Peach allergy is a common plant food allergy; specifically, sensitization to gibberellin-regulated protein (GRP; Pru p 7) and lipid-transfer protein (LTP; Pru p 3) is considered a predictor of severe allergic reactions in patients with peach allergy. However, the allergenic mechanisms in patients who are negative for these components remain unclear. Herein, we report the case of a 26-year-old Japanese man with a history of atopic dermatitis and pollinosis. The patient developed systemic allergic symptoms, including oral pruritus, pharyngeal swelling, respiratory discomfort, palpitations, and pallor, after ingesting a whole raw peach. Specific immunoglobulin E (IgE) to peach extract and Pru p 1 was positive, whereas specific IgE to Pru p 3, Pru p 4, and Pru p 7 was negative. Skin prick testing was positive for raw peach but negative for purified peach GRP. A proteomic approach was used to identify causative allergens. Two-dimensional electrophoresis and immunoblotting revealed an IgE-binding protein spot at approximately 25 kDa. Mass spectrometry identified the protein as peptidyl-prolyl cis-trans isomerase FKBP20-1 (FKBP20-1). Recombinant FKBP20-1 showed strong IgE reactivity with the patient’s serum but not with sera from nonallergic controls. Therefore, FKBP20-1 may represent a potential IgE-binding allergen involved in systemic reactions to peaches in patients who are not sensitized to GRP or LTP. Further studies are needed to clarify the clinical relevance of these findings.
Chronic rhinosinusitis, with or without nasal polyps, severely impairs the quality of life and imposes heavy economic costs. Standard care, including intranasal corticosteroids and endoscopic sinus surgery, is limited by poor drug penetration into narrow recesses and high rates of postoperative restenosis and recurrence. Biodegradable steroid-eluting stents provide sustained, targeted corticosteroid delivery directly to diseased mucosa. It has been 8 years since the first fully biodegradable steroid-eluting stent was approved for the treatment of chronic rhinosinusitis in China. In clinical practice, the standardized application of the stent calls for guidance based on high-quality evidence, while its real-world use continues to broaden the exploration of its clinical utility. To standardize the clinical use of sinus stents, experts from the Rhinology Group, National Medical Quality Control Center of Otorhinolaryngology (China), convened to establish this consensus based on current clinical evidence. An analysis of 13 randomized controlled trials (2011–2025) demonstrated that these devices significantly reduced polyp formation, eosinophilic inflammation, adhesions, and the need for revision surgery or systemic steroids, while maintaining frontal-sinus patency. Office-based implantation effectively manages recurrent polyposis. Safety data demonstrated minimal systemic exposure and a rare incidence of serious adverse events. Its optimal use was reported in refractory chronic rhinosinusitis with nasal polyps (guided by T2/eosinophilic endotype), high-risk ostial stenosis, and early postoperative care to prevent middle-turbinate lateralization. Although long-term efficacy and cost-effectiveness remain variable, steroid-eluting stents integrate surgical and pharmacologic strategies for achieving durable disease control.
Background: Hereditary angioedema is a rare disorder characterized by recurrent episodes of swelling of the skin and mucous membranes. Since 2021, the introduction of long-term prophylactic therapies in Japan has transformed treatment strategies; however, real-world data on attack frequency and patient-reported quality of life remain limited. Evidence from Japanese patients is needed to elucidate the clinical and social significance of prophylactic therapy. Methods: We analyzed longitudinal data from 16 patients with hereditary angioedema enrolled in RUDY JAPAN, a patient-participatory registry for rare diseases, between 2019 and 2024. Patients were categorized into three groups: those who never received prophylaxis throughout the study period, those observed before starting prophylaxis, and the same patients after starting prophylaxis. Attack frequency and patient-reported quality of life were compared across these groups. Results: A total of 191 attack episodes and 81 quality of life questionnaires were collected. The mean number of attacks was highest in patients before prophylaxis and lowest after initiation, demonstrating substantial suppression of attacks with long-term prophylaxis. Overall, quality of life scores showed only modest changes, but domain-specific improvements were observed, particularly in the functional and fears/shame domains, reflecting reduced psychological and social burden. Treatment behaviors also varied across groups: only half of the attacks were treated in patients without prophylaxis, whereas nearly all attacks were treated in those who later received prophylaxis. Conclusions: This study provides the first real-world evidence from Japan that long-term prophylaxis substantially reduces attacks and improves selected quality of life domains in hereditary angioedema. Despite ongoing challenges, the findings demonstrate that prophylaxis represents a transformative advance in clinical management, offering patients protection against life-threatening attacks and relief from the disease’s psychosocial burden.
