BACKGROUND:Small airway dysfunction (SAD) plays a critical role in the pathophysiology of asthma. OBJECTIVE:This study aimed to evaluate the frequency of SAD in patients with severe asthma, and to assess its association with asthma control. METHODS:A total of 84 severe asthma patients were included in the study. Patients were classified into phenotypes according to the presence of allergy, fungal sensitization, obesity, blood eosinophil counts and frequency of asthma exacerbations. Impulse oscillometry (IOS) and spirometry were performed for all patients. RESULTS:Sixty-nine patients (83.1%) had allergic, 75 (91.5%) eosinophilic, 43 (51.2%) obese asthma, 25 (31.6%) asthma with fungal sensitization, and 24 (28.6%) were frequent-exacerbators. The detection rates of SAD by IOS and spirometry in the overall group, allergic asthma, eosinophilic asthma, obese asthma, asthma with frequent-exacerbations and asthma with fungal sensitization groups were as follows, respectively: 85.7% and 84.0%; 87.0% and 86.4%; 89.3% and 86.1%; 86.0% and 82.5%; 87.5% and 85.7%; 92.0% and 87.0%. The rate of SAD detected by IOS was significantly higher in the eosinophilic group compared with the non-eosinophilic group (89.3% vs. 57.1%, p = 0.047). SAD was detected in 92.5% of patients with controlled and 100% of those with uncontrolled asthma (p = 0.292). Area of reactance (AX) and resonant frequency (Fres ) were lower in the controlled group (p = 0.044, 0.005, respectively). CONCLUSIONS:The frequency of SAD is significantly higher in eosinophilic asthma compared with non-eosinophilic asthma, while similar across allergic, obese, fungal sensitization and frequent-exacerbator phenotypes. Higher AX and Fres values may be potentially indicative of uncontrolled asthma.
BACKGROUND:Food allergy is an increasing global health concern, yet laboratory-based data on food allergen sensitization in Jordan remain limited. OBJECTIVE:To estimate the prevalence and burden of sensitization to common food allergens among patients undergoing serum specific IgE (sIgE) testing in Jordan, and to characterize co-sensitization patterns in routine clinical practice. METHODS:We retrospectively reviewed patients who underwent a standardized 34-food allergen sIgE panel between 2021 and 2024. Sensitization more frequently associated with clinical symptoms was defined a priori as Class ≥ 2; analyses were repeated at Class ≥ 1 as a sensitivity analysis. Patients were categorized as non-sensitized, monosensitized, oligosensitized (2-4 allergens), or polysensitized (≥ 5). Allergen-specific prevalence was estimated with Wilson 95% confidence intervals, and co-sensitization was explored using correlation matrices and hierarchical clustering. RESULTS:Among 405 patients (13,770 tests), 28.4% were sensitized to at least one food allergen (n = 115); most had no or a single positive result, whereas 6.7% (n = 27) were polysensitized. Shellfish (8.2%; 95%CI 5.8-11.4), cow's milk (7.4%; 5.2-10.5), and egg white (6.9%; 4.8-9.9) were most prevalent. No significant differences were observed by age or sex after adjustment for multiple comparisons. Co-sensitization analysis identified interpretable clusters, particularly among nuts/seeds, cereals, and selected animal-derived allergens. Similar patterns were observed at Class ≥ 1. CONCLUSIONS:These laboratory-based findings may support diagnostic testing, counseling, and allergy service planning in Jordan.
