Asian Pacific journal of allergy and immunology最新文献

Background: The effect of probiotics in the treatment of atopic dermatitis (AD) is inconclusive, partially due to the heterogeneities of AD.

Objective: The aim of the present study was to investigate the efficacy of probiotics in the treatment of AD with a subgroup analysis according to country, severity of AD, duration of supplementation, and probiotic strain.

Methods: Original articles reporting the therapeutic efficacy of probiotics for AD were identified by searching PubMed, Cochrane Library databases, and Embase from inception to September 30, 2022.

Results: This meta-analysis included 1,382 patients with AD from 25 randomized controlled trials. Probiotic supplementation was effective for the treatment of AD, reflected in a significant decrease in the SCORing Atopic Dermatitis (SCORAD) index (SMD, -4.0; 95%CI, -7.3 to -0.7). The subgroup analysis showed a significant therapeutic effect for AD among patients with mild or moderate AD (SMD, -1.4; 95%CIs -2.2 to -0.7), in those supplemented for more than three months (SMD, -5.1; 95%CIs -9.7 to -0.4), and in those supplemented with a probiotic that contained Lactobacillus spp. strains combined with or without other strains (SMD, -4.4; 95%CIs -8.0 to -0.8). In addition, the therapeutic effects of probiotics showed differences according to country and geographic region.

Conclusions: Probiotics can be beneficial for the treatment of AD, and their therapeutic effect may be individually tailored to improve it based on the severity of AD, strain of probiotics, duration of supplementation, and geographic region.

Background: Cutaneous manifestations of chronic spontaneous urticaria (CSU) are identical to type 1 hypersensitivity reactions. The daily occurrence of rash from occupational allergy could be misinterpreted as CSU exacerbation.

Objective: We aim to report a nurse with concomitant CSU suffering from latex-induced anaphylaxis.

Methods: Skin tests, specific IgE using ImmunoCAP, and gloves challenge were performed.

Results: A 27-year-old nurse with CSU suffered from several episodes of severe urticarial flare. H1-antihistamine up-dosing and oral corticosteroid burst were given. Unfortunately, she developed 3 episodes of anaphylaxis during her routine nursing care work on a medical ward, leading to allergist consultation. She had positive latex-specific IgE (6.86 kUA/L) and positive gloves challenge test.

Conclusions: Concomitant CSU treatment might hinder the recognition of latex allergy by masking or delaying skin manifestations. IgE-mediated allergy should be suspected if there was a change in severity or frequency of previously controlled CSU or the presence of systemic symptoms.

Background: Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) is a clinical syndrome characterized by chronic rhinosinusitis with nasal polyposis (CRSwNP), adult-onset asthma and hypersensitivity to NSAIDs. Long-term aspirin treatment after desensitization (ATAD) is used for clinical improvement in N-ERD patients. However, information on the potential effect of ATAD on the platelet-neutrophil aggregates (PNA) level in N-ERD patients is highly limited.

Objective: This study aimed to explore the impact of PNA on the pathogenesis of N-ERD and the potential effect of ATAD on N-ERD patient profiles from a platelet point-of-view.

Methods: Sixty-one individuals were enrolled, including 16 N-ERD patients with ATAD (ATAD+), 15 N-ERD patients without ATAD (ATAD-), 15 aspirin-tolerant asthma (ATA) patients, and 15 healthy controls (HCs). Lipid mediators classical in N-ERD, including urinary-LTE4 (uLTE4), prostaglandin-D2 (PGD2), and prostaglandin-E2 (PGE2) were assessed by ELISA. Platelet activation was estimated based on expression levels of sP-selectin, CD40L, Platelet Factor-4 (PF4), RANTES, Thromboxane-A2 (TXA2), PAF, 12-HETE in plasma levels by ELISA; and PNA percentage by flow cytometry.

Results: ATAD+; 12-HETE, and PF4 levels were remarkably low, while higher levels were determined in ATAD- and ATA groups. ATAD+; uLTE4 levels were positively correlated with 12-HETE. Another positive correlation was detected between sP-selectin and 12-HETE in ATAD-. Compared to HCs, it was found that among all N-ERD patients, significant increase in PNA.

