Asian Pacific journal of allergy and immunology最新文献

Background: House dust mite subcutaneous immunotherapy (HDM SCIT) is a therapeutic option for allergic rhinitis (AR) patients who are unable to properly manage symptoms with standard medications.

Objective: This study aimed to determine long-term efficacy and identify predictive factors in the clinical remission of AR patients who completed and discontinued HDM SCIT.

Methods: This study included 240 AR patients, who completed a three-year course of HDM SCIT at two tertiary hospitals and were currently being discontinued. We followed-up the patients to ask about their current symptoms and allergy medication. Clinical remission was defined by patients who no longer required daily intranasal steroid or oral antihistamine. We compared patients in clinical remission to those still taking medication.

Results: The enrolled patients had a median age of 21.0 (11.0-36.0) years at the time they began HDM SCIT. The clinical remission of AR was achieved in 174 (72.5%) patients. Starting HDM SCIT before the age of 15 and not having asthma were identified as significant and independent predictors of remission (aOR 4.44; 95%CI, 1.72-11.50; p-value 0.002, and 2.67, 95%CI 1.00-7.12; p-value 0.049), respectively, as determined by multivariate logistic regression analysis. There were no significant differences in HDM SCIT duration or sensitization patterns between patients in remission and those on medication after discontinuing HDM SCIT for at least one year.

Conclusion: HDM SCIT exhibited persistent long-term efficacy after treatment discontinuation. Starting HDM SCIT before the age of 15 and without asthma comorbidity might be predictors of AR remission with HDM SCIT.

Background: Intranasal corticosteroid (INCS) remains the primary treatment for allergic rhinitis (AR). Understanding adherence, safety concerns and sensory preferences is crucial for optimal care.

Objective: This review aims to determine medication adherence, sensory attributes and adverse effects of INCS in AR patients.

Methods: A systematic search of PubMed, Web of Science, Scopus, and Cochrane database was conducted for English articles published from 2004 to 2023. Eligibility includes clinical trials and observational studies with adult patients (18 years old or older) receiving INCS for AR (both intermittent and persistent).

Results: Thirty-one studies with 10,582 patients, comprising 10 cross-sectional studies and 21 randomized controlled trials (RCT) were included. Adherence rates ranged from 28% to 87%, with an average of 55.8%. Forgetfulness was the primary reason for non-adherence (63.1-77.8%), followed by adverse events (26.4-61.5%) and fear of adverse events (3.8-31.5%). Scent (38%), taste (28.5%), or aftertaste (24.3%) were the main differentiators for sensory attribute, with varying levels of intensity and preferences for each INCS. Common adverse events encompass epistaxis, nasal dryness/irritation, headache and nasopharyngitis. A meta-analysis of eight RCT detected no significant difference in adverse events between the INCS and control groups (risk ratio 1.05; 95% confidence interval, 0.88-1.24; p = 0.61).

Conclusions: The findings of this review indicate that medication adherence to INCS is not optimal, with non-adherence mostly attributed to forgetfulness, preferences for sensory attributes, and unpleasant effects associated with INCS. The underlying factors should be addressed as part of a multimodal strategy to improve adherence.

Background: Asthma is a heterogeneous disease with different outcomes. For children with asthma at the age of 7 years, 67-75% are symptom-free as adults. Data on the important link between childhood and adult asthma are sparse.

Objective: We aimed to investigate factors associated with persistence of childhood asthma over three years of follow-up by linking data between Korea childhood Asthma Study (KAS) and their matched claims data from Health Insurance Review and Assessment Service (HIRA).

Methods: We analyzed data from 450 preadolescent children aged 7 to 10 years and classified them into remission or persistence groups. Baseline clinical characteristics and exposure to air pollution materials including PM2.5 and PM10 during three years of follow-up were compared. The main outcome was asthma persistence which was defined as the presence of asthma episodes with healthcare utilization and prescription of asthma medications within three years after KAS enrollment.

Results: At the third year of follow-up, after stepwise regression analysis, lower age at enrollment (adjusted odds ratio (aOR): 0.79; 95% confidence interval (CI): 0.64-0.96), male sex (aOR: 1.66; 95%CI: 1.05-2.63), proximity from an air-polluting facility (aOR: 2.4; 95%CI: 1.34-4.29), higher level outdoor PM2.5 (aOR: 1.1; 95%CI: 1.02-1.20), and higher rate of doctor-diagnosed food allergy (FA) (aOR: 2.33; 95%CI: 1.06-5.12) were significantly associated with persistence.

