Frontiers in allergy最新文献

{"title":"Utility of tryptase genotyping in the screening, diagnosis, and management of systemic mastocytosis.","authors":"Jeremy C McMurray, Brandon J Schornack, Joaquin Villar, Tracy I George, Nathan A Boggs","doi":"10.3389/falgy.2025.1599358","DOIUrl":"10.3389/falgy.2025.1599358","url":null,"abstract":"<p><p>Tryptase genotyping has an expanding role in the screening, diagnosis, and management of patients with systemic mastocytosis (SM). Reference ranges for basal serum tryptase (BST) based on increased <i>TPSAB1</i> gene copy number can guide whether a patient's BST value is normal according to their specific tryptase genotype. Patients with an elevated BST based upon their tryptase genotype should be offered a bone marrow biopsy with sample evaluation by a hematopathologist. Tryptase genotyping is required when assessing patients for the WHO minor criterion, BST > 20 ng/ml, especially in those with monoclonal mast cell activation syndrome, bone marrow mastocytosis (BMM), and indolent systemic mastocytosis (ISM) when the major criterion is not met. Additionally, in patients with non-advanced SM, tryptase genotyping helps determine whether a patient with hereditary-alpha tryptasemia (HαT) has BMM with a BST < 125 ng/ml or fulfills the B-finding of BST > 200 ng/ml through application of a correction factor. Understanding a patient's BST level based upon their tryptase genotype also is helpful in guiding when to pursue a repeat bone marrow biopsy in patients with SM treated with a tyrosine kinase inhibitor (TKI). However, TKIs have variable KIT D816V as well as wild type KIT inhibition. Given this variable KIT inhibition, ongoing and future clinical trials with selective TKIs should report whether patients with SM and HαT experience normalization or persistent elevation of BST values as this is essential in understanding the expected treatment response and when to assess for pathological remission in the bone marrow.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"6 ","pages":"1599358"},"PeriodicalIF":3.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Urticaria and mimickers of urticaria.","authors":"R Maximiliano Gomez, Beré Kezia Mahoney","doi":"10.3389/falgy.2025.1625291","DOIUrl":"https://doi.org/10.3389/falgy.2025.1625291","url":null,"abstract":"","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"6 ","pages":"1625291"},"PeriodicalIF":3.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Preventing childhood asthma-the neglected impact of existing public health interventions.","authors":"David M Patrick, Stuart E Turvey, Meghan B Azad, Petra Zimmermann, Angela Dramowski, Hannah Lishman","doi":"10.3389/falgy.2025.1621332","DOIUrl":"10.3389/falgy.2025.1621332","url":null,"abstract":"","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"6 ","pages":"1621332"},"PeriodicalIF":3.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12141241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Steroid-sparing benefits of biologic use in hypereosinophilic syndrome and substantial disease burden across subtypes.","authors":"Jeremiah Hwee, Lynn Huynh, Wilson da Costa, Marc E Rothenberg, Mei Sheng Duh, Rafael Alfonso-Cristancho","doi":"10.3389/falgy.2025.1605397","DOIUrl":"10.3389/falgy.2025.1605397","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist on the burden of myeloproliferative, lymphocytic and idiopathic subtypes of hypereosinophilic syndrome (M-HES, L-HES and I-HES) and the characteristics of patients with HES receiving biologic therapies. This analysis aimed to further characterize these subtypes and explore the impact of biologics in a real-world European setting.</p><p><strong>Methods: </strong>This was a <i>post hoc</i> subgroup analysis of a retrospective, non-interventional, chart review (GSK ID: 214657) across five European countries. Index date was first clinical visit during January 2015-December 2019 (after or at time of HES diagnosis). Patients with HES aged ≥6 years with ≥1-year follow-up from index were included. Demographics, disease characteristics, diagnostic assessments, comorbidities, types of treatment, clinical manifestations, clinical outcomes and HES-related healthcare resource utilization were summarized for HES overall and subtypes. Oral corticosteroid (OCS) use and clinical manifestations/outcomes were assessed 12-months pre- and post-biologics.