Introduction: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous adverse drug reactions, in which leukocytes and immune cells play a central role in the pathogenesis. However, the changes of peripheral blood leukocyte counts in these patients remain unclear. Our objective was to evaluate leukocyte count fluctuations and their clinical correlations in patients with SJS/TEN. Methods: We conducted a case series on patients diagnosed with SJS/TEN from October 2017 to September 2019. Serum levels of tumour necrosis factor alpha (TNF-α) and interferon gamma (IFN-γ) were measured at hospital admission and during the re-epithelialization phase. Clinical characteristics and complete blood count results were recorded. Results: Our study included 26 patients diagnosed with SJS/TEN (9 with SJS and 17 with TEN). The common changes of leukocyte counts in our SJS/TEN patients showed a decrease between days 4 and 7 after symptom onset, followed by a marked increase, often exceeding the upper reference limit (10 × 10 9 /L). Most patients exhibited a rise in leukocyte counts during the re-epithelialization phase, accompanied by a decrease in serum levels of TNF-α and IFN-γ ( P = 0.118 and P < 0.001, respectively). Conclusion: In our SJS/TEN patients, peripheral blood leukocyte counts initially decrease during the early phase and subsequently increase during re-epithelialization. This leukocytosis appears to be associated with the skin healing process.
Background: Asthma symptoms are often influenced by a wide range of environmental, lifestyle, and other patient-reported triggers. The Japanese Practical Guidelines for Asthma Management (PGAM) include a comprehensive questionnaire on potential triggers; however, the PGAM framework lists various asthma triggers, their clinical implications, and reporting frequencies remain poorly characterised. Furthermore, the associations between specific triggers, recent symptoms, and clinical biomarkers have not been fully explored. Objective: To characterise the frequency of self-reported asthma triggers based on the PGAM framework and to evaluate their associations with recent symptoms and clinical biomarkers in adult patients. Methods: We conducted a cross-sectional study at a community hospital in Yamanashi, Japan, between January 4, and June 30, 2024. Adult outpatients with asthma completed the guideline-based trigger questionnaire, and we examined associations between questionnaire responses and clinical data, including biomarkers of type 2 (T2) inflammation. Results: Among 195 patients (median age, 57 years; 67.1% female), 93.3% met the criteria for T2 inflammation. Common triggers included “Dusty environments” (51.7%), “Decrease in temperature” (41.0%), and “Low pressure, typhoons” (40.0%). “Cough and sputum during the night” (19.4%) was the most frequent symptom, and specific stimulation factors such as “Rainy seasons” were associated with these symptoms. Several questionnaire items showed significant associations with allergen-specific immunoglobulin E levels. Patients with low fractional exhaled nitric oxide levels were more likely to respond “Yes” to environmental triggers than those with higher values ( P < 0.01). Conclusion: The PGAM-based questionnaire characterised common self-reported triggers and symptom patterns in adult asthma. These structured assessments can help clinicians systematically identify relevant environmental and lifestyle factors, supporting a more individualised approach to routine asthma care.
