Asian Pacific journal of allergy and immunology最新文献

Background: Rheumatoid arthritis (RA) is a disease characterized by synovitis. The synovium of RA patients is rich in macrophages, which are differentiated mainly from monocytes. The susceptibility gene of RA, tumor necrosis factor-α inducible protein 3 (tnfaip3), is considered an anti-inflammatory factor. Our previous study revealed the abnormal protein expression of TNFAIP3 in monocytes from patients with RA.

Objective: In the present study, we aimed to explore the role of TNFAIP3 in monocytes in RA and its potential functions.

Methods: In vivo, we injected adenoviral vectors overexpressing tnfaip3 into mice with collagen-induced arthritis (CIA) (the TNFAIP3-oe group). Arthritis scores, as well as the expression of iNOS and CD206 in the synovium, were compared between the TNFAIP3-oe group and the CIA group. In vitro, we used lentivirus transfection to upregulate/downregulate the expression of tnfaip3 in THP-1 cells. The ability of these cells to migrate, secrete cytokines and differentiate into macrophages was compared.

Results: Compared with that in the CIA group, arthritis in the TNFAIP3-oe group was ameliorated (p = 0.030). Moreover, the joints of these mice presented more CD206+ cells and fewer iNOS+ cells (both p < 0.001), indicating the anti-inflammatory effect of TNFAIP3 and its regulation of macrophage polarization. In vitro, the tnfaip3-depleted cells (the TNFAIP3-i group) had greater migration and differentiated into M1 macrophages, and more cells overexpressing tnfaip3 (the TNFAIP3-oe group) differentiated into M2 macrophages. Furthermore, cells in the TNFAIP3-i group showed increased secretion of the proinflammatory cytokines IL-6 and MMPs.

Conclusions: Taken together, these findings suggest that TNFAIP3 in monocytes can regulate inflammatory arthritis by modulating monocyte migration, differentiation, and cytokine secretion.

Background: Saltwater fish are associated with more allergic reactions compared to freshwater fish. However, the factors contributing to this difference remain unclear.

Objective: To compare the heat stability of freshwater and saltwater fish proteins, and assess their binding affinity to allergen-specific antibodies.

Methods: Protein extracts were isolated from saltwater fish-Selar crumenophthalmus, Euthynnus affinis, Ambassis urotaenia, and freshwater fish i.e., Rasbora argyrotaenia, Monopterus albus, and Poecilia reticulata. Protein extract from Penaeus monodon served as a standard allergen source. Both raw and heat-treated protein extracts were subjected to SDS-PAGE analysis. The number of protein bands, their molecular sizes, and intensities were evaluated. Protein binding frequencies to anti-tropomyosin antibodies and IgE-containing serum from allergic patients were measured using ELISA.

Results: The P. monodon protein extract < 100 kDa demonstrated heat stability, while A. urotaenia proteins < 40 kDa were also heat-stable. Raw protein extracts from R. argyrotaenia and M. albus exhibited binding frequencies to anti-tropomyosin IgG of 28.18 ± 1.05% and 14.79 ± 0.91%, respectively. In saltwater fish, raw protein extracts from A. urotaenia and S. crumenophthalmus showed binding frequencies of 61.74 ± 1.87% and 34.68 ± 1.39%, respectively. Freshwater and saltwater fish heat-treated protein extracts displayed binding frequencies below 10%. All heat-treated protein samples exhibited higher binding frequencies to polyclonal IgE in patient sera compared to their raw counterparts.

Conclusions: Proteins smaller than 20 kDa exhibit significant heat stability. Raw protein extracts show higher binding frequencies to monoclonal IgG against crustacean tropomyosin, while heat-treated samples have increased binding frequency to IgE-containing human serum.

Background: Selecting optimal biologics based on type 2 biomarkers has been of interest in severe asthma treatment. However, few direct biomarker stratification-based comparisons have been made.

