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Allergic and Eosinophilic Diseases: Diagnosis, Treatment, and Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Immunology".

Deadline for manuscript submissions: closed (20 October 2024) | Viewed by 15742

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Dr. Aikaterini Detoraki

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Division of Internal Medicine and Clinical Immunology, Dpt of Internal Medicine and Clinical Complexities, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
Interests: allergy and clinical immunology; dermatology; respiratory diseases

Special Issue Information

Dear Colleagues,

Allergic and eosinophilic diseases represent a collection of disorders including bronchial asthma, atopic dermatitis (AD), allergic rhinitis (AR), conjunctivitis, chronic rhinosinusitis with/without nasal polyps (CRSwNP/CRSsNP), food allergy, eosinophilic esophagitis (Eo) and other conditions mediated by eosinophilic inflammation.

These disorders affect over 25% of the population in industrialized countries and are rising in prevalence in developing countries, representing an important socioeconomic burden impacting patients’ health-related QoL.

Allergic/eosinophilic diseases are mediated by T2-driven pathophysiological mechanisms, shared across multiple allergic/eosinophilic disorders that often overlap in the same patient. The complexity of allergic/eosinophilic disorders in terms of treatment options and guideline indications highlights the need to identify specific advice to optimize the management of different types of patients who could benefit from the current standard of care medication, prevention strategies (allergen immunotherapy) or biological therapy.

This Special Issue aims to discuss new knowledge in clinical allergic/eosinophilic disorders in terms of diagnosis, treatment and management and welcomes inputs from researchers in different disciplines who feel they can contribute to this discussion.

Dr. Aikaterini Detoraki
Guest Editor

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Keywords

allergy
eosinophilic diseases
immunology
clinical immunology
asthma
diagnosis
treatment
management

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Published Papers (9 papers)

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Research

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8 pages, 256 KiB

Open AccessArticle

Severe Uncontrolled Asthma: A Longitudinal Retrospective Study Illustrating the Experience of the Pulmonology Clinic of Târgu-Mureș, Romania

by Edith-Simona Ianoși, Dragoș Huțanu, Mara Andreea Vultur, Hédi-Katalin Sárközi, Delia-Liana Rachiș and Gabriela Jimborean

J. Clin. Med. 2024, 13(21), 6582; https://doi.org/10.3390/jcm13216582 - 1 Nov 2024

Viewed by 578

Abstract

Introduction: Severe uncontrolled asthma (SUA) affects approximately 5% of asthma patients, leading to frequent exacerbations, reduced lung function, and lower quality of life. Recent biologic therapies target specific inflammatory pathways, offering new options for SUA. Objective: This study aimed to evaluate clinical characteristics, treatment outcomes, and biomarkers in patients with SUA treated with biologics (Omalizumab, Benralizumab, and Dupilumab) at our clinic. Material and Methods: A six-month retrospective longitudinal study was conducted on 28 patients aged 36–83 years with SUA. Patients were divided into three groups: Omalizumab (n = 4), Benralizumab (n = 18), and Dupilumab (n = 6). Lung function tests and biomarkers such as eosinophil and IgE levels were measured over 3-month periods (T0, T1, and T2). Asthma control was assessed using asthma control tests (ACT), and non-parametric statistical methods were applied. Results: The median patient age was 64 years, with 75% showing elevated eosinophil counts (>300 cells/µL). Benralizumab significantly improved lung function (p < 0.05) and ACT scores (p < 0.001), reducing eosinophil counts to zero (p < 0.001). Patients on Dupilumab and Omalizumab showed improved asthma control (p < 0.05) and reduced exacerbations, albeit to a lesser extent (p > 0.05). Conclusions: Biologics, particularly Benralizumab and Dupilumab, improved asthma control, lung function, and quality of life in SUA patients, with improved ACT scores and spirometry values. Some patients remained poorly controlled, emphasizing the need for personalized treatment and regular biomarker monitoring. Multidisciplinary management and lifestyle changes are critical for better outcomes in SUA. Full article

(This article belongs to the Special Issue Allergic and Eosinophilic Diseases: Diagnosis, Treatment, and Management)