Food-dependent exercise-induced anaphylaxis (FDEIA) is a distinct form of immunoglobulin E–mediated food allergy in which symptoms occur only when ingestion of the culprit food is followed by exercise or another cofactor, such as nonsteroidal anti-inflammatory drugs. We report an adolescent girl with recurrent FDEIA in whom stepwise food-exercise challenge testing identified Muscat grape as the most likely trigger despite negative routine in vitro testing. This case highlights the importance of stepwise provocation testing when FDEIA is suspected.
Background: The Visual Analogue Scale (VAS) is recommended for assessing allergic rhinitis severity and treatment response. Determination of the minimal clinically important difference (MCID) of the VAS assists physicians in making treatment decisions. Objective: This study aimed to determine the MCID of the VAS in Thai patients with allergic rhinitis. Methods: A prospective study was conducted in adult patients with allergic rhinitis. Participants recorded daily VAS scores for 28 days using a 100-mm scale (0 = not at all bothersome; 100 = most bothersome), and symptom change was evaluated using the Global Rating of Change Scale. MCID was calculated using anchor-based and distribution-based methods. The anchor-based estimate was determined as the primary value for interpretation because it directly reflects patient-perceived change. Results: A total of 316 patients were analyzed. Mean VAS scores decreased throughout the treatment period. The anchor-based MCID of VAS was 43.86 ± 27.49, whereas the distribution-based MCID was 32.25 mm. The mean VAS change reached the MCID threshold on day 5 after treatment. Conclusion: The MCID of the VAS for Thai patients with allergic rhinitis was 43.86 mm. Clinically meaningful improvement is generally perceived after 5 days of treatment, suggesting that this is an optimal follow-up time.
Background: Chronic spontaneous urticaria (CSU) is a debilitating condition with substantial patient burden. In Malaysia, patient-centered data remain limited. Objective: To investigate the lived experiences, unmet needs, diagnosis, and treatment challenges of Malaysian CSU patients using a hybrid approach combining social media listening and in-depth interviews. Methods: This infodemiology study analyzed publicly available social media records related to CSU in Malaysia from October 2019 to September 2024. A keyword-based filtering and manual curation process was used to identify relevant records. In addition, qualitative interviews were conducted with 36 diagnosed CSU patients. Thematic analysis was applied to identify key insights across both data sources. Results: A total of 2,123 chronic urticaria-related and 325 pharmacological treatment-related social media records were analyzed, along with data obtained from 36 patient interviews. Patients frequently report delays in diagnosis, reliance on self-management strategies, emotional distress, and dissatisfaction with treatment outcomes. More than 80% of the interviewed patients reported moderate-to-severe itch and hives, with significant impacts on work, social life, and daily functioning. Nearly half of the interviewed patients (47%) had switched treatments because of inefficacies highlighting the limitation of prolonged reliance on antihistamine monotherapy. Both data sources revealed a significant psychosocial burden and a fervent desire for better patient education, emotional support, as well as digital tools and alternative treatments to help manage their condition. Conclusion: This study underscores the high burden of CSU in Malaysia, marked by significant quality-of-life impairments. The findings highlight the urgency of timely diagnosis, improved patient-centered communication, and timely escalation to effective therapies beyond antihistamines to enhance patient outcomes and quality of life.
