Search Results (3,429)

Background: Micro- and nanoplastics (MNPs) are widespread environmental contaminants with growing evidence linking them to adverse health effects, including progression and worsening of allergic diseases. As allergies are rapidly increasing among youth (affecting almost 30% of children), this demographic represents a vulnerable population facing emerging environmental threats. Since no prior study has investigated MNP risks perceptions in an allergic population, this study aimed to assess public awareness and risk perception of MNP in Croatian youth, focusing on the influence of urbanicity, education, and allergy status. Methods: A total of 1155 participants (aged 6–18 years) were recruited from three Croatian regions as part of the EU Horizon 2020 IMPTOX and the Horizon Europe EDIAQI studies. Allergy status was determined via skin prick tests (SPT), and standardized questionnaires were used to collect data on MNP awareness and perception. Results: Awareness was significantly higher among allergic individuals (89.5% vs. non-allergic 79%, FDR p value= 0.036) and those with university-level education (88.3% vs. elementary 63.3%, FDR p value = 0.050). Allergic participants were also more concerned about food contamination by MNPs (87.7%) compared to non-allergic individuals (79.2%), FDR p value = 0.005). Media and social media were the primary sources of information regarding MNPs (FDR p value = 0.026). Conclusions: Education and allergy status are the strongest predictors of MNP awareness and related risk perceptions in the Croatian population. Targeted public health communication and educational strategies are needed to translate basic awareness into informed behavioral and policy engagement. Full article

Background: The clinical intra-anesthetic changes of perioperative hypersensitivity (POH) are not specific and require a thorough differential diagnosis with other mimicking conditions. Biomarkers such as tryptase and histamine provide supportive evidence for POH. From the suggested cutoffs, a common decision threshold has not been validated for use in daily practice. The aim of this systematic review and meta-analysis is to identify biomarkers investigated for POH and to evaluate their diagnostic performance. Methods: This meta-analysis included original diagnostic accuracy studies comparing patients with clinically suspected POH and controls with no signs of intraoperative hypersensitivity reactions, in whom allergy biomarkers were evaluated, aiming to investigate diagnostic performance of the assays. Data was pooled to evaluate sensitivity and specificity. Results: In seven studies on tryptase and three studies on histamine dosing for the diagnosis of POH/POA, different fixed or dynamic thresholds for positivity were proposed. For tryptase, fixed thresholds had 59.8% sensitivity and 95.2% specificity for an optimal cutoff of 12.68 ng/mL, while dynamic thresholds yielded 77.2% sensitivity and 88.5% specificity. For histamine, fixed cutoffs presented 78% sensitivity and 85% specificity, while dynamic thresholds investigated in a single study yielded 78.2% sensitivity and 91.1% specificity. Estimates for histamine are unreliable due to limited data. Conclusions: From published data, tryptase is clearly the most robust biomarker, dynamic thresholds boost sensitivity without major specificity loss and confirm the added diagnostic value of relative changes over fixed absolute cutoffs. Preliminary results suggest that histamine might have optimal diagnostic performance, but estimates are severely limited by small sample sizes. Full article

Parabens, a prevalent class of endocrine-disrupting chemicals (EDCs), are ubiquitous in consumer products; however, their role in linking pediatric allergic phenotypes remains poorly understood. This case-control study analyzed paraben levels in urine and indoor dust as proxies for internal and external exposures and investigated their associations with allergic rhinitis only (AR Only), asthma only (AS Only), and comorbidities (AR&AS) among children in Shanghai. The concentrations for each of four paraben compounds were quantitatively measured, and multi-pollutant frameworks—including Bayesian Kernel Machine Regression (BKMR) and Weighted Quantile Sum (WQS) regression—were employed to characterize the mixture exposure and risk. Propylparaben (PrP) was detectable in 100% of urine samples and over 90% of dust samples, and the concentrations ranked the highest out of the four compounds in both samples. Benzylparaben (BzP) was detected in >70% of urine samples and over 50% of dust samples at relatively lower levels. Urinary PrP exhibited significantly positive associations with all phenotypes (OR in 2.18–2.92) and BzP with the AR&AS Comorbidity (OR = 3.55, 95% CI: 1.32–9.55). Dust-borne PrP was associated with AR Only (OR = 2.26, 95% CI: 1.16–4.43), indicating a potential “Portal of Entry” effect via direct nasal deposition. According to BKMR and WQS analyses, urinary PrP and BzP emerged as two primary risk drivers. Using interaction analysis, an additive synergistic effect was observed between urinary PrP and BzP with parental history of allergy, suggesting heightened vulnerability to paraben exposure in genetically predisposed subgroups. In conclusion, children with respiratory allergies were associated with higher exposure to PrP and BzP and exhibited higher susceptibility in those with a parental history of allergy. Full article