7 pages, 216 KiB

Open AccessArticle

Characterization of a Romanian Pediatric Population with Eosinophilic Esophagitis

by Iulia Florentina Tincu, Luiza Elena Bordei, Lucica Luminita Gales, Larisa Alexandra Duchi, Loredana Dobrescu and Bianca Teodora Chenescu

J. Clin. Med. 2024, 13(17), 5041; https://doi.org/10.3390/jcm13175041 - 25 Aug 2024

Viewed by 863

Abstract

Background/objectives: An increase in the incidence of eosinophilic esophagitis (EoE) in children has been reported worldwide in the last decade. We conducted a study in a tertiary pediatric gastroenterology unit aimed at analyzing the clinical manifestations, biochemical markers, and endoscopic features of children with EoE in comparison to patients with non-eosinophilic esophagitis. Methods: This is a prospective analysis involving children with symptoms related to esophageal dysfunction, who had esophagogastroduodenoscopies with esophageal biopsies between January 2021 and April 2024 at “Dr. Victor Gomoiu” Clinical Children’s Hospital, in Bucharest, Romania. For the analysis, patients were considered in either Group 1, classified as EoE, or in Group 2, classified as reflux esophagitis. Results: Among the total of 72 patients diagnosed with esophagitis, 17 patients (Group 1—study group) were classified as EoE and 55 were classified as reflux esophagitis (Group 2—control group). The sex ratio analysis showed a male predominance in the study group (71% vs. 32%, p = 0.002). The main symptoms were regurgitation, eructation, and nausea. Dysphagia was present in two (11.76%) patients from Group 1. Eosinophilia was more prevalent in the EoE group than in the individuals with gastroesophageal reflux disease (GERD) (10 (58.85%) vs. 10 (18.18%, p = 0.001)), as well as the total IgE (11 (64.70%) vs. 6 (10.9%, p = 0.001)). Conclusions: Pediatric gastroenterologists need to be aware of EoE atypical presentation and perform adequate biopsies, mainly in children with refractory GERD-like symptoms, dysphagia, and food bolus impaction. Further analyses in terms of prognosis and treatment response should be addressed in longitudinal studies. Full article

(This article belongs to the Special Issue Allergic and Eosinophilic Diseases: Diagnosis, Treatment, and Management)

10 pages, 491 KiB

Open AccessArticle

Total IgE Trends in Children with Allergic Diseases

by Nikolaos Katsanakis, Paraskevi Xepapadaki, Ioannis-Alexios Koumprentziotis, Pavlos Vidalis, John Lakoumentas, Maria Kritikou and Nikolaos G. Papadopoulos

J. Clin. Med. 2024, 13(13), 3990; https://doi.org/10.3390/jcm13133990 - 8 Jul 2024

Viewed by 892

Abstract

Background/Objectives: The importance of non-invasive biomarkers for the diagnosis and monitoring of allergic diseases in childhood is currently unknown. From this perspective, data on the role of the total (t) immunoglobulin E (IgE) in relation to different allergic diseases across different age groups until adulthood remain unclear. The potential association of tIgE levels with types of allergic diseases diagnosed in an specialized tertiary allergy center, in relation to sex and the age group spanning from birth to 20 years, are evaluated in the present study. Methods: In this retrospective study, the tIgE values were obtained from children assessed for allergy-associated symptoms in our department from January 2015 to December 2020. The tIgE values were analyzed in relation to age and diagnosis. Results: Data from 2127 patients (1321 boys (62.1%)), with a median age of 6.31 (3.01–9.95) years, were available. The tIgE median values for the studied population were 132 (37.7–367.5) kU/lt. The tIgE values showed a significant increase from 0–2 years to 2–5 and 5–12 years, but not from 5–12 to 12–20 years. Boys exhibited significantly higher tIgE values compared to girls. Furthermore, the tIgE levels were significantly increased in children with asthma, allergic rhinitis, food allergy, and atopic dermatitis in comparison to children without these diagnoses. Conclusions: The total IgE values exhibit a significant and progressive longitudinal increase in children with allergic diseases, particularly notable in the 0–2 and 5–12 age groups, in boys, and in children diagnosed with atopic conditions. Full article