</p><p><strong>Results: </strong>The analysis included 280 patients with I-HES (<i>n</i> = 155), M-HES (<i>n</i> = 66), L-HES (<i>n</i> = 42) and chronic eosinophilic leukemia (<i>n</i> = 2). The most common clinical manifestations were fatigue (54.2% I-HES, 52.4% L-HES, 42.4% M-HES), skin itch (36.4% M-HES, 35.7% L-HES, 33.5% I-HES) and pain (31.0% L-HES, 30.3% M-HES, 27.1% I-HES). Biologic use was highest with L-HES (64.3%), followed by I-HES (43.9%) and M-HES (34.8%). Clinical response rates were highest for the I-HES subtype (75.5%; 66.7% L-HES, 63.6% M-HES). Hospitalizations were highest for L-HES (45.2%; 30.3% M-HES, 25.8% I-HES). The annualized rate of OCS prescriptions reduced by 56.8% (0.44-0.19 per person-year) and the proportion of patients with ≥1 clinical response increased 3.6-fold (6.5%-23.4%) between the pre- and post-biologics periods.</p><p><strong>Conclusions: </strong>All HES subtypes had a substantial disease burden and were commonly associated with fatigue, skin itch and pain. I-HES appeared to be more responsive to treatment than L-HES and M-HES. Biologic use for HES led to more patients experiencing clinical responses and was OCS-sparing.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"6 ","pages":"1605397"},"PeriodicalIF":3.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study protocol for a randomized double-blinded placebo-controlled trial on ASA therapy for patients with chronic rhinosinusitis with nasal polyps, NSAID-exacerbated respiratory disease, and asthma.","authors":"Sanna Toppila-Salmi, Annina Lyly, Viljami Salmi, Mikko Nuutinen, Michael Kilpiö, Tanzeela Hanif, Mikko Niemi, Anu Laulajainen-Hongisto, Lena Hafrén, Mika Mäkelä, Paula Kauppi, Paula Virkkula, Alma Helevä","doi":"10.3389/falgy.2025.1542481","DOIUrl":"10.3389/falgy.2025.1542481","url":null,"abstract":"<p><strong>Background: </strong>Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory condition affecting the nasal passages and paranasal sinuses. It is characterized by persistent inflammation and often leads to a considerable decline in health-related quality of life (HRQoL). A subset of these patients-approximately 17.7%-have NSAID-exacerbated respiratory disease (N-ERD), a more severe form that frequently necessitates repeated sinus surgeries and rescue therapies. Compared with individuals without N-ERD, affected patients are more prone to asthma flare-ups, severe hypersensitivity reactions, and loss of smell. Treatment with acetylsalicylic acid (ASA) following desensitization (ATAD) has been suggested as a therapeutic option in cases of severe CRSwNP with N-ERD. While this approach may offer symptom improvement, decreased polyp burden, and enhanced QoL, it is not without risks, such as gastrointestinal irritation and bleeding complications. This randomized, double-blind, placebo-controlled clinical trial (RDBCT) assesses the effectiveness and safety of ATAD in comparison with placebo in patients suffering from severe CRSwNP, N-ERD, and asthma. The study explores various outcomes, including reduction in polyp burden, improvement in QoL, treatment-related side effects, and biomarker analyses derived from nasal swabs, blood, and urine samples.</p><p><strong>Methods: </strong>AirGOs Medical is an investigator-initiated RDBCT conducted at Helsinki University Hospital. Participants are randomized to receive either ATAD or placebo. The primary endpoint is the change in the SNOT-22 score observed at the 11-month follow-up. Secondary measures include variations in nasal polyp scores, CRS symptom control, general HRQoL, work productivity loss, peak nasal inspiratory flow (PNIF) with or without acoustic rhinometry (ARM), olfactory function assessed by the Sniffin' Sticks identification test, spirometry, peak expiratory flow (PEF), and histopathological findings at the 12-month follow-up.</p><p><strong>Discussion: </strong>The AirGOs Medical trial is expected to generate data on the therapeutic value and safety profile of ATAD in patients with coexisting severe CRSwNP, N-ERD, and asthma, potentially informing future clinical practice.</p><p><strong>Trial registration: </strong>[ClinicalTrials.gov], identifier [NCT03825757]. Registered on 28.2.2019.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"6 ","pages":"1542481"},"PeriodicalIF":3.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hereditary alpha tryptasemia and food allergy.","authors":"Abigail Lang","doi":"10.3389/falgy.2025.1583462","DOIUrl":"10.3389/falgy.2025.1583462","url":null,"abstract":"<p><p>Food allergy (FA) and hereditary alpha-tryptasemia (HαT) are both relatively common conditions, but potential associations between these diagnoses have not been well-studied. Prior studies have suggested that acute rises in tryptase following food allergy reactions may not be as significant as reactions triggered by venom or drug allergy, but preliminary evidence suggests that the presence of α-tryptase and HαT is a risk factor for more severe reactions to foods. This mini review summarizes the epidemiology and diagnostic considerations of FA for patients with co-morbid HαT, potential effect of α-tryptase on food allergy reaction severity, and implications of tryptase genotyping in the management of FA. Additional research is needed to further investigate the relationship between FA and HαT.