BACKGROUND:Atopic dermatitis (AD) is common in children (affecting ~20% of children globally) and imposes a substantial burden. Many children in Latin America have moderate-to-severe AD with limited access to advanced therapies, highlighting an unmet need for safe and effective treatment options. Dupilumab, a targeted anti-interleukin-4 (IL-4)-IL-13 biologic, has demonstrated efficacy in pediatric AD, but real-world data in Latin American children are scarce. METHODS:We conducted a single-center retrospective observational study in Mexico City with children (aged 4-18 years) with moderate-to-severe AD treated with dupilumab from 2018 to 2024. Clinical outcomes (Eczema Area and Severity Index; Scoring Atopic Dermatitis [SCORAD], and pruritus Numerical Rating Scale [NRS]) and quality-of-life (Dermatology Life Quality Index) were assessed at baseline and ~3, ~6, and ~12 months. Changes over time were analyzed using nonparametric tests, and adverse events were documented. RESULTS:In all, 23 children (~50% female) with severe, treatment-refractory AD were included. Dupilumab led to rapid and significant improvement in all endpoints (P < 0.001). In 12 months, most patients achieved clear or almost clear skin with no pruritus (median SCORAD and itch NRS = 0), and quality-of-life scores improved from a median of 19 to 3. No serious adverse events occurred; mild conjunctivitis was reported in 13% patients (with one discontinuation). CONCLUSION:In this Latin American pediatric cohort, dupilumab achieved marked and sustained improvements in disease severity and quality of life, with a favorable safety profile. This real-world study addresses a regional evidence gap and supports dupilumab as an effective and well-tolerated treatment for moderate-to-severe pediatric AD.
BACKGROUND:The prevalence of food allergies among children is on the rise, presenting with a spectrum of severity from mild cases to those resulting in anaphylaxis. Ensuring the safe progression of home-based food ingestion is essential in managing food allergy. While the oral food challenge (OFC) test ideally confirms the threshold and tolerated dose, past findings indicated that about 30% of children who passed peanut OFCs experienced peanut-related allergic reactions when introducing peanuts at home. OBJECTIVE:It is presumed that the immune reactions occurring within individual patients vary in levels according to the situation. To date, no reports have objectively examined these conditions. MATERIAL AND METHODS:We present the symptoms and validation of an objective biomarker in eight pediatric cases during home introduction of food allergens. The urinary Prostaglandin D metabolite (PGDM) was measured as a noninvasive biomarker. RESULTS:Some cases exhibited mild symptoms and elevated urinary PGDM levels during home introduction despite ingesting half the dose that confirmed as safe during OFC. CONCLUSION:It underscores the importance of considering individual variability in determining food allergy thresholds.
BACKGROUND:In order to prevent total elimination of wheat from their diet, we introduced a very-low-dose (VLD) oral food challenge (OFC) in patients with severe wheat allergy in 2019. OBJECTIVE:This study investigated the efficacy of starting VLD wheat intake for achieving full-dose OFC. MATERIAL AND METHODS:Patients with a history of overt allergic reactions to low-dose (LD; 80-mg wheat protein) wheat or lesser within 6 months and those with complete wheat elimination were included in the study. We retrospectively compared the proportion of passing a full-dose OFC (2650-mg wheat protein) between patients who underwent an LD OFC prior to 2019 (LD group) and those who underwent a VLD OFC (26.5-mg wheat protein) after 2019 (VLD group). The period for passing the full-dose OFC was evaluated using Kaplan-Meier survival analyses. RESULTS:We enrolled 200 and 58 patients in LD group and VLD group, respectively. The median age at OFC initiation was 2.1 (1.6-4.2) and 1.9 (1.4-3.6) years in LD group and VLD group, respectively. Wheat- and ω-5 gliadin-specific immunoglobulin E (IgE) levels were 25.2 (7.7-59.8) kUA/L and 2.5 (0.8-12.6) kUA/L, respectively, in the LD group and 21.9 (7.4-94.9) kUA/L and 3.3 (1.2-9.4) kUA/L, respectively, in the VLD group. Over 4 years, the LD group and VLD group passed the full-dose OFC at proportions of 50% and 75%, respectively, with a significant difference (Log-rank test, P < 0.01). CONCLUSION:Starting VLD wheat intake may contribute to achieving a full-dose OFC in patients with severe wheat allergies.
