Clinical and Experimental Allergy最新文献

{"title":"Food Allergy Prevalence, Diagnosis and Impact: Unexpected Findings","authors":"Robert J. Boyle, Mohamed H. Shamji","doi":"10.1111/cea.14635","DOIUrl":"https://doi.org/10.1111/cea.14635","url":null,"abstract":"<p>In this issue, we present three studies which make important contributions to our understanding of food allergy epidemiology, food allergy diagnostics and food allergy's impact on populations. There are very few prior studies of changes in food allergy prevalence over time using robust methodology. Perhaps the only studies worldwide which have undertaken repeated, population-based assessments of confirmed food allergy prevalence are the UK Isle of Wight studies. In this issue, Carina Venter and colleagues summarise the findings of two birth cohorts on the Isle of Wight. They used these to evaluate whether a change in food allergy prevalence can be seen between a birth cohort born in 1989/90 and one born 12 years later in 2001/2 [<span>1</span>]. The significance of these years is that during this time, many reports have documented a sharp increase in hospital attendance and admission for food anaphylaxis in young children. Contrary to the popular narrative of a food allergy epidemic, Venter et al. did not identify a detectable change in food allergy overall between the two populations (Figure 1). This finding mirrors those of the US National Health and Nutrition Examination Surveys and the Australian HealthNuts and Melbourne Atopy Cohort studies, where no change in sensitisation to foods using blood specific IgE (US) or skin prick testing (Australia) to foods could be detected. Those studies compared children born in the 1970/80s with those born in the 1990s (US) and children born in 1993/4 versus 2010/11 (Australia) [<span>2, 3</span>]. The Isle of Wight findings are also consistent with a stable rate of fatal food anaphylaxis in national registry studies [<span>4</span>]. Taken together, these studies question whether food allergy has been increasing in high-income countries in recent decades.</p><p>If we look at two more studies published in this issue, we can start to understand why professionals and members of the public are convinced there is a food allergy epidemic, without good objective evidence to support that. The first issue is that food allergy diagnosis is difficult, so this health condition is susceptible to overdiagnosis. This is shown in the study of Chong et al. from Singapore, which involved evaluating the diagnostic accuracy of commonly used tests for milk, egg, wheat and peanut allergy in children [<span>5</span>]. They report poor diagnostic accuracy, especially for milk and wheat diagnostics, with the known issue of a high false positive rate for all testing modalities and allergens. Most children with food allergy do not have a supervised oral food challenge [<span>6</span>]. So, by relying on diagnostic tests and clinical history, and increasing the number of diagnostic tests performed, we may have allowed overdiagnosis to increase, fuelling a false food allergy epidemic [<span>7</span>].</p><p>The second issue is the social response to food allergy. There has been a marked increase in concern about food allergy in rec","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 2","pages":"108-110"},"PeriodicalIF":6.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14635","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Very Long-Term Stability of Tryptase in Frozen Serum Samples","authors":"Florent Broussal, Thomas Rouzioux, Dounia Khelifi-Touhami, Sibylle Bachelier, Brigitte Berthier, Aicha Abbas, Simone Choi, Yannick Chantran","doi":"10.1111/cea.70009","DOIUrl":"10.1111/cea.70009","url":null,"abstract":"<p>Mast cells are key players in allergic manifestations, which will affect 50% individuals by 2050. In physiological conditions, tryptase is produced almost exclusively by mast cells. A transient serum tryptase elevation is the biological hallmark of systemic acute mast cell activation, for example, occurring during anaphylaxis or Mast Cell Activation Syndrome.