DPU) is a chronic inducible subtype of urticaria, characterized by painful erythematous swelling triggered by sustained mechanical pressure. After pressure stimuli, lesions often appear within 4 to 6 hours, peak around 6 hours later, and persist for 8 hours to 3 days. More than half of patients may have associated symptoms, most often malaise and fatigue. The diagnosis of DPU is based on clinical history and confirmation through provocation testing. Dermographic tester and weighted rod testing are recommended as diagnostic tools by several current guidelines due to their reproducibility and capability to determine individual trigger thresholds. Although the exact pathogenesis remains unclear, mast cell activation, histamine release, eosinophil infiltration, and multiple mediators have been implicated. These mechanisms likely interact synergistically, contributing to the clinical manifestations of DPU. This article reviews the pathogenesis, histopathological findings, effector cells, inflammatory mediators, neuropeptides, adhesion molecules, and unmet clinical needs associated with DPU. A deeper understanding of these complex processes may facilitate the development of more effective targeted immunomodulators and biological therapies for severe and treatment-resistant cases of DPU.

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: Previous studies reported positive associations between exposure to air volatile organic compounds (VOCs) and daily visits for atopic dermatitis (AD).

Objective: This population-based study investigated associations between air VOCs exposure and daily hospitals visits for AD, severity subgroup (mild and severe), and lag-day effect in central-southern Taiwan.

Methods: The dependent variable was AD with diagnostic codes (ICD-9-CM 691.8 and ICD-10-CM L20) retrieved from the Taiwan National Health Insurance Research Database from 2008/01/01 to 2018/12/31. Independent variables included one-day 75th-percentile value of each VOC (benzene, ethylbenzene, toluene, m-/p-xylene, o-xylene, 1,3,5-trimethylbenzene, 1,2,4-trimethylbenzene, isopentane, n-pentane, n-hexane, methylcyclohexane, and cyclohexane) and four meteorological conditions from the Taiwan Air Quality Monitoring Network Database. This was a case-crossover design with multivariable conditional logistic regression, and the adjusted odds ratios (AORs) were reported.

Results: Concentrations of the 12 air VOCs significantly positively affected the total number of daily visits for AD (AOR = 1.02~1.69, P < 0.001) and subgroups of mild (AOR = 1.001~1.049, P < 0.001) and severe (AOR = 1.002~1.077, P < 0.001). The effect of air VOCs on the severe AD group was higher than that on the mild group. Values of the six VOCs on the 1st lag day (benzene: AOR = 1.16, 1,3,5-trimethylbenzene: AOR = 1.5, 1,2,4-trimethylbenzene: AOR = 1.13, isopentane: AOR = 1.07, n-pentane: AOR = 1.08, methylcyclohexane: AOR = 1.5, all P < 0.05) were significantly positively associated with the number of daily visits for AD.

Conclusions: Exposure to the 12 air VOCs on the visit days increased the risks of daily visits for AD in total and severity subgroup. The effects of six certain VOCs on the 1st lag day were significant positive.

Atopic dermatitis (AD) is a common inflammatory skin condition that can profoundly impact patients' quality of life. In Asia, AD is highly prevalent, and misperceptions of AD among the public and phobias of topical corticosteroid (TCS) treatments and the region's humid climate pose challenges to adherence. Emollients - moisturizing agents that hydrate the skin and improve its barrier function - are a core component of therapy for AD. This manuscript summarizes expert consensus from a group of Hong Kong experts on clinical management of AD, focusing on the role of emollients, and discusses if the term "treatment emollients" - emollients formulated with active non-drug disease-targeting ingredients such as antioxidants - could be helpful for communication and clinical practice. Summary statements, based on a literature review, were developed at an expert meeting and evaluated using a Delphi process. Treatment emollients have antioxidant or other disease-targeting ingredients that may provide additional therapeutic benefit in beyond moisturization alone. Emerging clinical data suggest that a treatment emollient containing the antioxidant furfuryl palmitate could improve AD symptoms and patients' quality of life. Such an agent has a potential role at various stages in the AD disease journey and may complement other therapies, such as TCSs or systemic therapies. The definition of the treatment emollient may evolve as additional examples with other therapeutic benefits (e.g., anti-inflammatory or antimicrobial effects) are developed. Treatment emollients represent a valuable additional option for AD patients, and they may be particularly useful where steroid phobia is prevalent.