This letter highlights key reporting and methodological issues in Demir et al.’s preclinical study assessing intranasal curcumin in an ovalbumin-induced allergic rhinitis rat model. We note an inconsistency in the reported number of experimental groups, potential misuse of parametric testing for ordinal histopathology scores, and overinterpretation of non-significant IgE comparisons as “comparable efficacy.” We also identify a citation mismatch regarding human clinical evidence and emphasize the need for clearer discussion of local tolerability signals, including goblet cell changes.
BACKGROUNDS:Food allergy (FA) is an immune-mediated hypersensitivity reaction to specific dietary antigens. While FA typically manifests with skin, respiratory, or gastrointestinal symptoms, its role in acute pancreatitis remains unclear. Acute pancreatitis is a potentially life-threatening inflammatory condition with well-known etiologies; however, in up to 30% of cases, no identifiable cause is found, resulting in a diagnosis of idiopathic acute pancreatitis (IAP). OBJECTIVE:This prospective study aimed to investigate the potential association between FA and IAP in adult patients. MATERIAL AND METHODS:Forty-nine adult patients diagnosed with IAP were evaluated. During the acute episode, serum tryptase, total immunoglobulin E (IgE), and eosinophil levels were measured. Eight weeks post-recovery, skin prick tests (SPT) and serum-specific IgE (sIgE) tests were performed for common and suspected food allergens. Patients with positive results underwent further testing, including prick-to-prick testing. RESULTS:Among 49 patients, eight (16.3%) demonstrated sensitization to food allergens, such as cow's milk, wheat, red meat, banana, plum, and tomatoes. These patients had significantly higher total IgE levels (P = 0.001). No significant differences were found in attack severity or tryptase levels between FA and non-FA groups. One patient experienced recurrence after re-exposure to the identified allergen. SPT alone failed to detect sensitization in several cases, whereas sIgE and prick-to-prick tests improved diagnostic accuracy. CONCLUSION:This is the first prospective study to suggest a potential link between FA and IAP. In cases of unexplained pancreatitis, FA should be considered in the differential diagnosis. Multidisciplinary collaboration between gastroenterologists and allergists is recommended for accurate diagnosis and management.
Atopic diseases are characterized by intense inflammation. There are increasing studies examining the relationship between atopic diseases and hematological parameters and indirect markers of inflammation, such as neutrophil-to-lymphocyte ratio (NLR), eosinophil-to-lymphocyte ratio (ELR), and platelet-to-lymphocyte ratio (PLR). The aim of this study was to investigate these parameters in patients with asthma, allergic rhinitis, and atopic dermatitis. The study was conducted retrospectively and cross-sectionally. The study group consisted of 172 patients (53 with asthma, 93 with allergic rhinitis, and 26 with atopic dermatitis) and 105 controls. There were no age or gender differences between patients and controls. When all atopic patients were compared to controls, ELR (P < 0.001), eosinophil count (P < 0.0019), and WBC (P < 0.05) were significantly higher in the patient group. When patient groups were compared independently, ELR (P < 0.001), eosinophil count (P < 0.001), and WBC (P < 0.05) were higher in asthmatic patients than in controls. In allergic rhinitis patients, ELR (P < 0.001) and eosinophil count (P < 0.001) were higher than in controls. In patients with atopic dermatitis, ELR (P < 0.001), eosinophil count (P > 0.001), WBC (P = 0.0019), and, additionally, NLR (P < 0.001) and PLR (P < 0.05) were higher than in controls. NLR and PLR were significantly higher in patients with atopic dermatitis than in controls, in patients with asthma and in patients with allergic rhinitis. Among all hemogram parameters, only ELR and eosinophil count stand out as markers that may be useful in the diagnosis of atopic diseases. NLR and PLR may be useful in the differential diagnosis of AD among atopic patients.
