Allergologia et immunopathologia最新文献

{"title":"Rapid desensitization to methotrexate: a successful case in acute lymphoblastic leukemia.","authors":"Rosa I Guzmán Avilán, Natalhie Acuña Ortega, Sandra N González Díaz, Cindy E de Lyra Quezada, Ana K Chávez Ruiz, Danna S Ríos González","doi":"10.15586/aei.v54i4.1526","DOIUrl":"10.15586/aei.v54i4.1526","url":null,"abstract":"<p><p>Methotrexate (MTX) is a folate antimetabolite indicated for the treatment of malignant and autoimmune diseases. It is one of the most effective drugs used for the treatment and maintenance therapy of acute lymphoblastic leukemia (ALL). This paper presents a 13-year-old patient with B-type ALL who experienced a severe hypersensitivity reaction, prompting the implementation of a MTX desensitization protocol. This protocol may serve as a useful reference for future desensitization procedures. This case challenged the medical team in determining how to safely continue with the prescribed therapy. Although cases of MTX desensitization have been published in the literature, most of these are adult patients; only a few were pediatric patients; and even a fewer were patients with ALL. Given the absence of alternative treatment options, MTX desensitization was implemented, leading to a successful continuation of the therapy.</p>","PeriodicalId":7536,"journal":{"name":"Allergologia et immunopathologia","volume":"54 4","pages":"132-134"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417860","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":"Right ventricular function in children with asthma: tissue doppler and two-dimensional speckle-tracking echocardiography.","authors":"Ezgi Topyildiz, Deniz Ozceker, Ramime Ozel, Kemal Nisli, Melike Zehra Bugra, Nermin Guler, Zeynep Ulker Altinel","doi":"10.15586/aei.v54i4.1773","DOIUrl":"https://doi.org/10.15586/aei.v54i4.1773","url":null,"abstract":"<p><strong>Background: </strong>Asthma-related cardiopulmonary interactions may affect right ventricular (RV) performance even when children are clinically stable. Two-dimensional speckle-tracking echocardiography (2D-STE) may detect subclinical myocardial dysfunction beyond conventional indices. This study aims to investigate the effects of childhood asthma on RV function by using 2D-STE.</p><p><strong>Methods: </strong>In this prospective case-control study, children aged 6-18 years with physician-diagnosed asthma (<i>n</i> = 70) and age-matched healthy controls (<i>n</i> = 30) underwent standard transthoracic echocardiography, tissue Doppler imaging (TDI), and 2D-STE. Primary outcomes were RV global longitudinal strain (RV GLS) and strain rate. Conventional RV systolic indices and RV diastolic indices were also assessed. Clinical characteristics and spirometry were recorded.</p><p><strong>Results: </strong>RV systolic mechanics were largely preserved in the asthma group. RV GLS, RV strain rate, and tricuspid annular plane systolic excursion (TAPSE) did not differ significantly between asthmatic children and controls. In contrast, tricuspid annular E' velocity was significantly lower in the asthma group (<i>p</i> = 0.007), and tricuspid E/E' ratio was significantly higher (<i>p</i> < 0.001). Interventricular septal diastolic thickness was also significantly increased among children with asthma (<i>p</i> = 0.027). Within the asthma cohort, TAPSE showed positive correlations with age (<i>r</i> = 0.478, <i>p</i> < 0.001), BMI (<i>r</i> = 0.398, <i>p</i> = 0.001), asthma duration (r = 0.431, <i>p</i> < 0.001), and FEV1 (<i>r</i> = 0.301, <i>p</i> = 0.011), whereas RV strain parameters were not significantly associated with demographic or respiratory variables.</p><p><strong>Conclusions: </strong>In predominantly mild-to-moderate, clinically stable pediatric asthma, RV systolic deformation by 2D-STE appears preserved, while TDI-derived indices indicate early RV diastolic involvement. Focused assessment of RV diastolic function may help to identify subclinical cardiopulmonary effects in selected children with asthma.</p>","PeriodicalId":7536,"journal":{"name":"Allergologia et immunopathologia","volume":"54 4","pages":"120-127"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417875","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":"Recurrent pediatric mast cell-mediated angioedema: a retrospective case series and reflection on classification.","authors":"Martha Jimenez-Freites, Rosa Jimenez-Feijoo, Jaime Lozano-Blasco, Adrianna Machinena-Spera, Olga Dominguez-Sanchez, Monica Piquer-Gibert, Maria Del Mar Folque-Gimenez, Gilda Yanez-Lema, Montserrat Alvaro-Lozano","doi":"10.15586/aei.v54i4.1651","DOIUrl":"https://doi.org/10.15586/aei.v54i4.1651","url":null,"abstract":"<p><strong>Background: </strong>Mast cell-mediated angioedema (MC-AE) is an increasingly recognized entity in pediatric allergy, distinct from bradykinin-mediated and allergic angioedema. Despite its clinical relevance, pediatric data remain limited and classification remains challenging in the absence of validated biomarkers.