Allergy and asthma proceedings最新文献

Background: Current therapies for food allergy prevention, oral immunotherapy and omalizumab, increase reaction threshold, but their curative potential remains unknown. Dupilumab has emerged as a promising treatment for several atopic conditions. We observed that many children with food allergy who are on dupilumab had profound reductions in food-specific immunoglobulin E (sIgE) levels over time. Objective: We sought to determine whether sIgE levels decrease in children with food allergy who are on dupilumab and whether changes over time were influenced by allergen type, race, sex, indication for therapy, or age of initiation of therapy. Methods: A retrospective analysis of 44 children with food allergy who were on dupilumab was conducted for longitudinal assessment of sIgE. Results: A statistically significant decrease in sIgE levels was observed across multiple allergens in the 44 children treated with dupilumab for a mean of 1.4 years. A stratified analysis identified a statistically significant decrease (p < 0.05) in sIgE levels in children receiving treatment for both atopic dermatitis (AD) and eosinophilic esophagitis (EoE). This reduction remained significant across all subgroups regardless of race, sex, or age of initiation of dupilumab. The rate of change in sIgE levels over time was greater in children with AD than with EoE, but this difference did not reach statistical significance. Notably, age < 6 years at dupilumab initiation was associated with steeper declines and greater absolute reductions in sIgE levels over time (-1.281 versus -0.784 log₂ IgE/year), with this difference approaching statistical significance (p = 0.0873), despite the small cohort size. Conclusion: We hypothesize that dupilumab may modify clinical tolerance in younger children during a window of immune plasticity and may increase reaction thresholds in older children. Even if this hypothesis is not confirmed, there is clinical utility in reductions of IgE levels, especially in children who are pansensitized, in whom these reductions likely improve signal-to-noise for clinically relevant sensitization. We advocate for prospective early-intervention trials that evaluate dupilumab as adjunctive therapy in children with comorbid atopy to determine its potential role in preventing food allergy development.

Backgroud: Nonspecific lipid transfer proteins (nsLTP) are major plant allergens associated with systemic allergic reactions. The major Cannabis allergen, Can s 3, has recently emerged as a potential contributor to nsLTP-mediated allergy and cross-reactivity. However, its role within the broader nsLTP sensitization network remains insufficiently characterized. Objective: This study aimed to evaluate the prevalence of sensitization to Can s 3 and to characterize its co-sensitization patterns with food- and pollen-derived nsLTPs in a large molecular cohort. Methods: A retrospective observational study, including 2409 patients referred for allergological evaluation, was conducted. Allergen-specific immunoglobulin E (IgE) was measured by using a multiplex allergen-specific IgE platform. Sensitization was defined as specific IgE level ≥ 0.35 kUA/L. Associations among allergens were assessed by using the Fisher exact test with odds ratios (OR) and 95% confidence intervals. Quantitative relationships between nsLTP components were evaluated by using the Spearman correlation. Principal component analysis and k-means clustering were applied to identify sensitization profiles. Results: Overall, 35.0% of the patients were sensitized to at least one nsLTP component. Strong associations were observed between Can s 3 and several food-derived nsLTPs, particularly Pru p 3 (peach) and Mal d 3 (apple) (ORs 222.9 and 227.6, respectively; p < 0.001). Can s 3 sensitization rarely occurred in isolation and was typically part of a broader nsLTP polysensitization pattern that involved both food and pollen allergens. Conclusion: Can s 3 sensitization seems integrated within the broader nsLTP sensitization landscape and is strongly associated with polysensitization to multiple nsLTP allergens. These findings support a shared nsLTP-mediated cross-reactivity network and highlight the relevance of including Can s 3 in molecular diagnostic panels for suspected nsLTP-mediated allergy.

Background: Cosensitization to multiple allergens may play an important role in the development and clinical expression of allergic diseases. This study aimed to characterize multidimensional patterns of allergen sensitization and their cross-sectional associations with allergic diseases among participants who were sensitized in the U.S. National Health and Nutrition Examination Survey (NHANES) by using allergen-specific immunoglobulin E (IgE) data from NHANES 2005-2006. Methods: In this cross-sectional analysis of participants with at least one positive allergen-specific IgE test, exploratory factor analysis and partitioning around medoids clustering were used to identify latent allergen factors and classify individuals into distinct sensitization patterns. Logistic regression, adjusted for sex, age, race/ethnicity, questionnaire-defined overweight, and household income, evaluated associations between clusters and self-reported allergic diseases. Results: Among 3512 participants who were sensitized, seven allergen factors were identified, and four clusters were defined: limited-sensitization (cluster 1), pollen-enriched (cluster 2), mite-enriched (cluster 3), and fungus-enriched (cluster 4). Notable differences in demographics and in the prevalence of allergic diseases were observed across clusters. Relative to cluster 1, cluster 2 had the highest odds of allergic rhinitis (odds ratio [OR] 2.04 [95% confidence interval {CI}, 1.69-2.48]), whereas cluster 3 had the highest odds of chronic rash (OR 1.58 [95% CI, 1.17-2.09]) and cluster 4 showed the greatest odds of asthma (OR 3.44 [95% CI, 2.68-4.40]). For eczema, clusters 3 and 4 showed comparable elevated odds (OR 1.63 [95% CI, 1.19-2.21] and OR 1.64 [95% CI, 1.14-2.32], respectively). After adjustment for confounders, associations for rhinitis, asthma, and chronic rash were essentially unchanged, whereas the eczema association persisted for cluster 3 (adjusted OR 1.61 [95% CI, 1.16-2.21]) but attenuated for cluster 4 (adjusted OR 1.39 [95% CI, 1.10-2.00]). Conclusion: The participants who were sensitized could be grouped into four distinct sensitization patterns differentially associated with asthma, rhinitis, eczema, and chronic rash. These patterns may help generate hypotheses for future clinical stratification and more tailored management research.

