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OBJECTIVE To analyze the safety of omalizumab in the treatment of allergic diseases in children. METHODS Clinical data of children with allergic diseases who were prescribed omalizumab therapy were collected from our hospital during February 2019 to July 2023， including the children’s basic conditions， allergen test results， serum levels of total immunoglobulin E （IgE）， omalizumab application and the occurrence of adverse events. The information on telephone follow-up was collected among the children who had completed treatment 12th month after drug withdrawal. At the same time， the causal relationship between adverse events and omalizumab was also evaluated by using the Naranjo assessment scale. RESULTS A total of 30 children were enrolled and received subcutaneous injections of omalizumab 245 times， accumulating 473 times. Four children suffered from four times of immediate-type hypersensitivity reactions （degree Ⅰ and Ⅱ every two times）， with an incidence of 13.3%； among them， two cases occurred after the first injection， one after the third injection， and one after the fifth injection； the results of the causality evaluation showed that two cases were “very likely” and two cases were “likely”. The telephone follow-up of 21 children showed that the children were in good health and there were no adverse events， such as malignant tumors， worm infections， serum disease- like reactions and arterial thromboembolism. CONCLUSIONS Omalizumab in children with allergic diseases is of good safety with a low incidence of adverse reactions， which are mainly mild immediate-type hypersensitivity reactions with a high long-term safety profile.
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Objective:To evaluate the clinical efficacy of omalizumab in the treatment of patients with chronic spontaneous urticaria accompanied by other allergic diseases.Methods:Clinical data were retrospectively collected from 74 patients, who were clinically diagnosed with chronic spontaneous urticaria and other allergic diseases, and received subcutaneous injections of omalizumab in the Department of Allergy, Tianjin Medical University General Hospital from June 2020 to September 2022. Types of allergic diseases, serum total IgE (tIgE) and allergen-specific IgE (sIgE) levels before treatment, treatment outcomes and adverse drug reactions were analyzed. Differences before and after treatment were assessed using paired t-test and Wilcoxon signed-rank sum test. Results:A total of 74 patients with chronic spontaneous urticaria were involved, including 29 with complicated allergic asthma (39.2%) , 61 with complicated allergic rhinitis (82.4%) , 6 with complicated atopic dermatitis (8.1%) , and 4 with food allergy (5.4%) . Before treatment, elevated serum tIgE or sIgE levels were observed in 44 (59.5%) patients. After the first omalizumab treatment, the urticaria control test (UCT) score significantly increased compared with that before treatment (16.00 [13.0.0, 16.00] vs. 6.00 [5.75, 9.00], Z = 7.39, P < 0.001) ; after 4 sessions of the omalizumab treatment, 82.5% (33/40) of the patients achieved complete control of urticaria symptoms or showed complete response. After omalizumab treatment, asthmatic attacks were decreased in 29 patients with allergic asthma, and asthma control test (ACT) scores significantly increased compared with those before treatment (21.07 ± 2.88 points [after the first treatment] vs. 18.48 ± 3.20 points [before treatment], t = 8.87, P < 0.001) ; among 61 patients with allergic rhinitis, global rhinitis symptom-based visual analog scale (VAS) scores (before treatment: 5.89 ± 1.29 points; after the first treatment: 3.28 ±1.46 points) and rhinoconjunctivitis quality of life questionnaire (RQLQ) scores (before treatment: 60.10 ± 20.53 points; after the first treatment: 37.26 ± 18.83 points) both significantly decreased after the first treatment ( t = 15.04, 10.01, respectively, both P < 0.001) , and rhinitis symptoms were relieved at the same time; skin itching was relieved in 4 patients with atopic dermatitis, and allergic symptoms after contact with food allergens were also relieved in the 2 patients with food allergy after omalizumab treatment. During the treatment, only 1 patient experienced erythematous swelling, induration, and pain at the injection site. Conclusions:In the treatment of chronic spontaneous urticaria accompanied by allergic diseases, the use of omalizumab not only effectively improved urticaria symptoms, but also well controlled allergic diseases, with a good safety profile. Multiple benefits may be achieved by the use of omalizumabin in patients with chronic spontaneous urticaria accompanied by other allergic diseases.