</p><p><strong>Objective: </strong>To describe the clinical presentation, diagnostic workup, and therapeutic outcomes of a pediatric case series with recurrent MC-AE without wheals.</p><p><strong>Methods: </strong>A retrospective review was conducted comprising pediatric patients with recurrent angioedema without urticaria, evaluated at a tertiary pediatric allergy unit in Barcelona between January 2021 and November 2024. Inclusion required ≥2 episodes, no wheals, and follow-up ≥12 months. Data collected included demographics, clinical features, laboratory evaluation, treatment response, and outcomes.</p><p><strong>Results: </strong>Seven children (six females, median age at onset 6 years) met inclusion criteria. All had superficial, well-demarcated, self-limiting angioedema, most commonly periorbital. C1-inhibitor studies were normal, excluding hereditary angioedema. All responded to high-dose second-generation antihistamines; corticosteroids were used transiently in moderate/severe episodes. No patients required biologics or hospital admission. Basophil activation was positive in 1/6 tested patients. Episode frequency decreased during follow-up.</p><p><strong>Conclusion: </strong>Pediatric MC-AE appears to represent a clinically identifiable phenotype characterized by recurrent superficial swelling, normal complement testing, and consistent antihistamine responsiveness. These findings support mechanism-oriented classification frameworks and highlight the importance of timely recognition to optimize management.</p>","PeriodicalId":7536,"journal":{"name":"Allergologia et immunopathologia","volume":"54 4","pages":"151-155"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417805","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":"Which sleep-related factors matter most in asthma? A prospective study of sleep duration, sleep quality, and nocturia.","authors":"Müge Erbay, Yılmaz Bülbül","doi":"10.15586/aei.v54i4.1694","DOIUrl":"https://doi.org/10.15586/aei.v54i4.1694","url":null,"abstract":"<p><strong>Background: </strong>Sleep disturbances are highly prevalent in asthma, but the relative importance of sleep duration, sleep quality, and nocturnal symptoms for asthma outcomes remains unclear.</p><p><strong>Objective: </strong>We aimed to investigate the association between sleep duration and sleep quality with asthma control and subsequent clinical outcomes in adults with asthma.</p><p><strong>Material and methods: </strong>We conducted a prospective cohort study of 53 adults with physician-diagnosed asthma who completed a 7-day sleep diary and the Pittsburgh Sleep Quality Index (PSQI) and were followed for 6 months. Short sleep duration was defined as <7 hours per night and poor sleep quality as PSQI ≥5. Asthma control was assessed using the Asthma Control Test (ACT), and asthma worsening during follow-up was defined as deterioration in ACT, increased exacerbations or hospitalizations, escalation of inhaled corticosteroids, or initiation of biologic therapy.</p><p><strong>Results: </strong>Of the participants, 42 (79.2%) were female and the median age was 42.0 years (range 18-71). Short sleep duration was common (41.5%) but was not significantly associated with asthma control or future worsening. In contrast, patients with uncontrolled asthma (ACT <20) had significantly higher PSQI scores, more nocturia, and greater sleep fragmentation. In multivariable analysis, nocturia was the only independent sleep-related predictor of uncontrolled asthma (OR 6.70, 95% CI 1.09-41.27). During follow-up, 47.2% of patients experienced asthma worsening, and chronic sinusitis was the only independent predictor of clinical deterioration (OR 6.54, 95% CI 1.23-34.75), whereas sleep parameters were not associated with future worsening.</p><p><strong>Conclusion: </strong>These findings suggest that in adults with asthma, qualitative aspects of sleep, particularly nocturia, are more closely associated with asthma control than sleep duration, while chronic sinusitis appears to be the dominant factor associated with subsequent asthma worsening.