Severe asthma as the initial clinical manifestation of IgG4-related disease: a retrospective clinical study

Xiangning Liu, 

Chi Shao, 

Chen Yu, 

Hui Huang, 

Ruili Pan, 

Kai Xu, 

Xin Zhang & 

Zuojun Xu 

BMC Pulmonary Medicine volume 22, Article number: 141 (2022) 

• details

Abstract

A–H Chest CT features for the enrolled
cases before administration with systemic
glucocorticoids: mediastinal lymphadenopathy
(A and B), mosaic attenuation sign (C),
diffuse bronchial wall thickening (D),
scattered solid or ground-glass nodule
(E and F, respectively), diffuse peribronchiolar
 ground-glass opacities (G), and multiple
bronchiectasis (H)

Background

Respiratory involvement is common in immunoglobulin G4-related disease (IgG4-RD). However, severe asthma as the initial clinical manifestation of IgG4-RD is rare and might be neglected by respiratory clinicians. We aimed to explore the clinical characteristics and prognoses of patients with immunoglobulin G4-related disease (IgG4-RD) manifesting as severe asthma.

Methods

A retrospective analysis of the clinical characteristics and prognoses of patients with severe asthma who were eventually diagnosed with IgG4-RD was performed in the Peking Union Medical College Hospital from 2013 to 2019.

Results

Twelve patients (5males, 7 females) were included. The mean age at enrollment and age of asthma onset were 59.4 ± 10.1 and 53.8 ± 10.4 years, respectively. The mean duration of asthma symptoms was 5.7 ± 2.0 years. In all patients, the proportion (25.1 ± 10.3%) and count (2.0 ± 1.1) × 109/L of eosinophils in peripheral blood increased. Additionally, all patients exhibited elevated total immunoglobulin E [IgE, (1279.3 ± 1257.9) KU/L] and IgG4 (9155.8 ± 9247.6) mg/dL.

Worldwide prevalence of rhinitis in adults: A review of definitions and temporal evolution

REVIEW ARTICLE

Open Access

Marine Savouré,Jean Bousquet,Jouni J. K. Jaakkola,Maritta S. Jaakkola,Bénédicte Jacquemin,Rachel Nadif

Clin Transl Allergy. 2022;e12130. 

Abstract

Introduction

Although rhinitis is among the most common diseases worldwide, rhinitis prevalence in the general adult population is unclear and definitions differ widely.

Objective

To summarize the literature on rhinitis prevalence in the general adult population and to assess: (1) the prevalence according to different rhinitis definitions overall and in different regions of the world, and (2) the evolution of rhinitis prevalence over time.

Physician vaccination practices in mild to moderate inborn errors of immunity and retrospective review of vaccine completeness in IEI: results from the Canadian Immunization Research Network

• Research
• Open Access
• 
  

• Sneha Suresh, 
• Joseline Zafack, 
• Anne Pham-Huy, 
• Beata Derfalvi, 
• Manish Sadarangani, 
• Athena McConnell, 
• Bruce Tapiéro, 
• Scott A. Halperin, 
• Gaston De Serres, 
• Jeffrey M Pernica & 
• Karina A. Top 

Allergy, Asthma & Clinical Immunology volume 18, Article number: 32 (2022) 

Abstract

Background and objectives

Safety and effectiveness concerns may preclude physicians from recommending vaccination in mild/moderate inborn errors of immunity (IEI). This study describes attitudes and practices regarding vaccination among physicians who care for patients with mild/moderate B cell or mild/moderate combined immunodeficiencies (CID) and vaccination completeness among patients diagnosed with IEIs.

Methods

Canadian physicians caring for children with IEI were surveyed about attitudes and practices regarding vaccination in mild/moderate IEI. Following informed consent, immunization records of pediatric patients with IEI evaluated before 7 years of age were reviewed. Vaccine completeness was defined at age 2 years as 4 doses of diphtheria-tetanus-pertussis (DTaP), 3 doses pneumococcal conjugate (PCV), and 1 dose measles-mumps-rubella (MMR) vaccines. At 7 years 5 doses of DTP and 2 doses MMR were required.

Results

Forty-five physicians from 8 provinces completed the survey. Most recommended inactivated vaccines for B cell deficiency: (84% (38/45) and CID (73% (33/45). Fewer recommended live attenuated vaccines (B cell: 53% (24/45), CID 31% (14/45)). Of 96 patients with IEI recruited across 7 centers, vaccination completeness at age 2 was 25/43 (58%) for predominantly antibody, 3/13 (23%) for CID, 7/35 (20%) for CID with syndromic features, and 4/4 (100%) for innate/phagocyte defects. Completeness at age 7 was 15%, 17%, 5%, and 33%, respectively.

Conclusion

Most physicians surveyed recommended inactivated vaccines in children with mild to moderate IEI. Vaccine completeness for all IEI was low, particularly at age 7. Further studies should address the reasons for low vaccine uptake among children with IEI and whether those with mild-moderate IEI, where vaccination is recommended, eventually receive all indicated vaccines.

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Allergic bronchopulmonary candidiasis: A review of the literature and a case report

Case report Open Access

• Martin Scurek, 
• Eva Pokojova, 
• Martina Doubkova & 
• Kristian Brat 

BMC Pulmonary Medicine volume 22, Article number: 132 (2022) 

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Abstract

Background

Allergic bronchopulmonary candidiasis (ABPC) is an uncommon clinical syndrome associated with immune hypersensitivity to Candida species.

Case presentation

The case presentation describes a 58-year-old man with acute respiratory failure and bilateral lung infiltrates. Due to high inflammatory markers and a chest X-ray indicating lung infiltration, he was initially treated for pneumonia with combined antibiotics. Despite comprehensive treatment at the ICU, the patient’s clinical status deteriorated rapidly, and further investigations provided a rare diagnosis of ABPC.

