International Archives of Allergy and Immunology最新文献

{"title":"Predictive Value of Systemic Inflammatory Indices in Drug Hypersensitivity Severity.","authors":"Aysu Okumuş Güçlü, Orbay Tutku Seren, Sultan Ece Özaydın Ünal, Mehmet Emin Kocabaş, Betül Aksu, Ümit Özmen, Mehtap Hafızoğlu, Papatya Bayrak Değirmenci","doi":"10.1159/000552668","DOIUrl":"10.1159/000552668","url":null,"abstract":"<p><strong>Introduction: </strong>Drug hypersensitivity reactions (DHRs) range from mild cutaneous symptoms to life-threatening anaphylaxis, necessitating practical biomarkers for severity prediction and risk stratification. This study aimed to evaluate the predictive value of Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI) measured during a stable period in patients with drug allergy.</p><p><strong>Methods: </strong>This study included 200 patients with DHRs, categorized into severe (anaphylaxis; n = 67) and non-severe (n = 133) groups. To reflect steady-state inflammatory status, hemogram parameters were obtained at least 1 month after resolution of acute symptoms. Diagnostic performances were assessed using age- and sex-adjusted logistic regression and ROC analysis.</p><p><strong>Results: </strong>Baseline SII, SIRI, and AISI were all significantly higher in the severe group (SII: 516.8 vs. 438.1, p = 0.009; SIRI: 1.08 vs. 0.88, p = 0.012; AISI: 286.6 vs. 221.9, p = 0.001). In age- and sex-adjusted models, each index independently predicted anaphylaxis per 1-SD increase: SII OR 1.55 (95% CI 1.13-2.20), AISI OR 1.50 (95% CI 1.12-2.06), and SIRI OR 1.45 (95% CI 1.08-1.97). Using Youden-optimized thresholds, AISI ≥197 yielded the highest adjusted odds of anaphylaxis (aOR 4.11, 95% CI 2.00-9.07; p < 0.001), followed by SII ≥333 (aOR 3.56, 95% CI 1.55-9.28; p = 0.005) and SIRI ≥1.37 (aOR 3.11, 95% CI 1.59-6.15; p < 0.001).</p><p><strong>Conclusion: </strong>Systemic inflammatory indices are independently associated with reaction severity in patients with immediate-type drug hypersensitivity. With AUC values ranging from 0.61 to 0.64, these indices demonstrate modest discriminatory performance and should be regarded as adjunctive screening tools rather than standalone diagnostic markers. Their elevation during the stable period may reflect a chronic pro-inflammatory state that predisposes individuals to more severe reactions upon drug exposure, a hypothesis requiring prospective validation in larger, multicenter cohorts.</p>","PeriodicalId":13652,"journal":{"name":"International Archives of Allergy and Immunology","volume":" ","pages":"1-8"},"PeriodicalIF":2.3,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148224690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lanadelumab in Hereditary Angioedema: Extending Dose Intervals from Every 2 Weeks to Every 4 Weeks.","authors":"Marc A Riedl, Daniel Soteres, Mark A Davis-Lorton, Tara Piccolo, Matt Otule, Irmgard Andresen, Timothy Craig","doi":"10.1159/000551678","DOIUrl":"10.1159/000551678","url":null,"abstract":"<p><strong>Background: </strong>Both clinical trial and real-world data demonstrate the effectiveness of lanadelumab long-term prophylaxis (LTP) to prevent hereditary angioedema (HAE) attacks, which may be maintained after dose interval extension from every 2 weeks (Q2W) to every 4 weeks (Q4W) in patients with well-controlled disease (attack free for >6 months).</p><p><strong>Summary: </strong>This narrative review summarizes published data on lanadelumab treatment patterns collected from clinical trials and observational studies since US approval in 2018. Disease activity and HAE-related healthcare resource use at baseline and during the first 6 months of lanadelumab treatment may be useful indicators of patients with well-controlled disease who will be eligible for, and may derive benefit from, dose interval extension on lanadelumab. Patients who receive a dose interval extension could benefit from a reduction in treatment burden, but not all patients may be a good fit for interval extension.</p><p><strong>Key messages: </strong>Although there are inherent limitations related to analyzing small sample sizes for subgroups of patients with a rare disease and for data derived from real-world studies, these data can inform physicians and patients about the characteristics and outcomes of patients who have successfully extended dosing intervals of lanadelumab LTP. This may in turn encourage regular monitoring to facilitate optimization of treatment and outcomes for each patient.