Allergy Clinic Research Articles

A Comprehensive Analysis of Immunoglobulin E Levels, Allergen-Specific Sensitivities, and Clinical Manifestations in Allergic Dermatological Conditions: A Multicenter Retrospective Study in China.

To assess the correlations between Immunoglobulin E (IgE) levels, pruritus, and lesion severity in patients with eczema, atopic dermatitis, or urticaria. A retrospective study was conducted and data of 814 patients who visited the dermatology or allergy clinics of multiple hospitals, from December 2019 to December 2021, were collected. Patients were divided into children group (<18 years, 325 cases), adult group (18-60 years, 435 cases), and older population group (>60 years, 54 cases) based on the age. Baseline information, pruritus severity, severity of skin lesions, total IgE level, and specific IgE level were recorded to analyze the complex relationship between them. The prevalence of allergic conjunctivitis and allergic rhinitis in the children group was significantly higher than that in the adult and older population group (P < 0.01 or P < 0.05). The positive rate of specific IgE in children group was significantly higher than that in the adult and older population group (P < 0.01). The IgE levels in children with moderate pruritus were significantly lower than those of severe pruritus (63.39vs 114.42 IU/mL, P < 0.05). The IgE levels in children with mild and moderate skin lesions were significantly lower than those in children with severe skin lesions (58.95 vs 72.88 vs 169.15 IU/mL, P < 0.001 or P < 0.01, respectively). Relationships among age, severity of skin pruritus and lesions, and allergen-specific IgE response are complex and subtle, displaying dynamic patterns.

Executive Summary of Clinical Practice Guideline on Immunotherapy for Inhalant Allergy.

Allergen immunotherapy (AIT) is the therapeutic exposure to an allergen or allergens selected by clinical assessment and allergy testing to decrease allergic symptoms and induce immunologic tolerance. Inhalant AITis administered to millions of patients for allergic rhinitis (AR) and allergic asthma (AA) and is most commonly delivered as subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT). Despite its widespread use, there is variability in the initiation and delivery of safe and effective immunotherapy, and there are opportunities for evidence-based recommendations for improved patient care. The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the management of inhaled allergies with immunotherapy. Specific goals of the guideline are to optimize patient care, promote safe and effective therapy, reduce unjustified variations in care, and reduce risk of harm. The target patients for the guideline are any individuals aged 5 years and older with AR, with or without AA, who are either candidates for immunotherapy or treated with immunotherapy for their inhalant allergies. The target audience is all clinicians involved in the administration of immunotherapy. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group. It is not intended to be a comprehensive, general guide regarding the management of inhaled allergies with immunotherapy. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. The guideline development group made a strong recommendation that (Key Action Statement [KAS] 10) the clinician performing allergy skin testing or administering AIT must be able to diagnose and manage anaphylaxis. The guideline development group made recommendations for the following KASs: (KAS 1) Clinicians should offer or refer to a clinician who can offer immunotherapy for patients with AR with or without AA if their patients' symptoms are inadequately controlled with medical therapy, allergen avoidance, or both, or have a preference for immunomodulation. (KAS 2A) Clinicians should not initiate AIT for patients who are pregnant, have uncontrolled asthma, or are unable to tolerate injectable epinephrine. (KAS 3) Clinicians should evaluate the patient or refer the patient to a clinician who can evaluate for signs and symptoms of asthma before initiating AIT and for signs and symptoms of uncontrolled asthma before administering subsequent AIT. (KAS 4) Clinicians should educate patients who are immunotherapy candidates regarding the differences between SCIT and SLIT (aqueous and tablet) including risks, benefits, convenience, and costs. (KAS 5) Clinicians should educate patients about the potential benefits of AIT in (1) preventing new allergen sensitization, (2)reducing the risk of developing AA, and (3) altering the natural history of the disease with continued benefit after discontinuation of therapy. (KAS 6) Clinicians who administer SLIT to patients with seasonal AR should offer pre- and co-seasonal immunotherapy. (KAS 7) Clinicians prescribing AIT should limit treatment to only those clinically relevant allergens that correlate with the patient's history and are confirmed by testing. (KAS 9) Clinicians administering AIT should continue escalation or maintenance dosing when patients have local reactions to AIT. (KAS 11) Clinicians should avoid repeat allergy testing as an assessment of the efficacy of ongoing AIT unless there is a change in environmental exposures or a loss of control of symptoms. (KAS 12) For patients who are experiencing symptomatic control from AIT, clinicians should treat for a minimum duration of 3 years, with ongoing treatment duration based on patient response to treatment. The guideline development group offered the following KASs as options: (KAS 2B) Clinicians may choose not to initiate AIT for patients who use concomitant beta-blockers, have a history of anaphylaxis, have systemic immunosuppression, or have eosinophilic esophagitis (SLIT only). (KAS 8) Clinicians may treat polysensitized patients with a limited number of allergens.

