Recent advances in biological therapies, small molecules and allergen-specific immunotherapy are reshaping the management of immunoallergic diseases, progressively shifting therapeutic goals from short-term disease control toward the possibility of achieving sustained clinical remission. Despite increasing evidence across multiple conditions, a universally accepted and disease-transversal definition of clinical remission (CR) remains lacking. In this review we propose a comprehensive framework for defining clinical remission across a broad spectrum of immune-mediated diseases traditionally managed in Allergy and Clinical Immunology practice, including asthma, allergic rhinitis, chronic rhinosinusitis with nasal polyps, chronic urticaria, atopic dermatitis, mastocytosis, food allergy, and eosinophilic esophagitis. Clinical remission is defined as a sustained state of absence of clinically relevant disease manifestations, independently of underlying biological activity; suppression of inflammatory pathways and normalization of biomarkers define biological remission, which may coexist with, but is not required for, clinical remission. We introduce the 3D-CR model, a pragmatic, disease-adaptable framework integrating 3 complementary domains - clinical, biological, and functional - to characterize remission states as complete, partial, or absent. Building on this model, we propose the Allergic Disease Remission Score (ADReS) as a modular tool designed to support standardized assessment, longitudinal follow-up, and cross-disease comparison in clinical trials and real-world settings. These tools are intended as conceptual and research instruments rather than prescriptive algorithms for individual therapeutic decision-making. Finally, we outline a World Allergy Organization call to action advocating for a harmonized global approach to defining, measuring, and implementing clinical remission as a meaningful treatment target. Establishing standardized remission endpoints has the potential to improve patient outcomes, facilitate precision medicine strategies, enhance comparability across studies, and reduce heterogeneity in clinical research and practice worldwide.
Effective knowledge mobilization (KM) and meaningful partnerships can improve research relevance, quality, and impact. While guidance for effective KM tool development and successful research partnerships exists, practices are not consistently described or evaluated. To address this gap, we applied a mixed-methods approach to (i) describe and evaluate a set of tailored KM tools and (ii) assess parent-partnership, within a study on caregiver recruitment networks. A custom survey, distributed to participants of the primary study, was used to evaluate KM tools. The Public and Patient Engagement Evaluation Tool 2.0© survey, and a facilitated discussion, was used to evaluate research partnership. Evaluations were conducted in year two of the two-year project. Quantitative data were analyzed descriptively. Qualitative feedback underwent directed content analysis followed by inductive analysis. Data were integrated during analysis and interpretation. KM tool evaluation: Participants reported that their views were adequately reflected in each KM tool, and they were likely to recommend the tools to others. Important messaging, clarity, and visual appeal were noted as positive features across tools. The lay summary and tip sheets were concise, easy to read, yet still full of information. The painting series was described as engaging and emotionally evocative, prompting reflection on one's personal experience and drawing out feelings of "hope, partnership, and a journey". Participants provided tangible feedback on missed messages in the KM tools, or where additional emphasis or clarification was needed to support accuracy. Partnership evaluation: All team members were satisfied with their involvement. Data within the category of "What went well" highlighted knowledge gained, and personal and team-level qualities (humility, balance, honesty, positivity). The category of "What could be improved" drew attention to systemic barriers to sustained partnership (time, finances, and logistics), and lack of diversity within the team. Involving primary participants in KM tool evaluation ensured message accuracy and highlighted the unique power of arts-based KM to evoke emotional resonance. Future research should consider integrating arts-based methods to complement traditional KM tools to enhance engagement with research findings. High partner satisfaction suggests that strong relational foundations can mitigate common logistical pitfalls in research partnerships. Parent-partnership in research, and the need for tools to share research findings, are recognized as important parts of conducting meaningful and impactful research. In a previous study our team, which includes parent partners and researchers, explored the experiences of parent partners who have been asked to use their personal networks to help recruit for research. Based on what we learned from the parent partner participants, we then created tools to share these insights with more people. These tools included a plain language summary, tip sheets for both researchers and for parent partners, and three paintings with write-ups that linked to the three themes uncovered in the study. We then developed a study to evaluate (i) what participants thought of each of the knowledge sharing tools, and (ii) how our team of researchers and parent partners worked together. These evaluations are the focus of the current paper. The feedback that participants provided on the knowledge sharing tools indicated that the lay summary and tip sheets were concise, easy to read, yet still full of information. The painting series was described as engaging, encouraging reflection, and evoking feelings of “hope, partnership, and a journey”. Participants provided feedback on key messages that were missed in the tools as well as where additional emphasis and clarification was needed. This feedback helped us correct and improve these information sharing methods before we released them to the public. We discovered that all research team members were satisfied with their involvement in the collaboration. Our team found that having humility, balance, honesty, and positivity went well when working together. Areas for improvement included time, finances (e.g., compensation), and logistics (e.g., role clarity, decision making). When research teams conduct evaluations on knowledge sharing and partnerships, the team can improve their research outputs and teamwork. We share our findings to encourage other teams to build evaluations into their projects, with the goal of enhancing partnerships and research impact.