</p>","PeriodicalId":13652,"journal":{"name":"International Archives of Allergy and Immunology","volume":" ","pages":"1-12"},"PeriodicalIF":2.3,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASTHMA PHENOTYPES AND COMORBID DISEASES.","authors":"Tuba Erdogan, Fusun Yildiz, Funda Seher Ozalp Ates, Ismet Bulut, Secil Kepil Ozdemir, Fatma Merve Tepetam, Selen Karaoglanoglu, Zeynep Yegin Katran, Seyma Ozden, Semra Demir, Elif Yilmazel Ucar","doi":"10.1159/000552377","DOIUrl":"https://doi.org/10.1159/000552377","url":null,"abstract":"<p><strong>Background: </strong>Asthma is a heterogeneous chronic airway disease frequently accompanied by comorbidities that influence symptom burden, treatment requirements, and disease control. Understanding the distribution of comorbidities across asthma phenotypes is essential for improving individualized management strategies.</p><p><strong>Methods: </strong>This cross-sectional study analyzed data from 2,053 adults enrolled in the nationwide Turkish Asthma Action and Research (TAAR) registry. Demographic characteristics, asthma phenotypes, comorbidities, treatment steps, and control status were extracted. Comorbidities were categorized as upper airway, lower airway, non-respiratory, and psychophysiological disorders. Comparative analyses were performed across phenotypes (eosinophilic, allergic, NERD, obese asthma), treatment steps, and control groups using appropriate statistical tests.</p><p><strong>Results: </strong>Allergic rhinitis (64.2%), chronic rhinosinusitis (32.1%), gastroesophageal reflux (GER) (26.4%), and nasal polyposis (19.9%) were the most frequent comorbidities. Upper airway diseases were significantly more common in eosinophilic asthma, NERD, and allergic asthma. Obesity-related comorbidities-including diabetes mellitus, hypertension, cardiovascular disease, and obstructive sleep apnea -were markedly higher in the obese asthma phenotype and among women. GER was particularly prevalent in NERD, obese asthma, and uncontrolled asthma. Patients in GINA step 5 had the highest comorbidity burden. Poorly controlled asthma was associated with higher frequencies of chronic rhinosinusitis, diabetes mellitus, GER, recurrent URTIs, and osteoporosis. The proportion of uncontrolled asthma increased significantly with rising numbers of comorbidities.</p><p><strong>Conclusion: </strong>Comorbidities are highly prevalent among adults with asthma and vary substantially across phenotypes, sex, treatment step, and control status. Upper airway disease, GER, obesity-related conditions, and metabolic disorders exert a major impact on asthma severity and control. Systematic identification and targeted management of comorbidities should be prioritized to optimize asthma outcomes and reduce disease burden.</p>","PeriodicalId":13652,"journal":{"name":"International Archives of Allergy and Immunology","volume":" ","pages":"1-24"},"PeriodicalIF":1.8,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinct Histopathological and Transcriptomic Signatures of Central Compartment Atopic Disease.","authors":"Ling Han, Kanghua Wang, Shihai Wu, Ling Ma, Chaopan Zheng, Jiahao Mai, Zhaoyang Ke, Jianbo Shi, Yueqi Sun","doi":"10.1159/000552582","DOIUrl":"10.1159/000552582","url":null,"abstract":"<p><strong>Introduction: </strong>Central compartment atopic disease (CCAD) is a distinct phenotype of chronic rhinosinusitis (CRS) characterized by central polypoid changes and a strong association with allergy. While its clinical presentation is established, its specific histopathological features and transcriptomic profile remain poorly characterized. This study aimed to comprehensively evaluate the pathological and molecular profiles of CCAD in comparison to other CRS subtypes.