</p><p>In contrast, basal serum tryptase (bST) is remarkably steady over years in a given individual [<span>1</span>]. The concentrations of bST are mainly determined by genetic factors like Hereditary alpha-Tryptasemia [<span>1, 2</span>] and by the number of mast cells, which evolves very slowly in most healthy and diseased individuals [<span>1</span>]. Inter-individual variability of bST is explained by several sociodemographic, environmental and health determinants [<span>3</span>]. Notably, we recently reported that higher bST concentrations were associated with higher risk of allergic sensitisation, FeNO values, allergic manifestations including IgE-mediated asthma, and poor asthma control, in teenagers from a birth cohort [<span>4</span>]. Given the lifelong intraindividual stability of bST, our results suggest that bST could be used as a predictive tool to stratify individuals at high risk of allergic manifestations. Provided sufficient tryptase stability in frozen biological samples, this hypothesis could be tested retrospectively on research and care setting biobanks. Long-term tryptase stability is highly suspected [<span>1</span>] but was never formally demonstrated to date.</p><p>The present study aimed to determine very long-term tryptase stability in a collection of serum samples frozen during several years.</p><p>Briefly, all samples were collected at the Armand-Trousseau (AP-HP) hospital allergology laboratory from January to December 2016 (T0), systematically frozen and stored at −20°C immediately after bST measurements, and reanalysed for bST in July 2024 (T8). Blood samples were collected on tubes with clot activator and send to the laboratory within 2 h at room temperature. After 2 h clotting, samples were centrifuged at 1500 <b><i>g</i></b>, 15°C. Sera were aliquoted, stored at +4°C, and bST was analysed within 7 days [<span>5</span>]. If enough sample remained, sera were stored right after bST measurement at −20°C until T8. The maintenance of adequate temperature during storage was monitored by a temperature probe (SPY RF, JRI (France)) connected to a live monitoring software (Sirius, JRI (France)). Samples were kept at −20°C (±4°C) during all the study, without major incident or defrosting. A total of exactly 100 samples with bST values at T0 within reference range (1–15 μg/L) [<span>1</span>] were retrieved. Samples were allowed to defrost in an upright position during 24 h at +4°C. After defrosting, sera were homogenised gently by a vortex at low intensity and centrifuged before reanalysis. Tryptase were re-assayed at T8 by the same method (ImmunoCAP Tryptase Test","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 3","pages":"276-277"},"PeriodicalIF":6.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.70009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptance and Commitment Therapy Eczema Management Program for Children With Eczema: A Pilot Randomised Controlled Trial.","authors":"Yuen Yu Chong, Wai Tong Chien, Huan Yu Mou, Sui Ping Leung, Oi Yin Wong, Shu Yan Lam","doi":"10.1111/cea.70003","DOIUrl":"https://doi.org/10.1111/cea.70003","url":null,"abstract":"<p><strong>Introduction: </strong>Eczema significantly affects the quality of life of affected children and their families, with psychological stress often overlooked. Acceptance and Commitment Therapy (ACT) provides a supplementary approach to address these psychological challenges and enhance overall care.</p><p><strong>Objective: </strong>This pilot randomised controlled trial aimed to examine the feasibility, acceptability and preliminary effectiveness of the Family ACT-based Eczema Management Program (FACT-EMP).