History Of Allergy Research Articles

Characteristics of pediatric patients with chronic cough: data from a pediatric immunology and allergy outpatient clinic

Aims: Chronic cough is a common complaint in childhood. A differential diagnosis is very important in children with a chronic cough. We aimed to investigate the etiology and underlying risk factors of chronic cough in children. Methods: Patients aged 1-18 years who were referred to Sincan Training and Research Hospital Pediatric Immunology and Allergy Outpatient Clinic were included. Demographic, clinical and laboratory features of patients were recorded. Results: The study included 403 children with a median age of 8 years (IQR 6-12) (53% males). 30% of patients had allergic rhinitis (AR), 4.7% of patients had atopic dermatitis (AD), and 2% patients had food allergy (FA) history. 78(19.3%) patients also complained of dyspnea and 9 (2.2%) patients had a diagnosis of cardiovascular disease. 245 (60.8%) asthma-wheezy infant, 107 (26.6%) post-infectious cough, 36 (9%) postnasal drip syndrome, 9 (2.2%) gastroesophageal reflux and 6 (1.5%) psychogenic cough were detected in the whole group. The number of patients with accompanying dyspnea 76 (28.5%) and familial history of atopy 113 (42.3%) were higher in the asthma-wheezy infant group than others group (p

Risk Factors Analysis of Cutaneous Adverse Drug Reactions Caused by Targeted Therapy and Immunotherapy Drugs for Oncology and Establishment of a Prediction Model.

Targeted therapy and immunotherapy drugs for oncology have greater efficacy and tolerability than cytotoxic chemotherapeutic drugs. However, the cutaneous adverse drug reactions associated with these newer therapies are more common and remain poorly predicted. An effective prediction model is urgently needed and essential. This retrospective study included 1052 patients, divided into train set, test set, and external validation set. As a data-driven study, a total of 76 variables were collected. Univariate logistic analysis, least absolute shrinkage and selection operator regression, and stepwise logistic regression were utilized for feature screening. Finally, nine machine-learning models were constructed and compared, and grid search was performed to adjust the parameters. Model performance was evaluated using calibration curve and the area under the receiver operating characteristic curve (AUROC). Nine risk factors were eventually identified: age, treatment modality, cancer types, history of allergies, age-corrected Charlson comorbidity index, percentage of eosinophils, absolute number of monocytes, Eastern Cooperative Oncology Group Performance Status, and C-reactive protein. Among the models, the logistic model performed best, demonstrating strong performance in test set (AUROC = 0.734) and external validation set (AUROC = 0.817). This study identified nine significant risk factors and developed a nomogram prediction model. These findings have important implications for optimizing therapeutic efficacy and maintaining the quality of life of patients from the perspective of managing cutaneous adverse drug reactions. Trial Registration: ChiCTR2400088422.

Risk of Obstructive Sleep Apnea in Patients With Muscle Tension Dysphonia: A Prospective Pilot Study.

To investigate the risk of obstructive sleep apnea (OSA) in patients with muscle tension dysphonia (MTD) in comparison to subjects with no dysphonia. Prospective cohort study. Patients who were diagnosed with MTD at a tertiary referral center between October 2022 and October 2023 were invited to participate in this study, alongside a healthy control group matched by age and gender, with no history of dysphonia. The risk of OSA was evaluated using the STOP-BANG and Epworth Sleepiness Scale (ESS) questionnaires. Demographic data included age, gender, history of smoking, history of allergy, and history of reflux disease. A total of 55 patients who had filled the STOP-BANG and ESS questionnaires were enrolled in this study, including 31 patients diagnosed with MTD and 24 healthy subjects. Using the STOP-BANG, two-thirds of the study group had an intermediate-to-high risk of having OSA as compared to 25% of the control group (P=0.002). The odds of having OSA was 6.3 times among patients with MTD in comparison to controls (OR=6.3; 95% CI [1.91-20.75]. When using the ESS, nine patients of the study group (29%) exhibited excessive daytime sleepiness compared to none in the control group (P=0.007). The results of this investigation indicate that the risk of OSA is significantly higher in patients with MTD vs. controls. Patients with MTD were 6.3 times more likely to have an increased risk of OSA in comparison to subjects with no dysphonia. A longitudinal study using objective tests for OSA is needed to establish a cause-effect relationship between OSA and MTD.