(This article belongs to the Special Issue Allergic and Eosinophilic Diseases: Diagnosis, Treatment, and Management)

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11 pages, 2450 KiB

Open AccessArticle

Upper Airway Alarmin Cytokine Expression in Asthma of Different Severities

by Hazel Marriott, Marc Duchesne, Subhabrata Moitra, Isobel Okoye, Luke Gerla, Irvin Mayers, Jalal Moolji, Adil Adatia and Paige Lacy

J. Clin. Med. 2024, 13(13), 3721; https://doi.org/10.3390/jcm13133721 - 26 Jun 2024

Viewed by 1830

Abstract

Background: The secretion of alarmin cytokines by epithelial cells, including thymic stromal lymphopoietin (TSLP), interleukin (IL)-25, and IL-33, initiates inflammatory cascades in asthma. However, alarmin cytokine expression in the upper airways in asthma remains largely unknown. Methods: We recruited 40 participants with asthma into four groups as per the Global Initiative for Asthma (GINA) steps (10 in each group of GINA 1/2, 3, 4, and 5). Cells were derived from nasal, buccal, and throat brushings. Intracellular cytokine expression (TSLP, IL-25, and IL-33) was assessed by flow cytometry in cytokeratin 8⁺ (Ck8⁺) epithelial cells immediately following collection. Results: TSLP was significantly increased (p < 0.001) in GINA 5 patients across nasal, buccal, and throat Ck8⁺ epithelial cells, while IL-25 was elevated in nasal and throat samples (p < 0.003), and IL-33 levels were variable, compared with GINA 1–4 patients. Individual GINA subgroup comparison showed that TSLP levels in nasal samples from GINA 5 patients were significantly (p = 0.03) elevated but did not differ between patients with and without nasal comorbidities. IL-25 and IL-33 (obtained from nasal, buccal, and throat samples) were not significantly different in individual groups. Conclusions: Our study demonstrates for the first time that Ck8⁺ nasal epithelial cells from GINA 5 asthma patients express elevated levels of TSLP. Full article

(This article belongs to the Special Issue Allergic and Eosinophilic Diseases: Diagnosis, Treatment, and Management)

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12 pages, 7345 KiB

Open AccessArticle

Expression of Immunoglobulin G4 in Eosinophilic Esophagitis

by See-Young Lee, Ji-Hae Nahm, Min-Jae Kim, Yuna Kim, Jie-Hyun Kim, Young-Hoon Youn and Hyojin Park

J. Clin. Med. 2024, 13(8), 2175; https://doi.org/10.3390/jcm13082175 - 10 Apr 2024

Cited by 2 | Viewed by 1399

Abstract

Background: Eosinophilic esophagitis (EoE) is a disease that has been subcategorized into two endoscopic phenotypes: inflammatory and fibrostenotic. Moreover, studies have shown a link between EoE and immunoglobulin G4 (IgG4), a subclass of the immunoglobulin G (IgG) antibody. In this study, we aimed to evaluate the relationship between histologic IgG4 expression and endoscopic phenotypes in patients with EoE. Methods: This case-control study included patients diagnosed with EoE (n = 19) and patients with non-obstructive dysphagia without abnormal findings as controls (NOD; n = 12). The EoE group was further divided into three subgroups based on endoscopic phenotype: inflammatory, fibrostenotic, or combined. Retrospective examination of endoscopic findings and pathological slides was performed to analyze IgG4 staining. Results: Histological analysis revealed a significant difference in IgG4 cell count (15.00 vs. 0.58, p = 0.003) and eosinophil cell count (84.67 vs. 0.08, p < 0.001) between the EoE and NOD groups. Symptom manifestation and blood test results were similar across all three endoscopic EoE phenotypes. However, histological analysis revealed a significant difference in IgG4 cell count between the inflammatory, fibrostenotic, and combined phenotypes (4.13 vs. 17.6 vs. 59.7, p = 0.030). Conclusions: IgG4 expression was higher in EoE patients than in those with NOD, the highest being in the combined phenotype subgroup. These findings emphasize the important role of endoscopic and histological examination in diagnosing EoE and the need for further research in this area. Full article