Total IgE in tears accurately reflects the severity and predicts the prognosis of seasonal allergic conjunctivitis

 

ORIGINAL ARTICLE Open Access

Jiayu Bao,Lei Tian,Yifan Meng,Binge Wu,Jingyi Wang,Jing He,Qiyan Shao,Chengshuo Wang,Ying Jie,Luo Zhang

https://doi.org/10.1002/clt2.12139

Abstract

Background

Although immunoglobulin E (IgE) increases significantly in tears and serum during seasonal allergic conjunctivitis (SAC), it is unclear whether tear total IgE can reflect the severity and prognosis of SAC more accurately than serum total IgE. We aimed to investigate the usefulness of measuring the total IgE in tears to evaluate the severity and determine the treatment of SAC.

Bradykinin-induced angioedema in the emergency department

• Review
• Open Access
• 
  

• Jacques Hébert, 
• Jean-Nicolas Boursiquot, 
• Hugo Chapdelaine, 
• Benoit Laramée, 
• Marylin Desjardins, 
• Rémi Gagnon, 
• Nancy Payette, 
• Oleksandra Lepeshkina & 
• Matthieu Vincent 

International Journal of Emergency Medicine volume 15, Article number: 15 (2022) 

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Abstract

Background

Acute airway angioedema commonly occurs through two distinct mechanisms: histamine- and bradykinin-dependent. Although they respond to distinct treatments, these two potentially life-threatening states present similarly. Poor recognition of the bradykinin-dependent pathway leads to treatment errors in the emergency department (ED), despite the availability of multiple pharmacologic options for hereditary angioedema (HAE) and other forms of bradykinin-induced angioedema. Here, we consider the pathophysiology and clinical features of bradykinin-induced angioedema, and we present a systematic literature review exploring the effectiveness of the available therapies for managing such cases.

Local nebulization of 1α,25(OH)2D3 attenuates LPS-induced acute lung inflammation

• Research
• Open Access
• 
  

• Jef Serré, 
• Carolien Mathyssen, 
• Tom Tanjeko Ajime, 
• Tobias Heigl, 
• Lieve Verlinden, 
• Karen Maes, 
• Annemieke Verstuyf, 
• Didier Cataldo, 
• Jeroen Vanoirbeek, 
• Bart Vanaudenaerde, 
• Wim Janssens & 
• Ghislaine Gayan-Ramirez 

Respiratory Research volume 23, Article number: 76 (2022) 

Abstract

Background

Evidence supports a critical role of vitamin D status on exacerbation in chronic obstructive pulmonary disease, indicating the need to avoid vitamin D deficiency in these patients. However, oral vitamin D supplementation is limited by the potential risk for hypercalcemia. In this study, we investigated if local delivery of vitamin D to the lungs improves vitamin D-mediated anti-inflammatory action in response to acute inflammation without inducing hypercalcemia.

Methods

We studied vitamin D sufficient (VDS) or deficient (VDD) mice in whom 1α,25(OH)2D3 (0.2 μg/kg) or a vehicle followed by lipopolysaccharide (LPS 25 µg) were delivered to the lung as a micro-spray.

Results

Local 1α,25(OH)2D3 reduced LPS-induced inflammatory cells in bronchoalveolar lavage (BAL) in VDS (absolute number of cells: − 57% and neutrophils − 51% p < 0.01) and tended to diminish LPS-increased CXCL5 BAL levels in VDS (− 40%, p = 0.05) while it had no effect on CXCL1 and CXCL2 in BAL and mRNA in lung of VDS and VDD. It also significantly attenuated the increased IL-13 in BAL and lung, especially in VDD mice (− 41 and − 75%, respectively). mRNA expression of Claudin-18 in lung was significantly lower in VDS mice with local 1α,25(OH)2D3 while Claudin-3, -5 and -8 mRNA levels remained unchanged. Finally, in VDD mice only, LPS reduced lung mRNA expression of adhesion junction Zona-occludens-1, in addition to increasing uric acid and total protein in BAL, which both were prevented by local 1α,25(OH)2D3.

Conclusion

Under normal levels of vitamin D, local 1α,25(OH)2D3 nebulization into the lung efficiently reduced LPS induction of inflammatory cells in BAL and slightly attenuated LPS-increase in CXCL5. In case of severe vitamin D deficiency, although local 1α,25(OH)2D3 nebulization failed to significantly minimize cellular inflammation in BAL at this dose, it prevented epithelial barrier leakage and damage in lung. Additional research is needed to determine the potential long-term beneficial effects of local 1α,25(OH)2D3 nebulization on lung inflammation.

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Outcome of a de-labelling algorithm compared with results of penicillin (β-lactam) allergy testing

• Research
• Open Access
• 
  

• Philipp Schrüfer, 
• Johanna Stoevesandt & 
• Axel Trautmann 

Allergy, Asthma & Clinical Immunology volume 18, Article number: 26 (2022) 

• details

Abstract

Background

Penicillin allergy labels frequently impede guideline-directed treatment with a penicillin or other β-lactam antibiotics. Despite presumed allergy, targeted questioning may indicate a low probability of sensitization and permit reasonably safe administration of the antibiotic in question. In this study, we evaluated a standardized algorithm aiming to differentiate non-allergic patients from those with true allergic β-lactam hypersensitivity.

Methods

We retrospectively applied a de-labelling algorithm in 800 consecutive patients with suspected β-lactam hypersensitivity. All had undergone complete allergy work-up permitting to definitely exclude or diagnose β-lactam allergy between 2009 and 2019.