Objective biomarkers that reflect systemic inflammation in pediatric allergic rhinitis to support clinical diagnosis. We aimed to evaluate serum levels of endocan (a marker of endothelial activation) and eosinophil-derived neurotoxin (EDN; reflecting eosinophil degranulation) in children with AR and investigate their diagnostic performance and associations with disease severity and conventional inflammatory markers. In this prospective case-control study, 85 children with AR and 67 healthy controls were enrolled. Serum endocan and EDN were measured via sandwich ELISA. Primary outcomes included group comparisons of biomarker levels and their diagnostic accuracy determined by receiver operating characteristic (ROC) curve analysis. Serum endocan and EDN levels were significantly elevated in children with AR compared to controls (both p < 0.001). Both biomarkers demonstrated high diagnostic performance, with an area under the curve (AUC) of 0.931 for endocan and 0.929 for EDN, showing greater diagnostic accuracy than absolute eosinophil counts (AUC, 0.871). Endocan and EDN showed a strong intercorrelation (r = 0.88, p < 0.001) and significant positive correlations with total IgE and eosinophil counts. However, no significant associations were observed between these biomarkers and disease severity, symptom control scores, or allergen sensitization patterns. Serum endocan and EDN are significantly elevated in children with AR and demonstrate high diagnostic discrimination in this cohort. These findings suggest that endocan and EDN may serve as promising complementary biomarkers for the objective assessment of allergic inflammation in children, although further multicenter studies are needed to confirm their clinical utility. • Allergic rhinitis (AR) is common in childhood and involves systemic inflammatory pathways; however, objective biomarkers to support diagnosis in pediatric practice remain limited. • Endocan and eosinophil-derived neurotoxin (EDN) reflect endothelial activation and eosinophil degranulation, respectively, and have been studied in other atopic and inflammatory conditions. • This study concurrently evaluates serum Endocan and EDN in children with AR in a prospective case-control design. • Both biomarkers demonstrated high discriminatory performance (AUC∼ 0.93 in this cohort) and showed greater diagnostic accuracy than absolute eosinophil counts . • Endocan and EDN are largely independent of generalized systemic inflammatory indices (NLR, SII, SIRI), supporting specificity for the endothelial- eosinophilic axis in pediatric AR.
The human microbiota is implicated in the development and progression of rheumatoid arthritis (RA). Given the increased RA burden in women and well-known correlations between the vaginal microbiota and local inflammation, we seek to understand the vaginal microenvironment in the context of RA pathology. Self-collected vaginal swabs and questionnaires on dietary, menstrual, and health information were obtained from 36 RA and 50 demographically-matched control women, 18-63 years of age. Medication regimen, along with disease activity and severity, was captured for the RA cohort. Vaginal swabs were subjected to long-read 16S rRNA gene sequencing, multiplex cytokine analyses, and quantification of rheumatoid factor, C-reactive protein, and anti-citrullinated protein antibodies (ACPAs). Vaginal microbial richness and Peptoniphilus and Prevotella, among other rare taxa, were elevated in RA versus control samples. Vaginal interleukin (IL)-18 and epidermeal growth factor (EGF) levels were increased in the RA group; IL-18 correlated with multiple microbial features, whereas EGF levels were not associated with bacterial composition or other host factors. When faceted by diet and menopausal status, several immune markers were increased in the RA vaginal environment. Vaginal ACPAs were higher in the RA group and positively correlated with Streptococcus and multiple vaginal inflammatory cytokines. We describe vaginal microbial and immunological differences in women with RA, particularly when accounting for diet and menopausal status, and disease activity and severity. This work opens a new avenue in the multidisciplinary approach to RA patient care.IMPORTANCERheumatoid arthritis (RA) is a debilitating autoimmune disease that disproportionately impacts women. Although it is widely recognized that microbial factors can trigger or aggravate RA symptoms and alter disease progression, it is unknown whether RA impacts the microbiota and immune responses within the vaginal tract. In this study, we compare the vaginal microbial communities and immune (cytokine) profiles in women with RA and healthy controls. Within RA patients, we also evaluate how these factors relate to clinical RA symptoms, RA biomarkers, and RA-related medications. Overall, we found that RA was associated with increased microbial diversity and multiple inflammatory markers, some of which were also associated with RA biomarkers and disease activity. These findings suggest that the vaginal tract may be an additional tissue impacted by RA disease, and further research is needed to understand mechanisms and potential for therapeutic intervention.