Background: Negative emotions are a major comorbidity of atopic dermatitis (AD). Evidence that supports the effectiveness of digital cognitive behavioral therapy (dCBT) as an adjuvant therapy for AD remains limited.

Objective: To investigate the preliminary efficacy of additional dCBT and potential neurotransmitter biomarkers for AD accompanied by negative emotions.

Methods: Thirty-two patients with AD were recruited and examined for clinical severity and negative emotions including insomnia, anxiety, and depression. Patients with mild-to-moderate negative emotions were divided into two groups that received standard care (N = 9) or mobile app-delivered CBT plus standard care (N = 11) for 12 weeks. Plasma levels of 40 neurotransmitters were determined using liquid chromatography tandem mass spectrometry pre- and post-treatment.

Results: Skin lesions, itch, and insomnia were significantly improved in both treatment groups. Improvements of itch (P = 0.0449) and insomnia (P = 0.0089) were more robust in the combination treatment group than those in the standard treatment group. Neurotransmitters that involve tryptophan, dopamine, and histidine pathways were markedly altered in patients with AD compared with healthy controls. Taurine levels were selectively increased following dCBT plus standard care (P = 0.0259). Baseline levels of L-tyrosine were negatively correlated with the reduction of skin lesions (r = -0.9073, P = 0.0334) and itch intensity (r = -0.9322, P = 0.0210) in the combination therapy group.

Conclusions: dCBT provides an efficacious supplementary approach for AD accompanied by negative emotions. Emotion-related neurotransmitters may contribute to AD and serve as indicators for treatment effects.

Background: Alongside vaccine hesitancy, impaired and waning immunity in autoimmune rheumatic diseases (ARDs) are barriers to immunization. The timeframe of immunity waning in ARD remains unclear.

Objective: We aimed to examine the waning of humoral immunogenicity in a cohort of ARD patients who received the heterologous inactivated vaccine followed by the adenoviral vector SAR-CoV-2 vaccine at a 3-month follow-up.

Methods: The levels of SARS-CoV-2 anti-RBD IgG were evaluated at 1 and 3 months in adults with ARDs (n = 29) and age- and sex-matched healthy controls (HC) that received the heterologous prime-boost CoronaVac vaccine followed by the ChAdOx1 nCoV-19 vaccine. Seropositivity was defined as anti-receptor binding domain (RBD) IgG levels of ≥ 7.15 binding antibody units (BAU)/mL. The kinetic properties of the vaccines were evaluated based on the ratio of anti-RBD IgG values obtained at each follow-up. Disease activity was evaluated.

Results: The seropositivity rate was lower among patients with ARDs than among HCs (89.7% vs. 100%, p = 0.237). At 3 months, the median (IQR) anti-RBD IgG level was lower among patients with ARDs than among HCs (122.3 [30.6, 247.8] vs. 294.2 [127.4,605.7] BAU/mL, p = 0.006). Mean antibody levels in patients with ARDs decreased 3.5 (1.9)-fold within 3 months post-vaccination (122.3 [30.6, 247.8] vs. 279.9 [86,1076.5] BAU/mL, p < 0.001). Disease flare-ups occurred in three patients.

Conclusions: Our findings included changes to anti-RBD IgG levels and may inform vaccination strategies. SAR-CoV2 vaccine-induced immunity was lower in patients with ARDs than in HCs and decreased within 3 months, suggesting a need for booster vaccinations.

Background: Knowledge of the prevalence of common sensitizing allergens may aid in overall management of allergic disease in a specified area.

Objective: The aim of this study was to identify and analyse the prevalence of common inhaled and food sensitizing allergens in Beijing.

Methods: This was a retrospective study, analysing demographic data and serum sIgE antibody test results from 59057 outpatients who presented to Beijing TongRen Hospital, from January 2013 to December 2019.