Clinical Practice Guideline: Immunotherapy for Inhalant Allergy.

Allergen immunotherapy (AIT) is the therapeutic exposure to an allergen or allergens selected by clinical assessment and allergy testing to decrease allergic symptoms and induce immunologic tolerance. Inhalant AITis administered to millions of patients for allergic rhinitis (AR) and allergic asthma (AA) and is most commonly delivered as subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT). Despite its widespread use, there is variability in the initiation and delivery of safe and effective immunotherapy, and there are opportunities for evidence-based recommendations for improved patient care. The purpose of this clinical practice guideline (CPG) is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the management of inhaled allergies with immunotherapy. Specific goals of the guideline are to optimize patient care, promote safe and effective therapy, reduce unjustified variations in care, and reduce the risk of harm.The target patients for the guideline are any individuals aged 5 years and older with AR, with or without AA, who are either candidates for immunotherapy or treated with immunotherapy for their inhalant allergies. The target audience is all clinicians involved in the administration of immunotherapy. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group (GDG). It is not intended to be a comprehensive, general guide regarding the management of inhaled allergies with immunotherapy. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. The GDG made a strong recommendation that (Key Action Statement [KAS] 10) the clinician performing allergy skin testing or administering AIT must be able to diagnose and manage anaphylaxis. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should offer or refer to a clinician who can offer immunotherapy for patients with AR with or without AA if their patients'symptoms are inadequately controlled with medical therapy, allergen avoidance, or both, or have a preference for immunomodulation. (KAS 2A) Clinicians should not initiate AIT for patients who are pregnant, have uncontrolled asthma, or are unable to tolerate injectable epinephrine. (KAS 3) Clinicians should evaluate the patient or refer the patient to a clinician who can evaluate for signs and symptoms of asthma before initiating AIT and for signs and symptoms of uncontrolled asthma before administering subsequent AIT. (KAS 4) Clinicians should educate patients who are immunotherapy candidates regarding the differences between SCIT and SLIT (aqueous and tablet) including risks, benefits, convenience, and costs. (KAS 5) Clinicians should educate patients about the potential benefits of AIT in (1) preventing new allergen sensitizations, (2) reducing the risk of developing AA, and (3) altering the natural history of the disease with continued benefit after discontinuation of therapy. (KAS 6) Clinicians who administer SLIT to patients with seasonal AR should offer pre- and co-seasonal immunotherapy. (KAS 7) Clinicians prescribing AIT should limit treatment to only those clinically relevant allergens that correlate with the patient's history and are confirmed by testing. (KAS 9) Clinicians administering AIT should continue escalation or maintenance dosing when patients have local reactions (LRs) to AIT. (KAS 11) Clinicians should avoid repeat allergy testing as an assessment of the efficacy of ongoing AIT unless there is a change in environmental exposures or a loss of control of symptoms. (KAS 12) For patients who are experiencing symptomatic control from AIT, clinicians should treat for a minimum duration of 3 years, with ongoing treatment duration based on patient response to treatment. The GDG offered the following KASs as options: (KAS 2B) Clinicians may choose not to initiate AIT for patients who use concomitant beta-blockers, have a history of anaphylaxis, have systemic immunosuppression, or have eosinophilic esophagitis (SLIT only). (KAS 8) Clinicians may treat polysensitized patients with a limited number of allergens.