β-lactam allergy labels (BALs) are commonly found in patient records but are often inaccurate. This can lead to suboptimal antibiotic selection, increased healthcare costs, and antimicrobial resistance. Most existing risk assessment tools were developed in Western settings and are not applicable in Chinese clinical contexts. This study developed and pilot-tested a pharmacist-led BAL risk assessment tool tailored to the Chinese healthcare environment. The study was conducted in three phases: (1) A systematic review of 90 studies to identify key β-lactam allergy risk factors; (2) Grounded theory and text co-occurrence analysis to extract high-risk features and construct the assessment framework; and (3) A pilot implementation in a tertiary hospital to evaluate the tool's feasibility, clinical impact, and patient outcomes using a quasi-experimental design. The final tool comprised eight dimensions, 35 subdimensions, and over 1328 distinct coded nodes. Of the 289 patients involved in the pilot, 18.7% were classified as high risk. Compared with patients with BALs but without high-risk features, those at lower risk had significantly shorter hospital stays (8.5 ± 4.3 vs. 10.6 ± 5.5 days; p < 0.001), reduced hospitalization costs (17,800 ± 6200 vs. 21,000 ± 7500; p = 0.0011), and lower allergy event rates (0% vs. 6.5%; p = 0.002). β-lactam use increased (75.3% vs. 40.3%; p < 0.001), whereas second-line antibiotic use decreased (24.7% vs. 59.7%; p < 0.001). The tool also demonstrated high feasibility, achieving a 100% completion rate and strong adherence among pharmacists. This pharmacist-led risk assessment tool has strong potential for accurately identifying high-risk β-lactam allergy patients and optimising antimicrobial stewardship in Chinese hospitals. Further large-scale validation is warranted.
Chronic rhinosinusitis (CRS) is a heterogeneous and often debilitating disease characterized by persistent sinonasal symptoms and inflammation and is phenotypically classified as CRS with nasal polyps (CRSwNP) or without nasal polyps (CRSsNP). Although CRSsNP is the more prevalent phenotype (approximately 80%), it remains disproportionately understudied, leading to critical gaps in understanding and management. This systematic literature review synthesized current global evidence on the epidemiological, clinical, humanistic, and economic burden of CRSsNP, highlighting areas of unmet need and raising awareness of the impact of this disease. PRISMA-compliant searches were conducted for CRSsNP records published 2004-2024 (epidemiological studies 2014-2024) across six electronic databases. Targeted hand searches were performed for abstracts (2022-2024), health technology assessments, guidelines, and clinical trial registries. Of 2215 records identified, 157 met inclusion criteria. CRSsNP prevalence was 4.3-10.4% in the USA, South Korea, and Spain. Patients experienced a range of symptoms including nasal/sinus (obstruction, discharge, crusting), pain, sensory (anosmia, cacosmia), respiratory (cough, asthma), oral (dry throat, halitosis), and sleep impairment. There was considerable variability in the availability and use of tools to assess severity; this impeded cross-study comparisons, consistent disease staging, and treatment escalation criteria. Associated comorbidities included asthma, chronic obstructive pulmonary disease, gastroesophageal reflux disease, and primary antibody deficiencies. Humanistic burden was assessed using a variety of outcome measures and was higher for patients with CRSsNP than for controls. Limited data were available on economic burden. Currently available therapies were associated with high rates of treatment failure, inadequately controlled symptoms, and the need for multiple lines of therapy. CRSsNP is associated with considerable burden across clinical, humanistic, and economic domains, exacerbated by diagnostic variability, treatment limitations, and a lack of standardized research methodologies. This highlights the need for coordinated efforts among stakeholders to better address this chronic condition and support future improvements in patient outcomes.
