Obesity and allergic diseases are among the most frequently discussed public health challenges in highly industrialized countries. At the same time, clinical observations and epidemiological data do not allow for a clear conclusion as to whether patients with allergic diseases more commonly present with underweight as a consequence of elimination diets, or with excess body weight associated with chronic inflammation, metabolic disturbances, and lifestyle factors. The aim of this review is to analyze the relationship between excess body weight and allergic diseases, with particular emphasis on clinical data regarding the influence of food allergy and elimination diets on nutritional status and body weight in children and adults. Particular attention is given to the dual nature of elimination diets, which, although remaining the cornerstone of food allergy management, may act both as an effective therapeutic tool and as a risk factor for impaired diet quality, reduced dietary diversity, and secondary nutritional disturbances, depending on how they are implemented. In light of the available evidence, body weight should be regarded as a clinically relevant and potentially modifiable component of comprehensive care for patients with allergic diseases.
IL-35 is a heterodimeric cytokine belonging to the IL-12 group. It consists of two chains alpha and beta and has mainly immunosuppressive effects. IL-35 is produced, among others, by regulatory T cells, regulatory B cells, dendritic cells and macrophages. IL-35 is responsible for modulating the innate and adaptive immune response, having both a protective effect and contributing to the development of diseases. IL-35 seems to be a promising parameter in the diagnosis of many diseases, e.g. autoimmune diseases, cancer, but also bacterial and viral infections.
Rhinitis is a chronic pathology of the nasal mucosa that affects 1-63% of the general population. This disease can develop on both allergic and non-allergic grounds. It has been shown that the occurrence of rhinitis can significantly negatively affect the athletic performance of swimmers. Recent studies show that the symptoms of rhinitis intensify during periods of intense training and subside after training ceases. It has been shown that limiting the contact of the nasal mucosa with pool water by using nose clips led to a significant reduction in cellular infiltration and a decrease in clinical symptoms in these individuals. However, the incidence of allergic rhinitis among swimmers and nonswimmers is the same, and changes in the nasal mucosa indicate a non-allergic basis for this condition in people who regularly swim in indoor pools. The compounds most likely responsible for this relationship are the so-called disinfection by-products, i.e., chloramines. They can enter the human body through inhalation in gaseous or aerosol form, ingestion with pool water, or absorption through the skin, which may cause an exacerbation of rhinitis and skin symptoms.
Biological drugs are substances produced by living organisms with the use of genetic engineering. These include for instance monoclonal antibodies, growth factors and gene and cell therapies which are widely used in various fields of medicine-from preventive aspects such as mass vaccination to the treatment of malignant tumours. Monoclonal antibodies are a type of biologics engineered to bind specifically to an allergen, cell, or other antibody. This connection triggers activation of the immunological system through mechanisms such as complement-dependent cytotoxicity (CDC), antibody-dependent cellular phagocytosis (ADCP) and antibody-dependent cellular cytotoxicity (ADCC). Monoclonal antibodies are commonly used in the treatment of pulmonary diseases, in allergology and immunology. Unfortunately, due to their immunogenic character, they can induce a specific immunological reaction. Approximately, one sixth of drug-related adverse events are related to hypersensitivity reactions, which are classified as immediate and delayed. The aim of this article is to summarize the current knowledge about the hypersensitive reaction to biological drugs used in pulmonology and allergology, providing known pathomechanisms, phenotypes, and diagnostic pathways, as well as therapeutic recommendations for desensitization proposed by scientists'organisations.
Introduction: Allergic diseases represent a significant and growing health problem. Accurate diagnosis requires the integration of a detailed clinical history with appropriately selected in vivo and in vitro diagnostic methods. In recent years, classical diagnostic approaches have been complemented by modern molecular allergy diagnostics. Aim: The aim of this study was to compare conventional and modern diagnostic methods for IgE-mediated allergy and to assess their clinical usefulness. Material and Methods: A review of the literature on allergy diagnostics was conducted, including skin tests, determination of allergen-specific IgE using allergen extracts, component-resolved diagnostics, and multiplex and point-of-care assays. Publications from the PubMed and Google Scholar databases, as well as specialist literature, were analyzed. Results: Skin prick tests remain a valuable first-line diagnostic tool and show high concordance with measurements of allergen-specific IgE. In vitro methods based on allergen extracts are widely available but are limited by cross-reactivity and the risk of false-positive results, including those related to cross-reactive carbohydrate determinants (CCD). Molecular diagnostics enable precise differentiation between primary sensitization and cross-reactivity, assessment of anaphylaxis risk, and appropriate qualification for allergen immunotherapy. Conclusions: Allergy diagnostics should follow a stepwise and integrated approach. Conventional and molecular methods are complementary and should be used together, always interpreted in the context of the patient's clinical presentation.