</p><p><strong>Methods: </strong>In this multicenter retrospective study, 221 eligible CRS patients were stratified into four phenotypes: CCAD (n = 48), sinonasal polyps with concomitant central compartment disease (CC, n = 40), and CRSwNP not otherwise specified (NOS). The NOS cohort was further subdivided based on the dominance of maxillary (M) versus ethmoid (E) sinus opacification (Lund-Mackay scores) into NOS M≤E (n = 90) and NOS M>E (n = 43) subgroups. We comprehensively analyzed demographics, symptom scores, computed tomography metrics, and structured histopathological features. Furthermore, RNA sequencing was performed on representative nasal tissues (n = 5 per group) to elucidate distinct transcriptomic signatures and underlying biological pathways.</p><p><strong>Results: </strong>Clinically, CCAD patients exhibited a significantly higher prevalence of allergic rhinitis (79.2%) compared to other groups, despite having lower overall radiological opacification scores. Histopathologically, CCAD was defined by an eosinophil-rich, stromal-dominant remodeling pattern, featuring prominent basement membrane thickening, fibrosis, and seromucinous gland hyperplasia. This contrasted sharply with the epithelial-centric remodeling (e.g., squamous metaplasia) observed in non-eosinophilic subtypes. Transcriptomic analysis revealed that CCAD shares a type 2 inflammatory signature with the CC subtype, showing high molecular similarity (only 19 differentially expressed genes). However, gene set enrichment analysis (GSEA) highlighted unique features in CCAD, including mast cell activation and macrophage cytokine production pathways.</p><p><strong>Conclusion: </strong>CCAD represents a specialized type 2 CRS endotype characterized by central anatomical obstruction, allergic burden, and specific stromal remodeling. While its molecular proximity to diffuse CC suggests a shared pathogenic origin, unique mechanisms involving mast cell activation and macrophage cytokine production distinguish its local pathophysiology. Longitudinal studies are needed to define its relationship with diffuse disease.</p>","PeriodicalId":13652,"journal":{"name":"International Archives of Allergy and Immunology","volume":" ","pages":"1-14"},"PeriodicalIF":2.3,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monoclonal Antibody-Based 2-Site ELISA for Profilin Measurement in Korean Melon and Other Melon Cultivars.","authors":"Yoon Ji Shin, Jae-Hyun Lee, Jung-Won Park, Kyoung Yong Jeong","doi":"10.1159/000552708","DOIUrl":"10.1159/000552708","url":null,"abstract":"<p><strong>Introduction: </strong>Pollen-food allergy syndrome (PFAS) is commonly associated with profilin, a highly cross-reactive pan allergen found in a variety of plants, including fruits, vegetables, and pollens. In Korea, the Korean melon (Cucumis melo var. makuwa), commonly known as Chamoe, has been identified as a major trigger for PFAS. However, the lack of standardized allergen extracts limits the consistency and reliability of diagnosis and therapeutic efficacy. This study aimed to develop a novel two-site ELISA for quantifying Cuc m 2, the major profilin allergen from Korean melon, to support the standardization of allergen extracts.</p><p><strong>Methods: </strong>Recombinant Cuc m 2.0301 was used to immunize mice and generate hybridomas that produce monoclonal antibodies recognizing both Cuc m 2.0102 and Cuc m 2.0301 isoallergens.</p><p><strong>Results: </strong>The ELISA system demonstrated high sensitivity, with detection limits as low as 10 μg/mL for melon extracts and 3 ng/mL for recombinant Cuc m 2. We quantified Cuc m 2 concentrations in various melon cultivars, with values ranging from 5.43 to 78.25 ng/mL. Cross-reactivity was observed with tomato profilin (Sola l 1) but not with profilins from pineapple, banana, or timothy grass pollen. The allergenic potency of melon extracts was generally correlated with Cuc m 2 concentration, except for Korean melon, suggesting the presence of additional allergenic components.</p><p><strong>Conclusion: </strong>This study provides a reliable method for quantifying Cuc m 2, which may support the standardization and consistency of allergy diagnostic materials and allergen surveillance.