(This article belongs to the Special Issue Allergic and Eosinophilic Diseases: Diagnosis, Treatment, and Management)

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17 pages, 5232 KiB

Open AccessEditor’s ChoiceArticle

Eosinophilic Patterns in Patients with Seasonal Allergy Affected by Bronchial Asthma and Rhinitis/Rhinosinusitis: Efficacy of Benralizumab in Patients with the Persistent Pattern

by Valentina D’Aiuto, Ilaria Mormile, Francescopaolo Granata, Antonio Romano, Francesca Della Casa, Caterina D’Onofrio, Valentina Marzio, Gabriele Mignogna, Luigi Califano, Amato de Paulis and Francesca Wanda Rossi

J. Clin. Med. 2024, 13(3), 754; https://doi.org/10.3390/jcm13030754 - 28 Jan 2024

Cited by 2 | Viewed by 1883

Abstract

Background: Eosinophilia can be influenced by multiple factors. This study aims to set a protocol for monitoring blood absolute eosinophil count (AEC) in patients with seasonal allergy affected by bronchial asthma (BA), allergic rhinitis (AR), or chronic rhinosinusitis with or without nasal polyposis (CRSw/sNP). Methods: We planned a total of four annual blood samples to measure AEC in- and out-seasonal pollen exposure (i.e., one measurement every three months for one year). Results: We identified two distinct groups of patients (non-eosinophilic and eosinophilic). Patients in the eosinophilic group presented with four different patterns (episodic, transient, floating, and persistent). Most patients with episodic, transient, and floating patterns were affected by mild allergy and the increase in eosinophils was related to allergen exposure. In contrast, patients with the persistent pattern mostly presented with more severe allergy (i.e., severe BA and relapsing CRSwNP) and the eosinophilia was unrelated to allergen exposure. The subgroup of patients with severe BA, relapsing CRSwNP, and persistent eosinophilc pattern were treated with benralizumab, which induced a noteworthy improvement in both severe BA and CRSwNP. Conclusions: Multiple AEC measurements in patients with seasonal allergy can better reflect patient’s eosinophilic status and help define the relationship of AEC enhancement with allergen exposure. Full article

(This article belongs to the Special Issue Allergic and Eosinophilic Diseases: Diagnosis, Treatment, and Management)

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11 pages, 3805 KiB

Open AccessArticle

Early Ear, Nose and Throat Manifestations in Eosinophilic Granulomatosis with Poliangioitis: Results from Our Cohort Group and Literature Review

by Mario D’Onofrio, Daniele La Prova, Maria Rosaria Galdiero, Elena Cantone, Eugenio Tremante, Massimo Mascolo, Vittoria Barbieri, Claudio Di Nola, Giuseppe Spadaro, Amato de Paulis and Aikaterini Detoraki

J. Clin. Med. 2023, 12(22), 6967; https://doi.org/10.3390/jcm12226967 - 7 Nov 2023

Viewed by 4882

Abstract

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, systemic necrotizing vasculitis affecting small-to-medium-sized vessels. EGPA’s clinical manifestations are heterogeneous, affecting different organs and systems, and the upper respiratory tract can be affected by ear, nose and throat (ENT) involvement. The aim of our study was to assess type manifestations at the time of diagnosis in a cohort of EGPA patients and correlate findings with baseline variables (sex, age, antineutrophil cytoplasmic antibodies—ANCA-status) and literature reports. The main ENT manifestations in our patients at the time of diagnosis were: chronic rhinosinusitis with nasal polyposis (CRSwNP) (52%), turbinate hypertrophy (48%), nasal swelling (40%), rhinorrhea (40%), chronic rhinosinusitis without nasal polyposis (CRSsNP) (32%), nasal bone deformities (32%), nasal crusts (20%), nasal mucosal ulcers (12%), corditis (12%), hoarseness/dysphonia (12%), hearing loss (12%), mucoceles (4%) and eosinophilic rhinitis (4%). No correlations were found between sex, age, ANCA status and ENT clinical manifestations. A polymorphic ENT involvement is often observed in the early stages of EGPA. The presence of nasal, sinus, ear and/or laryngeal manifestations in patients with asthma and hypereosinophilia, independently of sex, age or ANCA status, should raise an alert for further investigation and differential diagnosis for EGPA. ENT specialists should be aware of their leading position in this diagnostic race. Full article