</p><p><strong>Methods: </strong>Parents and children aged 6-12 diagnosed with eczema from three outpatient clinics in Hong Kong were randomly assigned to either the FACT-EMP group, receiving four weekly ACT-based sessions plus eczema management education, or a waitlist control group receiving routine care. Feasibility and acceptability were assessed through recruitment, retention and completion rates, supplemented by focus group feedback on parental experiences. Primary clinical outcomes were children's eczema Severity Scoring of Atopic Dermatitis (SCORAD) and parental self-efficacy. Secondary outcomes included parental distress, quality of life, psychological flexibility and self-compassion of both parents and children.</p><p><strong>Results: </strong>From July 2021 to June 2023, 181 of 944 screened parent-child dyads met the inclusion criteria, and 78 were randomised and analysed (parents' mean [SD] age, 41.3 [11.0] years; 70 mothers [89.7%]; children's mean [SD] age, 8.3 [1.9] years; 53 boys [67.9%]). Recruitment, retention and completion rates were 43.1%, 87.2% and 76.9%, respectively. No significant between-group differences in SCORAD scores were observed immediately post-intervention. At 3-month post-intervention, SCORAD scores decreased significantly more in the FACT-EMP group than in the waitlist control group (adjusted mean difference, aMD, -7.73; 95% CI, -13.92 to -1.54). Parental self-efficacy scores also improved significantly more in the FACT-EMP group than the control, with an aMD of 18.69 (95% CI, 13.80 to 33.58) immediately post-intervention and 28.90 (95% CI, 13.93 to 43.84) at 3 months.</p><p><strong>Conclusion: </strong>FACT-EMP is potentially feasible, acceptable and effective in improving children's eczema symptoms and enhancing parents' self-efficacy in disease management over 3 months.</p><p><strong>Trial registration: </strong>NCT04919330.</p>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Small Airways Dysfunction With Dupilumab Using Airway Oscillometry in Uncontrolled Severe Asthma","authors":"Kirsten E. Stewart,&nbsp;Chris RuiWen Kuo,&nbsp;Rory Chan,&nbsp;Brian J. Lipworth","doi":"10.1111/cea.70002","DOIUrl":"10.1111/cea.70002","url":null,"abstract":"&lt;p&gt;Dupilumab acts on IL-4 receptor alpha inhibiting IL-4 and IL-13 signalling which in turn attenuates type 2 inflammation (T2I) in patients with asthma. The presence of small airway dysfunction (SAD) may be assessed using airway oscillometry (AO) which is performed during normal tidal breathing. AO may exhibit a high degree of sensitivity in detecting SAD in asthma, which can be evaluated using either peripheral lung resistance as the heterogeneity in resistance between 5 Hz and 20 Hz (R5-R20) or peripheral lung compliance as the area under the reactance curve (AX).&lt;/p&gt;&lt;p&gt;The presence of SAD as increased R5-R20 in asthmatic patients with an FEV&lt;sub&gt;1&lt;/sub&gt; &gt; 80% predicted is associated with significantly greater use of oral corticosteroids and salbutamol [&lt;span&gt;1&lt;/span&gt;]. Moreover, SAD as altered R5-R20 and AX, but not as FEV&lt;sub&gt;1&lt;/sub&gt;, is closely related to T2I biomarkers [&lt;span&gt;2&lt;/span&gt;]. A real-life retrospective study in patients with uncontrolled severe asthma receiving dupilumab revealed improved SAD detected through R5-R20 and AX [&lt;span&gt;3&lt;/span&gt;]. The objective of the present study was to prospectively assess the impact of 12 weeks of treatment with dupilumab on SAD in patients with type 2 high (T2H) poorly controlled severe asthma.