Conclusions: Plasma levels of PGE2, PF4, and 12-HETE appear to be affected by aspirin treatment. We believe that 12-HETE could play a significant role in the N-ERD pathogenesis by contributing to platelet activation.

Background: Henoch-Schönlein purpura (HSP), the most typical kind of pediatric vasculitis, can also affect adults. Over the last 10 years, research has been increasing on improvements in HSP diagnosis, physiopathology, symptoms, and therapy. Joint involvement is highly frequent in this condition; however, it typically undergoes spontaneous resolution and does not lead to long-term complications.

Objective: To provide a deeper understanding of the constituting pathogenic mechanisms and clinical presentation of articular involvement, focusing on the effect of neutrophil activation on systemic small vessels.

Methods: This literature review utilized a systematic search of academic databases, employing specific keywords to select recent peer-reviewed articles and scholarly sources on the topic.

Results: The manifestations of joint involvement in HSP can vary in severity and frequency. Non-steroidal anti-inflammatory medications or acetaminophen are considered the first-line treatment for joint pain; however, corticosteroids may help achieve quick remission. In cases where standard treatment fails or manifestations persist, immunosuppressive drugs like rituximab, methotrexate, cyclophosphamide, or azathioprine have been used.

Conclusions: While it tends to resolve without lasting joint damage, accurate diagnosis and appropriate management are crucial to ensure optimal patient outcomes.

Biologic therapies have transformed the management of moderate to severe psoriasis, providing targeted and effective interventions against key inflammatory pathways. Due to their action specifications compared to conventional therapies, they generally provide better efficacy-safety profiles, especially the second-generation of biologics for psoriasis. Furthermore, the broader aspects of patients' quality of life can improve dramatically. This review overviews the efficacy, safety, and real-world application of biologic agents, including tumor necrosis factor-alpha inhibitors, interleukin (IL)-12/23 inhibitors, IL-17 inhibitors and IL-23 inhibitors. Their effectiveness in difficult-to-treat areas such as the scalp, nails, palmoplantar region, and genital area, where conventional treatments often fail is also highlighted. Immunogenicity differences between biologics, along with variations in binding affinity and half-life, may influence treatment response and drug persistence. Intra-class and inter-class biologic switching have been utilized to optimize treatment outcomes in patients experiencing inadequate response or adverse effects. Long-term data suggest that biologics are well-tolerated, with a favorable safety profile. As biologic options continue to expand, individualized treatment selection such as patients' comorbidities, prior treatment history, and real-world drug survival are essential for optimizing patient outcomes in psoriasis management.

Background: Severe cutaneous adverse drug reactions (SCARs) can cause significant morbidity and mortality. Clinical data regarding such conditions is still limited in the pediatric population.

Objective: To investigate the incidence, clinical characteristics, treatment, and outcome of SCARs in Thai pediatric patients.

Methods: This retrospective study enrolled 52 patients aged less than 18 years who were diagnosed with acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), or SJS/TEN overlap during January 2005 to August 2021 at Siriraj Hospital.

Results: SCARs were slightly more prevalent in females than in males (51.9% vs. 48.1%). Median age at diagnosis was 97 months, and median length of hospital stay was 11 days. DRESS, SJS, TEN, AGEP, and SJS/TEN overlap was found in 44.2%, 36.5%, 9.6%, 5.8%, and 3.8%, respectively. The most common etiologies were antimicrobial agents (40.3%) and anticonvulsants (35.5%). Target lesions, vesicobullous lesions, purpura, positive Nikolsky's sign, and skin tenderness were significant in blistering SCARs. Hematologic (84.6%) and hepatic (65.5%) manifestations were common. Treatment varied according to the clinical features of each condition. Systemic corticosteroids showed some benefit in SJS/TEN. One patient diagnosed with TEN died for an overall SCARs mortality rate of 1.9%.

Conclusion: The unique characteristics of SCARs described herein can lead to timely and accurate diagnosis and proper management.

Background: Few studies have investigated the risk factors for recurrent anaphylaxis. Identifying these factors may help patients implement preventive measures.

Objective: To determine the rate and risk factors for recurrent anaphylaxis, assess the time to recurrence, and compare the characteristics, triggers, and clinical manifestations between recurrent and non-recurrent cases.