</p>","PeriodicalId":13652,"journal":{"name":"International Archives of Allergy and Immunology","volume":" ","pages":"1-8"},"PeriodicalIF":2.3,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of L-Asparaginase Hypersensitivity and Desensitization in Children with Acute Lymphoblastic Leukemia.","authors":"Hilal Unsal, Hilal Eda Korkmaz, Selin Aytac, Umit Murat Sahiner, Bulent Enis Sekerel, Fatma Gumruk, Ozge Soyer","doi":"10.1159/000552669","DOIUrl":"10.1159/000552669","url":null,"abstract":"<p><strong>Introduction: </strong>L-asparaginase is a key chemotherapeutic component of acute lymphoblastic leukemia (ALL) regimens. When hypersensitivity reactions (HSRs) occur, limited availability of alternative L-asparaginase preparations can jeopardize adherence to intended chemotherapy protocols. The aim of this study was to assess the impact of L-asparaginase-related hypersensitivity and subsequent desensitization on survival outcomes in patients with ALL.</p><p><strong>Methods: </strong>Children with ALL treated according to the modified St. Jude Total XIII protocol between January 1997 and December 2007 who experienced systemic HSRs to L-asparaginase were included in the study. Recorded variables included demographics, ALL characteristics, event-free survival, desensitization procedure, and premedication regimens.</p><p><strong>Results: </strong>Of 221 children with ALL (65.2% male; median age at diagnosis 6.11 years [3.2-9.1]), L-asparaginase HSR rate was 12.6%, including 19 (67.8%) cases of anaphylaxis. Concomitant drug allergies were reported to methotrexate (n = 2), etoposide (n = 2), and daunomycin (n = 1). HSRs were most frequent during remission induction (50%) and least during maintenance (10.7%). Desensitization to asparaginase was performed in 15 patients; others received premedication (n = 5) or E. coli asparaginase was discontinued according to the protocol and replaced with Erwinia or polyethylene glycol (PEG)-asparaginase (n = 8). Among the 190 patients with long-term follow-up, 10-year overall survival was lower in the L-asparaginase-allergic group than in nonallergic patients (20/26, 76.9% vs. 149/164, 90.9%; p = 0.035). In the desensitization group (n = 13), the overall survival rates at five and 10 years were 92.3% and 69%, respectively, while in the no desensitization group (n = 13), the rates were 92.3% and 84.6%, respectively (p > 0.05).</p><p><strong>Conclusion: </strong>In this cohort of pediatric patients with ALL, desensitization to L-asparaginase was not associated with a statistically significant difference in prognosis.</p>","PeriodicalId":13652,"journal":{"name":"International Archives of Allergy and Immunology","volume":" ","pages":"1-8"},"PeriodicalIF":2.3,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neutrophil-to-Lymphocyte Ratio in Pediatric Anaphylaxis: A Potential Indicator of Cardiovascular Involvement.","authors":"Asli Kuzu Kusakli, Zeynep Sengül Emeksiz, Can Demir Karacan, Emine Dibek Misirlioglu","doi":"10.1159/000551802","DOIUrl":"10.1159/000551802","url":null,"abstract":"<p><strong>Introduction: </strong>The diagnostic utility of the neutrophil-to-lymphocyte ratio (NLR) in anaphylaxis is often obscured by the rapid immunomodulatory effects of epinephrine and corticosteroids. We evaluated NLR as a marker of reaction severity and clinical phenotype in pediatric anaphylaxis, employing a strict sampling protocol to minimize treatment-induced leukocytosis.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 81 children meeting EAACI anaphylaxis criteria. To isolate the intrinsic inflammatory signal, blood samples were included only if obtained within 30 min of epinephrine and 1 h of systemic corticosteroid administration. Acute-phase NLR was compared to patient-specific healthy baselines, clinical severity grades, anaphylaxis triggers, and acute serum tryptase levels.</p><p><strong>Results: </strong>Paired analysis (n = 68, patients with both acute and healthy-state complete blood counts) confirmed a significant acute inflammatory response; acute NLR (median 1.10) was significantly elevated compared to healthy baselines (median 0.97; p = 0.032). Although NLR failed to statistically discriminate between broad severity groups (mild-to-moderate vs. severe; p = 0.40), phenotypic analysis revealed that patients with cardiovascular involvement exhibited numerically higher NLR values compared to those without. This pattern was mirrored by the trigger analysis, where NLR was significantly higher in drug-induced anaphylaxis than in food-induced reactions (median 2.64 vs. 0.92; p < 0.001). Furthermore, patients with elevated acute serum tryptase (≥11.4 ng/mL) had significantly higher NLR values (p = 0.038), reinforcing the association between intense neutrophilic mobilization and systemic instability.