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The rapid increase of childhood allergic disorders has become one of the major challenges in the pediatric health care system. Laboratory diagnosis is essential in order to determine appropriate strategies towards best clinical practice strategies, including accurate diagnosis, prophylaxis and optimized management. Once there are sufficient clinical grounds to support a diagnosis of allergy, confirmatory in vivo and in vitro tests should be performed. In vivo tests mainly include skin prick tests and allergen provocation tests. Provocation tests are the gold standard for diagnosing allergic diseases. In vitro tests mainly include allergen-specific IgE antibody, Th2 related cytokines, and mast cell activity markers. These tests can clarify the immune state status of the patient and lead to optimized treatment, such as avoiding allergens avoidance, allergens-specific immunotherapy, and anti-IgE therapy. Controlling disease progress and preventing relapses can benefit children who are suffering from the consequences of allergies.
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Abstract Objective: To analyze the impacts of climate change on the development of immature respiratory and immune systems in children. Source of data: The authors of the present study performed a non-systematic review of English, Spanish, and Portuguese articles published in the last five years in databases such as PubMed, EMBASE, and SciELO. The terms used were air pollution OR climate changes OR smoke, AND children OR health. Synthesis of data: The increase in the prevalence of some diseases, such as allergic ones, is attributed to the interactions between genetic potential and the environment. However, disordered growth combined with inadequate waste management has caused problems for the planet, such as heatwaves, droughts, forest fires, increased storms and floods, interference in food crops and their nutritional values, changes in the infectious disease pattern, and air pollution resulting from the continuous use of fossil fuels. Children, beings still in the development stage with immature respiratory and immune systems, are the primary victims of the climate crisis. Conclusions: The authors documented that prenatal and postnatal exposure to ambient air pollutants will accelerate or worsen the morbidity and mortality of many health conditions, including allergic diseases. Ambient air pollutants change the microbiota, interfere with the immune response, and take direct action on the skin and respiratory epithelium, which facilitates the penetration of allergens. Understanding how the children and adolescent health and well-being are affected by climate change is an urgent matter.
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The increasing incidence of allergic diseases in children has become a global public health problem, which not only endangers physical health, but also imposes a heavy economic burden on society and families.Allergen immunotherapy is a cause-specific treatment therapy for allergic diseases in children, which can change the natural course of allergic diseases and works by inducing the body to establish immune tolerance to allergens.Allergen immunotherapy can not only reduce the clinical symptoms and medication use of children, but also prevent allergic reactions to new allergens, and has good efficacy and safety.This paper reviews the research progress of allergen immunotherapy in children with allergic diseases, especially respiratory allergic diseases, in order to provide more treatment options and new ideas for clinical practice.
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Intestinal microbiota plays an important role in the establishment and maturation of the host immune system.In recent years, it has been found that the disorder of intestinal microecology is related to the occurrence and development of allergic diseases in children.Probiotics can improve intestinal microecological disorders, and its relationship with the prevention and treatment of allergic diseases is currently a research hotspot.In this review, we review the research progress on the relationship between intestinal microbiota and allergic diseases in children, the immunomodulatory mechanisms of probiotics rebalancing intestinal microecology, and the relationship between Lactobacillus paracei and allergic diseases such as atopic dermatitis, allergic rhinitis, and bronchial asthma.
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Objective:To investigate the therapeutic effects of Omalizumab in children suffering from multiple allergic diseases.Methods:All children who developed with multiple allergic diseases and were treated with Omalizumab in Department of Pediatrics, Peking University Third Hospital from September 2018 to December 2020 were retrospectively analyzed.Their gender, age, type of allergic disease, serum total IgE (TIgE) and serum allergen-specific IgE (sIgE) levels before treatment, Omalizumab dosage, therapeutic effect and adverse drug reactions were analyzed.Results:In terms of the 28 children who were treated with Omalizumab, the male/female ratio was 17/11, and the age was (9.6±2.7)years.There were 24 cases of asthma (85.7%), 24 cases of allergic rhinitis (85.7%), 9 cases of food allergy (32.1%), 7 cases of atopic dermatitis (25.0%), and 2 cases of chronic urticaria (7.1%), with 26 cases (92.8%) having more than two kinds of allergic diseases, and 28 children having elevated TIgE or sIgE.TIgE was between 39.5 to 3 826.0 kU/L, and the median was 611 kU/L.After treatment, the frequency of wheezing attacks in 24 children with asthma was reduced, the nasal symptoms in 24 children with allergic rhinitis were alleviated, the skin it-ching in 6 children with atopic dermatitis was alleviated, and 1 case had poor improvement, the symptoms in 2 cases with chronic urticaria were alleviated, 9 children had food allergy and 3 cases reached tolerance.Conclusions:The treatment of allergic diseases in children, apart from asthma, Omalizumab is suitable for allergic rhinitis, atopic dermatitis and chronic urticaria.In the treatment of food allergy, it also has the function of increasing the threshold of food allergen tolerance.There are significant therapeutic benefits in children with multiple allergic diseases or being allergic to multiple allergens.