BACKGROUND:Allergen-specific immunotherapy (AIT) is the only intervention capable of modifying the natural course of allergic diseases by inducing long-term immune tolerance. Its clinical efficacy depends on complex regulations of humoral and cellular immunity, yet objective assessment remains hindered by the absence of standardized biomarkers. SUMMARY:This review summarizes recent advances in the immunological mechanisms of AIT and highlights emerging biomarkers-including allergen-specific immunoglobulin G4, regulatory T and B cells, and innate lymphoid cells-that may provide objective measures of efficacy and support individualized treatment strategies. KEY MESSAGES:(1) AIT uniquely modifies the natural history of allergic diseases; (2) current evaluation relies on subjective measures, highlighting the urgent need for standardized and clinically applicable biomarkers; (3) molecular markers and immune cell subsets offer promising tools for bridging mechanistic insights with clinical endpoints, supporting real-time monitoring and precision-guided optimization of AIT.
BACKGROUND:Hypersensitivity reactions to drugs represent a significant and growing health concern worldwide, with the potential to cause severe and life-threatening outcomes. Accurate diagnosis of drug allergies is essential for effective patient management, particularly in differentiating true allergic reactions from other adverse drug reactions. OBJECTIVE:This study aimed to evaluate for the first time the Basophil Activation Test (BAT) using flow cytometry as a reliable diagnostic tool for immediate-type drug allergies in Tunisia. METHODS:This study included 35 BATs, conducted between November 2022 and December 2024. Only one patient underwent two separate BATs on different drugs. From each patient, venous blood was drawn and BAT was assessed using flow cytometry. Serial dilutions of suspected drugs, including antibiotics (e.g., amoxicillin and cefixime), non-steroidal anti-inflammatory drugs (e.g., mefenamic acid), and others, were tested. For each sample, basophils were incubated with the drug dilutions stained with antibodies marked with different fluorescents, such as CRTH2-FITC, CD3-PC7, CD203c-PE, and then analyzed on a Navios Ex flow cytometry. RESULTS:Of all the performed BATs, antibiotics represented the majority of tested drugs accounting for 56%. However, only three tests were positive, in favor of a type I hypersensitivity drug reaction. CONCLUSION:By applying BAT in the Immunology Department of the Military Hospital of Tunisia, this study seeks to enhance diagnostic accuracy and contribute to personalized patient care.
Allergic rhinitis and asthma are among the most important chronic diseases in children and young adults, with increasing prevalence and significant impact on the healthcare system and quality of life. Allergen Immunotherapy (AIT) remains the only causal treatment capable of modifying the natural course of allergy. However, despite its proven efficacy, real-world data on its application in the pediatric population remain limited. This study aimed to evaluate and compare the management and clinical practice of allergic diseases in the pediatric population, particularly the current use of AIT for respiratory allergy, by pediatricians and allergists in Italy, Spain, and Portugal. A comprehensive online survey developed by the pediatric allergy societies of the three countries was distributed to pediatric allergists to collect demographic data, diagnostic and treatment approaches, and AIT prescription attitudes. A total of 171 responses were analyzed in this study. The results show that most allergists treat high numbers of pediatric allergic patients on weekly basis, primarily using skin and laboratory tests for diagnosis of allergy, and pulmonary function tests to diagnose asthma. AIT was prescribed by the majority of allergists (91.2%), primarily for children aged ≥5 years, and mainly for allergic rhinoconjunctivitis and asthma. Of the respondents, 64.1% chose sublingual AIT over subcutaneous AIT (35.9%) because of compliance (77.6%) or practical reasons (67.9%). Patients were mainly treated for 3 years (39.7%) to 5 years (21.2%) and were regularly monitored every 6 months (51.3%). This initiative marks the first multinational collaboration between pediatric national allergology societies in Mediterranean countries, establishing a fundamental network for future collaborations. This study provides valuable insights and encourages further efforts to harmonize pediatric allergy care across similar sociocultural and environmental regions.