Objective: To compare the effectiveness of anti-IL-5 (mepolizumab, benralizumab), omalizumab, and dupilumab in reducing the number of hospitalizations from asthma and exacerbations across all and eosinophil-stratified subgroups.

Methods: A retrospective cohort study using the National Hospital Organization database (2016-2020) was performed. Asthmatic patients using biologics were selected, and the baseline backgrounds of the groups were balanced using inverse probability treatment weighting for propensity scores. Weighted rate ratios (RRs) were obtained using a Poisson regression model.

Results: Among the 320 patients with asthma using biologics, 205 (64.1%), 75 (23.4%), and 40 (12.5%) were categorized into the anti-IL-5, omalizumab, and dupilumab groups, respectively. After weighting, there were 47.1, 30.0, and 62.6 hospitalizations per 100 person-years [omalizumab vs. anti-IL-5: weighted RR, 0.61 (0.34-1.08); dupilumab vs. anti-IL-5: 1.48 (0.81-2.72)], and 117.0, 134.6, and 287.3 exacerbations per 100 person-years [omalizumab vs. anti-IL-5: 1.13 (0.83-1.54); dupilumab vs. anti-IL-5: 2.69 (1.91-3.78)] in these respective groups. In patients with eosinophil of ≥ 300/μL, the dupilumab group had more exacerbations compared with the anti-IL-5 group [weighted RR, 2.85 (1.82-4.46)]. In patients with eosinophil of < 300/μL, the omalizumab group had fewer hospitalizations compared with the anti-IL-5 group [weighted RR, 0.32 (0.13-0.51)].

Conclusion: Anti-IL-5 biologics may be more effective than dupilumab in patients with high blood eosinophil counts, while less effective than omalizumab in patients with low eosinophil counts.

Background: Non-allergic rhinitis (NAR) is characterized by symptoms of nasal inflammation without allergic sensitization. The long-term outcome of NAR in children is poorly defined.

Objective: To determine the natural history of childhood-onset NAR and the development of allergic rhinitis (AR) in these children.

Methods: NAR patients who were followed for more than 10 years were evaluated at 3-5 years (E2) and 9-12 years (E3) after the first evaluation (E1). Nasal symptoms, disease severity, comorbidities, medication used, and aeroallergen sensitization were assessed.

Results: Eighty-two NAR patients (58.5% male) completed all 3 evaluations. The age at onset was 2.0 (range 2.0-4.0) years. The follow-up period was 13.6 (range 12.3-14.3) years. At E2, 37.8% of patients developed AR. At E3, the patients were classified into four groups based on results of skin prick tests in E2 and E3 (group I: NAR→NAR→NAR, 39.0%, group II: NAR→NAR→AR, 23.2%, group III: NAR→AR→NAR, 12.2% and group IV: NAR→AR→AR, 25.6%). The most common aeroallergen sensitization was house dust mite. The family history of atopy, asthma and allergic rhinitis were higher in group III and IV than other groups (p < 0.05). The atopic dermatitis, obstructive sleep apnea and adenotonsillar hypertrophy at E1 and E2 were predominantly found in group IV (p < 0.05). At E2, group III and IV patients had higher proportion of exposure to house dust, animal dander and smoking compared to other groups (p < 0.05). The overall remission rate was 14.6%.

Conclusions: Children with NAR should be reevaluated periodically to determine aeroallergen sensitization for the appropriate diagnosis and management.

Background: Skin prick testing and serological identification of allergen specific immunoglobulin E (spIgE) are standard tests for allergic rhinitis but can only identify systemic responses. In contrast, nasal allergen challenge (NAC), directly assess localized nasal mucosal reactivity, but is time consuming. Identification of spIgE from nasal brushings (nasal spIgE) is an alternative technique.

Objective: This study aimed to determine the diagnostic performance of nasal spIgE compared to NAC in order predict house dust mite (HDM) driven AR.