Evidence-Based Approaches to Food Allergy Diagnosis

The prevalence of food allergy has increased in the past decades. However, most studies are based on self-reported clinical history of food allergy rather than food challenge-confirmed ones; these may overestimate the prevalence of food allergy. Food allergy has been identified as one of the most common causes of anaphylaxis, especially among children. Like other studies, the study by Rosero et al., published in this issue, identified that food is the most common trigger for anaphylaxis among pediatric patients admitted to a tertiary hospital.1 The incidence of food-induced anaphylaxis in children worldwide is varied, with a range of 1 to 77 per 100,000 person‐years.2 Moreover, almost half of all patients with food allergies experienced anaphylaxis in any previous reaction (46%, 2556/5587), based on the Food Allergy Research & Education (FARE) Patient Registry.3 The most common food triggers causing anaphylaxis in adults are crustaceans and eggs, cow’s milk, nuts, wheat, and shellfish among children.4,5 A detailed allergy-focused clinical history is the first step in the diagnostic work-up among patients suspected to have food allergies. The allergy-focused history will serve as a guide to the allergy tests that will be done. Skin prick tests (SPT) to allergen extracts and fresh food, serum-specific IgE (sIgE) to allergen extracts and individual allergen components, and basophil activation test (BAT) are recommended tests to support the diagnosis of IgE-mediated allergy.6 These tests have high to moderate sensitivity (negative result rules out FA) and specificity (positive result rules in FA) to a variety of food.7 BAT is suggested to support the diagnosis of food allergy among those with an equivocal diagnosis of IgE-mediated allergy to peanut and sesame. The gold standard for diagnosing food allergy is the oral food challenge (OFC). However, the OFC is resource-intensive and may pose severe allergic reactions. In the EAACI guidelines on diagnosing IgE-mediated FA, OFC is the recommended reference diagnostic procedure to confirm or exclude FA.6 Based on the same guidelines, the double-blind placebo-controlled food challenge is suggested if an open OFC outcome is indeterminate and in research studies. There are tests available in laboratories that lack evidence of diagnostic validity and do not show a correlation with food allergy. Patients will seek physicians' opinions regarding these tests or will come to the clinic with the results of these tests marketed as food allergy or food intolerance tests. Society guidelines and practice parameters do not recommend unvalidated tests to diagnose food allergy.6,8-10 These tests, such as IgG or IgG4 antibody level, hair analysis, electrodermal testing, antigen leukocyte antibody test, mediator release test, and kinesiology.11 The Philippine Society of Allergy, Asthma, and Immunology does not recommend food-specific IgG testing to identify or predict adverse reactions to food.9 The production of food-specific IgG or IgG4 is a normal immunologic response linked to the development of tolerance, not food allergy or intolerance. Identifying the food trigger through an allergy-focused clinical history and validated diagnostic tests is essential to prevent future adverse reactions, eliminate unnecessary food elimination, prevent nutritional deficiencies, and improve quality of life.

Drug prescription pattern in asthma in a tertiary care hospital in South India

Background: Asthma, a chronic inflammatory disorder of the airways, affecting millions of individuals is a global health concern. It necessitates long-term management for optimal outcomes. impacting therapy costs and patient’s compliance. This study was done to analyse current prescribing trends in the management of asthma patients. This study examines current asthma treatment trends to enhance patient care and disease outcomes. Methods: This is an Observational cross-sectional study conducted at Government T. D. medical college, Alappuzha between October 2019 to September 2022. All patients clinically diagnosed with or a previously known case of asthma between 18-60 years of both sex attending the outpatient department of Pulmonary Medicine who gave consent for study were included. Data was collected by interviewing and from the patients OP card using a prestructured proforma. Data collected included patient details, allergy and smoking history, comorbid conditions, drugs prescribed for asthma along with dose, route and frequency of administration, concomitant medications, diagnostic tests if any. Results: Out of 200 asthma cases, 119 (59.5%) were females. The mean age was 43.95±10.62 years. 21 patients (10.5%) were smokers. 57 (28.5%) patients had an allergic predisposition. Hypertension n=48 (24%) was the most common comorbidity among the patients. A mean of 3.05±1.52 drugs per prescription. Out of 609 drugs prescribed, 450 (73.89%) drugs were from the National list of essential medicines (NLEM) and 366 (60.09%) drugs were from the WHO essential list. A combination of LABA with ICS was the most common drug given in 121 (60.5%) patients followed by Glucocorticoids 101 (50.5%) and PDE-inhibitor-Deriphylline 74 (37%) patients. Antibiotics was prescribed in 43 (21.5%) patients. 164 (82%) patients received a combination therapy. Out of the 609 drugs prescribed, 334 (54.8%) were oral followed by inhalational route 264 (43.3%). Conclusion: Study demonstrates the variability of drug utilization in asthma patients. The rising significance of PPMS (Prescription pattern monitoring studies) stems from heightened marketing of new medications, shifts in prescribing patterns and drug consumption, escalating worries regarding delayed adverse reactions, drug costs, and prescription volumes.