(This article belongs to the Special Issue Allergic and Eosinophilic Diseases: Diagnosis, Treatment, and Management)

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Review

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9 pages, 220 KiB

Open AccessReview

Recurrent Kounis Syndrome: A Case Report and Literature Review

by Raffaele Brancaccio, Laura Bonzano, Alessia Cocconcelli, Rostyslav Boyko, Giuseppe Ienopoli and Alberico Motolese

J. Clin. Med. 2024, 13(6), 1647; https://doi.org/10.3390/jcm13061647 - 13 Mar 2024

Cited by 2 | Viewed by 1862

Abstract

Kounis syndrome is a condition where inflammatory cells (mostly mast cells with the contribution of macrophages and T-lymphocytes) cause an acute coronary syndrome. Kounis syndrome comes in four variants: type I in patients with normal coronary arteries; type II in patients with inactive pre-existing atheromatous disease; type III in patients with pre-existing coronary artery stenting; type IV in patients with a pre-existing coronary artery bypass. Recently, we came across a case of recurrent type I Kounis syndrome in our clinical practice. The purpose of the paper is to present our case and conduct a review using the Pubmed scientific database about the most relevant cases of recurrent Kounis syndrome. This review shows that recurrent Kounis syndrome is a rare condition and is mostly associated with Kounis syndrome type III. Recurrent Kounis syndrome may be also triggered by vaccination and it could be associated with chronic spontaneous urticaria. In the last condition, therapy is represented by second-generation anti-histamines and corticosteroids, but also by an anti-IgE monoclonal antibody (omalizumab) in the recalcitrant cases. Full article

(This article belongs to the Special Issue Allergic and Eosinophilic Diseases: Diagnosis, Treatment, and Management)

Other

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7 pages, 753 KiB

Open AccessBrief Report

The Occurrence of Atopy in Patients with Isolated Spontaneous Mast Cell (or Nonallergic) Angioedema

by Magdalena Zajac, Andrzej Bozek and Alicja Grzanka

J. Clin. Med. 2024, 13(2), 477; https://doi.org/10.3390/jcm13020477 - 15 Jan 2024

Viewed by 966

Abstract

Background: Isolated mast cell angioedema (MC-AE) can be divided into allergic and nonallergic (spontaneous) forms. The former is often associated with food, Hymenoptera venoms or drug allergies. This study aimed to evaluate the relationship between the occurrence of atopic diseases and the risk of angioedema. Methods: A retrospective study analyzed 304 patients with confirmed MC-AE and 1066 controls. All were analyzed for allergic asthma (AA), atopic dermatitis (AD) and allergic rhinitis (AR) based on ICD-10 codes. In addition, total IgE and peripheral eosinophilia were calculated. Results: The analyzed atopic diseases were more frequent in the group of patients diagnosed with MC-AE than in the controls: 78 (25.7%) vs. 173 (16.2%) for p < 0.01. Patients diagnosed with AD had a higher risk of MC-AE (hazard ratio (HR) = 1.48,) similar to those diagnosed with AR (HR = 1.51). However, in patients with two or three atopic comorbidities, the risk increased significantly to HR = 2.45 or HR = 4.1, respectively. There was a positive correlation between the serum total IgE concentration or eosinophilia and the risk of angioedema (p < 0.01). Conclusion: Patients with MC-AE had a more frequent occurrence of atopic diseases associated with inhalant allergies. This risk increased in patients with IgE-mediated polymorphic disease. Full article

(This article belongs to the Special Issue Allergic and Eosinophilic Diseases: Diagnosis, Treatment, and Management)

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