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"6 ","pages":"1583462"},"PeriodicalIF":3.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The safety and efficacy of oral immunotherapy compared to epicutaneous immunotherapy in peanut allergen desensitisation amongst the paediatric cohort-a narrative review.","authors":"Ehtesam A Chowdhury, Olivia C Jadeja","doi":"10.3389/falgy.2025.1613237","DOIUrl":"10.3389/falgy.2025.1613237","url":null,"abstract":"<p><p>Peanut allergies result from a type 1 hypersensitivity reaction, with a prevalence of approximately 1% in children under 5 years of age. The allergens that instigate this reaction are the peanut proteins (Ara h 1-Ara h 8) for which IgE antibodies are specifically produced. Allergen immunotherapy (AIT), despite the uncertainty regarding its mode of action, has been increasingly utilised with the aim of desensitisation against these allergens. AIT encompasses various modes of administration, including epicutaneous immunotherapy (EPIT) and oral immunotherapy (OIT). The review adheres to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, with a comprehensive literature search conducted using databases including MEDLINE®, Embase™, PubMed®, and Google Scholar™. Search terms targeted OIT and EPIT in the desensitisation and management of peanut allergy in children, with studies spanning the past 20 years included based on predefined eligibility criteria. The extent of the immunotherapies' efficacy and safety in children is yet to be thoroughly established; however, OIT demonstrated increased desensitisation rates amongst children when compared to EPIT. The long-term efficacy has not been fully established, with sustained unresponsiveness not reported within most studies. Both modes of administration had a high proportion of participants experiencing adverse effects (AEs), with gastrointestinal symptoms more common with OIT and cutaneous reactions with EPIT. Serious AEs were observed less frequently, however, systemic reactions such as anaphylaxis were more apparent with OIT. Future research should focus on peanut EPIT, as the literature was relatively scarce. Furthermore, research studies should assess sustained unresponsiveness to fully gauge the long-term effects of AIT in children.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"6 ","pages":"1613237"},"PeriodicalIF":3.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and treatment of unilateral allergic fungal rhinosinusitis: a retrospective case series and literature review.","authors":"Xiaodong Chen, Jiawei Chen, Jian Wang, Min Xu, Tao Xue, Dingjun Zha, Fuquan Chen","doi":"10.3389/falgy.2025.1521574","DOIUrl":"10.3389/falgy.2025.1521574","url":null,"abstract":"<p><p>To retrospectively summarize the clinical manifestations, pathological characteristics, and efficacy of unilateral allergic fungal rhinosinusitis (AFRS), we analyzed the clinical data of 23 patients diagnosed with unilateral AFRS in a teaching hospital setting. All the patients showed positive reaction for fungal allergens via the skin prick test or serum-specific IgE test. CT scan showed lesions of the sinuses were unilateral. The average postoperative follow-up time was 72 months. Among the cases, 20 cases were cured, and 3 cases were improved. The VAS score decreased from 8.5 preoperatively to 1.1 postoperatively. The eosinophilic mucin, typical CT findings, and fungal-specific type I hypersensitivity are the three clinical features of AFRS. Endoscopic sinus surgery and oral glucocorticoids are effective treatments for AFRS.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"6 ","pages":"1521574"},"PeriodicalIF":3.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real world evidence of dupilumab effectiveness in a Colombian cohort of patients diagnosed with severe asthma.","authors":"Abraham Alí-Munive, Josefina Zakzuk, Nelson J Alvis-Zakzuk, Elizabeth García, Claudia Diaz Bossa, Diana Jimena Cano Rosales, Fabio Bolívar, Alejandro Carreño, Paula Rodríguez-Ordoñez, Natalia Gómez-Ardila, Gabriel Patiño, Sergio Londoño, Carlos A Torres-Duque","doi":"10.3389/falgy.2025.1564033","DOIUrl":"10.3389/falgy.2025.1564033","url":null,"abstract":"<p><strong>Background: </strong>Real-world effectiveness and safety of dupilumab for asthma treatment have been evaluated in USA and Europe, but research from Latin America is lacking. We aimed to describe the effectiveness of dupilumab in terms of changes in the annual rate of asthma exacerbations (AER) and their impact on lung function in Colombian patients.