Introduction: Pediatric asthma is a prevalent chronic respiratory condition globally, posing significant clinical and public health challenges. While physical activity (PA) is essential for healthy childhood development, integrating PA into asthma care remains complex due to both medical and psychosocial factors. Purpose: This review explores the multifactorial relationship between asthma and physical activity in children. It analyzes how clinical symptoms, psychological barriers, environmental contexts, family dynamics, and socioeconomic factors influence activity levels among pediatric asthma patients. The goal is to identify actionable strategies for supporting physical activity without compromising asthma control. Conclusion: Although well-managed asthma does not inherently limit physical activity, many children-especially those with poorly controlled symptoms, obesity, or from marginalized backgrounds-face barriers to active lifestyles. Emotional factors like fear of exacerbations, parental anxiety, and restricted environments further complicate engagement in PA. Successful interventions require personalized, multidimensional approaches involving medical management, family education, behavioral support, and environmental improvements to promote both physical health and disease control. Materials and methods: Our review is based on analysis of materials collected in 'Pubmed' using the keywords: physical activity, pediatric asthma, asthma management.
Currently, the prevalence of self-reported food allergies is increasing. Food-related skin symptoms such as pruritus and rash are often attributed to food allergy. However, other conditions such as histamine intolerance, lactose intolerance, atopic dermatitis, chronic urticaria, or mastocytosis may also present with similar symptoms. This report presents a rare clinical case involving the coexistence of histamine intolerance and cutaneous mastocytosis, which resulted in food-triggered skin manifestations.
Asthma is one of the most common comorbidities during pregnancy, with approximately one-third of women experiencing disease exacerbation, particularly in the third trimester. Inadequate asthma control may result in serious complications such as gestational hypertension, preterm delivery or low birth weight. Biological therapy, particularly involving monoclonal antibodies (omalizumab, mepolizumab, dupilumab, benralizumab), may represent an alternative to conventional treatment strategies, including long-acting beta2-agonists , short-acting beta2-agonists and oral glucocorticosteroids. The safety of biologic agents during pregnancy has not been sufficiently confirmed. The most robust data concern omalizumab, which appears to have a favorable safety profile, although concerns about a potential risk of congenital malformations remain. Due to the exclusion of pregnant women from the B.44 drug program and the limited data available for some agents (e.g., tezepelumab, reslizumab), further studies are needed to evaluate the safety and efficacy of biological therapy in this population.
Objective(s) Interleukin-5 (IL-5) concentration has been reported to be associated with asthma severity, where the serum concentration can be reduced with glucocorticoid inhaler therapy. This study aimed to assess the associations of asthma severity and glucocorticoid therapy adherence with serum IL-5 concentration. Methods This cross-sectional study was conducted on patients in the pulmonary department. A total of 40 clinically confirmed adult asthma patients were recruited and subjected to adherence and IL-5 measurements. Adherence to inhaler use was measured using the Medication Adherence Report Scale Asthma (MARS-A). IL-5 concentration was measured using the Enzyme-Linked Immunosorbent Assay. Results The results revealed that the majority of the patients adhered to inhaler use (n=29, 72.5%). More than 50% (n=23, 57.5%) received an inhaler use demonstration. There were only 37.5% of the total patients (n=15) experienced exacerbations, where intermittent, mildly persistent, and moderately persistent asthmas were recorded in 34% (n=18), 23% (n=12), and 19% (n=10) of the total patients, respectively. In comparison with individuals having moderately persistent asthma, the IL-5 concentrations were significantly lower in intermittent and mildly persistent asthma (both with p<0.001). We found no statistical significance in IL-5 concentrations in adherent versus non-adherent groups (p=0.207). Conclusion IL-5 is associated with asthma severity but not with adherence to glucocorticoid therapy. To confirm the absence of glucocorticoid effect on IL-5 concentration, further studies employing larger participants and more robust methodology are warranted.