β-lactoglobulin hydrolysates by L.plantarum AHQ-14 and L.bulgaricus BD0390 alleviate allergic responses to β-lactoglobulin in sensitized mice

The β-lactoglobulin (β-Lg) from cow whey protein is highly allergenic. β-Lg allergy often leads to digestive allergies or allergic gastroenteritis, damages intestinal micro ecological balance, and impacts on infant growth and health seriously. Milk protein can be partially degraded by lactic acid bacteria (LAB) and its allergenicity can be decreased to some extent. The immunological consequence of hydrolyzed β-Lg by L.plantarum AHQ-14 (H14) or L.bulgaricus BD0390 (H390) was investigated in a sensitized mouse model. BALB/c mice were stimulated with β-Lg or β-Lg hydrolysate sensitization, followed by oral stimulation of high doses of β-Lg or β-Lg hydrolysate sensitization. The results showed that β-Lg stimulated mice had increased the level of total IgE and IgG. Conversely, mice stimulated with H14 or H390 inhibited the allergic symptoms and reduced serum IgE/IgG levels. The H14 and H390 groups also decreased concentrations of mast cell protease-1 (mMCP-1) and plasma histamine (HIS), induced T helper (Th) 1 or T regulatory cells to regulate Th1/Th2 immune balance. Mice stimulated with H14 or H390 showed no signs of intestinal inflammation. They kept normal cytokine levels of IL-4 and IL-10 and increased IFN-γ production. Thus, H14 and H390 protected and avoided clinical allergy symptoms in sensitized mice, and have the potential to be used for β-Lg allergy to provide safe and effective treatment for infants with milk allergy.

A Quality-of-life Study in Patients with Anaphylaxis to Hymenoptera Venom in Iran.

Little is known about the quality of life of patients with anaphylaxis to Hymenoptera venom. The Vespid Allergy Quality of Life Questionnaire (VQLQ) is commonly used to assess the psychological burden of this condition. This study aimed to evaluate the validity and reliability of the Persian version of VQLQ. In this cross-sectional study, VQLQ was translated into Persian according to expert recommendations. The final translated version of VQLQ was then administered to 115 patients with Hymenoptera venom allergy at an asthma and allergy clinic in Iran. More than half of the participants were between 20 and 40 years of age, and 60% were male. Fear, anxiety, and outdoor activities had the most significant impact on the quality of life of patients with Hymenoptera venom allergy. Additionally, quality of life was more affected in women than in men, while no correlation was found with age. Furthermore, the quality of life was affected by a history of acute anaphylactic shock due to Hymenoptera venom. The Persian version of VQLQ enables the measurement of quality of life in patients with Hymenoptera venom allergy in the Iranian population. The inclusion of VQLQ in the initial evaluation of these patients may potentially guide allergist in providing support for venom-specific immunotherapy.

Clinical characteristics of children with asthma exacerbations: a cross-sectional descriptive study

Aim In this cross-sectional descriptive study, we aimed to determine the clinical characteristics of children admitted to a tertiary hospital with asthma exacerbations in a city in southern Turkey where aeroallergens are common and to determine how these characteristics affect the severity of exacerbations. Methods Data from a cross-sectional analysis of children with asthma exacerbations who were followed up at the Cukurova University Medical Faculty Pediatric Emergency Department (ED) and Pediatric Allergy & Immunology inpatient clinic were retrospectively analyzed. The study included 106 children who were diagnosed with asthma and did not have any additional comorbidities. In a comparative analysis, the clinical characteristics and laboratory parameters of children with mild/moderate and severe exacerbations were examined. Results While 81.1% of the patients had mild/moderate exacerbation, 18.8% had severe exacerbation. Additional atopic disease, Alternaria positivity in the skin prick test, the frequency of exacerbations in the previous year, Streptococcus pneumoniae infection, and the rate of noncompliance with treatment were significantly higher in children with severe asthma exacerbations. PEF, FEV1, and FEV1/FVC values were considerably lower in patients with severe exacerbations. Conclusions Bacterial infections, presence of atopic disease, Alternaria exposure, low spirometric measures, number of exacerbations in the previous year, and low rate of treatment adherence may be relevant in predicting the severity of asthma exacerbations.

Local anesthetics allergy in children: Evaluation of diagnostic tests with Real-Life data.