Background: Olfactory dysfunction, ranging from mild impairment to complete loss, is a prevalent and bothersome symptom in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Objective: This study aimed to identify risk factors associated with the severity of olfactory dysfunction in the CRSwNP population, which have been largely overlooked. Methods: A total of 282 patients with CRSwNP were enrolled and categorized into normosmia, hyposmia, and anosmia groups according to their olfactory levels examined by the smell identification test specifically for the Chinese population (CSIT). Patients' demographic characteristics, history of asthma, computed tomography (CT)-based imaging scores, blood cytology, immunoglobulin E, and serum lipid profiles were recorded for all participants. Ordinal logistic regression analysis was used to identify risk factors of gradual olfactory dysfunction, and receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of those factors for discriminating different degrees of olfactory dysfunction from normosmia. Results: Significant differences were observed in age, prevalence of comorbid asthma, blood eosinophils, serum lipid profiles, and CT-based imaging scores of CRSwNP among the 3 groups stratified by olfactory outcomes ( P < 0.05, respectively). Multivariate ordinal logistic regression analysis identified Lund-Mackay scores, ethmoidal-to-maxillary (E/M) sinus ratio, age, and total cholesterol as independent risk factors for gradual olfactory dysfunction in CRSwNP ( P < 0.01, respectively). Correlation analysis indicated that the 4 identified risk factors were all significantly inversely correlated with the olfactory score measured by CSIT ( P < 0.001, respectively). ROC analysis demonstrated that the combined model based on the 4 risk factors showed strong power to discriminate between anosmic and normosmia (area under the curve [AUC]: 0.893, 95% confidence interval [CI]: 0.848–0.939), and moderate accuracy in classifying hyposmia and normosmia (AUC: 0.716, 95% CI: 0.640–0.792). When compared the AUC between different models, the combined model shows a better prediction ability than E/M ratio, age, and total cholesterol alone ( P < 0.05, respectively). Conclusion: Lund-Mackay score, E/M ratio, age, and serum total cholesterol are independent risk factors for gradual olfactory dysfunction in patients with CRSwNP, which can be used to develop a predictive model for olfactory outcomes.
Background: Asthma comorbidity may reflect the heterogeneity of type 2 inflammation in children with severe atopic dermatitis (AD). However, its impact on long-term clinical and biomarker trajectories during dupilumab treatment remains unclear. Objective: To investigate whether asthma comorbidity influences 52-week clinical and biomarker trajectories in children with severe AD treated with dupilumab. Methods: In this 52-week prospective study, 16 children (6–11 years) with severe AD (Eczema Area and Severity Index [EASI] ≥ 21) were stratified by asthma status: AD + asthma (n = 7) and AD-only (n = 9). The primary endpoint was the longitudinal EASI trajectory assessed by linear mixed-effects models. Serum thymus and activation-regulated chemokine (TARC) dynamics were analyzed as a key secondary endpoint. Exploratory analyses evaluated associations between baseline TARC and early treatment response. Results: Both groups demonstrated marked and sustained clinical improvement. While the AD + asthma group showed numerically faster early EASI improvement (week 0–4), trajectories converged by week 8 and remained similar thereafter (group × time interaction P = 0.68). By week 52, median EASI scores were low in both groups (1.9 vs 3.1). In contrast, serum TARC showed differing observed temporal patterns, with lower postbaseline levels in the AD + asthma group (interaction nominal P = 0.041). Exploratory analyses suggested a possible association between higher baseline TARC and early clinical improvement, although estimates were imprecise and require validation in larger cohorts. Conclusion: Dupilumab provided sustained clinical benefit irrespective of asthma comorbidity. Apparent differences in serum TARC dynamics despite comparable clinical outcomes are consistent with potential heterogeneity in biomarker responses. These findings are exploratory and hypothesis-generating, warranting validation in larger, adequately powered studies.