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Allergic diseases which affect children′s health and quality of life are common diseases.Many pediatric patients′ symptoms are uncontroled after routine treatments.Omalizumab, a highly specific and binding humanized monoclonal anti-IgE antibody, has been approved as an additional treatment for moderate to severe persistent asthma and chronic spontaneous urticaria now.At the same time, there are also data confirming its efficacy and safety in other allergic diseases.This review mainly summarizes the application of omalizumab in children with allergic diseases, and focuses on the evaluation system of clinical efficacy in various diseases.Meanwhile, it discusses how the potential biomarkers predict and evaluate clinical reactions.
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According to the etiology, allergic diseases are related to wind and heat; according to the pathogenesis, most of allergic diseases are
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Humans , Acupuncture Points , Acupuncture Therapy , Hot Temperature , Hypersensitivity/therapy , MeridiansABSTRACT
Objective To understand the distribution of allergens in children with common allergic diseases in Guangzhou, and to provide evidence for the prevention and treatment of environmental allergens in children with different allergic diseases. Methods This study enrolled a total of 6 869 children with allergic diseases, including wheezing diseases and asthma (1 013 cases), allergic rhinitis (660 cases), allergic conjunctivitis (422 cases), eczema (2 762 cases), atopic dermatitis (831 cases) and urticaria (1 181 cases). Western blotting was used to detect the serum allergen type E specific antibodies (sIgE) of the patients. The results were statistically analyzed. Results The total positive rate of sIgE in 6 869 children was 74.01%. The positive rate of male children (75.02%) was higher than that of female children (72.25%). The positive rate of inhalation allergens (53.47%) was higher than that of food allergens (57.39%). House dust mites and milk were the most common inhalation allergens and food allergens, respectively. Eczema was the most common allergic disease in infants and toddlers. Allergic rhinitis and urticaria were common in school-age children. Conclusion The main allergens causing allergic diseases in children in Guangzhou were dust mites and milk. Different allergic diseases had its specific allergens. It is necessary to take targeted prevention measures accordingly.
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Recent studies have revealed that the interactions of nervous and immune system play a role in the advancement of allergy diseases. Allergy diseases are the consequence of an aberrant response from the immune system to foreign substances and harmful stimuli, have high incidence and the related allergic symptoms seriously affect the patient's quality of life. Specific immune mediator receptors [such as type 1 histamine receptors (H1R), protease activating receptor 2 (PAR-2), tropomyosin receptor kinase A (TrkA)] may be expressed on the surface of neurons and nerve fibers of the nervous system, while neuropeptide receptors [such as neurokinin receptor-1 (NK-1R), vasoactive intestinal peptide receptor (VPAC)] and neurotransmitter receptors [such as α7 acetylcholine nicotinoid-like receptor (α7nAChR), Beta 2 adrenergic receptor (β2AR)] may also be expressed on the immune cell membrane in the immune system. Therefore, esthesioneure can be activated by inflammatory mediators secreted by immune cells to conduct sensation and release neuropeptides and neurotransmitters, while the function of immune cells can be regulated by neuropeptides and neurotransmitters from the nervous system. Further understanding the role of neuroimmune in allergic diseases may provide guidance for the treatment of allergic diseases.
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The academic thought of professor - on "no allergy without any deficiency" was explored. Theory and the clinical application were elaborated on allergic diseases treated with heat-sensitive moxibustion. It is believed that the critical pathogenesis of allergic diseases is deficiency, particularly the deficiency of the lung, the spleen and the kidney. The invasion of exogenous factors or the disturbance of the retained pathogens in the body may induce allergy. Regarding the therapeutic method, the warming method is applicable for the deficiency and the heat-sensitization counteracts allergy. The sensitized points are detected in accordance with the two-step location method and they are stimulated with the suspended moxibustion. The feeling of heat-sensitive moxibustion is a sign of activation of endogenous regulatory function in the human body. It is a kind of external therapy for the internal disorders, directly acting on the pathogenesis, strengthening the antipathogenic and removing the allergic factors. This therapy is a new endogenous anti-allergic approach.