Background and Objective: This study aimed to evaluate the correlation between fractional exhaled nitric oxide (FeNO) levels and peripheral blood eosinophil (EOS) counts in patients with stable asthma who were undergoing general anesthesia as well as to assess their association with postoperative acute asthma exacerbations (AAE) during the perioperative period. Method: A retrospective analysis was conducted by using perioperative clinical data from 118 patients with stable asthma who received general anesthesia in Chongqing University Fuling Hospital. Logistic regression models and receiver operating characteristic curve analysis were used to identify predictive factors for AAEs during the perioperative period. The early predictive value of FeNO levels and EOS counts for AAEs after general anesthesia was quantitatively evaluated. Results: Perioperative intubation response, elevated intraoperative peak airway pressure, postoperative arterial carbon dioxide tension, extubation time, postoperative FeNO levels, and postoperative EOS counts were significantly associated with the occurrence of AAEs (p < 0.05). Multivariate logistic regression analysis demonstrated that the area under the curve for the combined postoperative FeNO and EOS levels was 0.866, with a sensitivity of 88.5% and specificity of 80.4%. These findings indicate that the combined measurement of these biomarkers offers superior early predictive value for postoperative AAEs in patients with stable asthma. Conclusion: Postoperative measurement of FeNO and peripheral EOS counts seem to enhance the early prediction of AAEs in patients with stable asthma who were undergoing general anesthesia. The combined use of these biomarkers may offer a useful tool for early risk stratification, which supports timely implementation of preventive strategies and improved perioperative management, although further validation in larger and prospective studies is needed.

Objective: Penicillin allergy (PA) is associated with an increased risk for cesarean delivery, prolonged postpartum hospital stay, and less-preferred antibiotic prophylaxis and treatment. However, the majority of pregnant women with PA can safely receive penicillin after an allergy evaluation. We aimed to evaluate the safety and efficacy of PA delabeling across all trimesters and to characterize rates of first-line Group B Streptococcus (GBS) prophylaxis after PA delabeling. Methods: We conducted a retrospective analysis of clinical visits for pregnant women with PA referred to Duke Allergy and Immunology Clinic from October 2023 through May 2025. Outcome measures included removal of the PA label and subsequent peripartum antibiotic use. Results: Of the 117 pregnant patients with PA evaluated in the Allergy and Immunology clinic, 112 (96%) underwent PA testing, with gestational age spanning all trimesters. Two patients (2%) had direct oral challenge, which was tolerated without adverse reaction. The other 110 patients (98%) had skin testing, of which 106 (96%) were negative. Of these, 101 women (95%) subsequently passed oral amoxicillin challenge. All patients with negative testing results were delabeled. Among these, 30 women required GBS prophylaxis. Yet, 10 women (33%) received a penicillin alternative or no antibiotics. In total, 18 women were delabeled and reexposed to intrapartum penicillin. None had adverse reactions. Conclusion: PA evaluation is likely safe and effective through all trimesters of pregnancy. Further research, including randomized controlled trials, are needed to expand this knowledge. Most pregnant women referred for PA evaluation can have PA delabeled. Surprisingly, a large portion of women did not receive first-line GBS prophylaxis despite PA removal, reiterating the need for improved interdisciplinary communication.

Background: Cow's milk and hen's egg allergy are the most common immunoglobulin E (IgE) mediated food allergies in childhood. Current oral immunotherapy protocols use the native raw allergen, with severe anaphylaxis reported. Objective: The objective was to retrospectively evaluate the safety and clinical outcomes of a biscotti (twice baked cake) based milk and egg ladder by using stepwise oral food challenges in children at high risk. Methods: In this single-center retrospective review (June 2024 to April 2025), records of 33 children with IgE-mediated cow's milk protein allergy (n = 11) or hen's egg allergy (n = 22) were reviewed. The milk ladder comprised seven steps over 12 weeks and progressed from 3-, 2-, and 1-hour second-bake biscotti to a single-bake cake, tempered yogurt soup, yogurt, and pasteurized milk. Yogurt, rather than liquid milk, served as the dairy matrix until the final pasteurized-milk step. The egg ladder comprised six steps with an analogous structure ending at boiled egg. At each step, a five-step in-hospital oral food challenge was performed on the first day. Results: The median age was 19.0 months (milk) and 14.0 months (egg). The median baseline specific IgE levels to milk and egg were 49.7 kUA/L and 19.85 kUA/L, respectively. All adverse reactions were mild. Gastrointestinal reactions clustered in the first three biscotti steps, whereas cutaneous reactions were concentrated in later steps. No reactions were observed at the cake or soup steps, and no anaphylaxis or epinephrine requirement occurred. At the end, 33 of 33 patients tolerated pasteurized milk or boiled egg. Conclusion: This biscotti-based milk and egg ladder, structured according to cooking duration, was implemented with a mild adverse-reaction profile and achieved clinical desensitization in all 33 patients. Adaptation of the biscotti approach to egg allergy and the use of yogurt as the dairy matrix in place of liquid milk are original design contributions; findings are hypothesis-generating and warrant randomized controlled prospective validation.