Results: 28879 patients (48.9%) showed positive sIgE test results; with significantly more males aged under 16 years sensitized to at least one allergen than females, and most patients (53.62%) were sensitized to multiple allergens. The first inhaled sensitizing allergens was Artemisia grass (11910 (41.24%)); and the first food allergens was crab (3547 (12.28%)). For Artemisia sensitized patients, sIgE levels were mostly at level 5. The number of patients with ragweed allergy is increasing year by year. The detection rates for sIgE to Artemisia, common ragweed, and Humulus grass allergens were significantly higher in August and September. R package ggplot2 analysis, demonstrated strong correlations between tree allergens and common ragweed and Humulus grass allergens (phi coefficients = 0.50 and 0.46, respectively; both P < 0.01).

Conclusions: The prevalence of sensitization to different allergens in Beijing showed Artemisia grass was the most commonly inhaled sensitizing allergen, and the number of patients with ragweed grass allergy was increasing by year.

Background: Alere™ HIV Combo is the only rapid and sensitive point-of-care 4th generation (antigen/antibody) HIV test newly available in Thailand which is advantageous of differentiating between positivity of antigen or antibody or both, especially in acute HIV infection (AHI). AHI in this study was defined by positive machine-based 4th generation test with measurable HIV-RNA but negative 3rd generation (IgM/IgG antibody only) tests.

Objective: To evaluate the performance characteristics of Alere™ HIV Combo.

Methods: Fifty stored plasma samples of subjects diagnosed with AHI were used to evaluate Alere™ HIV Combo.

Results: Of the 50 AHI samples, Alere™ HIV Combo was positive in 37 (74%): 5 with antibody positive only (R1), 26 with p24 antigen positive only (R2), and 6 with both p24 antigen and antibody positive (R3). Mean sample/cut-off (S/ CO) ratios from machine-based 4th generation test of R1, R2 and R3 were 21.55, 148.38 and 72.97 respectively as compared to 7.57 for the 13 non-reactive (NR) samples. The corresponding median log10 HIV-RNA of NR, R1, R2 and R3 were 5.59, 5.86, 7.00 and 6.61 copies/mL respectively. R2 and R3 had significantly higher S/CO and HIV-RNA than NR and R1. Alere™ HIV Combo detected mainly p24 antigen in AHI as seen in 32/50 (64%) subjects and could detect 11/50 (22%) antibody in AHI samples which were missed by the two 3rd generation HIV tests used in our testing algorithm.

Conclusions: Alere™ HIV Combo is the ideal screening test in a setting with high AHI where machine-based 4th generation test is not available.

Background: Lactic acid bacteria may be used as probiotics to prevent or treat various diseases, and Lactobacillus delbrueckii has an inhibitory effect on the development of atopic diseases.

Objective: This study explored the effects of L. delbrueckii subsp. lactis strain LDL557 administration on a mouse asthma model resulting from Dermatophoides pteronyssinus (Der p) sensitization and investigated the associated gut microbiota.

Methods: Der p-sensitized and challenged BALB/c mice were orally administered with three different doses of live (low, 107 colony-forming units (CFU); medium, 108 CFU; high, 109 CFU) and heat-killed (109 cells) LDL557 in 200 μL of PBS daily, starting 2 weeks before Der p sensitization and lasting 4 weeks. After the allergen challenge, airway responsiveness to methacholine and the influx of inflammatory cells to the lungs were assessed. The gut microbiome was obtained by sequencing the V3-V4 region of the 16S rRNA gene from mice stool samples.

Results: LDL557 in the live (109 CFU) and heat-killed (109 cells) conditions reduced the airway hyper-responsiveness after stimulation with methacholine, inflammatory cell infiltration, and mucus production. These effects were similar to those in groups treated with dexamethasone. No significant change in the gut microbiota was observed after LDL557 treatment, except for the tendency of heat-killed LDL557 to change the gut microbial profile to a greater extent than live LDL557.

Conclusion: In summary, we found that live and heat-killed LDL557 had the beneficial effect of preventing Der p-induced allergic inflammation in a mouse model of asthma.