Methods: A retrospective cohort study was conducted at Naresuan University Hospital from March 2011 to February 2021, using medical records of patients with ICD-10-confirmed anaphylaxis. Risk factors for recurrence were analyzed using Cox proportional hazards regression model.

Results: A total of 439 anaphylactic episodes were identified in 381 patients (49 children, 332 adults). Of these, 42 patients (11.2%) experienced 58 recurrent episodes (7/49 [14.3%] children, 35/332 [10.6%] adults). Food and medications were the most and second most common triggers. The median time to recurrence was 9.9 months (IQR: 3.1-18.8), while the median follow-up duration for non-recurrent cases was 41.8 months (IQR: 23.8-61.8). The recurrent anaphylaxis rate was 4.1 events per 100 person-years. Statistically significant risk factors included a history of food, a history of insect, a history of drug allergies, chest discomfort, and severe anaphylaxis (HR [95%CI]: 3.31 [1.50-7.29], p = 0.003; 4.96 [1.47-16.82], p = 0.010; 5.87 [2.64-13.07], p < 0.001; 2.43 [1.19-4.99], p = 0.015; and 2.29 [1.07-4.88], p = 0.033, respectively). Conversely, palpitations were associated with a lower risk of recurrence (HR 0.11 [0.01-0.86], p = 0.036).

Conclusions: Identifying risk factors in anaphylaxis patients enhances medical care and aids in preventing recurrence.

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: Candida albicans remains the most common fungal pathogen among the species, causing candidemia. Thus, early diagnosis is indispensable in patients with severe underlying infections.

Objective: To develop a short-polymerase chain reaction (short-PCR) coupled with lateral flow strip (LFS) assay for the detection of C. albicans in clinical blood samples.

Methods: A short-PCR-LFS was enhanced to detect clinical isolates and clinical blood samples. The ITS2 gene of C. albicans was amplified using the modified primers-probes to produce highly specific, dual-labeled amplicons. The sensitivity and specificity of the test system were evaluated using C. albicans, Candida spp. other than C. albicans and other microbial DNAs. The test system was validated by 44 clinical isolates and 51 clinical blood samples.

Results: The short-PCR-LFS revealed a high specificity for C. albicans with no cross-reactivity and a limit of detection (LOD) of 0.1 ng per 2 mL of blood and 2 CFU/mL using a direct colony as a template. The result was consistent with the validation by short-PCR agarose gel electrophoresis (AGE). The short-PCR-LFS assay showed all positives with all C. albicans relevant samples and exhibited negative for other microbial relevance samples.

Conclusions: The entire process of this system provides visual detection results less than 1 h with high sensitivity, high specificity, DNA extraction-free method, and little dependence on instruments. Thus, it can be considered as a promising method for professional use to early detect and identify clinical relevance samples of C. albicans.

Background: Inhaled corticosteroids (ICS) represent an alternative treatment option to systemic corticosteroids (SCS) in the treatment of asthma and chronic obstructive pulmonary disease (COPD); however, detailed clinical guidance on the use of nebulized ICS, such as budesonide, in the management of asthma and COPD remains scarce.

Objective: To review the literature and develop Delphi consensus statements on the use of nebulized ICS for the management of asthma and COPD in adults.

Methods: An expert panel of 13 respiratory physicians, comprising pulmonologists (n = 9), allergists (n = 1), and emergency department consultants (n = 3) from tertiary medical centers in Thailand, undertook a Delphi procedure with the aim of developing evidence-based consensus statements on the use of nebulized ICS in patients with asthma and COPD. Panelists used a 5-point Likert scale to score their agreement with each statement.

Results: A total of 12 Delphi consensus statements pertaining to the use of nebulized ICS in the management of asthma and COPD in both acute and maintenance care were developed. The overall consensus of the panel across the 12 statements was very high (mean agreement score, 4.2-4.9/5). The panelists expressed strongest consensus agreement (84.6% strong agreement) with the following two statements: 1) inhalation devices are the cornerstone of drug delivery in patients with asthma and COPD, and 2) for adult asthma and COPD patients with severe exacerbations, nebulization is more suitable for drug delivery than a pMDI plus spacer.

Conclusions: Nebulized budesonide is an effective and well tolerated treatment option for the management of asthma and COPD.