Local anesthetic (LA) drugs are commonly used in clinical practice to provide effective analgesia, including in dentistry and minor surgical procedures. The perception of a high risk of allergy in daily applications leads to the referral of atopic patients and those with other drug allergies to allergy clinics for the evaluation of allergic reactions to LA. The aim of this study was to determine who should be referred to the allergy clinic for LA allergy testing, assess the frequency of LA allergy in pediatric patients, and identify the negative predictive value of skin tests in diagnosis. January 2017-July 2023, the clinical and laboratory data, as well as the results of drug allergy tests, of patients referred to our pediatric allergy clinic by dentists and physicians performing minor surgical procedures with suspected LA allergy were retrospectively evaluated. Our study included a total of 153 patients, comprising 84 girls (54.9%) and 69 boys (45.1%), with a mean age of 8.9 (±3.3) years. The most common reason for referral was a history of non-LA drug allergies (n = 66, 43.2%), followed by asthma (n = 25, 16.3%). Hypersensitivity reactions (HRs) with LA were most commonly associated with articaine (n = 7, 4.8%), followed by lidocaine (n = 6, 4.1%). When intradermal tests were evaluated, 17 patients (11.1%) had a positive test result. The positivity for lidocaine was 70.6% (n = 12), and prilocaine was 29.4% (n = 5). Subcutaneous provocation was administered to 109 patients (71.2%), and one patient exhibited local erythema and swelling with prilocaine. Although LA allergy is a rare occurrence, consultations of this nature are frequently requested from allergy clinics in real life. Considering the negative predictive value of skin tests performed with LA drugs, the reaction rate appears to be low in patients with atopy or other drug allergies. It is crucial for all relevant healthcare professionals to be knowledgeable about the appropriate approach to suspected LA allergies to avoid unnecessary tests. To the best of our knowledge, our study is the most comprehensive work in the literature that evaluates the results of diagnostic tests in children referred with a suspicion of LA allergy.

Is bronchial provocation test positivity associated with blood eosinophil count and cut-off value?

Asthma is characterized by airway hyperresponsiveness due to chronic inflammation in the airways. One of the main cells involved in airway inflammation is eosinophils. In the current study, a bronchial provocation test (BPT) was performed to demonstrate airway hyperresponsiveness. We investigated the relationship between BPT and blood eosinophil count and the cut-off value of blood eosinophil count. In this study, we retrospectively evaluated the data of 246 patients who visited our immunology and allergy clinic, a tertiary reference center, with asthma symptoms between May 2017 and March 2020 and underwent BPT with methacholine for the diagnosis of asthma. The cases were grouped according to the level of BPT positivity and negativity. Of 246 patients, BPT was positive in 90 (36.6%) and negative in 156 (63.4%). The blood eosinophil measurement of the BPT-positive cases was found to be statistically significantly higher than that of the BPT-negative cases (135 vs. 119 cells/µl, respectively, p=0.029). When BPT is grouped according to positivity levels, there was no statistically significant difference in blood eosinophil measurements between subgroups (p=0.174). As a result of the evaluations, the cut-off point obtained for the blood eosinophil count was determined as ≥226 cells/µl. For the blood eosinophil count, for the cut-off value of ≥226 cells/µl, sensitivity was 30.0%, specificity 87.7%, positive predictive value 58.7%, and negative predictive value 68.3%. This study shows that BPT positivity is associated with blood eosinophil count. The cut-off value (≥226 cells/µl) determined for blood eosinophil count may be helpful when planning BPT and evaluating the diagnosis of asthma.

Increase in peg-asparaginase clearance as a predictor for inactivation in patients with acute lymphoblastic leukemia

Asparaginase is an essential component of acute lymphoblastic leukemia (ALL) therapy, yet its associated toxicities often lead to treatment discontinuation, increasing the risk of relapse. Hypersensitivity reactions include clinical allergies, silent inactivation, or allergy-like responses. We hypothesized that even moderate increases in asparaginase clearance are related to later inactivation. We therefore explored mandatory monitoring of asparaginase enzyme activity (AEA) in patients with ALL aged 1–45 years treated according to the ALLTogether pilot protocol in the Nordic and Baltic countries to relate mean AEA to inactivation, to build a pharmacokinetic model to better characterize the pharmacokinetics of peg-asparaginase and assess whether an increased clearance relates to subsequent inactivation. The study analyzed 1631 real-time AEA samples from 253 patients, identifying inactivation in 18.2% of the patients. This inactivation presented as mild allergy (28.3%), severe allergy (50.0%), or silent inactivation (21.7%). A pharmacokinetic transit compartment model was used to describe AEA-time profiles, revealing that 93% of patients with inactivation exhibited prior increased clearance, whereas 86% of patients without hypersensitivity maintained stable clearance throughout asparaginase treatment. These findings enable prediction of inactivation and options for either dose increments or a shift to alternative asparaginase formulations to optimize ALL treatment strategies.