Risk factors of Hypersensitivity Reactions to Carboplatin: A Systematic Review and Meta-analysis.

The development of hypersensitivity reactions (HSRs) to carboplatin can interrupt anticancer treatment and may shorten patient survival. Several studies have evaluated the risk factors for carboplatin HSRs, but the results have been inconclusive. This systematic review and meta-analysis aim to establish a consensus on the risk factors of HSRs to carboplatin in cancer patients. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, relevant studies were searched across MEDLINE, EMBASE, and Korean Medical Database. Inclusion criteria focused on original articles of case-control or cohort studies that evaluated risk factors for carboplatin HSRs in cancer patients. Exclusion criteria targeted articles with incomplete or overlapping data. The latest search and quality assessment of the included studies, using the Newcastle-Ottawa scale, was performed on February 1, 2023. Among 1,182 articles identified, 19 studies were included in the final systematic review and meta-analysis. The identified risk factors for carboplatin hypersensitivity included a history of allergy to medicines, food, or environmental factors (OR of 1.76, 95% CI 1.46 - 2.12), BRCA mutation (OR of 4.03, 95% CI 2.00 - 8.13), carboplatin free interval of 12 months or more (OR of 4.93, 95% CI 2.89 - 8.40), increased cumulative dose (SMD of 0.58, 95% CI 0.41 - 0.75), relapse (OR of 2.26, 95% CI 1.58 - 3.25), and younger age (SMD of -0.15, 95% CI: -0.26 - -0.03). This meta-analysis provides the first comprehensive quantitative evaluation of risk factors for carboplatin HSRs in cancer patients. These findings can guide the development of personalized risk assessment tools and preventive strategies, potentially improving patient safety and treatment outcomes in carboplatin-based chemotherapy.

Features of humoral immunity in persons with post-COVID syndrome burdened by history of allergy

From December 2019 to March 2020, the human population faced a new coronavirus pandemic, COVID-19, caused by SARS-CoV-2, which led to global morbidity and high mortality worldwide. Typical features of coronavirus infection tended to resemble a seasonal infection over time. Despite this fact, it has been proven that, after acute disease, numerous disorders are detected in the patients, manifesting both with general health disturbances and as complications of pre-existing chronic diseases, including allergic syndrome. On the basis of these findings, the study of post-COVID syndrome became an important aspect of the ongoing COVID-19 research. It has been shown over recent decades that the number of people suffering from various types of allergic reactions is growing every year. Therefore, the studies in allergic pathology in the structure of post-COVID syndrome are among the most pressing issues. In addition to studying exacerbations of allergic reactions, a thorough analysis has shown that adverse reactions caused by coronavirus infection are viewed from new aspects, being characterized by functional disorders of acquired and innate immune response, causing increasingly severe consequences for the immune system and the whole body. Currently, the features of humoral immune response in post-COVID syndrome have not been sufficiently studied. In this respect, we have evaluated the features of humoral immunity in patients with post-COVID syndrome, with clinically confirmed allergic anamnesis. The study revealed changes in humoral immune system, indicating that the most significant changes are observed in post-COVID patients with a burdened history of allergies, thus requiring a more detailed study of immune status in order to develop an individualized approach to immunocorrection of these disorders in this group of patients.

A Study Of the effect of Sex on drug dosing, concentrations, and pharmacogenomics in the Montreal Heart Institute Hospital Cohort (SOS-PGx): methodology and research progress.