</p><p><strong>Conclusion: </strong>Although NLR does not align with standard clinical severity grading in a general pediatric cohort, it serves as a sensitive gauge of the systemic magnitude of anaphylaxis. Elevated NLR specifically reflects the intense hemodynamic stress associated with drug-induced phenotypes and massive mast cell degranulation. Thus, rather than a general severity stratification tool, NLR should be interpreted as a biological \"red flag\" for cardiovascular compromise, particularly in drug-induced cases, warranting early cardiac monitoring.</p>","PeriodicalId":13652,"journal":{"name":"International Archives of Allergy and Immunology","volume":" ","pages":"1-9"},"PeriodicalIF":2.3,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Prophylaxis for Hereditary Angioedema: Real-World Treatment Patterns in Selected US Allergy Clinics.","authors":"Jason Raasch, Henry Li, Marc A Riedl, Valeria Duran, E Dawn Flick, James Ruggles, Catherine A Schnabel, Kathleen F Villa","doi":"10.1159/000551984","DOIUrl":"10.1159/000551984","url":null,"abstract":"<p><strong>Introduction: </strong>Hereditary angioedema (HAE) is a rare genetic disorder which causes recurrent and unpredictable swelling attacks that pose high morbidity and risk of death. Long-term prophylactic (LTP) treatments are an important clinical management tool to reduce attack frequency. This study aims to assess real-world treatment patterns among US patients receiving LTP therapy.</p><p><strong>Methods: </strong>The Patient Important Outcomes National Data Repository for Hereditary Angioedema (PIONEER) HAE registry contains structured and unstructured data for patients within the Consortium of Independent Immunology Clinics (CIIC). Eligibility criteria included diagnosis of HAE due to C1-inhibitor deficiency (HAE-C1NH), observation between April 2021 and March 2024 and record of a LTP therapy. Index therapy was defined as the earliest prophylactic therapy for which the patient had at least 180 days of medical history prior to initiation and 180 days of follow-up thereafter. Patients were observed for up to 3 years.</p><p><strong>Results: </strong>This study included 179 patients; most had HAE-C1INH Type 1 (86%) with median age 38 years (IQR: 25-53). Index therapy included kallikrein inhibitors (55%), C1-esterase inhibitors (37%), androgens (6%), and antifibrinolytic agents (2%); most often initiated in 2019 (21%). Eighty-three (46%, 83/179) discontinued index therapy, with a median 12 (IQR: 4.8-33) months to discontinuation. Discontinuations were most commonly due to lack of efficacy (29%, 22/76). Of those, 48/83 (58%) switched or restarted prophylactic therapy.</p><p><strong>Conclusion: </strong>Nearly half of patients discontinued their index LTP at some point during the observation period, primarily due to efficacy, administration, or dosing challenges. Advanced understanding of unmet treatment needs and other important factors in the HAE treatment landscape will require more robust and detailed data on real-world treatment decision-making.</p>","PeriodicalId":13652,"journal":{"name":"International Archives of Allergy and Immunology","volume":" ","pages":"1-6"},"PeriodicalIF":2.3,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13363107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conventional and Molecular Approaches to Pediatric Wheat Allergy: Insights from an East Mediterranean Cohort.","authors":"Hilal Unsal, Elif Soyak Aytekin, Umit Murat Sahiner, Ozge Soyer, Bulent Enis Sekerel","doi":"10.1159/000552552","DOIUrl":"10.1159/000552552","url":null,"abstract":"<p><strong>Introduction: </strong>Wheat allergy (WA) diagnosis in children is complex due to the low specificity of conventional tests. This study evaluates clinical characteristics and the diagnostic utility of skin prick tests (SPT), specific IgE (sIgE), and molecular allergology, including Tri a 19, Tri a 14, and alpha-amylase inhibitors (AAI), in a pediatric cohort from the East Mediterranean.