</p>","PeriodicalId":7536,"journal":{"name":"Allergologia et immunopathologia","volume":"54 4","pages":"93-104"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417902","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":"Evaluation of sleep, fatigue, and quality of life in patients with primary immunodeficiency.","authors":"Fikriye Kalkan, Sait Yeşillik, Fevzi Demirel, Ezgi Sönmez, Ali Selçuk, Yasemin Balaban, Mustafa İlker İnan, Özgür Kartal","doi":"10.15586/aei.v54i4.1539","DOIUrl":"10.15586/aei.v54i4.1539","url":null,"abstract":"<p><strong>Introduction: </strong>Primary immunodeficiency (PID) is a heterogeneous group of genetic disorders characterized by recurrent infections and immune dysregulation. Despite advances in therapy, many patients experience impaired quality of life (QoL), fatigue, and sleep disturbances. This study aimed to evaluate sleep quality, fatigue, and health-related QoL in adults with PID and to explore the associations between comorbidities and treatment modalities.</p><p><strong>Materials and methods: </strong>This retrospective, observational, single-center study was conducted at the University of Health Sciences, Gülhane Training and Research Hospital between May and August 2024. Forty-nine adult patients with PID, diagnosed according to international criteria, completed validated questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), and SF-36 QoL scale. Clinical and demographic data were retrieved from the medical records. Statistical analyses included t-tests, Mann-Whitney U, chi-square, and Pearson's correlation, with significance set at P < 0.05.</p><p><strong>Results: </strong>Of 49 patients (55.1% males, mean follow-up 9.9 years), 36.7% had poor sleep quality, 42.9% reported severe fatigue, 49% showed impaired SF-36 physical scores, and 87.8% had preserved mental scores. Poor sleep quality was correlated positively with fatigue (r = 0.623, P < 0.001) and negatively correlated with physical QoL (r = -0.491, P < 0.001). Patients with autoimmune and inflammatory bowel disease had significantly worse PSQI and FSS scores, whereas bronchiectasis was associated with reduced SF-36 physical scores. No differences were observed between the IVIG and SCIG groups in fatigue or mental scores; however, SCIG recipients had significantly higher physical scores (P = 0.018).</p><p><strong>Conclusion: </strong>Patients with PID experience substantial impairment in physical QoL, with fatigue and poor sleep quality frequently coexisting. Comorbidities, such as autoimmunity, bronchiectasis, and inflammatory bowel disease, exacerbate these impairments. SCIG therapy confers better physical outcomes than IVIG therapy. Comprehensive care strategies that address psychosocial and physical health are essential for the management of PID.</p>","PeriodicalId":7536,"journal":{"name":"Allergologia et immunopathologia","volume":"54 4","pages":"167-174"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417787","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":"Beyond sensitization: real-life thresholds for cat allergy in children.","authors":"Güler Yıldırım, Nilay Çalışkan, Merve Karaca Şahin, Hamit Boloğur, Muhammed Fatih Erbay, Hilal Güngör, Şefika İlknur Kökçü Karadağ, Aslı Berivan Topçak, Hasan Tunç Şarman, Özlem Terzi, Deniz Özçeker","doi":"10.15586/aei.v54i4.1617","DOIUrl":"https://doi.org/10.15586/aei.v54i4.1617","url":null,"abstract":"<p><strong>Background: </strong>Cat sensitization is common in patients with allergic diseases and may not always produce clinical symptoms.</p><p><strong>Objective: </strong>This study aimed to assess the correlation between skin prick test (SPT), cat-specific immunoglobulin E (cat sIgE), and symptoms in sensitized children, and to determine optimal thresholds and predictors for clinical cat allergy.</p><p><strong>Methods: </strong>We retrospectively evaluated 1052 cat-sensitized children (2017-2024) who underwent SPT and/or cat sIgE testing. Patients were grouped by presence of cat-related symptoms, and their clinical, laboratory, co-sensitization, and exposure characteristics were compared.</p><p><strong>Results: </strong>Clinical symptoms developed after exposure in 39% of cat-sensitized patients. The optimal cat sIgE cut-off was 1.05 kU/L (sensitivity 71.4% and specificity 93.0%), and 4.5 mm for SPT (sensitivity 64.1% and specificity 75.9%). Multivariate analysis identified cat sIgE positivity as the only independent risk factor for symptom development (odds ratio [OR]: 23.22, 95% confidence interval [ 95% CI]: 11.62-46.39). Environmental exposure characteristics were significant in univariate analysis; in particular, contact at home (OR: 2.35; 95% CI: 1.48-3.71; P < 0.001), family visitation/indoor contact (OR: 2.99; 95% CI: 1.88-4.74; P < 0.001), and sharing a household with a cat (OR: 3.74; 95% CI: 1.78-7.85; P < 0.001) were associated with symptom development. Positivity for the house dust mites <i>Dermatophagoides farinae</i> (OR: 1.59; P < 0.001) and <i>Dermatophagoides pteronyssinus</i> (OR: 1.65; P < 0.001) and grass pollen sensitization (OR: 1.69; P < 0.001) were also significantly associated with symptomatic patients.