Women are underrepresented in drug development trials and there is no sex-tailored drug regimen for most medications. It has been repeatedly shown that women have more adverse drug reactions than men for several medications. These differences could be explained by higher dose-adjusted drug concentrations in women. Thus, we aim to identify sex-related differences and to characterize the clinical and genetic predictors of these differences in drug concentrations, dosing, and adherence for 47 commonly used drugs in a large cohort. The objective of this article is to present an overview of the methods and characteristics of the study population. We performed a cross-sectional study that included 10,082 men and women of European ancestry aged ≥ 18years from the Montreal Heart Institute Hospital Cohort taking at least one of the 47 medications regularly. Of the 10,082 participants included, 36% were women. Women had lower weight, height, waist girth, and body mass index than men, but they had higher hip girth (all p < 0.001). Men had a higher level of education and annual income and were more likely to be employed full-time compared to women. Furthermore, men had a higher prevalence of hypertension, type2 diabetes, dyslipidemia, andmyocardial infarction (all p < 0.001) and were more likely receiving lipid-lowering agents, beta-blockers, antidiabetic drugs, and angiotensin-converting enzyme inhibitors. Conversely, proton pump inhibitors were more prevalent in women. Interestingly, nearly half of the women had a history of drug allergy or intolerance, compared with less than one-third of the men (p < 0.001). This study has a high potential in understanding eventual sex differences in drug dosing requirements and will most likely provide useful information to personalize drug regimens in women.

Pathophysiology of De Novo Food Allergies After Solid Organ Transplant in Pediatric Patients.

De novo food allergy is a common phenomenon among pediatric solid organ recipients (8.5%-57%) when compared with the general population (0.45%-10%). Other associated disorders include non-IgE-mediated immune reactions and clinical predisposition to asthma and alterations in the oral mucosa. Originally, passive mechanisms (passive transfer of IgE and immune cells) were thought to be responsible for acute, transient cases of food allergies with a previous history of sensitization for a specific allergen in the donor. Recently proposed pathophysiological mechanisms to explain de novo allergies include TH2/B-cell imbalance, regulatory T-cell (Treg) disruption, gastrointestinal immaturity, and altered gastrointestinal permeability. Recent studies also suggest that immunosuppressive drugs, especially tacrolimus, promote naïve T-cell differentiation into TH2 cells, IgE-promoting cytokine production, decreased IL-5 and IL-10 levels, increased IgA levels, and Treg disruption. Such immunological interactions, in conjunction with altered intestinal permeability, intestinal immaturity in children, history of viral infection, and a personal history of allergies or eczema, are thought to explain most clinical cases of pediatric de novo food allergy after solid organ transplantation reported in the literature. A better understanding of the immunological mechanisms underpinning organ donors and recipients may unveil some of the caveats concerning therapeutic management and improve the quality of life of affected individuals.

A Case of Acute Eosinophilic Granulomatous Tubulointerstitial Nephritis in a Patient Receiving Combination Treatment with Three Drugs.

We herein report a 69-year-old man with acute kidney injury who required dialysis after receiving a combination of three drug-induced lymphocyte stimulation test-positive drugs. A kidney biopsy showed tubulointerstitial nephritis with severe eosinophilic infiltration and numerous granuloma formations. Acute eosinophilic granulomatous tubulointerstitial nephritis was diagnosed. Eosinophilic granulomatosis with polyangiitis was ruled out because there was no evidence of vasculitis or serum antineutrophilic cytoplasmic antibody and no history of allergy. No clinical findings were suggestive of sarcoidosis. Based on the above findings, the disease was considered to be induced by these three drugs. The renal function was normalized with glucocorticoid treatment.

Rare and Fatal Complication: A Case of Ketorolac-Induced Anaphylaxis Leading to Cardiac Arrest and Hypoxic-Ischemic Brain Injury in a Young Adult

Background: Anaphylaxis is a severe, life-threatening allergic reaction that can lead to cardiac arrest and hypoxic-ischemic brain injury (HIBI). Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID) commonly used for postoperative pain management, has been rarely associated with anaphylaxis. Case presentation: We present the case of a 32-year-old woman who developed anaphylaxis and subsequent cardiac arrest following intravenous administration of ketorolac after an appendectomy. Despite successful resuscitation, the patient suffered from HIBI and remained in a persistent vegetative state. Conclusion: This report highlights the potential for fatal complications associated with ketorolac administration and emphasizes the importance of prompt recognition and management of anaphylaxis in the perioperative setting. This case underscores the need for heightened vigilance regarding potential anaphylactic reactions to ketorolac, even in patients with no prior history of drug allergies. Early recognition and aggressive management of anaphylaxis are crucial to minimize the risk of severe complications like cardiac arrest and HIBI.