Atopic dermatitis (AD) is a chronic inflammatory skin disease with complex immune dysregulation. Acute oral corticosteroids relieve measures of AD severity during flares; however, the association of disease severity with anti-inflammatory effects in skin remains unclear. We sought to evaluate the association between clinical severity and skin inflammation in AD. Sixteen patients with moderate to severe AD were randomized 1:1 to prednisolone (0.75-0.25 mg/kg tapered over 15 days) or placebo following an 8-day run-in without systemic anti-inflammatory medications. Clinical scores were measured and biopsies from lesional and allergen-challenged skin were collected and analyzed by histology, immunofluorescence microscopy, and ELISA for cells and cytokine levels. Posttreatment day 8, prednisolone improved clinical scores for Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (SCORAD), and Investigator's Global Assessment (IGA), suppressed eosinophils, basophils, and select TH17/proinflammatory cytokines (IL-17A, IL-1β, and TGF-α) in allergen-challenged skin, reduced TH2 (IL-5, IL-9, IL-10, and IL-13) and TH1 (TNF-α) cytokines, and reduced chemokines (MIP-1β and TARC) in skin lesions (P < .05). IL-13, TNF-α, IFN-γ, and MCP-1 levels positively associated with the EASI, SCORAD, and IGA (r > 0.5; P < .05) in both allergen-challenged and lesional skin. Prednisolone modulated a broad range of inflammatory pathways in acute versus chronically inflamed AD skin. Furthermore, identification of positive associations between inflammation and clinical outcomes supports the development of therapeutics beyond type 2 inflammation.
Behcet's syndrome (BS) was first described in 1937 as a triad of oral aphthae, genital ulceration, and ocular involvement. It is now recognized as a multisystemic vasculitis that can affect central nervous, gastrointestinal, and cardiovascular systems. Despite extensive research, the etiology of BS remains unclear, and genetic, viral, and environmental factors are thought to contribute to its pathogenesis. This study aimed to investigate the role of interleukin-17 (IL-17) and IL-23 receptor (IL-23R) gene polymorphisms in the etiology of BS and to evaluate their associations with disease activity and clinical features. The IL-23/IL-17 axis was selected due to its pivotal role in T cell-mediated inflammation and vasculitis, which are key pathogenic mechanisms in BS. This study was conducted at the Ankara University Faculty of Medicine over a 1-year period. A total of 142 patients with BS aged ≥18 years and 140 healthy controls without known rheumatologic or immunological diseases were included. BS was diagnosed according to the International Study Group criteria for Behçet's disease. Disease activity was assessed using the BS Activity Scale, and patients were classified as having active or inactive disease. Genomic DNA was extracted from peripheral blood samples. IL-17 and IL-23R gene polymorphisms were analyzed using the polymerase chain reaction-restriction fragment length polymorphism method. The IL-17 rs2275913 and rs763780 polymorphisms and the IL-23R rs11209032 polymorphism were evaluated. The frequency of the homozygous AA genotype of the rs11209032 was significantly higher in the BS group than in healthy controls (85.9% vs. 17.4%, p < 0.001). Carriage of the A allele was associated with a markedly increased risk of BS; after adjustment for age and sex, carriers had approximately 16-fold higher odds of disease (adjusted odds ratios [OR] = 16.32, 95% confidence intervals [CI]: 9.76-27.12, p < 0.001). No significant differences were observed between BS patients and controls for the IL-17 polymorphisms. Gene polymorphisms were not associated with specific clinical manifestations. However, in the IL-17 rs763780 polymorphism, inactive patients had a higher frequency of the TT genotype compared with the TC genotype (p = 0.03), suggesting a potential role in disease activity rather than susceptibility. These findings suggest that IL-17 and IL-23R-related pathways may contribute to the pathogenesis of BS. While the IL-17 variant may be associated with disease activity, the IL-23R rs11209032 polymorphisms show a strong association with disease susceptibility. However, larger studies are needed to confirm these findings and clarify their clinical relevance.