Conclusion: We discovered various independent risk factors for the persistence of childhood asthma. By linking HIRA claims data, we could clarify risk factors for persistence in a well-defined study population.

Background: Barrier disruption in the airway mucosae has been implicated in allergic type 2 inflammatory diseases such as allergic rhinitis and asthma. Zingiber cassumunar Roxb. has long been used in traditional medicine to treat allergic diseases. The active compound, namely compound D, has proven anti-inflammatory benefits. However, the effect of compound D on allergic inflammation remains unclear.

Objective: This study aimed to investigate the protective effects of compound D on allergic inflammation-induced barrier disruption.

Methods: Type 2 cytokine (IL-4 and IL-13)-exposed 16HBE human bronchial epithelial cells were treated with compound D. After 24, 48, and 72 h, cytotoxicity, epithelial integrity, and tight junction (TJ) disruption were determined by viability assays, transepithelial electrical resistance measurement, and immunofluorescence staining, respectively. Moreover, the mechanism of action of compound D was investigated by western blotting.

Results: Compound D (100 and 200 µM) prevented IL-4/IL-13-induced barrier disruption at 24 and 48 h with no effect on cell viability. Compound D rescued the localization of ZO-1 to pericellular areas, and the barrier-protective effect of compound D was mediated by inhibiting STAT6 signaling.

Conclusions: Compound D can suppress IL-4/IL-13-induced epithelial inflammation and TJ disruption through STAT6 inhibition. The agent is a promising candidate for therapeutic or adjunctive treatment of type 2 inflammation-associated diseases, including asthma.

Background: Studies investigating the genetic association of the C677T methylenetetrahydrofolate reductase (MTHFR) genotype and dietary methyl donors with asthma and atopy are limited, and have variable results.

Objective: To investigate the effect of dietary methyl donor intake on the risk of childhood asthma and atopy, based on the C677T polymorphism in the MTHFR gene.

Methods: This cross-sectional study included 2,333 elementary school children aged 6-8 years across Korea during 2005 and 2006, as part of the first Children's Health and Environmental Research survey. Genotyping for the MTHFR (rs1801133) polymorphism was performed using the TaqMan assay. Multivariable-adjusted logistic regression analysis was performed to determine a descriptive association between the dietary methyl donor intake, MTHFR polymorphism, and childhood asthma and atopy.

Results: Intake of dietary methyl donors like folates was significantly associated with a decreased risk of the wheezing symptom, in the past 12 months, and "ever asthma" diagnosis, respectively. Vitamin B6 intake was also associated with a decreased atopy risk. The T allele of the MTHFR (rs1801133) gene was significantly associated with a decreased risk of atopy. Increased intakes of folate, vitamin B2, and vitamin B6 were protective factors against atopy, especially in children with the T allele on the MTHFR gene, compared to those with lower intakes and the CC genotype.

Conclusions: High intakes of dietary methyl donors were associated with reduced risk of atopy and asthma symptoms. These may have additive effects related to the susceptibility alleles of the MTHFR gene. The clinical implications require evaluation.

Background: There are two major pathological phenotypes of asthma, type 2 (T2)-high and T2-low asthma, which are important in determining treatment strategies. However, the characteristics and phenotypes of T2-high asthma have not yet been fully identified.

Objective: This study aimed to identify the clinical characteristics and phenotypes of patients with T2-high asthma.

Methods: This study used data from a nationwide asthma cohort study in Japan, NHOM Asthma Study. T2-high asthma was defined as a blood eosinophils count ≥ 300 /μL and/or fractional exhaled nitric oxide level ≥ 25 ppb, and the clinical characteristics and biomarkers were compared between T2-high and T2-low asthma. Furthermore, T2-high asthma was phenotyped via hierarchical cluster analysis using Ward's method.

Results: Patients with T2-high asthma were older, less likely to be female, had longer asthma duration, had lower pulmonary function, and had more comorbidities, including sinusitis and SAS. Patients with T2-high asthma showed higher serum thymus and activation-regulated chemokine and urinary leukotriene E4 levels and lower serum ST2 levels than those with T2-low asthma. There were four phenotypes among patients with T2-high asthma: Cluster 1 (youngest, early-onset, and atopic), Cluster 2 (long duration, eosinophilic, and low lung function), Cluster 3 (elderly, female-dominant, and late-onset), and Cluster 4 (elderly, late-onset, and asthma-COPD overlap-dominant).