</p><p><strong>Conclusions: </strong>Cat sIgE positivity independently predicts symptoms, with 1.05 kU/L for sIgE and 4.5 mm for SPT identified as reliable diagnostic cut-offs.</p>","PeriodicalId":7536,"journal":{"name":"Allergologia et immunopathologia","volume":"54 4","pages":"11-19"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417645","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":"Novel pathological genetic variant associated with DOCK8 deficiency: case report with successful hematopoietic stem cell transplantation.","authors":"Hilal Karabag Citlak, Ayberk Turkyilmaz, Hakan Kot, Fatih Sultan Mehmet Koc, Saglam Kubra Adanur, Seyma Celikbilek Celik, Salih Guler, Nalan Yildiz, Sevgi Keles, Fazil Orhan","doi":"10.15586/aei.v54i4.1585","DOIUrl":"https://doi.org/10.15586/aei.v54i4.1585","url":null,"abstract":"<p><p>Deficiency of dedicator of cytokinesis 8 (DOCK8) is a combined immunodeficiency characterized by severe atopic dermatitis, recurrent infections, and elevated serum immunoglobulin E (IgE) levels. Following genetic confirmation, early hematopoietic stem cell transplantation (HSCT) is the treatment of choice. We report a 7-year-old girl who presented with refractory atopic dermatitis and recurrent sinopulmonary infections. Laboratory evaluation revealed markedly elevated total IgE, lymphopenia, decreased memory B cells, and poor vaccine responses. Whole exome sequencing identified a previously unreported homozygous nonsense mutation in the <i>DOCK8</i> gene (c.5382C>A; p.Tyr1794*). Functional validation was achieved through flow cytometry, which demonstrated significantly reduced DOCK8 protein expression. The patient underwent successful HSCT from a fully matched (10/10) HLA-compatible donor following conditioning with fludarabine and treosulfan. At 1 year follow-up, full donor chimerism was achieved, and the patient remained in remission. This case highlights a novel pathogenic variant in DOCK8 deficiency and demonstrates curative success following definitive diagnosis and timely HSCT.</p>","PeriodicalId":7536,"journal":{"name":"Allergologia et immunopathologia","volume":"54 4","pages":"144-150"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417868","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":"Baseline systemic inflammatory indices as predictors of treatment escalation in chronic spontaneous urticaria: a cohort study.","authors":"Orbay Tutku Seren, Aysu Okumuş Güçlü, Mehmet Emin Kocabaş, Betül Aksu, Ümit Özmen, Mehtap Hafızoğlu, Sultan Ece Özaydın, Papatya Bayrak Değirmenci","doi":"10.15586/aei.v54i4.1628","DOIUrl":"https://doi.org/10.15586/aei.v54i4.1628","url":null,"abstract":"<p><p>Management of chronic spontaneous urticaria (CSU) remains challenging due to frequent patient refractoriness to high-dose H1-antihistamines, necessitating omalizumab therapy. At diagnosis, reliable and accessible biomarkers are critical to predict which patients will require treatment escalation. This study aimed to evaluate baseline hematological parameters and derive inflammatory indices for their capacity to predict maximum H1-antihistamine dose and subsequent need for omalizumab in a homogenous CSU cohort without major comorbidities. This single-center, retrospective cohort study included 185 adult CSU patients. Baseline inflammatory markers were analyzed relative to the primary outcome of omalizumab requirement and secondary outcome of intensity of antihistamine dose. Multivariate logistic regression and receiver operating characteristic analyses identified independent predictors and optimized cut-off values. Higher baseline levels of inflammatory markers, such as white blood cell count, neutrophils, neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and aggregate index of systemic inflammation (AISI), were significantly associated with the need for four-fold antihistamine dosing. Adjusted multivariate analysis identified AISI ≥ 346.8 (adjusted odds ratio [aOR] = 7.45) as an independent predictor of omalizumab requirement, while erythrocyte sedimentation rate (ESR) > 7.5 (aOR = 0.24) was identified as an independent protective factor against omalizumab requirement. As a standalone biomarker, AISI demonstrated an area under the curve (AUC) of 0.733 and a negative predictive value (NPV) of 96.4% at this threshold. In this cohort, baseline AISI was independently associated with omalizumab requirement and appears to be a promising marker that warrants external validation, whereas elevated ESR appears protective. Given the retrospective single-center design, these findings should be interpreted cautiously. A high NPV of the AISI cut-off suggests potential clinical utility for ruling out patients unlikely to require treatment escalation.