Adverse reactions to iodinated contrast media in patients with a history of allergies

Adverse reactions to iodinated contrast media in patients with a history of allergies

What is the science underpinning the prescription of antibiotics in dentistry?

A critical review on the use of antimicrobials in dentistry. To provide a general overview of the use of antimicrobials in dentistry. The paper was divided into different topics, starting with an approach to understanding both commensal and pathogenic oral microbiota. Subsequently, emphasis was placed on the main categories of antibiotics used in dentistry (β-lactams, tetracyclines, macrolides, lincosamides, nitroimidazoles and quinolones), and the basis for their prescription. Finally, the implications between systemic diseases and the use of orally-administered antibiotics are presented. The study suggests that an adequate medical history can minimize the risk of systemic adverse effects, unwanted drug interactions, and allergies related to the use of antibiotics. In this regard, when facing a potential history of allergy to a particular group of antibiotics, the prescription of a different group is mandatory. In most indications, β-lactam antibiotics represent the first-choice in dentistry. Moreover, a short-term prescription of antibiotics when treating acute oral infections is recommended. The use should be extended for 2 to 3 days following the resolution of the infection, with an average duration of 6 days in order to prevent the development of antibiotic resistance. Oral infections should be managed with interventions aiming at the elimination/reduction of the associated pathogens. Furthermore, inadequate prescription of antibiotics can lead to potential risks to the patient such as allergy, adverse effects, and development of microbial resistance.

Profile of contact dermatitis in the inpatient department of Dr. Soetomo General Hospital Surabaya

Background: Contact dermatitis (CD) is a common inflammatory skin disorder triggered by exposure to external substances, resulting in immune responses and skin or mucosal inflammation. CD is categorized into allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD), with CD accounting for 70-90% of skin diseases. Of these, 80% are ICD and 20% ACD. In Indonesia, the prevalence of dermatitis is 6.78%, with ICD comprising 66% and ACD 34%. Objective: To evaluate the clinical profile of CD patients admitted to the inpatient department of Dr. Soetomo General Hospital, Surabaya, during the years 2020-2021. Methods: This descriptive, retrospective study used total sampling from medical records of all CD patients admitted to the hospital who met the inclusion criteria. Results: The number of contact dermatitis patients found was 44 patients, ACD was the most common type (61.36%), and the majority of patients stayed for 0-7 days (45.45%). Most patients were aged 18-65 years (47.73%) and female (52.27%). Allergens were the primary trigger (50%). Among the patients, 88.64% had no history of allergies, but 97.73% had underlying history. Erythema was the most frequent clinical manifestation (16.48%), predominantly in the genital area (20.34%). Conclusion: ACD was the predominant form of CD among inpatients, with a high prevalence in females aged 18-65 years. Allergens were the primary trigger, and erythema was the most common clinical presentation, particularly in the genital area.

Aesthetic crown lengthening in gingival enlargement patients with orthodontic treatment: A case report

Introduction: The orthodontic treatment process that is carried out can cause changes in the soft tissue and hard tissue of the tooth support and the most common is the enlargement of the gingiva. One of the managements in the case of gingival enlargement is crown lengthening, which is carried out by taking gingival tissue with or without bone reduction to further expose the tooth structure so that a better ratio of dental crown and gingiva is obtained. The purpose of this article is to describe the crown lengthening procedure with bone reduction to correct excessive gingival display in patients with orthodontic treatment on the anterior teeth of the upper jaw Case Report: A 19-year-old female patient came to the Periodontology Specialist Poly on a referral from the Dental Orthodontic Specialist of RSGM Universitas Airlangga with complaints that the upper front teeth looked shorter. The patient does not have problems with the periodontal tissue and has no history of systemic diseases such as diabetes, high blood pressure, and no history of allergy to medications. Case management: After the analysis is carried out on the periodontal tissue, the therapy option is in the form of crown lengthening with bone reduction for the treatment of the case. Conclusion: Determining etiological factors and proper examination is very important to determine a crown lengthening action plan as the elimination of gingival enlargement so that it can improve aesthetic appearance.