BACKGROUND:Allergic rhinitis (AR) is increasingly prevalent in China, yet allergen sensitization data in coastal subtropical cities such as Shenzhen remain scarce. OBJECTIVE:To investigate allergen distribution and demographic characteristics among AR patients in Shenzhen, China. METHODS:A retrospective analysis was conducted on 3351 AR patients from January to December 2022. Serum-specific immunoglobulin E (sIgE) levels were measured; values ≥0.35 kU/L were considered positive and graded into six levels. Allergen patterns were compared by gender, age (<14 vs. ≥14 years), and sIgE level. RESULTS:Clinic visits peaked in August. The most prevalent allergens were Blomia tropicalis (Bt), Dermatophagoides pteronyssinus (Dp), and Dermatophagoides farinae (Df). Other important indoor allergens included cockroach, dog dander, and cat dander. Leading outdoor allergens were Ambrosia artemisiifolia (ragweed), Chenopodium album/Amaranthus retroflexus, and Platanus/Fraxinus. Male patients showed higher sensitization to Dp and Df (P < 0.05). The sensitization proportions for leading allergens (Bt, Dp, and Df) declined with increasing age: compared with adolescents and adults (≥14 years), pediatric patients (<14 years) had significantly higher sensitization to indoor allergens, whereas the adolescent/adult group showed significantly higher sensitization to pollens and molds (P < 0.05). Dp and Df responses peaked at class 3, Bt and cat dander at class 2, and cockroach/dog dander/pollens/molds at class 1, with significant differences in sIgE levels among allergens (P < 0.05). CONCLUSION:Dust mites, especially Bt, are the primary source of allergens affecting AR patients in Shenzhen. Sensitization patterns differ by age, gender, and sIgE levels, highlighting the importance of region-specific allergen surveillance and personalized AR management.
The current study evaluated the quality of life, anxiety, and depression in adolescents diagnosed with atopic dermatitis. Adolescents diagnosed with atopic dermatitis (AD) (n = 25) who were not receiving regular treatment were compared with 41 healthy adolescents. Disease severity in adolescents with AD was evaluated using the Scoring Atopic Dermatitis (SCORAD) index and the Children's Dermatology Life Quality Index (CDLQI). In both groups, depression and anxiety were assessed using the Beck Depression and Anxiety Scales. Results indicated that quality of life was severely affected (Median = 16.0, AD group). The mean anxiety and depression scores were 34.0 and 16.0, respectively, in the AD group, and 35.0 and 11.0, respectively, in the control group. Pruritus severity was significantly correlated with both anxiety (r = 0.524, p = 0.01) and depression (r = 0.472, p = 0.02). Quality of life decreased in adolescents with AD, while signs and symptoms of anxiety and depression were more prevalent. The results also revealed a significant relationship between pruritus severity and psychological burden. These findings suggest that it is important to evaluate patients with AD using a holistic approach, not solely based on dermatological assessment but in concert with psychosocial needs.
BACKGROUND:Hereditary angioedema (HAE) is a genetic disorder characterized by recurrent, spontaneous, and sometimes life-threatening episodes of swelling. Attacks of angioedema that negatively impact quality of life can occur anywhere in the body. The chronic and unpredictable course of the disease can also affect mental health, sleep quality, and sexual life. OBJECTIVE:This study aimed to investigate sexual function, sleep quality, and related factors in HAE patients. MATERIAL AND METHODS:In all, 40 patients diagnosed with type 1 and type 2 HAE were followed up in the Immunology and Allergy Clinic, and 40 healthy controls were included in the study. Participants completed the Arizona Sexual Experience Scale (ASEX), Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HADS). RESULTS:The patient group had significantly higher ASEX and PSQI scores compared to the healthy control group. In the patient group, ASEX scores showed a significant positive correlation with HADS-Depression (HADS-D) and HADS-Anxiety (HADS-A) scores. It was shown that as frequency of monthly attacks in patients increased, both HADS-D and HADS-A scores increased, and with increase in HADS-D scores, sleep efficiency decreased. Furthermore, a strong positive correlation was shown between HADS-A scores and PSQI scores. Longer disease duration, history of genital attacks, and decreased sleep quality were found to be significantly correlated with sexual dysfunction. CONCLUSION:The results supported our hypothesis that sexual life and sleep quality are more affected in this patient group than known previously. It is expected that evaluating sexual life, sleep quality, and general well-being in the routine follow-up of these patients may contribute to disease control.