Methods: A diagnostic cross-sectional study involving adult rhinitis patients was performed. Sensitization to HDM allergens (Dermatophagoides pteronyssinus (DP), Dermatophagoides farina (DF) were assessed serologically and/or skin prick test, nasal brushing and NAC. Patients with both positive systemic test and NAC were defined to have HDM driven AR, while patients with a positive systemic test and negative NAC were defined to have non-clinically relevant HDM sensitization. The performance of nasal spIgE to predict positive NAC was determined using the receiver operating curve. The chosen cut-off was then used to predict HDM driven AR among those with positive systemic test.

Results: 118 patients (29.42 ± 9.32 years, 61.9% female) were included. Nasal spIgE was predictive of positive NAC (AUC 0.93, 95%CI: 0.88-0.98, p < 0.01). Among those with positive systemic test, the cut-off value of >0.14 kUA/L was able to predict HDM AR from incidental HDM sensitization with 92% sensitivity and 86% specificity.

Conclusions: Nasal spIgE is comparable to NAC. A cut-off value of >0.14 kUA/L identifies HDM-driven AR from incidental sensitization among patients with positive systemic tests for allergy.

Background: Corticosteroids added to high volume saline nasal irrigation have been introduced as a more effective method of delivering corticosteroids to the sinuses than nasal sprays. However, information regarding the effect of this intervention on the hypothalamic-pituitary-adrenal (HPA) axis is still limited.

Objective: To evaluate the safety of long-term corticosteroid (6 months) nasal irrigation in patients with chronic rhinosinusitis (CRS) post endoscopic sinus surgery.

Methods: Seventeen patients with CRS were included. After undergoing endoscopic sinus surgery, the patients were prescribed budesonide nasal irrigations (250 ml via squeeze bottle) twice daily (1 mg/day) for six months. The serum morning cortisol levels of these patients were then evaluated at 3 and 6 months post-operatively.

Results: Median serum morning cortisol levels were 10.5 mcg% at pre-operative baseline; 10.3 mcg% at 3 months; and 11.2 mcg% at 6 months on post-operative follow-up. There were no significant changes in the serum morning cortisol levels (P value = 0.71 and 0.63 respectively). Three of 17 patients (17.65%) had mildly abnormal serum morning cortisol levels (4, 4.3 and 4.9 mcg%) at 3 months. However, these levels were within a normal range at 6 months.

Conclusions: Serum morning cortisol levels were not significantly changed after usage of budesonide nasal irrigation for 6 months.

Background: Air impurities can exacerbate or cause rhinologic diseases. However, only a few studies have assessed rhinologic patients' symptoms at work.

Objective: This study surveys the impact of work on rhinology clinic patients' quality of life in relation to work-related respiratory exposures. In addition, we surveyed patients' sick leave periods.

Methods: We recruited adult employed rhinology patients referred to the otorhinolaryngology clinic. A total of 177 patients were included. We collected data on patients' medical history, rhinologic disease-specific and generic quality of life, current or most recent job title, a description of current work, nasal symptoms, possible worked-related symptom triggers and sick leave periods during the preceding year.

Results: In total, 101 (57.1%) patients reported exacerbated rhinologic symptoms at work and reported more severe rhinologic disease and a lower disease-specific quality of life compared to non-work-related rhinologic patients (P = 0.008). A minority, 24.3% of our patients were exposed to any specific occupational respiratory sensitizer or irritant at work. The mean sick leave period due to rhinologic disease was 7.7 days per year.

Conclusions: Exposure to specific occupational sensitizers or irritants did not associate with increasing symptoms at work or quality of life amongst our patients. Most rhinology patients reported exacerbated symptoms at work. They appeared to be more symptomatic than the rest of the patients and, therefore, possibly hyperreactive to unspecific respiratory triggers at work. Rhinologic diseases caused our patients a marked burden with high work absenteeism.

Background: Chronic cough has led to a substantial socioeconomic burden globally. Psychiatric comorbidities are reported in many chronic diseases. However, the relationship between mental disorders and chronic cough remains unclear.

Objective: This study aims to explore the relationship between anxiety, depression and chronic cough.