One-Bag 8-Step Ferric Carboxymaltose Desensitization Protocol for Patients with a History of Hypersensitivity Reactions to Iron Preparations

Introduction: Iron deficiency is the most common cause of anemia in both sexes, although it is more common in women. Intravenous (IV) iron replacement is preferred in patients who cannot tolerate oral treatment or when iron stores need to be replenished rapidly. In this study, we wanted to share the ferric carboxymaltose (FCM) desensitization protocol that we self-created and successfully applied. Methods: This retrospective cross-sectional study included patients with a history of hypersensitivity reactions (HSRs) to IV or oral iron replacement and patients who were planned to receive IV iron replacement but were referred to the allergy clinic because of have risk factors (atopic diseases, history of HSR to other drugs, high serum tryptase levels, etc.) for HSRs. Before desensitization, some of the patients underwent skin tests (skin prick test and intradermal test) with FCM, and the results were recorded. Skin tests were not performed in patients with a history of drug use (antihistamine, systemic steroid, omalizumab, etc.) that affected the results of skin tests. All patients underwent a one-bag 8-step desensitization protocol with 500 mg FCM and were observed for 2 h after desensitization. Results: A total of 15 patients (14 females and 1 male) with a mean age of 41.13 ± 11.18 years were included in the study. When the patients were evaluated in terms of the risk of allergic reactions according to their clinical history, 8 patients had a history of anaphylaxis with iron preparations (FCM, n = 4; ferric hydroxide sucrose, n = 2; iron [II] glycine sulfate, n = 1; and iron [III] hydroxide polymaltose, n = 1), and 7 patients had a history of HSR other than anaphylaxis with iron preparations (urticaria, n = 6 [FCM, n = 2; iron (II) glycine sulfate, n = 2; and iron (III) hydroxide polymaltose, n = 2] and urticaria + angioedema [ferric hydroxide sucrose, n = 1]). Desensitization was successfully completed in all patients. No HSR was observed during or after the procedure in any of the patients. Conclusion: IV iron replacement is a very effective method, especially in cases where iron stores need to be replenished more rapidly. In patients with a history of iron HSR or at risk of developing HSR, replacement can be safely performed without an allergic reaction with successful desensitization protocols.

Multidisciplinary atopic dermatitis program: A novel approach to managing difficult-to-control atopic dermatitis patients.

Disease improvement for difficult-to-control pediatric atopic dermatitis may be more challenging to achieve when directed by single specialties due to disjointed and conflicting dialogue with patients. The Multidisciplinary Atopic Dermatitis Program (MADP) was developed through collaborations with the Rady Children's Hospital and UC San Diego Health Divisions of Dermatology, Allergy & Immunology and Clinical Pharmacy, to create team-based evaluation and management of children and adolescents with atopic dermatitis (AD). The MADP allows concurrent, comprehensive evaluations by multiple specialists to develop treatment plans. The program includes extensive patient education to support shared decision making, incorporating patient and family's perspectives along with those of clinical experts into their care. Objective severity measures and patient reported outcome data were collected, along with assessment of patient and family satisfaction with the MADP. Data showed significant improvement in AD severity as assessed by providers, patients and families by the first follow-up visit. BSA mean percentage decreased by up to 56% by the 7th visit, and pruritus (NRS), CLDQI and POEM mean scores decreased by more than 4 points, 12 points, and over 11 points, respectively. After management was initiated in the MADP, 72.73% of patients achieved an EASI 50 and 47.73% achieved an EASI 75 from a baseline mean of 21.7. Patients who continued in clinic beyond the second visit showed further clinically significant decreases in disease measures. The multidisciplinary approach shows success in the treatment of difficult-to-control AD patients with improvements in clinician and patient reported outcome measures.