Mastocytosis is a disease characterized by the abnormal accumulation and activation of mast cells in the body. When this accumulation occurs only in the skin, it is called cutaneous or childhood mastocytosis. However, when mast cells spread beyond the skin to other organs, it is called systemic mastocytosis. Cutaneous Mastocytosis accounts for less than 5% of cases in adults, while in 90% of children with mastocytosis, the disease is limited to the skin. Mast cells produce and release chemicals to protect the body against germs and other harmful agents. Nevertheless, certain external factors can trigger and activate these mast cells. These triggers include mechanical irritation, temperature changes, heat, cold, massage, friction, certain medications (such as antibiotics, analgesics, anesthetics, opioids, and NSAIDs), venoms, and some vaccines. Vaccines having proteins and adjuvants, in particular, can overstimulate mast cells. This review will discuss drugs, venoms, and vaccines that cause excessive responses in children with cutaneous mastocytosis and how to approach these cases practically and realistically. As a result, patients with mastocytosis must receive clear guidance on which medications are safe for them and which ones they should avoid. This is because the risk of anaphylaxis in patients with mastocytosis is much higher than in the general population, and they need to be closely monitored by a doctor or healthcare provider.
Introduction: Hypersensitivity reactions to non-steroidal antiinflammatory drugs (NSAIDs) affect up to 1.9% of the European population, constituting a significant clinical problem. Possible symptoms of hypersensitive drug reaction (HDR) to NSAIDs include urticaria, angioedema, and co-existing clinical conditions that might be excerbated: bronchial asthma or chronic sinusitis with nasal polyps. When no alternative treatments to ASA exist, desensitization remains the only therapeutic option. It involves inducing a temporary state of tolerance to the drug that causes HDR. A 63-year-old woman with coronary heart disease was referred to the Allergology Department of the University Clinical Hospital in Opole to undergo an ASA desensitization procedure due to the lack of another, more beneficial option for cardiac treatment. She reported a history of swelling of the eyelids, nose and lips after taking ibuprofen eight years earlier and an identical reaction a year later, after taking ASA. Since then, the patient avoided taking any NSAIDs. Desensitization was performed according to the Silberman protocol to a total dose of 150 mg, with a maintenance dose of 75 mg/day. The woman was discharged home with a referral to the Cardiology Department for further treatment and a recommendation for a healthy lifestyle and daily intake of ASA. Conclusions: The desensitization procedure allows for the most beneficial treatment, even in patients suffering from hypersensitivity to NSAIDs. The presented clinical case confirms the effectiveness of desensitization and its usefulness in everyday clinical practice.
Assessing asthma control and exacerbation risk in patients with asthma are so important to define. Our aim was to explore the relationship between the history exacerbations in asthmatic patients and key inflammatory markers, namely eosinophil levels, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR). We also aimed to evaluate the potential of these biomarkers as indicators for asthma exacerbation. Patients with asthma were categorized into two groups based on their exacerbation history, with one group having at least one exacerbation the last year (Group I) and the other group having none (Group The differences in eosinophil, NLR, and PLR values between the two groups were assessed. The mean age of the patients was 52 +/- 13 years, and 194 of the 252 asthmatic patients were female (77%). There were 79 (31.6%) patients in Group Iand 173 (68.4%) patients in Group II. No statistically significant relationship was found between eosinophil count and asthma exacerbation (p=0.551). However, the NLR and PLR values were significantly higher in Group I (p=0.013 and p=0.002, respectively). In regression analysis, the PLR value was found to significant marker for predicting exacerbation. This study revealed higher PLR levels in patients experiencing asthma exacerbations and showed that this parameter significantly predicted exacerbations. Eosinophils and NLR values are not suitable biomarkers for predicting exacerbation risk but can be used phenotype patients with asthma.