Ensuring the safety of gluten-free foods is essential for individuals with coeliac disease and other gluten-related disorders, for whom even minimal gluten exposure can cause adverse effects; this study aimed to evaluate the long-term compliance of gluten-free labeled foods marketed in Italy. A total of 4139 pre-packaged gluten-free products were collected between 2015 and 2024 and analyzed using validated analytical methods. Products were categorized into macro-categories: cereal-based foods, processed non-cereal-based foods, confectionery, flours, baby foods, and dietary supplements. A descriptive analysis and risk modeling were generated to visualize relative risks. Overall non-compliance remained consistently very low (<1%) throughout the 10-year period, with an average rate of 0.27% and minor peaks in 2016 and 2018. The highest frequencies of gluten contamination were observed in cereal-based products and flours-particularly corn flour-while occasional non-compliance occurred in some processed non-cereal-based foods and confectionery; no non-compliance was detected in baby foods or dietary supplements. These findings are reassuring and consistent with, or better than, available EU data, confirming the effectiveness of current control systems and highlighting the importance of continuous monitoring, validated analytical methods and effective allergen management strategies. Strengthened collaboration among regulators and manufacturers remains essential to prevent cross-contamination and protect consumer health. Full article

Background: Urticaria, particularly chronic urticaria (CU), is a highly prevalent inflammatory skin disorder characterized by recurrent wheals and/or angioedema with a fluctuating and unpredictable course that significantly impairs quality of life and requires long-term monitoring. Despite established therapeutic guidelines, disease control remains suboptimal in a considerable proportion of patients. Telemedicine has emerged as a promising adjunctive strategy for chronic disease management. This review aims to critically evaluate the role, applications, benefits, and limitations of telemedicine and digital health interventions in urticaria management. Methods: A scoping review of the literature was conducted focusing on studies addressing telemedicine, digital patient-reported outcomes, mobile health applications, and remote monitoring strategies in urticaria. Evidence from pandemic and post-pandemic telemedicine models was also analyzed to identify transferable approaches. Results: Telemedicine demonstrates significant potential in urticaria management by enabling structured symptom monitoring, facilitating remote follow-up during therapeutic escalation (including biologic therapies), improving patient empowerment and adherence, and reducing healthcare utilization and indirect costs. Digital tools such as electronic diaries and validated PRO-based applications support continuous disease assessment. However, telemedicine cannot replace direct clinical examination, and limitations include diagnostic uncertainty, digital inequalities, data privacy concerns, and lack of large disease specific trials. Conclusions: Telemedicine represents a valuable complementary and integrative model for urticaria care, particularly suited for chronic disease monitoring. Hybrid care pathways combining remote and in-person management appear to be the most effective and sustainable strategy. Further high-quality urticaria-specific studies and standardized digital frameworks are required to optimize its clinical implementation. Full article