BACKGROUND:Penicillins are the most commonly prescribed antibiotics; however, penicillin allergy (PA) labels are highly prevalent and often inaccurate, leading to suboptimal antibiotic selection use. In Mainland China, PA mislabeling is exacerbated by inappropriate penicillin skin testing (PST) practices. Nurses play a crucial role in assessing and labeling suspected PA, but the lack of systematic, evidence-based training limits their ability to address mislabeling effectively. OBJECTIVE:To evaluate the impact of a structured one-day PA training course targeting nurses on their knowledge and self-reported confidence in PA assessment and skin testing practices. METHODS:A quasi-experimental pre- and post-test design was employed with 60 nurses in Mainland China who completed training course. Knowledge and self-reported confidence were assessed using a standardized 0-100 questionnaire (≥70=satisfactory) before training and at 1-month follow-up. Baseline results were also compared with those of nurses in Hong Kong. RESULTS:At baseline, overall knowledge did not differ significantly between Chinese Mainland and Hong Kong nurses, but Mainland nurses scored lower on PST-related practical knowledge questions (63.5 ± 32.9% vs. 56.6 ± 23.6%; p = 0.031). Following the training, there were significant improvements in both knowledge (64.3 ± 18.8 to 86.9 ± 9.9; p < 0.001) and self-reported confidence (72.0 ± 12.6 to 81.9 ± 8.7; p < 0.001). The proportion achieving a "satisfactory" score increased from 45.0% to 93.3% (p < 0.001). CONCLUSIONS:A structured one-day training program significantly enhanced nurses' knowledge and confidence in PA assessment and PST. These findings support the integration of standardized, evidence-based PA training into nursing curricula, which may contribute to reducing mislabeling and promoting optimal antibiotic stewardship.
BACKGROUND:Real-world comparative data on alternatives to omalizumab for antihistamine-refractory chronic spontaneous urticaria (CSU) are limited, particularly in resource-constrained Asia-Pacific settings. OBJECTIVE:To compare drug survival among patients treated with omalizumab, cyclosporine, or hydroxychloroquine and evaluate associations between biomarkers and treatment persistenceใ. METHODS:This retrospective single-center cohort of 409 patients (omalizumab n = 97, cyclosporine n = 85, hydroxychloroquine n = 227) analyzed drug survival using Kaplan-Meier analysis and Cox regression. Patients were stratified by total IgE and autoimmune biomarkers (antinuclear antibodies [ANA], thyroid autoantibodies). RESULTS:Omalizumab showed significantly longer drug survival than hydroxychloroquine (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.50-0.85), while cyclosporine did not retain significance after multivariable adjustment. After stratification by potential biomarkers, omalizumab demonstrated significantly longer drug survival than hydroxychloroquine in patients with elevated total IgE (HR 0.48, 95% CI 0.32-0.72), negative ANA (HR 0.63, 95%CI 0.45-0.88), or negative IgG thyroid autoantibodies (HR 0.58, 95% CI 0.37-0.93). In patients with normal total IgE levels, no significant differences in drug survival were observed among the three treatments (p = 0.795). Hydroxychloroquine showed drug survival comparable to cyclosporine irrespective of ANA status and among patients with IgG thyroid autoantibodies. CONCLUSIONS:While omalizumab demonstrated longer overall drug survival, our findings suggest that in patients with normal total IgE or positive autoimmune biomarkers, hydroxychloroquine and cyclosporine may offer comparable drug persistence. These observations warrant prospective validation and suggest the potential value of biomarker-informed treatment approaches in resource-limited Asia-Pacific settings.
BACKGROUND:Beta-lactams (BLs) are commonly implicated in hypersensitivity reactions among children. However, majority of self-reported BL allergies may be viral exanthems and antibiotics side effects. International guidelines have recommended de-labelling BL allergies in children with delayed mild hypersensitivity reactions via direct drug provocation tests (DPTs) without prior skin testing. However, studies on the safety of direct DPTs in Asia remain limited. OBJECTIVE:Our study aims to describe the diagnostic approach and clinical outcomes in children with suspected BL allergies and evaluate the safety of direct DPTs for children with immediate and delayed mild BL hypersensitivity reactions. METHODS:This is a retrospective cohort study involving 395 children who underwent 425 BL DPTs for suspected BL hypersensitivity reactions, with or without skin testing. RESULTS:Median age of children at the time of DPT was 8.0 years, with 47.3% being males. The onset of hypersensitivity symptoms was immediate (within one hour from last BL dose) in 21.3% of children, delayed in 30.1% while the remaining had unknown onset. Of the diagnostic direct oral DPTs to index BLs, 89.3% passed and were successfully de-labelled. Majority (88.9%) of challenge reactions in diagnostic direct oral DPTs were mild cutaneous symptoms, except for three cases (8.3%) of cytokine release syndrome and one case of anaphylaxis (2.8%). A younger age at index reaction was the only statistically significant factor associated with passing diagnostic direct oral DPTs. CONCLUSIONS:Direct oral DPT is a safe method for de-labelling BL allergies in children for both immediate and delayed mild hypersensitivity reactions.