Asthma-COPD overlap syndrome (ACOS) is a distinct subtype of obstructive airway disease, marked by overlapping features of asthma and COPD. Its prevalence varies, and diagnosis remains challenging due to patient variability. ACOS patients face worse symptoms, frequent exacerbations, higher healthcare needs, and increased costs, emphasizing the need for personalized treatment strategies. This hospital-based cross-sectional study was conducted in the Department of Respiratory Medicine of NKPSIMS & LMH, Nagpur, from November 2022 to May 2024. Eighty-four adults (>= 40 years) with obstructive airway disease were included based on GINA 2022 and GOLD 2022 criteria. Data collection involved PFT, CBC and statistical analysis using SPSS 26.0. The study found that ACOS patients exhibited more severe symptoms, higher exacerbations, and persistent airflow limitation compared to asthma and COPD. Significant differences were observed in age, occupational exposure, smoking, and biomass exposure. ACOS had the highest prevalence of very severe obstruction and mixed patterns of reversibility, with elevated eosinophil counts in overlap cases. ACOS presents complex overlapping features of asthma and COPD, complicating diagnosis and management. Patients exhibit more severe symptoms, frequent exacerbations, and increased healthcare utilization compared to asthma or COPD alone.
Anaphylaxis resulting from sensitization to defensins and lipid transport proteins (LTPs) is becoming an increasingly frequent clinical issue. This case report describes a 38-year-old female patient who has been diagnosed with irregularly occurring anaphylactic reactions for over 20 years. These episodes manifested as generalized edema, pruritus, dyspnea, sudden diarrhea, and loss of consciousness. The most severe reaction occurred in August 2017, during the mugwort pollen season, when the patient consumed fresh sunflower seeds while walking in a forest. Within minutes, she experienced intense dyspnea, a sensation of chest tightness, pruritus of the palms, sudden diarrhea, muscle weakness, and visual disturbances (scotomata). The patient did not recall her journey back home, where she took prednisone (dose unspecified), resulting in the resolution of all symptoms. During the diagnostic work-up, the patient underwent skin prick tests for both food and inhalant allergens, which yielded positive results for hazelnut and common mugwort (Artemisia vulgaris). The diagnostic work-up was extended to include multiplex testing using the ALEX2 method, which revealed a very high IgE level for Art v 1 (the major allergen of common mugwort), a high IgE level for LTPs from common mugwort, and the presence of specific IgE antibodies for plant-derived food allergens belonging to the nsLTP family, including grapes, hazelnuts, and celery. These test results, in combination with the presence of cofactors, may provide an explanation for the reactions observed in the patient's medical history and offer a coherent explanation for the cause of her previous anaphylactic episodes. Based on the clinical presentation and immunological test results, the patient was diagnosed with anaphylaxis induced by allergies to defensins and LTPs.
The subject of allergen immunotherapy in patients sensitised to hymenoptera venom is a well-recognised area in the daily practice of allergy specialists. However, as in many areas, the therapeutic process may at times deviate from standard treatment protocols and sometimes requires individualized adjustments. Here, we report a case of a 63-year-old man eligible for bee venom VIT who developed a recurrent anaphylactic reaction during the induction phase of the ultra-rush protocol performed with an aqueous bee venom solution (Venomenhal (R), Hal Allergy). The article discusses modifications in the patient's therapeutic approach, necessitated by the need to adjust the preparation dosing schedule to prevent the recurrence of VIT-induced anaphylaxis, while still facilitating the implementation of immunotherapy as a life-saving intervention.