Methods: 238 patients (96 males and 142 females) with chronic cough were enrolled in this study. Responses were collected using the Cough Visual Analog Scale, the Hospital Anxiety and Depression Scale (HADS), and the Leicester Cough Questionnaire.

Results: According to the HADS, 9.2% and 6.3% of patients were identified as having anxiety and depression, respectively. Patients with anxiety and depression were more likely to have a reduced quality of life. Cough duration, cough severity and history of anaphylaxis were found to be positively associated with reduced quality of life in patients with chronic cough. Cough severity was considered as a dependent risk factor for symptoms of anxiety and depression. Also, more severe symptoms of anxiety were observed in patients reported that a history of anaphylaxis. More female patients had a history of anaphylaxis and reduced cough-related quality of life.

Conclusions: Symptoms of anxiety and depression, longer cough duration, more severe cough and a history of anaphylaxis may reduce the quality of life in patients with chronic cough. Cough severity and a history of anaphylaxis are associated with symptoms of anxiety.

Background: Allergic rhinitis (AR) represents a significant global health concern that can give rise to numerous diseases and result in labor productivity. T regulatory (Treg) cells are pivotal players in the pathogenesis of AR, and their deficiencies are closely related to Prostaglandin E2 (PGE2). However, the downstream mechanisms of this relationship remain poorly understood.

Objective: This study aims to investigate the inhibitory mechanisms through which PGE2 impacts the differentiation of Treg cells.

Methods: We compared the differentiation of Treg cells from naïve CD4+ T cells of AR patients and healthy controls, with or without the presence of PGE2 by flow cytometry. Intracellular cAMP concentration, mRNA and protein levels of cyclic-AMP dependent protein kinase A (PKA), as well as their downstream target, Peroxisome Proliferator-Activated Receptor-γ (PPAR-γ) were examined in Treg cells from AR and healthy donors. AR mouse model was established by pollen administration.

Results: PGE2 suppressed the differentiation of Treg cells from human naïve CD4+ T cells through the EP4 receptor. Furthermore, in AR patients and AR mouse, the expression of EP4 receptor were observed enhanced. The PGE2-EP4 signal was carried out by activating cAMP-PKA signaling pathway. Subsequently, phospholated PKA would suppress PPAR-γ expression. Treatment of Pioglitazone, a PPAR-γ agonist, was demonstrated to rescue the differentiation of Treg and help alleviate inflammation in the AR mouse model.

Conclusion: In AR disease, the PGE2-EP4 signaling exerts an inhibitory effect on Treg differentiation by influencing the cAMP-PKA pathway and its downstream target PPAR-γ.

Background: Environmental changes have led to shifts in allergen sensitization patterns globally.

Objective: To assess changes in aeroallergen sensitization profiles among AR patients in Yichang, a city located in central China along the Yangtze River and develop an optimized allergen panel for the diagnosis of AR through specific IgE (sIgE) testing.

Methods: This retrospective study encompassed all patients with suspected AR who sought care at a university hospital in Yichang between 2018 and 2023 and underwent IgE testing. Demographic and sIgE data were collected.

Results: A total of 11,855 patients were included in the study, with 7,453 (62.88%) testing positive for at least one allergen. The predominant allergen identified was house dust mite (HDM), with sensitization rates of 58.65% for D. pteronyssinus and 58.63% for D. farinae. Notably, sensitization to animal dander showed a significant increase, with cat dander rising from 4.41% in 2018 to 12.50% in 2023, and dog dander from 4.41% to 10.42%. Sensitization rates for various allergens also exhibited fluctuations, with seasonal peaks observed: HDM (summer/autumn), molds (spring/autumn), and Blattella germanica (autumn/winter). A five-allergen panel (HDM, B. germanica, mixed animal dander, mixed molds) identified over 95% of sensitized patients.

Conclusions: HDM remains the primary allergen among AR patients in this area, with rising sensitization to animal dander. A five-allergen panel effectively detects most sensitized patients.