Background: Chronic rhinitis, including allergic rhinitis (AR) and nonallergic rhinitis (NAR), is frequently influenced by environmental factors such as temperature. This study aimed to investigate the characteristics of temperature-sensitive rhinitis patients and to explore the effects of temperature on nasal symptoms. Methods: A cross-sectional study was conducted from February 2023 to February 2024 at Beijing Tongren Hospital, enrolling 5,595 adult outpatients with chronic rhinitis. Patients were diagnosed with AR or NAR, with AR further classified into seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR). Standardized questionnaires and serum-specific immunoglobulin E testing were performed. Nasal symptoms (congestion, itching, sneezing, and rhinorrhea) were assessed using a visual analogue scale. A generalized linear model with cubic spline functions was used to examine nonlinear associations between ambient temperature and nasal symptoms, adjusting for potential confounders. Associations between temperature sensitivity, symptom severity, and environmental exposures were analyzed. Results: A total of 83.6% of patients with AR and 84.5% of those with NAR reported temperature sensitivity. Patients sensitive to temperature changes had significantly higher nasal symptom scores than those insensitive to temperature changes ( P < 0.001). The proportion of temperature-sensitive individuals increased with the severity of chronic rhinitis symptoms. In SAR, symptoms exhibited an inverted U -shaped relationship with temperature, peaking around 20°C, which corresponded to the pollen peak. In PAR, low-temperature environments (<20°C) aggravated nasal congestion and were the main factor affecting quality of life. Conclusions: Temperature-sensitive rhinitis patients experience more severe nasal symptoms. Low-temperature environments have the greatest impact on patients with PAR, particularly exacerbating symptoms of nasal congestion. Temperature indirectly affects the nasal symptoms in SAR patients by influencing pollen exposure.
Background: Hen’s egg allergy (HEA) is a prevalent food allergy in infants and young children. This study aimed to identify the progression of HEA over 48 months and identify factors that may predict its resolution. Methods: This prospective study was conducted on infants with HEA. We collected demographic information, clinical symptoms, and potential predictive factors. Skin prick tests were performed, and the infants were monitored over 48 months, with the resolution of allergy confirmed by successful egg ingestion. Results: A total of 121 infants were initially enrolled, of whom 98 completed the 48-month follow-up. By the end of follow-up, 80.6% developed tolerance, while 19.4% had persistent allergy. Kaplan–Meier analysis showed a median time to tolerance of 24 months, with 25%, 50%, and 75% of infants achieving tolerance by 18, 24, and 36 months, respectively. A smaller skin prick test wheal size (<10 mm) was associated with earlier tolerance acquisition ( P = 0.038), whereas erythema size was not associated with time to tolerance ( P = 0.507). Conclusion: While many infants with HEA outgrow their allergy by the age of 4, a significant minority remains affected. The size of the wheal may serve as a critical indicator of the likelihood of persistent allergy.
Hereditary alpha-tryptasemia (HαT) is an autosomal-dominant trait caused by increased tryptase alpha/beta 1 gene ( TPSAB1 ) copy number, resulting in elevated basal serum tryptase levels and variable clinical expression. Despite the association with anaphylaxis and mediator-related symptoms, risk stratification and management remain challenging. To describe the phenotypic spectrum of HαT in a single-center case series and assess omalizumab’s role in symptom control, we retrospectively analyzed five patients with confirmed HαT. Demographics, clinical data, and outcomes were recorded. Conventional therapy refractoriness was defined after ≥3 months. Efficacy was assessed at 2 months for cromoglicate and 3 to 6 months for omalizumab. All patients had persistently elevated basal serum tryptase (14–38 μg/L) and increased TPSAB1 copy number (3 α-tryptase copies). Clinical expression ranged from recurrent pruritus (n = 2) to hymenoptera venom–induced anaphylaxis (n = 1) and recurrent anaphylaxis with chronic spontaneous urticaria and multiple drug hypersensitivity (n = 2). Standard antihistamines and leukotriene antagonists provided insufficient control in two patients; omalizumab (300–600 mg every 3–4 weeks), however, led to sustained remission of urticaria and prevention of further anaphylaxis. Additionally, venom immunotherapy was effective in the patient with hymenoptera venom allergy. All patients and relatives at risk were referred for genetic counseling. This series illustrates the heterogeneous presentation of HαT, ranging from pruritus to severe systemic reactions. Overall, our findings support emerging evidence that omalizumab may provide effective symptomatic control in selected patients, though its role remains adjunctive to conventional antimediator therapy rather than disease-modifying. Larger prospective studies are needed to refine risk stratification and therapeutic strategies.