</p><p><strong>Methods: </strong>Real-world, descriptive, and multi-centric (five clinical centers located in four different cities in Colombia) retrospective study that included patients aged ≥18 years with severe asthma, as defined by the GINA criteria. Data were collected from medical records of medical centers specialized in pulmonology or allergy care) spanning from 12 months before the prescription of dupilumab (baseline) to 25 months later. Follow-up data were categorized at various time points (2-4, 5-7, 8-10, 11-13, 14-18, and 19-25 months). Main outcomes were annual rates of asthma exacerbations (emergency visits or hospitalizations due to asthma), lung function measured through FEV₁ and percent predicted FEV₁ (FEV₁pp), and Asthma Control Test (ACT) scores. Outcome rates were compared between baseline and follow-up data points. FeNO and absolute eosinophil counts throughout the observed period was also explored.</p><p><strong>Results: </strong>A total of 98 patients were included. At baseline, the mean AER was 0.61 ± 1.45 per adult. Lower AER were observed after one (0.11 ± 0.54) or two-years (0.08 ± 0.20) of dupilumab treatment (<i>p</i> = 0.03). FEV1 measurements after one or two years of dupilumab treatment were significantly lower than baseline (<i>p</i> = 0.03). Mean change from baseline in FEV₁ was 302.1 ± 481.97 ml (<i>n</i> = 19), 282.00 ± 231.99 ml (<i>n</i> = 10), and 248.18 ± 281.21 ml (<i>n</i> = 11) in the 2-4-, 11-13-, and 19-25-month follow-up periods, respectively. FEV₁pp showed higher but not significant values from the 2-4-month period, with a median change of 12.5% (IQR: 0.3, 21.5). The proportion of patients with uncontrolled asthma (ACT ≤15) decreased from 68% at baseline to 19% and 20% at year-one and second year of treatment, respectively (<i>p</i> = 0.003). The proportion of patients reaching FeNO values below 25 ppb was lower after dupilumab treatment than in baseline (<i>p</i> < 0.0001). Of the total cohort (<i>n</i> = 99), 15 (15.2%) experienced an adverse event (AE). Three patients discontinued dupilumab permanently, and two discontinued dupilumab due to AEs.</p><p><strong>Conclusions: </strong>Dupilumab is an effective and well-tolerated treatment for severe asthma in Colombia, resulting in reduced exacerbations and improved asthma control, lung function, and FeNO levels.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"6 ","pages":"1564033"},"PeriodicalIF":3.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining \"Normal\" basal serum tryptase levels: a context-dependent approach to improve diagnostics in systemic mastocytosis.","authors":"Francesca Crupi, Jessica Caroprese, Francesco Mannelli","doi":"10.3389/falgy.2025.1592001","DOIUrl":"10.3389/falgy.2025.1592001","url":null,"abstract":"<p><p>Serum tryptase level has long been used as a biomarker in clinical practice to suspect mast-cell associated disorders. Basal serum tryptase (BST) above 20 ng/ml represents a minor criterion according to WHO and ICC for the diagnosis of systemic mastocytosis (SM) although normal BST value does not exclude the diagnosis. Nevertheless, BST can be elevated also due to non-SM related diseases as well as hereditary alpha-tryptasemia (H<i>α</i>T), an autosomal dominant germline condition that consists in the increase of the number of copies of the <i>TPSAB1</i> gene encoding the alpha isoform of tryptase. The prevalence of H<i>α</i>T is estimated at around 5% of the general population. Individuals with H<i>α</i>T genotype can be asymptomatic; however, some of them can experience a range of symptoms with a large variability in type and severity, posing a problem of differential diagnosis with SM. The increasing awareness on a potentially SM underlying diverse clinical manifestations has led to excessive BST testing by several specialists, a trend that risks over interpreting some borderline results. The interpretation of elevated BST should thus be carefully appraised in specific clinical contexts on individual basis. This review is intended to examine the existing literature on this topic and offers a guide for interpreting the BST to rationalize the application of invasive diagnostic procedures.</p>","PeriodicalId":73062,"journal":{"name":"Frontiers in allergy","volume":"6 ","pages":"1592001"},"PeriodicalIF":3.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}