Long waitlists for outpatient drug allergy referrals: An Australian tertiary centre experience

Drug allergy clinic waitlist time data are limited. A 24-month retrospective study of drug allergy referrals was undertaken at a tertiary hospital in Australia. One hundred six patients were reviewed with a median age of 50 years (IQR 40.5–67.3) and a female predominance (n = 76, 71%). Face-to-face consultations were common (n = 83, 78.3%) with the remainder being telephone consultations.General practitioners comprised just over one-third (n = 38, 35.9%) of the referrers but majority being from within the hospital, such as the emergency department (n = 22, 20.8%). Most patients (n = 100, 94.3%) were triaged as Category 1 or urgent. Antibiotic allergies were common (n = 75, 70.8%), of which majority were beta-lactam antibiotics (n = 71, 95%): 55 (73.3%) for penicillins and 16 (15.1%) for cephalosporins.The median waitlist time was 178 days (IQR 48.5–502.5) and only 18 (17%) of Category 1 were seen within urgent timeframe. Telephone consultation had a significantly shorter waitlist time (median 47 days; IQR 6–245) compared to face-to-face consultations (median 267 days; IQR 69–519) (p = 0.026).Large waitlist times are present for drug allergy, and given the majority of referrers are from hospitals, inpatient drug allergy assessment remains paramount. Beta-lactam antibiotic drug allergy labels remain common, and given their negative implications, further work is needed. Economic and human resources evaluations are required to address this shortfall.

P06 Outcomes from a New Combined Allergy and Dermatology Clinic- A Retrospective Review

Abstract Early introduction to known allergens such as peanuts can reduce subsequent development of allergies [1]. In 2019, an audit in our department of 35 babies under age 1 referred with eczema showed that 4 were concomitantly referred to allergy and 20 were referred to allergy after dermatology consultation. The majority had moderate/severe eczema and 31% had implemented dietary restrictions before the dermatology consultation. In 2021, a combined allergy and dermatology clinic was introduced to provide a holistic approach, particularly for young children. Patients are triaged from GP referrals or as follow-up from either team. We conducted a retrospective notes review to explore the benefits/outcomes. 57 patients were included with an average age of 4.75 years and 58% were below age 2. 58% had their dermatology plans changed. Before the clinic, 81% had dietary exclusions but only 46% had new allergies confirmed. 29% of the patients who underwent testing tested negative to all allergens, which allowed parents to reintroduce foods at an early age. This review shows that the combined clinic allowed young patients early access to allergy testing due to streamlined services, preventing unnecessary dietary exclusions. Additionally, patients with severe eczema without allergies benefit from early dermatology intervention. In fact, 44% of patients were suitable for discharge from dermatology directly from the combined clinic or at first follow-up appointment.

Determination of Clinical and Demographic Characteristics in Patients with Primary Antibody Deficiency Evaluated in Immunology and Allergy Clinic

Determination of Clinical and Demographic Characteristics in Patients with Primary Antibody Deficiency Evaluated in Immunology and Allergy Clinic

Pediatric asthma and COVID-19 vaccination: unveiling patterns of hesitancy and acceptance.

The global COVID-19 pandemic, declared in January 2020, necessitated urgent preventive measures, with vaccination as a key strategy. Despite progress in vaccine development and distribution, widespread hesitancy persists, impeding global disease control efforts. This study specifically explores COVID-19 vaccine hesitancy and acceptance among Iranian children with asthma, aiming to understand factors unique to this subgroup. A cross-sectional investigation was carried out in an allergy clinic in Iran, including a total of 522 asthmatic children between the ages of 5 and 18 years. A comprehensive questionnaire, built upon previous studies, investigated the factors that influence vaccine hesitation and acceptance. Data pertaining to demographics, vaccination status, and factors influencing hesitancy or acceptance were collected. Among the participants, 27.5% were administered the COVID-19 vaccine. Decisions were greatly influenced by family dynamics, with a notable association between parent and child vaccination. Children's vaccination rates were associated with their age and the frequency of COVID-19 diagnosis among their parents. The primary factors motivating individuals to get vaccinated were safety concerns (67.1%) and a strong belief in the severity of COVID-19 (43.4%). On the other hand, vaccine hesitancy resulted from concerns about potential adverse effects (77%), lack of confidence (28.3%), and a belief that children who had already contracted COVID-19 did not require vaccination (22.5%). The study highlights COVID-19 vaccine hesitancy and acceptance among asthmatic children in Iran, emphasizing parental decision-making factors. Tailored interventions are required due to the lower vaccination rate in this specific group. Healthcare providers play a vital role in influencing opinions, urging actions against misinformation, enhancing vaccine understanding, and promoting positive attitudes.