</p><p><strong>Methods: </strong>Sixty-three children (median age 30 months) evaluated for IgE-mediated WA were retrospectively analyzed. Patients were classified as wheat-allergic (n = 30) or wheat-sensitized (n = 33) based on oral food challenges (OFCs) or recent systemic reactions. Sensitization was assessed via SPT, ImmunoCAP, and the ALEX2 multiplex platform.</p><p><strong>Results: </strong>Most participants (93.7%) were multi-allergic, with high sensitization rates to rye (89.6%) and barley (77.1%). Wheat-allergic patients had significantly higher rates of anaphylaxis (83.3% vs. 9%, p < 0.001). Optimal cutoffs were 6.73 kU/L for wheat sIgE (area under the curve [AUC] 0.828, sensitivity 93.3%) and 5 mm for SPT (AUC 0.898, sensitivity 90.0%). In multiplex analysis, Tri a 19 (>0.61 kUA/L) and AAI (>2.92 kUA/L) were significant predictors of reactivity. Tri a 14 sensitization was observed in 4 intolerant patients, 2 of whom experienced anaphylaxis. While Tri a 14 showed 100% specificity at a 12.96 kUA/L cutoff, AAI achieved an AUC of 0.801, providing critical utility for Tri a 19-negative patients. All patients challenged with gluten-free oats demonstrated tolerance.</p><p><strong>Conclusions: </strong>Pediatric WA in this region involves a high atopic burden and frequent multi-allergy. Systemic reactivity, including Tri a 14, occurs despite relatively low sIgE levels. Incorporating molecular components like Tri a 19/14 and AAI into diagnostic algorithms improves risk stratification.</p>","PeriodicalId":13652,"journal":{"name":"International Archives of Allergy and Immunology","volume":" ","pages":"1-10"},"PeriodicalIF":2.3,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Threshold Concentration of Ragweed Pollen for Inducing Allergic Symptoms: Initial Data Using an Allergen Challenge Chamber.","authors":"Conny Höflich, Philipp Badorrek, Christina Gress, Meike Müller, Wolfgang Straff, Jens M Hohlfeld","doi":"10.1159/000551344","DOIUrl":"10.1159/000551344","url":null,"abstract":"<p><strong>Introduction: </strong>Climate change may increase the spread of allergenic plants such as ragweed. Ragweed pollen is assumed to be more allergenic than birch pollen. Determining pollen threshold concentrations triggering symptoms is challenging. Technical modifications to the Fraunhofer allergen challenge chamber (ACC) now allow investigation of very low pollen concentrations. Based on Total Nasal Symptom Score (TNSS) data from 15 subjects with birch pollen allergic rhinitis (AR), a birch pollen threshold between 50 and 100 pollen grains/m3 of air was previously derived. This study explored threshold concentrations of ragweed pollen.</p><p><strong>Methods: </strong>Two ragweed pollen AR patients were exposed to varying concentrations of ragweed pollen for 4 h. TNSS was recorded every 20 min, and nasal secretion and peak nasal inspiratory flow hourly. Area under the curve (AUC_0-240) values were calculated. Ex vivo basophil activation tests with varying concentrations of ragweed pollen, Amb a 1, birch pollen, and Bet v 1 were performed for both ragweed pollen AR patients and 6 of the 15 birch pollen AR patients. Mean effective concentrations (EC₅₀) for CD63 expression were calculated.</p><p><strong>Results: </strong>Ragweed pollen exposure resulted in the following TNSS AUC_0-240 values: 28/23 at 0, 18/17 at 50, 13/27 at 100, 40/40 at 200, 29/16 at 300, and 55/47 at 1,000 pollen grains/m3. For CD63 expression, the mean EC₅₀ was 277 pollen/mL for ragweed pollen, 884 ng/mL for Amb a 1, 11 pollen/mL for birch pollen, and 0.13 ng/mL for Bet v 1. On average, the proportion of Amb a 1 in ragweed pollen was 0.17%, and the proportion of Bet v 1 in birch pollen 1.96%.</p><p><strong>Conclusion: </strong>The modified Fraunhofer ACC can investigate pollen threshold concentrations under defined conditions. The assumed differences in threshold concentrations of ragweed and birch pollen for triggering symptoms were not confirmed. To derive reliable threshold concentrations for ragweed pollen, larger studies have to be followed.</p>","PeriodicalId":13652,"journal":{"name":"International Archives of Allergy and Immunology","volume":" ","pages":"1-8"},"PeriodicalIF":2.3,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}