&lt;/p&gt;&lt;p&gt;This was a phase 4 single-arm proof of concept clinical trial with a single-centre, open-labelled design which included adults aged 18–75 years with T2H poorly controlled severe asthma despite taking ICS/LABA with or without other second line controllers. Eligible patients entered a 4-week run-in period with standardisation of ICS/LABA as maintenance and reliever therapy (MART) 2–8 actuations per day using extra fine particle Fostair NEXThaler 100/6μg dry powder inhaler beclomethasone dipropionate/formoterol (BDP/FM). A treatment period of 12 weeks of dupilumab was then employed with an initial 600 mg loading dose followed by 300 mg 2 weekly doses in addition to BDP/FM MART. Participants were then followed for a subsequent 12-week washout period without dupilumab to week 24. ERS and ATS guidelines were followed for spirometry (Micromedical, Chatham, UK) and airwave oscillometry (AO) (TremoFlo c100, Thorasys, Montreal, Canada) according to the manufacturer's instructions and following published guidance [&lt;span&gt;4&lt;/span&gt;]. The study was approved by a local research ethics committee (21/WS/0151) and all participants gave written informed consent. The clinical trial was registered with ISRCTN:70810039. The presence of SAD at baseline was defined using values as follows: R5-R20 ≥ 0.1 kPa/L/s, R5-R20/R5 Ratio ≥ 19%, AX ≥ 1.0 kPa/L and FEF&lt;sub&gt;25–75&lt;/sub&gt; ≤ 60% predicted [&lt;span&gt;5&lt;/span&gt;]. Repeated measures analysis of variance (RM-ANOVA) was initially performed to compare results overall between baseline, week 12 and week 24. In the presence of a significant overall RM-ANOVA, pairwise Students &lt;i&gt;t&lt;/i&gt;-tests were used to assess differences between baseline (week 0) versus post dupilumab (week 12), and betwe","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 3","pages":"264-266"},"PeriodicalIF":6.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Urticaria Is Associated With an Increased Risk of Psoriasis: An Observational and Validation Study.","authors":"Lin-Hong Shi, An-Ping Huo, Yu-Hsun Wang, James Cheng-Chung Wei","doi":"10.1111/cea.70000","DOIUrl":"https://doi.org/10.1111/cea.70000","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Skin Deep: Olfactory Dysfunction as a Common Problem Among Chinese Hereditary Angioedema Patients.","authors":"Hugo W F Mak, Valerie Chiang, Jackie S H Yim, Elaine Lee, Dorothy L Y Lam, Philip H Li","doi":"10.1111/cea.70001","DOIUrl":"https://doi.org/10.1111/cea.70001","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Bronchodilator Reversibility and Spirometry Response to Dupilumab in Type 2 High Uncontrolled Severe Asthma","authors":"Robert Greig,&nbsp;Kirsten Stewart,&nbsp;Chris RuiWen Kuo,&nbsp;Rory Chan,&nbsp;Brian Lipworth","doi":"10.1111/cea.14634","DOIUrl":"10.1111/cea.14634","url":null,"abstract":"&lt;p&gt;Airway hyperresponsiveness is a key tenet of persistent asthma, along with the type 2 inflammatory phenotype in most patients, while bronchodilator reversibility (BDR) may be absent in patients with a preserved FEV&lt;sub&gt;1&lt;/sub&gt;. Biologics act on downstream type 2 cytokine pathways inhibiting signalling of interleukins (IL) 4, 5 and 13 [&lt;span&gt;1&lt;/span&gt;]. A retrospective study in severe asthma patients receiving anti-IL-5 or anti-IL-5Rα showed no difference in clinical outcomes when stratified by baseline BDR. Dupilumab is a monoclonal antibody which targets the alpha subunit of IL4 receptor which in turn inhibits IL4 and IL13 signalling, resulting in reduced exacerbations, improved symptom control and better lung function [&lt;span&gt;2&lt;/span&gt;]. We wanted to evaluate the putative relationship between baseline BDR to salbutamol and the lung function response to dupilumab, expressed as either force expiratory volume in 1 s (FEV&lt;sub&gt;1&lt;/sub&gt;) or forced mid-expiratory flow (FEF&lt;sub&gt;25-75&lt;/sub&gt;).