Human umbilical cord mesenchymal stem cells toxicity and allergy effects: In vivo assessment.

Human umbilical cord mesenchymal stem cells (hUCMSCs) hold significant promise across various clinical applications. Therefore, regulatory requirements necessitate a thorough investigation of the hUCMSCs safety before clinical trials and potential allergic reactions after transplantation. Abnormal toxicity test employed mice and guinea pigs dosed daily at 0.5×106 cells and 5×106 cells, respectively for 7 days. Acute toxicity test employed low, medium, and high doses of hUCMSCs injected into mice once, followed by observations for 23 days. In systemic allergy test, guinea pigs received low and high dose of hUCMSCs, with sensitization and excitation stages at day 14 and 21, respectively. The abnormal toxicity test of hUCMSC injections revealed no abnormal reactions over a seven-day observation period, indicating the safety of this administration route. In acute toxicity studies, the high-dose hUCMSCs group resulted in fatalities due to pulmonary embolism. Conversely, the low-dose group exhibited no toxic reactions or deaths. The maximum tolerated dose was determined to be >2×107 cells/kg. Systemic active allergy test showed that high doses of hUCMSC intravenous injections did not induce allergic reactions. This research affirms hUCMSC injections meet safety standards for clinical cell therapy, emphasizing their safe and promising clinical utility.

Assessment of Tenascin C levels in the serum of patients with bronchial asthma

Asthma is a heterogeneous disease that affects a large proportion of the global population and is distinguished by airway hyperresponsiveness to direct and indirect stimulations. It is a multifactorial disease that is triggered by heredity and environmental causes. Tenascin C (TNC) is an extracellular matrix glycoprotein that promotes inflammatory cell migration from the interstitium to the airways. Stimulation of TNC is through cytokines from T helper 2 (Th2) cells, in addition, it proliferates within basement membranes of the airways in asthmatic patients. This study aimed to determine whether serum TNC can be used as a novel biomarker for asthma diagnosis and to evaluate the association between serum TNC measurement and asthma severity. This case-control study included 64 patients with mild to severe bronchial asthma, diagnosed according to GINA 2022, referred to the Allergy and Clinical Immunology outpatient clinic at Ain Shams University Hospital, and 64 normal subjects as controls. Serum TNC levels were measured by ELISA. Serum TNC levels were significantly higher among bronchial asthma patients than controls (p ˂0.001). The sensitivity of serum TNC measurement in the diagnosis of bronchial asthma was 93.75%, the specificity 60.94%, and the negative predictive value 90.7%. Besides, a significant relation was found between serum TNC levels and the severity of bronchial asthma (p=0.004), as elevated serum TNC levels were the highest among severe asthmatic patients. In conclusion, the results gained in this study revealed that serum TNC level could be proposed as a potential biomarker for the diagnosis of bronchial asthma and a potential predictor of disease severity.

Prevalence of food allergy and other atopy among children with eosinophilic esophagitis in single center retrospective study, Riyadh, Saudi Arabia