INTRODUCTION:Identifying the eosinophilic, neutrophilic, or infectious phenotypes of exacerbations, particularly those occurring during biologic agent therapy, may provide valuable guidance for determining maintenance therapy for patients and preventing recurrent exacerbations. Our study primarily aimed to evaluate the clinical phenotypic features of exacerbations in patients with severe asthma receiving biologic agent therapy. METHODS:The first asthma exacerbation experienced by the patients after the 16th week of biological agent treatment was evaluated in terms of inflammatory phenotype and clinical features. White blood cell counts and C-reactive protein levels, related season, antibiotic use, and hospitalization during the exacerbation were recorded from patients' medical file records. RESULTS:Data of 75 patients with severe asthma receiving biological treatment were analyzed. Subjects were aged 48.0 (mean) ± 11.0 (standard deviation), and 52 (69.3%) of them were female. Biological agent used in treatment was omalizumab in 53 (70.7%) subjects and mepolizumab in 22 (29.3%) subjects. The majority of exacerbations in asthmatics treated with either biologic agent were eosinophilic. In patients using omalizumab, the median eosinophil count was significantly higher compared to those using mepolizumab (p=0.032). CONCLUSION:Phenotyping of asthma exacerbations that persist in spite of biologic therapy will guide treatment adjustments and decisions to switch biologic agents to improve outcomes.
BACKGROUND:Severe eosinophilic asthma with nasal polyps (SEAwNP) is a clinical phenotype characterized by elevated peripheral eosinophil counts and heightened type 2 (T2) inflammation. OBJECTIVE:In this study, we aimed to compare the transcript/protein expression ratios of factor XIII-A (F13A), B-cell activating factor (BAFF), interleukin-5 (IL-5), and thymus- and activation-regulated chemokine (TARC), as well as serum Staphylococcus aureus Enterotoxin B-Specific IgE (SEB-IgE) levels, among patients with SEAwNP, SEA without nasal polyps (NP), NP without asthma, and healthy controls groups. MATERIAL AND METHODS:A total of 73 participants were enrolled and stratified into four groups: SEAwNP (n=20), SEA without NP (n=18), NP without asthma (n=15), and healthy controls (n=20). Peripheral blood samples were analyzed using real-time quantitative PCR and protein levels using ELISA for periostin, F13A, BAFF, IL-5, and TARC. Serum SEB-IgE levels were also assessed. RESULTS:SEAwNP patients exhibited significantly elevated transcript/protein expression ratios of periostin, F13A, BAFF, and IL-5 compared to SEA without NP (p=0.007, p=0.001, p=0.019, and p=0.017, respectively). Furthermore, periostin, F13A, BAFF, IL-5, and TARC transcript/protein ratios were significantly higher in SEAwNP patients compared to healthy controls (p=0.0001, p=0.001, p=0.003, p=0.014, and p=0.02, respectively). SEB-IgE positivity rates were 45% in SEAwNP, 38% in SEA without NP, 13% in NP without asthma, and 0% in healthy controls. CONCLUSION:SEAwNP is associated with elevated transcript/protein expression ratio of key T2 inflammatory mediators and increased SEB-IgE positivity, supporting their potential role in the immunopathogenesis of this phenotype. These findings underscore the importance of biomarker profiling in distinguishing endotypes within the spectrum of eosinophilic airway diseases.