Cats are among the most common household pets in Malaysia, and cat dander is a significant aeroallergen. This study aimed to estimate the prevalence of cat dander sensitisation, characterise allergic disease patterns across age groups, and explore the relationship between cat dander sensitisation and allergic multimorbidity. A retrospective cross-sectional study was conducted on laboratory records of patients tested for specific immunoglobulin E to cat dander between January 2023 and December 2024. Specific immunoglobulin E levels were measured using fluoroenzyme immunoassay on the Phadia ImmunoCAP 250 system. Demographic information, allergic diseases history, and co-sensitisation patterns were analysed. Of 2840 patients tested, 30% (n=851) were sensitised to cat dander, with 817 included in the final analysis. Most sensitised patients had single allergic disease (asthma, allergic rhinitis, or eczema) (51.2%), followed by those with allergic multimorbidity (35.6%). Asthma was the most common allergic disease (25%), followed by the combination of asthma and allergic rhinitis (18.4%). There was a significant association between age group and allergic disease patterns (p<0.001), where eczema was more prevalent in children and allergic airway diseases increased with age. Allergic multimorbidity peaked among school-aged children. Polysensitisation (≥4 allergens) was observed in 65.9% of patients. House dust mite was the most common co-sensitised allergen (96.3%), followed by cockroach (84.8%), grass pollen (62.6%) and fungal (45.7%). Cat dander sensitisation affects nearly one-third of tested patients in Malaysia, and is frequently associated with polysensitisation. Age-specific disease patterns align with the atopic march paradigm, highlighting the need for targeted, age-appropriate intervention and prevention strategies.
STAT3 hyper-IgE syndrome (STAT3-HIES) is a multisystem disorder with both immunologic and non-immunologic manifestations. We sought to characterize the spectrum of clinical manifestations, genetics, treatment approaches, and long-term outcomes of patients with STAT3-HIES. Clinical features, laboratory findings, treatment, and survival were reviewed in the largest single-center STAT3-HIES cohort (n = 164) prospectively followed under a natural history protocol (NCT00006150). In addition to the classic skin, lung, dental, and musculoskeletal manifestations captured in the 1999 scoring system, we comprehensively characterized disease phenotypes across multiple organ systems, including previously underrecognized features. Lung disease remained the major morbidity with both infectious and parenchymal complications. During longitudinal follow-up, age-related vascular and skeletal degeneration emerged and significantly affected quality of life in patients 45 years and older. No genotype-phenotype correlations were identified. In terms of management, optimal supportive measures, including antimicrobials and immunoglobulin replacement therapy, tailored to disease features and individual risk factors, remained the primary approach. Dupilumab was used primarily for the eczematous dermatitis and demonstrated significant clinical benefit. In highly selected cases (n = 6), allogeneic hematopoietic stem cell transplantation was performed and showed reduction in infection burden. The median overall survival was 55 years, significantly shorter than that of the general United States population, and was not affected by sex, variant location, or proband status. STAT3-HIES is a multisystem disorder that requires multidisciplinary care. Early diagnosis and supportive measures have altered its natural history. Recognition and improved understanding of the non-immunologic manifestations of this disorder will further improve patient outcomes.
Asthma is one of the most common chronic conditions in the United States and disproportionately affects racial and ethnic minority populations and low-income communities. While both social and environmental factors are known contributors to asthma prevalence, the extent to which they interact to shape geographic disparities remains insufficiently understood. This study aimed to explore how these factors vary across regions with differing asthma prevalence to identify patterns that may inform targeted public health responses. We used the CDC's 2022 Environmental Justice Index (EJI), which includes standardized social and environmental measures at the census tract level. K-means clustering identified geographic clusters with varying asthma prevalence based on asthma rates and related health outcomes. A random forest model was trained to predict asthma rates using social and environmental variables, and feature importance was analyzed. We identified nine clusters, with three showing the highest asthma prevalence. High-prevalence areas had greater social vulnerability, including higher poverty rate, minority population rate, limited English proficiency, unemployment, and housing cost burden. They also experienced greater environmental exposures, such as elevated PM2.5, ozone, diesel pollution, and more land near hazardous waste sites, chemical facilities, and older housing. The random forest model predicted asthma rates with strong predictive performance (R2 = 0.81). Socioeconomic variables consistently ranked as stronger predictors than environmental exposures. Geographic areas with high asthma prevalence are shaped by overlapping social and environmental vulnerabilities. Socioeconomic disparities emerged as particularly influential. These findings support integrated, data-driven public health strategies to address asthma inequities.