Background: Eosinophilic esophagitis (EoE) is increasingly recognized as a significant public health issue in pediatric populations. The multifaceted mechanisms involving genetic, environmental, and immunological factors, particularly the role of allergens, are central to understanding EoE&amp;apos;s pathogenesis. This study aims to analyze the prevalence of food allergies and atopic diseases among children diagnosed with EoE, offering insights into their interrelations and informing improved management strategies. Methods: This retrospective study analyzed 47 pediatric patients diagnosed with EoE at the Allergy and Gastroenterology Clinic, Children&amp;apos;s Hospital, King Saud Medical City, Riyadh, from February 2012 to December 2018. Patients were selected based on documented food allergies, anaphylactic reactions, comorbid atopic conditions, positive radioallergosorbent test (RAST) results, and elevated eosinophilia. Data collection involved medical records and detailed family questionnaires. Immunological assays and endoscopic biopsies were used for diagnosis, with EoE defined as more than 15 eosinophils/high power field. Results: The study population predominantly comprised Saudi males, with a mean age of 8.36 years. A significant portion had consanguineous parents. Notable findings include a high prevalence of asthma (46.8%), allergic rhinitis (23.4%), and eczema (25.5%). The most common food allergens identified were peanuts, nuts, and seafood. Asthma severity varied, with ventolin and fluticasone being the most prescribed medications. Laboratory investigations showed elevated white blood cell, absolute neutrophil count, lymph, eosinophil sedimentation rat (ESO), eosinophil percentage, and immunoglobulin E (IgE) levels. RAST indicated specific allergen sensitivities in 34.0% of patients. Conclusion: This study provides essential insights into the demographic, clinical, and therapeutic aspects of pediatric EoE, emphasizing the importance of a comprehensive, personalized approach to management.

Epigenomic and epigenetic investigations of food allergy.

As a potential link between genetic predisposition, environmental exposures, and food allergy outcomes, epigenetics has been a molecular variable of interest in ongoing efforts to understand food allergy mechanisms and outcomes. Here we review population-based investigations of epigenetic loci associated with food allergy, focusing on established clinical food allergy. We first provide an overview of epigenetic mechanisms that have been studied in cohorts with food allergy, predominantly DNA methylation but also microRNA. We then discuss investigations that have implemented epigenome-wide approaches aimed at genome-wide profiling and discovery. Such epigenome-wide studies have collectively identified differentially methylated and differentially regulated loci associated with T cell development, antigen presentation, reaction severity, and causal mediation in food allergy. We then discuss candidate-gene investigations that have honed in on Th1, Th2, T regulatory, and innate genes of a priori interest in food allergy. These studies have highlighted methylation changes in specific candidate genes as associated with T regulatory cell activity as well as differential methylation of Type 1 and Type 2 cytokine genes associated with various food allergies. Intriguingly, epigenetic loci associated with food allergy have also been explored as potential biomarkers for the clinical management of food allergy. We conclude by highlighting several priority directions for advancing population-based epigenomic and epigenetic understandings of food allergy.

Global knowledge mapping and emerging research trends in the microbiome and asthma: A bibliometric and visualized analysis using VOSviewer and CiteSpace

BackgroundNumerous prior studies have extensively highlighted the significance of the microbiome in association with asthma. While several studies have concentrated on the asthma microbiome in previous research, there is currently a lack of publications that employ bibliometric methods to assess this area. MethodsIn this study, the Web of Science Core Collection database was utilized as the data source, and the SCI-EXPANDED index was employed to ensure that the retrieved data were comprehensive and accurate. All original research articles and review articles related to the correlation between asthma and the microbiome were systematically searched from the inception of the database until June 20, 2023. These articles were subsequently visualized and analyzed using VOSviewer and CiteSpace software. ResultsA total of 1366 relevant publications were acquired, indicating a consistent annual increase in global publications in the field. The United States and China emerged as the top two contributors to international publications. Among prolific authors, Susan V. Lynch achieved the highest publication record, with Hans Bisgaard and Jakob Stokholm sharing the second position. The majority of publications concentrated on allergy-related and microbiome areas, with a few comprehensive journals standing out. Journals with 40 or more publications included the Journal of Allergy and Clinical Immunology, Allergy, Frontiers in Immunology, and PLOS One. The top 5 cited journals were the Journal of Allergy and Clinical Immunology, PLOS One, American Journal of Respiratory and Critical Care Medicine, Clinical and Experimental Allergy, and Nature. Upon analyzing keywords, high-frequency terms, such as asthma, gut microbiota, microbiome, children, childhood asthma, allergy, risk, exposure, inflammation, diversity, and chain fatty acids emerged as representative terms in the field. ConclusionThis study systematically presented a comprehensive overview of the literature regarding the association between asthma and the microbiome over the last two decades. Through a bibliometric perspective, the findings may assist researchers with a better understanding of the essential information in the field.