Colloid Bodies in Cutaneous Basal Cell Carcinoma: Clinical and Histologic Correlates-An Analysis of 405 Cases.

Colloid bodies (CB), also known as Civatte bodies, are commonly seen in inflammatory dermatoses and are thought to represent cell degeneration. No studies have investigated the incidence and clinical associations of CB in cutaneous basal cell carcinoma (BCC). The aim of this study is to assess the incidence of CB in BCC lesions and analyze their clinical associations. Four hundred and five sequential cases of cutaneous BCC from 396 patients diagnosed from 1/1/2023 to 12/31/2023 in our institution were studied for the presence of CB. Only cases of BCC with a single growth pattern were included. BCC subtype, patient age, location of the lesion, history of previous BCC at other site, smoking history, and allergy history were collected. Cases with and without CB were compared for each parameter using the paired t-test for age and the Chi-square test for categorical data. Patients were grouped based on the presence of CB into a study group (57 cases) and control group with no CB (348 cases). CB were identified in 14% (57/405) of BCCs. 19% (54/281) of nodular, 12.5% (1/8) of infiltrative, and 1.7% (2/116) of superficial type BCCs had CB. BCC with CB were more common on the face/scalp than other sites (66.7% vs. 34.2%, p < 0.001). Patients with CB were older (median 72 vs. 68 years ±12, p = 0.04), predominantly male (63% vs. 47%, p = 0.02), more frequently had a prior BCC (0.61% vs. 0.38%, p = 0.012), and did not differ in smoking history compared to the control cohort. We identified CB in 14% of BCCs studied, most commonly in nodular, followed by infiltrative, and least often superficial type. After cohort matching, significant clinical associations of CB in BCC were sun-exposed location and personal history of one or more prior BCC at other site(s). Their pathogenesis is not known, however their presence suggests tumor regression, which may potentially be exploited for new therapies in a subset of patients.

Beyond Skin Deep: Patient Insights Into Cosmetic Procedures and Their Risks in Madinah, Saudi Arabia.

Background The demand for cosmetic procedures has increased significantly due to their positive effects on self-satisfaction. However, individuals often underestimate the potential complications associated with these procedures, driven by a strong desire for transformation. Therefore, this study aimed to evaluate the Madinah community's awareness of cosmetic procedures and plastic surgery, as well as to assess the risks, complications, and clinical outcomes associated with these procedures. Materials and methods A non-probability consecutive sampling method was employed to select study participants, including every patient who met the inclusion criteria until the target sample size was reached, between March and June 2023. An intervener-based questionnaire survey was conducted to assess participant's understanding of the severity and associated risks of cosmetic procedures and plastic surgery. The minimum required sample size was determined to be 82 using OpenEpi version 3 software. Data were analyzed using t-tests, chi-square tests, and analysis of variance (ANOVA) as appropriate. Results The study included 82 participants, with 48.80% aged between 18 and 30 years and only 3.7% of them were male. The majority were of Saudi nationality (86.60%). While most participants (82.9%) were aware of cosmetic procedures and their risks, 28% lacked knowledge about potential complications, highlighting a notable knowledge gap. Some of the participants reported underlying health conditions such as obesity (8.5%), diabetes (3.7%), asthma (3.7%), and hypertension (2.4%), along with family histories of hereditary diseases (37.8%) and allergies (15.9%). The most common complications were facial swelling (63.41%), bruising (51.22%), rashes (30.49%), and subcutaneous blood pooling (19.51%). Less frequent complications included infections (15.85%) and reduced facial expressions (9.76%). Conclusion The study revealed that most participantsdemonstrated an overall awareness of the potential complications associated with cosmetic procedures. The commonly recognized complications of cosmetic facial procedures included swelling, bruising, rash, subcutaneous blood pooling, and infection. However, no specific factors related to the planning of facelift procedures were identified.