The National Heart, Lung, and Blood Institute (NHLBI)-sponsored workshop, Maternal and Perinatal Nutritional Programming of Lung Health and Disease in Childhood and Early Adulthood: Research Gaps and Opportunities, was convened (October 24-25, 2024) to explore how nutrition before, during, and after pregnancy influences lung development and respiratory health across the lifespan. The workshop focused on identifying critical knowledge gaps, mechanistic pathways, and intervention opportunities. Presentations spanned maternal dietary patterns, specific nutrient supplementation, gestational weight gain, and the role of maternal obesity in offspring wheeze and asthma. The role of early postnatal nutrition, particularly human milk for preterm infants at risk for bronchopulmonary dysplasia (BPD) was emphasized. Emerging areas included circadian rhythms and the maternal and infant microbiome, metabolome, and epigenome in mediating nutrition-related respiratory outcomes. Research needs included randomized trials of dietary interventions, mechanistic studies to elucidate biological pathways, and implementation strategies to integrate nutritional interventions into practice. Vulnerable populations were emphasized, including preterm infants and families experiencing food insecurity. Participants emphasized the need for a coordinated research agenda to inform future interventions that could improve outcomes across generations.
Prompt and effective on-demand treatment is critical in hereditary angioedema (HAE). Although multiple on-demand therapies are available, including recombinant human C1 esterase inhibitor (rhC1-INH) and sebetralstat, no head-to-head efficacy trials exist. A series of indirect treatment comparisons evaluated the relative efficacy of US Food and Drug Administration-approved doses of intravenous rhC1-INH (50 U/kg for patients weighing < 84 kg; 4200 U otherwise) vs oral sebetralstat (600 mg) for the on-demand treatment of HAE attacks. Patient-level data from rhC1-INH trials (C1 1310, C1 1205, and C1 1304 [placebo only]) were reweighted to match aggregate baseline characteristics (i.e., prophylaxis use, pooled attack location) from the sebetralstat KONFIDENT trial; matching variables were identified from a validated, clinician-informed study of treatment effect modifiers. In the primary analysis, time to complete resolution (TTCR) and redosing were compared using unanchored matching-adjusted indirect comparisons. TTCR subgroup analyses were performed for variables not matched for in the primary analysis due to population differences (i.e., attack severity, time to treatment). Scenario and sensitivity analyses were performed to support TTCR results; a scenario analysis was performed to support redosing results. Hazard ratios (HRs) and odds ratios (ORs), with 95% confidence intervals (CIs), were estimated using a weighted Cox proportional hazards model and a weighted logistic regression model, respectively. In the primary analysis, rhC1-INH was associated with a statistically significant 4.5-fold increased likelihood of achieving complete resolution (HR 4.52; 95% CI 2.84-7.18) and a significant 82% reduction in redosing (OR 0.18; 95% CI 0.06-0.53) vs sebetralstat. Similar results for TTCR were observed in subgroup analyses of patients with severe/very severe baseline attacks and patients receiving earlier treatment (within the median time to treatment). Scenario and sensitivity analyses confirmed the robustness of these findings. rhC1-INH provides significantly faster symptom resolution and lower redosing rates vs sebetralstat.
Determining the current burden of asthma in countries is important in the diagnosis and follow-up of asthma patients and for the development of national health policies. Our study aimed to clarify the epidemiological and clinical data regarding asthmatic adults in Türkiye. The study was designed as a nationwide descriptive, observational cross-sectional study. Data on adult patients who were followed with the diagnosis of asthma in all public, private, and university hospitals in Türkiye between January 2016 and December 2022 were obtained from the e-Nabız database of the Ministry of Health and analyzed. The number of patients followed with a diagnosis of asthma in Türkiye between 2016 and 2022 was 2,700,183. The mean age of these patients was 45.70 years (standard deviation: 15.87) and 74.5% of them were female. Of the patients, 92.3% were prescribed dry powder inhalers, 98.41% metered dose inhalers, and 80.38% montelukast. The short-acting beta-2 agonist (SABA) prescription rate was 65.74% and SABA was prescribed as the sole medication for 0.10% of patients. The percentage of patients prescribed nebulized treatment was found to be 69.83%. Among asthmatic adults, the rate of at least one emergency room visit was 12.4%, the rate of hospitalization in the ward was 5.6%, and the rate of intensive care unit admission was 0.1%. Asthma is a major health burden in Türkiye, as is the case around the world. National planning for the diagnosis and follow-up of patients needs to be improved and continued.