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Background: Globally, inhalant allergen sensitization (IAS) in allergic diseases (ADs) is commonly associated with indoor allergens, mainly house dust mites (HDMs). Objective: The objective of this study was to determine the association between HDM sensitization (HDM-SN) and ADs. Materials and Methods: A retrospective study was conducted which included all patients with allergies, >15 years of age, and seen over a 1-year period at the Allergy Center, Lalune clinics, Jeddah, Saudi Arabia. Results of serum specific immunoglobulin E (sIgE) to 30 common inhalant allergens (INHs) were collected by medical students. Severity of sensitization was classified as 1–6 (1–2 being mild, 3–4 being moderate, and 5–6 being severe). Medical records of patients with HDM-SN were reviewed to determine any clinical diagnosis of ADs and other associated IAS. Results: A total of 55 adults with HDM-SN, 34 males (62%) and 21 females (38%), with an age range of 15>56 years were studied. ADs associated with HDM-SN were allergic rhinitis (AR) (27%), asthma (22%), allergic conjunctivitis (AC) (18%), atopic dermatitis (ATD) (16%), allergic sinusitis (9%), and chronic urticaria (8%). The average severity class of HDM-SN in our sample was moderate (Dermatophagoides pteronyssinus [2.3] and Dermatophagoides farinae [2.2]). Other IAS found to be associated with HDM-SN were cockroaches (13.86%), Alternaria (12.4%), cats (12.4%), Bermuda (11.67%), and mesquite (10.21%). Conclusion: Average HDM-SN severity class was moderate in the studied group of patients (early to middle adult ages). HDM-SN is always associated with other IAS (INH-SNs) which explains the importance of obtaining an all-INH panel in patients with HDM-SN. IAS which most frequently had an association with HDM-SN was cockroaches, Alternaria, and cats with two outdoor allergens Bermuda, and mesquite, following closely. HDM-SN is usually associated with multiple ADs mainly involving INHs including AR, asthma, and AC, and less commonly ATD, sinusitis, and chronic urticaria.
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Allergic diseases, including allergic rhinitis, asthma, and atopic dermatitis, are common heterogeneous diseases that encompass diverse phenotypes and different pathogeneses. Phenotype studies of allergic diseases can facilitate the identification of risk factors and their underlying pathophysiology, resulting in the application of more effective treatment, selection of better treatment responses, and prediction of prognosis for each phenotype. In the early phase of phenotype studies in allergic diseases, artificial classifications were usually performed based on clinical features, such as triggering factors or the presence of atopy, which can result in the biased classification of phenotypes and limit the characterization of heterogeneous allergic diseases. Subsequent phenotype studies have suggested more diverse phenotypes for each allergic disease using relatively unbiased statistical methods, such as cluster analysis or latent class analysis. The classifications of phenotypes in allergic diseases may overlap or be unstable over time due to their complex interactions with genetic and encountered environmental factors during the illness, which may affect the disease course and pathophysiology. In this review, diverse phenotype classifications of allergic diseases, including atopic dermatitis, asthma, and wheezing in children, allergic rhinitis, and atopy, are described. The review also discusses the applications of the results obtained from phenotype studies performed in other countries to Korean children. Consideration of changes in the characteristics of each phenotype over time in an individual’s lifespan is needed in future studies.
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Child , Humans , Asthma , Bias , Classification , Dermatitis, Atopic , Phenotype , Prognosis , Respiratory Sounds , Rhinitis, Allergic , Risk FactorsABSTRACT
A20 (also known as TNFAIP3 ) is a zinc finger which can be activated by a variety of inflammatory factors such protein with both ubiquitination and deubiquitination functions, as LPS, IL-1 and TNF-α. To date, A20 has been considered a negative regulator of NF-kB with immunomodulatory effects. And the latest researches have shown the involvement of A20 in the occurrence and development of various allergic diseases. This article reviews the origin, structure, and biological functions of A20 and its role in allergic asthma, through which new methods and ideas might be enlightened for the treatment and prevention of allergic asthma.