Asthma is a chronic respiratory disease common throughout the world. It is inflammatory in nature and progresses with bronchial hyperresponsiveness. It is manifested by coughing, breathlessness and wheezing. Immune cells secreting inflammatory mediators due to exposure to allergens are responsible for the onset of chronic inflammation. Exposure to other risk factors such as polluted air and tobacco smoke is also important. Smoking electronic cigarettes involves aspiration of heated liquid, containing substances such as propylene glycol, glycerine, vegetable glycerine, flavourings and nicotine. When heated, the liquid produces numerous toxic compounds that are inhaled by the user. Carbonyl compounds irritate the respiratory epithelium, causing bronchospasm and the secretion of mucus. Propylene glycol aerosol has a similar effect. Nicotine, on the one hand, has an anti-inflammatory effect, but also increases the viscosity of mucus in the bronchial tree. Diacetyl, a flavouring substance, leads to acute bronchiolitis. Cinnamaldehyde has documented immunosuppressive effects and impairs ciliary clearance. Menthol, on the other hand, exacerbates chronic inflammation within the bronchioles. In addition, users of electronic cigarettes are exposed to metal particle aspiration, which also negatively impacts the respiratory system. A substance with well-documented harmful effects on the respiratory system is tocopheryl acetate, which causes pulmonary oedema, neutrophilia, epithelial cell death, has a pro-inflammatory effect and interferes with surfactant function. Although electronic cigarettes are widely regarded as a safer alternative to traditional cigarettes, the substances they contain have documented toxic effects on the respiratory system.
Eosinophilic esophagitis is a chronic, immunological disease of the esophagus clinically manifested by symptoms of esophageal dysfunction, and histologically by eosinophilic infiltration of its wall. The last 3 decades have seen a rapid increase in the incidence of this disease to the point that it is sometimes called the second most common esophageal disease after gastroesophageal reflux disease, becoming one of the most important therapeutic challenges at the interface of allergology and gastroenterology. As a result, new European and American guidelines and recommendations from British societies have emerged, which have radically changed our approach to recognizing, diagnosing, and treating this disease. This paper attempts to systematize and present recommendations from recent years regarding the treatment of this disease, with particular emphasis on indications for biological treatment.
The article discuss the problem of differential diagnosis of abnormal tryptase serum level, serine protease, a recognised biomaker of allergic reactions focusing one's attention on the problem of hereditary alpha- tryptazemia, the genetic defect manifested by high serum tryptase level and highly diverse phenotype manifestation of this disorder
Nowadays, number of patients with multimorbidities and requiring systemic immunosuppression (SI) is increasing. These therapies pose serious risk of reactivation of latent, chronic infections, especially Hepatitis B and C viral infections (HBV, HCV). A relatively safe therapeutic alternatives to SI are biologicals. In treatment of patients with moderate-to-severe Atopic Dermatitis (AD) and contraindications to SI, such as HBV infection, Dupilumab (DUPI), a monoclonal antibody against IL-4R, is used with therapeutic success. We present such case description with emphasis of personalized eligibility for biological drug program in perspective of national and international qualification guidelines. Review of current clinical and experimental data regarding this problem was conducted. Practical aspects of this study are intended to show the diagnostic and therapeutic process to better understand current guidelines of evidence-based biological therapies.
Introduction Strawberry is a fruit of the Rosaceae family commonly consumed in Poland. To date, 4 strawberry allergens have been identified, including those belonging to the PR-10 proteins family Fra a 1. The most relevant mechanism of allergy to plants of the Rosaceae family, including strawberry, are IgE-mediated cross-reactions in the form of pollen-food syndrome, resulting from the homology of plant proteins with analogous tree and grass pollen proteins. It is estimated that cross-reactions resulting from pollen-food allergy syndrome underlie 1-2% of all anaphylactic reactions. Aim The aim of this study is to present a case of anaphylaxis following the ingestion of strawberry yogurt in a 5-year-old girl. Case report A 5-year-old girl with allergic rhinitis, sensitized to numerous airborne allergens, including birch pollen allergens, developed an anaphylactic reaction within 30 minutes after consumption of strawberry yogurt. The clinical presentation included spasmodic abdominal pain, shortness of breath, dry cough, urticarial lesions on the skin all over the body and swelling of the eyelids and lips. The diagnosis revealed sensitisation to proteins of the PR-10 family of inhalant and food allergens, including strawberries. It was recommended to exclude strawberries from the diet. The child was provided with an Individual Management Plan in case of the next anaphylactic reaction. Conclusions Although fruits of the Rosaceae family are rarely the causative agent of generalised reactions, they should be kept in mind when during diagnosing process of anaphylaxis, especially in patients with concomitant allergies to tree and grass pollens..