Asthma is a debilitating disease, and its diagnosis and disease management remain imprecise. It continues to impose a major global burden on public health, medicine, and the economy. Asthma exhibits marked heterogeneity in clinical phenotypes, and environmental and genetic risk factors remain incompletely defined. Moreover, its significant geographical and ethnic variation limits diagnostic precision. They also hinder effective risk stratification and accurate prediction of disease exacerbations. To date, most asthma research and therapeutic development have focused on allergen-mediated immune responses. Conversely, the adverse effects of environmental chemical pollutants have received less attention. This imbalance has limited the development of a comprehensive understanding of asthma pathogenesis. It has also slowed progress toward truly precision-based therapies. Simultaneously, growing experimental and clinical evidence highlights causal links between environmental exposures and disease. The concepts of the exposome and exposomics have also emerged. These provide useful frameworks to study disease development and progression. In this review, we summarize recent multicenter studies on asthma. These studies show that environmental determinants of asthma are not uniform, as different asthma phenotypic clusters have distinct environmental exposure profiles. Moreover, environmentally driven metabolic reprogramming plays an important role, resulting in bioactive metabolites that also deserve careful attention. These factors are crucial for advancing precision environmental medicine.
The prevalence of food allergy (FA) is increasing worldwide and becoming more widely recognized as a public health concern. Estimates of FA prevalence have relied on heterogenous methodologies across studies making it difficult to compare patients' groups or to generalize findings. This study aims to report the prevalence of FA in the general population across multiple countries using a standardized methodology. This was a cross-sectional, international, population-based study including children, adolescents, and adults from 9 countries (USA, Canada, UK, France, Germany, Italy, Spain, Japan, and China). Participants completed an online questionnaire developed to recognize FA based on different levels of evidence. The prevalence of FA was estimated based on data indicative of symptom-convincing FA to at least one allergen. A total of 46,711 children and 44,219 adults participated in the study. The prevalence of symptom-convincing FA in children was the highest in Canada and the lowest in Germany; 7.5% versus 2.4% respectively. Among adults, the highest prevalence was 6.6% in Italy, and the lowest was 2.1% in Japan. In both age groups, the majority had FA to only one allergen. Peanut, milk and/or dairy products, and tree nut were the most identified allergens in children, while peanut, shrimp, and shellfish were the most common among adults. This study is one of the few that have comprehensively assessed FA globally, offering consistent evidence that FA is prevalent internationally and across age groups, making itself a public health burden that affects a wide spectrum of demographics.
Neuroangiostrongyliasis is a neuroinvasive helminth infection caused primarily by the rat lungworm Angiostrongylus cantonensis, which is the main causative agent of eosinophilic meningitis in humans. The closely related species Angiostrongylus malaysiensis coexists in many endemic regions particularly in Asia and Oceania and shares substantial morphological and genetic similarity with A. cantonensis, yet its pathogenic potential remain poorly understood. Here, we performed a direct comparative investigation of neuropathogenesis and host immune responses following experimental infection with A. cantonensis or A. malaysiensis in a murine model. Both species established central nervous system infection and induced neurological manifestations and inflammatory responses. However, infection with A. malaysiensis resulted in more severe clinical disease, characterized by greater weight loss, higher clinical scores, and extensive cerebral hemorrhage, accompanied by increased parasite invasion into the brain parenchyma. In contrast, A. cantonensis infection elicited stronger neuroimmune activation, including increased leukocyte recruitment and elevated expression of type 2 cytokines and chemokines within the brain and meninges. Despite the more severe neurological complications observed in A. malaysiensis infection, immune cell accumulation in the central nervous system was comparatively reduced, suggesting differences in parasite containment at the neuroimmune interface. Together, these findings demonstrate that closely related Angiostrongylus species can induce distinct patterns of neuropathogenesis and immune regulation. Our results highlight the importance of species-specific host-parasite interactions in shaping disease severity and provide new insight into mechanisms underlying the pathogenesis of neuroangiostrongyliasis.