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The prevalence of allergic diseases has increased dramatically in recent decades, and are now considered major chronic diseases at the global level. The increasing burden of allergic diseases has led to numerous worldwide and local researchers to investigate the time trends in its prevalence and identify its driving factors. Environmental changes such as urbanization and industrialization have been suggested to explain the increasing prevalence, but recent reports from Western countries suggest that this prevalence has reached a plateau or even possibly, started to decrease. However, such environmental changes are still occurring in many Asia-Pacific countries, including Korea, and it is speculated that the peak in allergy epidemics has yet to come. The present systematic literature review aimed to explore the time trends in the prevalence of allergic diseases in Korea and to identify the unmet needs for facilitating further studies.
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Chronic Disease , Epidemiology , Hypersensitivity , Incidence , Korea , Prevalence , UrbanizationABSTRACT
With the change of environment and life-style,the incidence of allergic diseases in children is increasing,but its pathogenesis is not entirely elucidated.It is shown that tryptophan catabolism mediated by indoleamine 2,3-dioxygenase plays a significant role in the pathophysiology of allergic diseases of children such as asthma and allergic rhinitis.These roles include inducing Treg cell,inhibiting Th2 cell response,mediating immune tolerance and so forth.Therefore,it is a new target for the prevention and treatment of allergic diseases by stimulating the immune cells and changing the diet structure to regulate tryptophan catabolism.This article reviews the role of tryptophan decomposition in children allergic diseases.
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Allergic diseases is a major worldwide health problem.The abnormal structure of intestinal microbiota is closely related to the occurrence and development of allergic diseases.The formation of intestinal microbiota in early life is influenced by many factors,such as the mode of delivery,feeding methods,the addition of probiotics or prebiotics,heredity and so on.The abnormal structure of intestinal microbiota in early life is an important factor influencing the occurrence of allergic diseases in the later life.In this paper, we will discuss the relationship between the abnormal structure of intestinal microbiota in early life and allergic diseases with the latest literature.
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In order to overcome a certain disease, it is necessary to confirm the prevalence, natural course and risk factors of the disease. The Korean Academy of Pediatric Allergy and Respiratory Disease has become the mainstream and has been paying a great deal of attention to the epidemiologic research of allergic diseases in Korean children since 1995. In this review, we would like to summarize the International Study of Asthma and Allergies in Childhood epidemiology study in Korea, the cohort study for allergic diseases, and the national medical big data. New epidemiological studies are needed to clarify the relationships between allergic diseases and factors such as air pollution, climate changes, microbiome, and diet, which are likely to be new risk factors for allergic diseases. Based on these epidemiological studies, we hope to find ways to overcome pediatric allergic diseases in Korea and also to share epidemiologic techniques and manpower.
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Child , Humans , Air Pollution , Asthma , Climate Change , Cohort Studies , Diet , Epidemiologic Studies , Epidemiology , Hope , Hypersensitivity , Korea , Microbiota , Prevalence , Risk FactorsABSTRACT
Interleukin 31 (IL-31)is one of the cytokines which appears to be an important regulator of Th2 responses. Previous study has been done to determine IL-31 serums levels in atopic dermatitis (AD). However, the serum levels of IL-31 in allergic rhinitis (AR) and atopic asthma (AA) is not many reported and still unclear. The objective of this cross sectional study is to determine an association between IL-31 and other predisposing factors with allergic diseases in HRPZ II (Hospital Raja PerempuanZainab II) and HUSM (Hospital UniversitiSains), Kelantan, Malaysia. This study involved 70 patients of AD, 70 patients of AR, 70 patients of AA and 70 healthy controls from staffs and people in HUSM.Five milliliters of blood were withdrawn and centrifuged for 5 minutes at 2000 rpm to obtain the serum and analyzed for IL-31 levels by using enzyme-linked immunosorbent (ELISA) kits (Human IL 31 Duoset, R&D System). Simple and multiple logistic regressions were used to analyze the association between IL-31 levels and predisposing factors among allergic diseases. The levels of IL-31 and other predisposing factors showed significant associations in smoking status, occupational exposure and area of living for AD and AR, however in AA, the significant association only found in smoking status and occupational exposure. In conclusion, we found that there were associations between IL-31 serum levels and other predisposing factors with AD, AR and AA. The findings can be the pilot study to determine IL-31 levels in allergic diseases in Malaysia.