The porcine epidemic diarrhea virus (PEDV) causes a gastrointestinal disease generating mortality rates approaching 100% in piglets worldwide. The S glycoprotein of PEDV is the main target for the development of vaccines. Two vaccines approved by the Ministry of Agriculture and Rural Development are used in Mexico: the first vaccine is based on an inactivated virus isolated more than a decade ago, whereas the second vaccine is based on mRNA technology. The most important tool for controlling PEDV outbreaks is vaccination; however, coronaviruses are characterized by the accumulation of multiple mutations, which compromise the immune response elicited by outdated vaccines. In this work, we classified the Mexican strains of PEDV reported so far in GenBank, according to their genotypes. Subsequently, we searched for B and T cell epitopes conserved in Mexican PEDV strains using bioinformatic tools. In addition, we explored whether these epitopes can induce allergies, autoimmunity, and/or toxic effects. Next, we determined the localization of B cell epitopes in the S glycoprotein using the protein crystal and protein modeling of several S glycoproteins. Finally, we carried out molecular docking analysis to assess whether these T cell epitopes could interact with the peptide-binding groove of the Swine Leukocyte Antigens (SLAs). Five conserved B cell epitopes were found to be exposed on the surface of the S glycoprotein, whereas several promiscuous CTL and HTL epitopes were bound, with low free energy, to the peptide-binding grooves of SLA-I and SLA-II, respectively. The best epitopes were used to generate a plasmid carrying the sequence to produce a recombinant protein. This plasmid was used for transfection experiments in PK-15 cell culture. The B cell epitopes reported here were recognized by the sera from pigs infected with PEDV but not by the sera from uninfected animals. These results justify future evaluations of the ability of these epitopes to stimulate cytokine production by T cells, antibody generation, and their neutralizing activity. Full article

Background/Objectives: Severe infusion-related reactions to rituximab are rare; we aim to extend our knowledge about them in children, focusing on rituximab-induced serum sickness (RISS) and anaphylaxis. Methods: We conducted a monocentric retrospective study on children and adolescents who received rituximab. Patients were defined as having RISS if they had fever and at least rash and/or arthralgia, 1 to 30 days following infusion, and without another diagnosis to explain symptoms. Anaphylaxis was defined according to the diagnostic criteria proposed by the World Allergy Organization. Results: 1534 rituximab infusions in 391 patients were analyzed. Seven patients developed RISS; all received rituximab for an autoimmune disease, including four for immune thrombocytopenia (ITP). Six patients had fever, rash, and arthralgia. C-reactive protein or sedimentation rate was increased in all patients, and complement was decreased in 83%. Evolution was favorable within a few days with corticosteroids and/or intravenous immunoglobulins. Rituximab was reinfused in one patient, which resulted in an immediate anaphylactoid reaction. Lower doses of rituximab were less likely to induce RISS. RISS was associated with a greater chance of achieving ITP remission. Seven patients developed anaphylaxis; five successfully received further infusions using desensitization protocols. Conclusions: RISS in children is a severe complication of rituximab infusion. Our study suggests that it may be more frequent in individuals treated for autoimmune conditions, especially ITP. The classical triad of fever, rash, and arthralgia appeared to be frequently present, and biological inflammation and/or low complement can further support the diagnosis. In contrast to anaphylaxis, where rituximab may be safely rechallenged upon desensitization protocol, treatment alternatives should be pursued in patients experiencing RISS, given the higher risk of severe RISS recurrence. Full article

The relationship between lifestyle, ocular biomechanical behavior, and myopia is not well established in the literature. The present study aims to describe changes in ocular biomechanics during adolescence and to explore their relationship with lifestyle factors and myopic progression. Prospective cohort study including 63 adolescents (126 eyes) with a mean age of 14.1 ± 2.6 years old examined twice over a 30 ± 0.9-month period. The data from biomechanics, biometry, corneal tomography, and lifestyle was addressed. The relationships between biomechanical changes, biometric and refractive variation, and lifestyle variables were analyzed using parametric and non-parametric statistics with a significance level of p < 0.05. A biomechanical stiffening trend was found. Axial elongation was 0.12 ± 0.17 mm, and refractive shift was −0.32 ± 0.87 D. The history of allergies was associated with greater axial growth (p = 0.032) and smaller increase in stress–strain-index (SSI) (p = 0.01). Myopization was higher in eyes with ocular surface symptoms (p = 0.049) and those with reported eye-rubbing habits (p = 0.04), with a lower gain in stiffness (p < 0.05). Outdoor activities were associated with higher gain in corneo-scleral stiffness (p < 0.05). Reduced myopization correlated directly with the increase in the SSI (p < 0.05) and inversely with the Integrated Radius (p < 0.05). Greater increases in axial length (AL), vitreous cavity length (VCL), and the ratio between VCL and AL (R_VCL/AL) correlated negatively with the increase in the SSI (p < 0.05). The increase in the R_VCL/AL correlated positively with the time spent on digital devices and negatively with the amount of outdoor activity (p < 0.05). Biomechanics may represent the physiological bridge between the environmental exposure and myopization, as lower gain in corneo-scleral stiffness was consistently associated with greater axial elongation and refractive myopization, with outdoor activity appearing to be protective. Full article