</p>","PeriodicalId":7536,"journal":{"name":"Allergologia et immunopathologia","volume":"54 4","pages":"54-62"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417610","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":"Lower airway microbiome and metabolomic profiles of recurrent wheezing in infants: a case-control study.","authors":"Jiebin Chen, Sainan Chen, Huiquan Sun, Yuqing Wang","doi":"10.15586/aei.v54i3.1433","DOIUrl":"10.15586/aei.v54i3.1433","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize the microbiome shifts and subsequent metabolite alterations associated with recurrent wheezing (RW) in infants.</p><p><strong>Methods: </strong>A total of 33 subjects were enrolled in this study, including 18 infants diagnosed with RW, and 15 normal infants as controls. Bronchoalveolar lavage (BAL) fluid was collected from all the subjects. Bacterial DNA was then isolated and analyzed by 16S ribosomal RNA sequencing. In addition, the metabolomic profile of BAL fluid samples was analyzed with mass spectrometry using complementary chromatographic methods. Spearman's rank correlation analysis was conducted to explore associations between microbial taxa and metabolites.</p><p><strong>Results: </strong>The study had 21 (63.6%) boys and 12 (36.4%) girls. The mean age was 26.8 ± 4.9 months. Haemophilus (P = 0.003) and Porphyromonas (P = 0.007) genera showed significant difference between the two groups. The metabolites of \"starch and sucrose metabolism pathway\" and \"pentose phosphate pathway\" showed significant correlations with the two bacterial genera. For starch and sucrose metabolism pathway, glucose-6-phosphate showed significant positive correlations with Haemophilus (r = 0.44 and P = 0.009) and Porphyromonas (r = 0.45 and P = 0.008). For pentose phosphate pathway, Sedoheptulose 7-phosphate, an intermediate in the pentose phosphate pathway, showed significantly positive correlations with Haemophilus (r = 0.42 and P = 0.02) and Porphyromonas (r = 0.43 and P = 0.01).</p><p><strong>Conclusions: </strong>Our study provided new evidence that alteration in respiratory tract microbiome could be associated with RW in infants. By elucidating the microbiome and metabolite profile, we identified novel biomarkers potentially useful for personalized management of RW in infants. The future studies should validate the underlying mechanisms in longitudinal cohorts and explore interventions targeting metabolic-microbial crosstalk.</p>","PeriodicalId":7536,"journal":{"name":"Allergologia et immunopathologia","volume":"54 3","pages":"49-80"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147872797","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":"Dupilumab after sequential omalizumab and benralizumab failure in T2-high asthma-COPD overlap: A case report.","authors":"Orbay Tutku Seren, Aysu Okumuş Güçlü, Mehmet Emin Kocabaş, Betül Aksu, Özmen Ümit, Yelda Varol, Papatya Bayrak Değirmenci","doi":"10.15586/aei.v54i3.1566","DOIUrl":"10.15586/aei.v54i3.1566","url":null,"abstract":"<p><p>Asthma-COPD overlap (ACO) remains therapeutically challenging, and evidence for biologic selection is limited due to the under-representation of overlap phenotypes in trials. We report a T2-high ACO patient who did not benefit from omalizumab or benralizumab but improved with dupilumab. This presents the case of a 67-year-old man with a long-term smoking history, atopy (elevated total IgE with polysensitization), eosinophilia, persistent airflow limitation, and frequent exacerbations despite optimized inhaled triple therapy. Sequential biologics included anti-IgE (omalizumab) and anti-IL-5Rα (benralizumab), with no meaningful reduction in exacerbations or improvement in lung function. After initiating dupilumab at a dose of 300 mg every 2 weeks, the patient reported a rapid improvement in symptoms, with no further exacerbations observed during the follow-up period. Pulmonary function showed a notable increase, with postbronchodilator FEV₁ rising from 61 to 72% of the predicted value, and FEV₁/FVC ratio improving from 69 to 84.5%. Asthma control scores increased from 12 to 20 by Week 12. Oral corticosteroid therapy was successfully discontinued, and no adverse events requiring discontinuation of dupilumab were recorded. In T2-high ACO unresponsive to anti-IgE and anti-IL-5Rα therapies, IL-4/IL-13 pathway inhibition with dupilumab may deliver a clinically meaningful benefit. Controlled studies are warranted to define its role in overlap phenotypes.</p>","PeriodicalId":7536,"journal":{"name":"Allergologia et immunopathologia","volume":"54 3","pages":"180-183"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147872506","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}