The increasing prevalence of allergic diseases in China necessitates a comprehensive understanding of allergen sensitization patterns to inform effective public health strategies and clinical management. This nationwide cross-sectional study aimed to identify allergen sensitization profiles, demographic variations, and regional disparities among Chinese patients. Data from 33,308 initial outpatient visits between 2021 and 2024 were analyzed. Sensitization to 25 common allergens was assessed using the ImmunoCAP system. Demographic and geographic factors, including age, gender, and regional distributions, were evaluated for their impact on allergen sensitization. Dermatophagoides pteronyssinus (D. pteronyssinus) and Dermatophagoides farinae (D. farinae) were the predominant aeroallergens, sensitizing 48% of patients. Significant regional variation was observed, with South China showing the highest sensitization rates to D. farinae (63.51%) compared to the Northwest (36.95%). Among food allergens, shrimp (17.22%) and crab (11.85%) were most common, especially in adolescents aged 13-18 years. Polysensitization was prevalent in patients with atopic dermatitis (63.79%). Gender differences revealed higher sensitization rates among males. Regional disparities underscored the need for geographically customized health interventions. This study provides critical insights into allergen sensitization patterns across China, emphasizing the importance of tailored public health strategies and personalized immunotherapy to improve allergic disease management. Findings contribute to the global understanding of allergic disease epidemiology and foster advancements in prevention, diagnosis, and treatment strategies.
Eosinophilic myocarditis can result from drug hypersensitivity or various systemic disorders. Although corticosteroids are effective, treatment strategies are not standardized. A 78-year-old male presented with dyspnoea. On admission, he was febrile and hypotensive and had sinus tachycardia with a newly developed right bundle branch block. Laboratory findings showed marked eosinophilia with elevated troponin. The patient rapidly progressed to cardiogenic shock, and venoarterial extracorporeal membrane oxygenation (VA-ECMO) was applied. Eosinophilic myocarditis was suspected, and endomyocardial biopsy confirmed dense myocardial eosinophil infiltration consistent with the diagnosis. Review of history revealed recent cefaclor use for a hand injury as the probable cause. The patient's condition quickly improved after initiation of high-dose intravenous methylprednisolone, allowing weaning from VA-ECMO. However, persistent troponin elevation and myocardial inflammation on fluorodeoxyglucose positron emission tomography (FDG-PET) were observed despite 5 weeks of steroid therapy. Subcutaneous mepolizumab, an anti-interleukin-5 monoclonal antibody, was initiated as an adjunctive immunosuppressive therapy. After seven cycles, troponin levels normalized, cardiac function fully recovered, and follow-up FDG-PET demonstrated a marked reduction in myocardial inflammation. We describe a case of fulminant eosinophilic myocarditis that was possibly associated with cefaclor use and successfully managed with VA-ECMO and adjunctive immunosuppressive therapy. Fluorodeoxyglucose positron emission tomography imaging helped detect residual inflammation and assess treatment response. Immunosuppressive therapy allowed a reduction of steroid dose, mitigating the risk of steroid-related side effects.
This study aims to explore the application of machine learning techniques in assessing macrophage activation syndrome (MAS) in Still's disease. A multicenter, observational, prospective study was conducted, including patients with Still's disease enrolled in the Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale (GIRRCS) AOSD Study Group and the AutoInflammatory Disease Alliance (AIDA) Network Still's Disease Registry. A total of 737 patients (age: 35.5 ± 17.8, male sex: 44.7%) with Still's disease were assessed; 11.4% were affected by MAS, and 3% had a poor prognosis. First, random forest imputation was applied to the original dataset. Subsequently, a machine-learning-driven assessment was developed to explore MAS occurrence. Collectively, regression models, an exploration decision tree, and a random forest were applied, suggesting the importance of ferritin, age, C-reactive protein (CRP), and systemic score. A logistic regression model accounting for data leakage concerns was then generated using these variables, and missing values were imputed using random forest imputation. This analysis supported the role of the selected variables, which were further combined across different clinical scenarios to estimate the probability of MAS. The highest risk of MAS was estimated for patients simultaneously characterized by age ≥ 45 years, ferritin ≥ 4,178.10 ng/mL, CRP ≥ 27.15 mg/L, and a systemic score ≥ 7, corresponding to a 34.7% probability of MAS, as well as for those characterized by ferritin ≥ 4,178.10 ng/mL, CRP ≥ 27.15 mg/L, and systemic score ≥ 7, corresponding to a 33.5% probability of MAS. A machine-learning-driven prediction of MAS was explored in Still's disease, highlighting the importance of age of onset, hyperferritinaemia, increased CRP, and multiorgan involvement. A combination of these features may suggest a clinician-friendly algorithm for stratifying the probability of MAS during Still's disease.