Grass and birch pollen are major allergens in the United Kingdom (UK), responsible for seasonal respiratory diseases between late March and July. East Anglia is an under-represented region in pollen allergy research, while patterns of continuous days of high pollen levels have not been studied at all. Analysis of pollen statistics and trends in East Anglia addresses a regional gap for pollen exposure in the UK and assesses the intensity of the exposure. Trends and statistics for start, end, length, first high day (FH), number of high days (NH), seasonal pollen integral (SPIn) and number of high days occurring in a run together were presented. Birch pollen occurred from late March to late April, with little indication that onset, end or duration were changing temporally. Severity (SPIn) and the number of days in a run together have increased, in line with severity trends in nearby regions. Grass pollen occurred from late May until the third week in July, with almost no indication of changing trends in this region, apart from a likely earlier first high day. These results inform clinicians that the information and advice on when to treat hay fever symptoms and for how long should not change at the present time. Full article

In the body, mast cells are found in the circulation and located in tissues. These immune cells arise in the bone marrow and are often associated with conditions such as allergies and asthma. However, these cells also play roles in other inflammatory reactions, dysregulated wound healing and chronic conditions. Regarding their presence in tissues of the intervertebral disc (IVD), mast cells have been located in the normal nucleus pulposus, and reports indicate mast cell numbers are elevated in IVD degenerative conditions. As the integrity of the IVD is reported to decline with ageing as well as in sciatica and clinically defined degenerative conditions, targeting mast cell function may be a viable conservative treatment option for the ageing IVD in health and disease. This review discusses the possible involvement of mast cells in IVD health and disease, and the rationale for the use of mast cell stabilizers such as ketotifen as potential treatment options for conditions affecting IVD integrity. Such mast cell targeting treatments may be considered alone or in combination with other molecules such as specific proteinase inhibitors impacting proteinases known to be present in the affected tissues, such as MMP-3 and HTRA1. Thus, a multicomponent approach in such treatments may provide effectiveness in inhibiting progressive loss of IVD integrity and function in chronic degenerative conditions or adverse outcomes due to non-resorption of extruded nucleus pulposus in sciatica. Full article

Syphilis remains a global public health concern, with maternal infection posing a substantial risk for congenital syphilis, a preventable condition associated with severe morbidity and mortality. Penicillin, particularly benzathine penicillin G, remains the cornerstone of treatment and the only therapy with proven efficacy in preventing vertical transmission during pregnancy. However, recurrent global shortages, limited manufacturing capacity, mislabeling of penicillin allergy, and the absence of validated alternative regimens for pregnant women and neonates threaten progress toward elimination goals. This review summarizes current evidence on the treatment of syphilis in pregnancy and congenital syphilis, highlighting the established maternal and neonatal regimens, diagnostic and therapeutic challenges, and clinical consequences of delayed or inadequate treatment. We examine the scope and drivers of benzathine penicillin G shortages, the overestimation of penicillin allergy and its impact on care, and the role of neonatal management when maternal therapy is suboptimal. Emerging data on alternative antimicrobial agents, including cephalosporins, tetracyclines, lipoglycopeptides, and novel compounds are discussed considering recent advances in Treponema pallidum culture and susceptibility testing. While several non-penicillin agents show promise for non-pregnant populations, robust evidence supporting their use during pregnancy and for the prevention of congenital syphilis is lacking. Addressing these gaps through coordinated supply chain strategies, guideline harmonization, and targeted clinical research is essential to ensure resilient and equitable syphilis control and advance global efforts toward the elimination of congenital syphilis. Full article