&lt;/p&gt;&lt;p&gt;Here we assessed patients with uncontrolled severe asthma (EudraCT 2021-005593-25) who had BDR measured at their initial screening visit. Then after a 4 week run-in period patients also had lung function measured after receiving 12 weeks of dupilumab 300 mg given every 2 weeks. We assessed the spirometry response to either salbutamol or dupilumab calculated as % predicted changes from baseline, as well as relative % change from baseline (post–pre/pre), and absolute change (FEV&lt;sub&gt;1&lt;/sub&gt; in L and FEF&lt;sub&gt;25-75&lt;/sub&gt; as L/s). To ensure an equal comparison, the pre-salbutamol baseline at screening prior to run-in was used for both assessments.&lt;/p&gt;&lt;p&gt;Spirometry (Micromedical, Chatham, UK) measurements were performed in triplicate according to the ERS guidelines [&lt;span&gt;3&lt;/span&gt;]. 400 μg of salbutamol via a pressurised metered dose inhaler with an Aerochamber spacer device (Trudell Medical, London, Canada) was administered to all patients and after 20 min, the spirometry was repeated to assess BDR. Following the manufacturer's instructions and ERS guidelines, FeNO was obtained using NIOX Vero (NIOX, Oxford, UK) [&lt;span&gt;4&lt;/span&gt;]. SPSS version 29 was used for statistical analysis. Paired students &lt;i&gt;t&lt;/i&gt;-tests were applied with an alpha error of 5% and Pearsons test was used to evaluate correlations. Nominal &lt;i&gt;p&lt;/i&gt; values are quoted as either &lt;i&gt;p&lt;/i&gt; &lt; 0.05, &lt; 0.01 or &lt; 0.001 (two tailed).&lt;/p&gt;&lt;p&gt;The cohort consisted of 24 patients, 14 females, mean (SEM) age 52.3 (2.96); BMI 30.0 (1.23). The mean % predicted pre-bronchodilator pulmonary function values and type 2 inflammation markers were: FEV&lt;sub&gt;1&lt;/sub&gt; 88.1% (3.5); FEF&lt;sub&gt;25-75&lt;/sub&gt; 47.5% (3.0); FVC 105.8% (4.0) ACQ 3.0 (0.2); FeNO 68.0 ppb (8.9); eosinophils 510/μL (48), total IgE 204.7 kU/l (42.8).&lt;/p&gt;&lt;p&gt;There were significant improvements in FEV&lt;sub&gt;1&lt;/sub&gt; and FEF&lt;sub&gt;25-75&lt;/sub&gt; in response to salbutamol. However, the response to dupilumab was significant for FEV&lt;sub&gt;1&lt;/sub&gt; but not FEF&lt;sub&gt;25","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 3","pages":"253-255"},"PeriodicalIF":6.3,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14634","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary Lipid Production Profile of Patients With Food Allergy","authors":"Sakura Masuko,&nbsp;Shinichiro Inagaki,&nbsp;Taiki Hamabata,&nbsp;Takeru Ishii,&nbsp;Nanae Nagata,&nbsp;Kiwako Yamamoto-Hanada,&nbsp;Tatsuki Fukuie,&nbsp;Masami Narita,&nbsp;Tatsuo Shimosawa,&nbsp;Yukihiro Ohya,&nbsp;Takahisa Murata","doi":"10.1111/cea.14636","DOIUrl":"10.1111/cea.14636","url":null,"abstract":"&lt;p&gt;Upon immediate allergic inflammation, activated mast cells produce abundant bioactive lipid mediator prostaglandin (PG) D&lt;sub&gt;2&lt;/sub&gt;. PGD&lt;sub&gt;2&lt;/sub&gt; is metabolised and excreted in urine as tetranor-PGDM. We have previously reported urinary tetranor-PGDM as a sensitive biomarker for food allergy (FA) reactions in children [&lt;span&gt;1&lt;/span&gt;]. However, the production profile of other lipid mediators in the urine of FA patients remains unknown. Bioactive lipids are produced by enzyme-dependent or independent metabolism of polyunsaturated fatty acids (PUFAs) such as arachidonic acid (AA), linoleic acid (LA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and dihomo-gamma-linolenic acid (DGLA). There are three types of oxidative enzymes for PUFAs: cyclooxygenase (COX), lipoxygenase (LOX) and cytochrome P450 (CYP). The produced lipid mediators regulate inflammation and are extracted mainly in urine, thus their production profile can reflect the inflammatory status of our bodies. In this study, we comprehensively analysed the production profile of lipid mediators in the urine of subjects who received oral food challenge (OFC).