Conclusions: Patients with T2-high asthma have distinct characteristics and four distinct phenotypes, in which eosinophil-dominant Cluster 2 is the most severe phenotype. The present findings may be useful in precision medicine for asthma treatment in the future.

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: Allergic bronchopulmonary aspergillosis (ABPA) is a severe type of asthma characterized by hypersensitivity to Aspergillus fumigatus and lung infiltration with eosinophilia. The central pathogenesis of asthma is airway hyperresponsiveness (AHR), with eosinophils playing a critical role. Anti-interleukin (IL)-5 antibody therapy has been recently introduced to treat severe asthma, which reportedly inactivates and reduces eosinophil count. A recent case series highlighted the improvement in asthmatic symptoms associated with ABPA, but previous reports failed to demonstrate any improvement in AHR.

Objective: Herein, we aimed to elucidate the efficacy of mepolizumab in a patient with ABPA who showed improvement in AHR.

Methods: Case report.

Results: A 63-year-old Asian woman with ABPA showed improvement in asthmatic symptoms and AHR following mepolizumab therapy.

Conclusions: Our results suggest that IL-5 may serve in the pathogenesis of ABPA.

Background: During the COVID-19 pandemic, national lockdowns were implemented worldwide. Asthma control was reported to have improved. However, some patients lost follow-up from the clinic because they intended to avoid crowds at the hospital.

Objective: To evaluate the level of asthma control during the COVID-19 pandemic and explore factors influencing asthma outcomes.

Methods: Subjects 8-18 years old from our previous study in 2019 were recruited. The data during the pandemic period were collected between June 2021 - May 2023. The level of asthma control was compared before and during the pandemic. We also evaluated inhaled corticosteroid (ICS) adherence and factors related to poor asthma control during the COVID-19 pandemic.

Results: One hundred and three subjects were enrolled. Asthma control levels remained relatively stable during the pandemic. However, an asthma exacerbation was significantly decreased from 36 (36.3%) in 2019 to 19 (19.2%)and 15 (15.1%) in 2021 and 2022 (p = 0.012, p < 0.001), respectively. Spirometry results demonstrated improved pre-bronchodilator FEV1 (89.91 ± 11.02 vs. 101.91 ± 14.11, p < 0.001). The factors related to the poor asthma outcome were not wearing a face mask (aOR = 8.52, 95%CI 1.26-57.79) and previously poor-controlled by the ACT score (aOR = 2.55, 95%CI 1.41-4.63). The median adherence rate during the pandemic was 85%. The main reasons for poor adherence were hectic lifestyle and misunderstandings of disease.

Conclusion: Asthma exacerbation was significantly decreased during the lockdown. Not wearing a face mask and previously poorly controlled by the ACT score are related to poor asthma outcomes.

Background: Despite nebulized budesonide being identified by the Global Initiative for Asthma report as a viable alternative to inhaled corticosteroids (ICS) delivered by pressurized metered-dose inhalers (pMDIs) with spacers, practical guidance on nebulized corticosteroid use in the pediatric population remains scarce.

Objective: To review the current literature and provide practical recommendations for nebulized budesonide use in children aged ≤ 5 years with a diagnosis of asthma.

Methods: A group of 15 expert pediatricians in the respiratory and allergy fields in Thailand developed Delphi consensus recommendations on nebulized budesonide use based on their clinical expertise and a review of the published literature. Studies that evaluated the efficacy (effectiveness) and/or safety of nebulized budesonide in children aged ≤ 5 years with asthma were assessed. AR patients.

Results: Overall, 24 clinical studies published between 1993 and 2020 met the inclusion criteria for review. Overall, results demonstrated that nebulized budesonide significantly improved symptom control and reduced exacerbations, asthma-related hospitalizations, and the requirement for oral corticosteroids compared with placebo or active controls. Nebulized budesonide was well tolerated, with no severe or drug-related adverse events reported. Following a review of the published evidence and group consensus, a treatment algorithm as per the Thai Pediatric Asthma 2020 Guidelines was proposed, based on the availability of medications in Thailand, to include nebulized budesonide as the initial treatment option alongside ICS delivered by pMDIs with spacers in children aged ≤ 5 years.

Conclusions: ThNebulized budesonide is an effective and well-tolerated treatment option in children aged ≤ 5 years with asthma.