Background: Aspirin-exacerbated respiratory disease (AERD), also known as nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, is a chronic condition that is both clinically complex and often difficult for patients to understand. As patients increasingly turn to online tools for medical information, it is important to evaluate the quality of the responses they may receive. Objective: This study assessed the medical accuracy and readability of responses generated by ChatGPT 5.1, Gemini 2.5 Flash, and Claude Sonnet 4.5 to 12 common questions that patients often ask their providers about AERD. Methods: The 12 questions were developed by clinicians and patients; the resulting chatbot responses were de-identified and reviewed by an expert panel of 11 AERD specialists who rated each response for medical accuracy on a 10-point scale. Readability was measured by using readability and grade-level analysis programs. Results: Gemini's responses had the highest overall ratings for medical accuracy, followed by Claude and ChatGPT. The models generated responses written at a postgraduate reading level, which is substantially higher than recommended targets for patient-education materials. Questions with more complex responses showed greater variability in expert ratings, potentially reflecting differences in clinical interpretation. Conclusion: Analysis of these findings suggests that, whereas chatbots may improve access to medical information, their current outputs require clinician review and substantial simplification before they can be reliably used for patient education.

A 30-year-old woman presented with glucocorticoid-dependent chronic spontaneous urticaria (CSU) previously treated with high-dose H1-second generation antihistamines, omalizumab, and cyclosporin (This is the current Chronic spontaneous urticaria guidelines: Step 1 - second generation H1 antihistamine up to 4 times than standard dose; Step 2 - Omalizumab; Step 3 - Cyclosporin) that were either intolerable or ineffective at providing symptom relief. She also had two prolonged treatment courses with omalizumab that failed. Her CSU was cyclical worsening during ovulation and improving but not resolving midway through her cycle. Markers for chronic autoimmune urticaria (CAU) were positive. Treatment with progesterone desensitization was partially successful, which allowed her to taper her daily glucocorticoids to prednisone 20 mg a day. She was diagnosed with progesterone hypersensitivity with concomitant CAU. Subsequent treatment with rituximab to remove pathogenic autoantibodies was successful in allowing her to taper off prednisone and tolerate progesterone without hives during or independent of her menstrual cycle. She subsequently was able to conceive a healthy baby girl without recurrence of hives.

Background: Hereditary angioedema is a rare bradykinin-mediated disorder characterized by recurrent, unpredictable swelling attacks that can substantially impair quality of life. Objective: The objectives were to describe attack triggers reported during the previous 4 weeks, compare the clinical impact of emotional and physical and/or organic triggers on attack outcomes, Angioedema Control Test (AECT) based disease control, and quality of life; and, secondarily, to examine the associations of the attack burden with the AECT and Angioedema Quality of Life (AE-QoL) Questionnaire scores. Methods: This single-center retrospective cross-sectional study included 50 adults with type I or type II hereditary angioedema followed up between January 2019 and October 2025. Data extracted from medical records included the number of attacks during the preceding 4 weeks, characteristics of the most severe attack, trigger category, disease control assessed by the AECT, and quality of life assessed by the AE-QoL Questionnaire. Triggers were grouped as emotional (stress/sadness) or physical/organic (trauma, infection, physical exertion, hormonal/metabolic). Results: The median age was 40.5 years, 54% of the patients were women, the median diagnostic delay was 16.5 years, and 82% had a positive family history of hereditary angioedema. Emotional stress was the most commonly reported trigger of the most severe attack (60%). No significant differences were observed between emotional and physical/organic trigger groups in attack frequency, duration or severity of the most severe attack, emergency department visits, AECT-based disease control, or quality-of-life scores (all p > 0.05). Attack frequency was negatively correlated with AECT-based disease control (r = -0.631; p < 0.001) and positively correlated with quality-of-life impairment (r = 0.428; p = 0.002), with the strongest association in the fear/shame domain (r = 0.500; p < 0.001). AECT-based disease control was strongly inversely correlated with quality-of-life impairment (r = -0.734; p < 0.001). Conclusion: Emotional stress was the most frequently reported trigger of recent hereditary angioedema attacks. Although clinical outcomes did not differ according to trigger type, a higher attack frequency was associated with poorer AECT-based disease control and worse quality of life.