&lt;/p&gt;&lt;p&gt;We collected the same urine samples from subjects as previously reported [&lt;span&gt;1&lt;/span&gt;]. Children suspected of having FA who underwent OFC to milk, egg, peanut or sesame were recruited between December 2014 and August 2015, and urine samples were collected before (pre) and 4 h after OFC (post). Of a total of 42 children, 31 were assessed as having positive results (OFC-positive; FA). This study received ethical approval from the Committee, University of Tokyo School of Medicine (2017,10586). All participants provided informed consent.&lt;/p&gt;&lt;p&gt;Initially, we confirmed that OFC and/or its positivity did not influence urinary pH, or specific gravity, while they did influence the lipid content (Figure 1A). There was no difference in urinary lipid content in children who ingested offending food, suggesting that lipid content may reflect the inflammatory reaction in the body. Next, we analysed the levels of 196 types of lipid metabolites in urine using LC–MS/MS and detected 19 lipid metabolites. These methods are available in the following repository (https://zenodo.org/records/14207617).&lt;/p&gt;&lt;p&gt;Figure 1B shows the AA metabolites levels in subjects' urine. As reported previously, the urinary levels of tetranor-PGDM were increased in OFC-positive-post urine, and its levels were higher than those of OFC-negative-post urine [&lt;span&gt;1&lt;/span&gt;]. The levels of other PGD&lt;sub&gt;2&lt;/sub&gt; metabolites, 13,14-dihydro-15-keto-tetranor-PGD&lt;sub&gt;2&lt;/sub&gt; and tetranor-PGJM (precursor and non-enzymatic metabolite of tetranor-PGDM, respectively), were also higher in the OFC-positive-post urine. It is well known that mast cells express H-PGDS and produce PGD&lt;sub&gt;2&lt;/sub&gt; [&lt;span&gt;2&lt;/span&gt;]. During the progression of FA, mast cells infiltrate into the relatively large area of intestinal mucosa and release PGD&lt;sub&gt;2&lt;/sub&gt;. This phenomenon presumably re","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 3","pages":"256-259"},"PeriodicalIF":6.3,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14636","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Anxiety to Work Productivity and Activity Impairment: The Mediating Role of Fatigue in Hereditary Angioedema","authors":"Hugo W. F. Mak,&nbsp;Jane C. Y. Wong,&nbsp;Valerie Chiang,&nbsp;Dorothy L. Y. Lam,&nbsp;Philip H. Li","doi":"10.1111/cea.14632","DOIUrl":"10.1111/cea.14632","url":null,"abstract":"&lt;p&gt;Hereditary angioedema (HAE) is a rare genetic disorder characterised by recurrent episodes of swelling [&lt;span&gt;1&lt;/span&gt;]. In recent years, the humanistic burden of HAE, including impaired health-related quality of life (HRQoL), work productivity loss and mental health issues, has been increasingly recognised [&lt;span&gt;2, 3&lt;/span&gt;]. At a societal level, absenteeism and productivity impairments also indirectly contribute to disease burden. Yet, causal relationships between these psychological and social outcomes are not well-understood in HAE. Thus, we carried out this study utilising causal mediation analysis, a method frequently used in health psychology research.&lt;/p&gt;&lt;p&gt;We analysed data from adult HAE patients in Hong Kong's CaSE-HAE program, a prospective family screening initiative offered in Hong Kong [&lt;span&gt;4&lt;/span&gt;]. Their responses to patient-reported outcome measures (PROMs), namely the Hospital Anxiety and Depression Scale (HADS), Angioedema Quality of Life Questionnaire (AE-QoL) and Work Productivity and Activity Impairment Questionnaire (WPAI) at time of diagnosis were retrieved [&lt;span&gt;3&lt;/span&gt;]. Their clinicodemographic characteristics (sex, age of diagnosis, HAE type, education level, comorbidities, past availability of HAE mediations, angioedema attacks and days of hospitalisation per year) were extracted. Patients with incomplete data were excluded. This study was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster. All patients provided informed consent.