Characteristics of patients with low serum IgE levels and selective IgE deficiency: Data from an immunodeficiency referral center

Low immunoglobulin E (IgE) levels are defined as values below 2.5 IU/mL. Selective IgE deficiency (sIgED) refers to reduced serum IgE levels in patients with normal IgA/G/M levels. We evaluated 677 patients with low IgE levels. Recurrent infections (78.8 %), a history of allergy (27.3 %), and autoimmune/inflammatory diseases (18.3 %) are common. The primary immunodeficiency disease (PID) (n = 483, 71.3 %) diagnoses include 313 (46.2 %) patients with antibody deficiency and 119 (17.6 %) with combined immunodeficiency. Genetic pathogenic variants were present in 154 out of 207 PID patients. Within sIgED group, 23 (19.8 %) had primary immunodeficiencies. We observed a high prevalence of autoimmune/inflammatory diseases, allergies, malignancies, and PID among patients with low IgE levels. Therefore, clinicians should be vigilant when evaluating patients with low IgE levels, as this finding may indicate an underlying systemic disease or PID.

Association between gut microbiota and acute upper respiratory tract infection: a Mendelian randomization study

Targeting specific gut microbiota (GM) species to prevent and treat acute upper respiratory tract infection (AURTI) has attracted researchers’ attention, but the relationship between the two is unclear. Based on the summary data from genome-wide association studies (GWAS) on GM and five types of AURTIs (acute nasopharyngitis (common cold), acute pharyngitis, acute sinusitis, acute upper respiratory infections, and acute upper respiratory infections of multiple and unspecified sites), we performed two-sample bidirectional Mendelian randomization (MR) to assess the causal relationship. Through inverse variance weighting (IVW) method, we found that 33 potential microbial taxa can influence the occurrence of AURTI. Sensitivity analysis showed no potential horizontal pleiotropy and heterogeneity bias. We further employed multivariable Mendelian randomization to investigate the impact of potential interference factors on the significant associations previously identified, considering aspects such as comorbidities associated with AURTI, seasonal variations, pathogen specificity, and history of antibiotic allergies. Ultimately, 11 microbial taxa remained significantly associated. This study provides robust evidence for a causal relationship between GM and five types of AURTIs, thereby offering a foundation for the development of microbiota-targeted therapies and related probiotic interventions aimed at AURTI.

Carbimazole-induced eosinophilic gastroenteritis in a young female with abdominal pain and ascites: a case report

BackgroundEosinophilic gastroenteritis is a rare disease characterized by eosinophilic infiltration into one or more layers of the gastrointestinal tract. It commonly affects children more than adults. The clinical features depend on the site of gut involvement, but the most common symptoms include abdominal pain and diarrhea. The most common cause reported in the literature is hypersensitivity, as many patients have a history of seasonal allergies, atopy, asthma, food allergies, and so on. However, drugs can be a rare triggering factor. In the literature review, we found multiple case reports of eosinophilic gastroenteritis; however, only one other case of carbimazole-induced eosinophilic gastritis has been reported.Case presentationWe report herein the case of a 36-year-old female from the Philippines who developed eosinophilic gastroenteritis localized to the esophagus and ileum 12 months following treatment with carbimazole for hyperthyroidism. In our facility, she was extensively investigated for malignancy, autoimmune pathologies and infectious etiologies. As the symptoms coincided with carbimazole exposure and other causes were ruled out, we labeled her as carbimazole-induced eosinophilic gastroenteritis. On subsequent follow-up after discharge, her symptoms and eosinophilia resolved when carbimazole was discontinued, suggesting a causative role. This is the first case of eosinophilic gastroenteritis secondary to carbimazole encountered in our region.ConclusionDiagnosis of eosinophilic gastroenteritis requires three criteria, namely (1) presence of gastrointestinal symptoms, (2) histologic evidence of eosinophilic infiltration in one or more areas of the gastrointestinal tract, and (3) exclusion of other causes of tissue eosinophilia. Our patient fulfilled all the criteria; additionally, she had a positive history of atopic tendencies and drug exposure. The diagnosis of hyperthyroidism was established a year ago and in another facility, so we were not sure of the underlying etiology of hyperthyroidism. Upon subsequent follow-up, her thyroid function remained stable. The case highlights the need for a collaborative multidisciplinary approach toward managing rare conditions.