Group B Streptococcus (GBS) remains a major cause of early- and late-onset neonatal sepsis worldwide, despite the widespread use of intrapartum antibiotic prophylaxis (IAP). β-lactam antibiotics, including penicillin G and ampicillin, remain the cornerstone of both GBS prophylaxis and neonatal treatment, supported by sustained susceptibility, favorable pharmacokinetics, and extensive clinical experience. However, increasing global resistance to macrolides and lincosamides has markedly reduced the reliability of clindamycin and erythromycin, which are commonly used as second-line agents in women with severe penicillin allergy. This narrative review summarizes current evidence on antibiotic strategies for the prevention and treatment of neonatal GBS disease, with a particular focus on antimicrobial resistance patterns and their clinical implications. Available surveillance data demonstrate substantial geographic variability in resistance but consistently low resistance to β-lactams and vancomycin. These trends have expanded the role of vancomycin in IAP for women with high-risk β-lactam allergy and in neonatal treatment when first-line agents are contraindicated. Alternative agents such as linezolid and teicoplanin exhibit activity against GBS, but their use remains limited by sparse neonatal data and pharmacokinetic variability. Ongoing antimicrobial surveillance, susceptibility-guided therapy, and stewardship initiatives are essential to preserve effective GBS prevention and treatment strategies. Full article

Objectives: Lesion-level dynamics may reveal pulmonary tuberculosis (PTB) heterogeneity and help identify factors associated with treatment outcomes. Methods: A total of 288 serial Computed Tomography (CT) scans from 125 PTB patients were obtained from the National Institute of Allergy and Infectious Diseases (NIAID) TB Portals database (2008–2023). Lesions were segmented and annotated to obtain volume and imaging features, and a conservative longitudinal volume quantification method was used to characterize dynamic volume patterns. The proportion of lesions with different patterns was analyzed at the patient level to assess trajectory diversity. Firth’s penalized logistic regression was used to identify factors associated with treatment outcomes. Results: Among 435 lesions in 125 patients, five patterns emerged: Stable, Decrease, Increase, Mix-I-D (increase then decrease), and Mix-D-I (decrease then increase). Multiple patterns coexisted in 66.7% of treatment success patients and all treatment failure patients. Mix-D-I lesions were identified more frequently in treatment failure patients (25.0% vs. 1.4%, p = 0.027), and in multivariable analysis, the presence of Mix-D-I lesions was statistically associated with treatment failure (p = 0.024). Conclusions: PTB lesions showed high trajectory heterogeneity. The presence of Mix-D-I lesions may point to an unfavorable treatment course, suggesting lesion dynamics could serve as a potential indicator for poor outcomes. By quantifying lesion-level trajectories on serial CT scans, we extend PET/CT-based evidence and support the value of routine monitoring in clinical management of tuberculosis. Full article

Trained immunity confers protection against subsequent unrelated infections through metabolic and epigenetic reprogramming. Unlike adaptive immunity, trained innate immunity provides broad, non-specific protection against diverse heterologous pathogens. In addition to potentiating inflammatory responses upon secondary challenge, trained innate immune cells can also acquire anti-inflammatory and tolerogenic phenotypes, a property with important implications for chronic inflammatory diseases such as allergic disorders. Trained immunity-based vaccines (TIbVs) have emerged as promising immunomodulatory strategies capable of attenuating allergic inflammation by inducing immune tolerance. Similarly, allergen-specific immunotherapy (AIT) promotes long-term tolerance to allergens through metabolic and epigenetic reprogramming of innate immune cells. AIT drives the differentiation of monocytes into tolerogenic dendritic cells, thereby reshaping downstream adaptive immune responses. This review summarizes the current understanding of trained immunity and its role in protection against the same and heterologous infections. We discuss the molecular mechanisms underlying trained immunity, with an emphasis on metabolic and epigenetic reprogramming. Furthermore, we highlight the therapeutic potential of TIbVs and AIT as next-generation vaccines for allergic diseases. A deeper understanding of AIT-induced immune tolerance, the identification of predictive biomarkers, and the optimization of delivery platforms—such as lipid nanoparticle-based systems—will be critical for improving the safety and efficacy of future anti-allergy vaccines. Full article