&lt;/p&gt;&lt;p&gt;Causal mediation analysis was performed on R version 4.3.1 (R Foundation, Vienna, Austria) via the &lt;i&gt;mediation&lt;/i&gt; package [&lt;span&gt;5&lt;/span&gt;]. &lt;i&gt;HADS Anxiety&lt;/i&gt; and &lt;i&gt;AE-QoL Fatigue&lt;/i&gt; were designated as model exposure and mediator, respectively. To increase the robustness of our results, we constructed three models, respectively with &lt;i&gt;WPAI Work productivity loss&lt;/i&gt;, &lt;i&gt;WPAI Activity impairment&lt;/i&gt;, and &lt;i&gt;AE-QoL Functioning&lt;/i&gt; as model outcomes. Sex, age of diagnosis, education level, angioedema attacks per year and days of hospitalisation per year were included in the three models as covariates. Besides, a bootstrapping analysis was conducted with 5000 simulations to yield a 95% confidence interval for our estimates. The Spearman correlations between PROM domains were also computed using IBM SPSS Statistics version 28 (IBM, Armonk, NY). Two-sided &lt;i&gt;p&lt;/i&gt; &lt; 0.05 denotes statistical significance.&lt;/p&gt;&lt;p&gt;This study included 25 HAE patients (52.0% female, median diagnosis age = 44 years, 72.0% Type 1 and 28.0% Type 2). Their clinicodemographic characteristics and PROM results can be found in Online Repository (https://osf.io/3nafm/). Overall, the median (interquartile range) scores were 11.0 (6.0–19.5) for &lt;i&gt;HADS Anxiety&lt;/i&gt;, 35.0 (2.5–52.5) for &lt;i&gt;AE-QoL Fatigue&lt;/i&gt;, 30.0 (10.0–60.0) for &lt;i&gt;AE-QoL Functioning&lt;/i&gt;, 50.0 (10.0–80.0) for &lt;i&gt;WPAI Work productivity loss&lt;/i&gt; and 50.0 (10.0–85.0) for &lt;i&gt;WPAI Ac","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 6","pages":"505-507"},"PeriodicalIF":6.3,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14632","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Penicillin Allergy Management in India and Sri Lanka: Current Challenges","authors":"Saibal Moitra,&nbsp;Guwani Liyanage,&nbsp;Sarah Tonkin-Crine,&nbsp;Neil Powell,&nbsp;Yogini Jani,&nbsp;Dhanushka Dasanayake,&nbsp;Nadisha Badanasinghe,&nbsp;Mohammad Ziaul Haque,&nbsp;Wasana Kudagammana,&nbsp;Raj Kumar,&nbsp;Padukudru Anand Mahesh,&nbsp;Bernard Yu-Hor Thong,&nbsp;Juan Meng,&nbsp;Devasahayam Jesudas Christopher,&nbsp;Mamidipudi Thirumala Krishna","doi":"10.1111/cea.14624","DOIUrl":"10.1111/cea.14624","url":null,"abstract":"<div>\u0000 \u0000 <p>Data regarding Penicillin allergy labels (PALs) from India and Sri Lanka are sparse. Emerging data suggests that the proportion of patients declaring an unverified PAL in secondary care in India and Sri Lanka (1%–4%) is lesser than that reported in High Income Countries (15%–20%). However, even this relatively small percentage translates into a large absolute number, as this part of the world accounts for approximately 25% of the global population. There is a huge unmet need for allergy specialists in India and Sri Lanka. Penicillin allergy management is further compromised by unavailability of skin test reagents, lack of formal training in drug allergy, pre-emptive, non-standardised and unregulated skin testing by untrained operators and a weak health service framework. This has an adverse impact on antimicrobial stewardship, particularly in the management of rheumatic fever, rheumatic heart disease, bacterial endocarditis, syphilis and other sexually transmitted infections. This narrative review highlights the burden of PALs in India and Sri Lanka, as well as gaps in the published literature. It describes current challenges and a pragmatic, cautious and staged bespoke mitigation approach to improve and standardise antimicrobial stewardship in accordance with the World Health Organisation AWaRe guidance.</p>\u0000 </div>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"55 5","pages":"367-377"},"PeriodicalIF":6.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}