Clinical and Experimental Allergy最新文献

The clinical characteristics of asthma patients with fixed airflow obstruction were compared with those with asthma-COPD overlap. Asthma patients with fixed airflow obstruction had comparable small airway dysfunction to asthma-COPD overlap patients.

Background: Asthma prevalence is increasing in the Asia-Pacific region. China and India account for > 35% of the world's population and are often underrepresented in clinical studies. This phase 3 study (NCT03782532) evaluated efficacy and safety of dupilumab, a monoclonal antibody blocking interleukin-4/13 signalling, in patients with persistent asthma from China and India.

Methods: Patients (≥ 12 years) were randomised 1:1 to dupilumab 200 mg or matched placebo every 2 weeks for 24 weeks (primary analysis population: blood eosinophils ≥ 150 cells/μL or fractional exhaled nitric oxide ≥ 25 parts per billion without maintenance oral corticosteroid [OCS]; OCS maintenance population: 300 mg OCS).

Primary endpoint: change from baseline to week 12 in forced expiratory volume in 1 s (FEV₁). Secondary endpoints: change from baseline to week 24 in 5-item Asthma Control Questionnaire (ACQ-5/7) scores, annualised severe exacerbation rate, and safety.

Results: In the primary analysis population (n = 414), change in FEV₁ by week 12 was significantly greater for dupilumab versus placebo (least squares mean difference: 0.31 L [95% CI: 0.23-0.39]; p < 0.0001). At week 24, greater reductions in ACQ-5 score were seen for dupilumab versus placebo (least squares mean difference: -0.20 [95% CI: -0.35 to -0.05]; p = 0.0097). Dupilumab reduced severe exacerbation risk by 62% versus placebo during the treatment period (relative risk: 0.38 [95% CI: 0.21-0.70]; nominal p = 0.002). Safety was similar between treatment arms; injection-site reactions were more common with dupilumab treatment (5.0%) than with placebo (1.2%). The OCS maintenance population showed similar outcomes.

Conclusion: Dupilumab significantly improved lung function and asthma control, numerically reduced asthma exacerbations, and was well tolerated in patients from China and India with persistent asthma and evidence of either type 2 inflammation or OCS maintenance.

Trial registration: ClinicalTrials.gov identifier: NCT03782532.

Non-IgE-mediated food allergy encompasses a wide spectrum of allergic disorders ranging from mild to severe presentations, including food protein-induced allergic proctocolitis, food protein-induced enterocolitis syndrome, and food protein-induced enteropathy. Other gastrointestinal symptoms such as constipation and gastroesophageal reflux disease have not previously been recognised as symptoms of non-IgE-mediated food allergy in food allergy guideline publications. Recently, two new consensus documents from the European Academy of Allergy, Asthma and Immunology address a potential role of food allergens in these disorders, where standard treatment has failed, and provide guidance for diagnosis and management of these conditions. Additional updates include the World Allergy Organisation guidance on the diagnosis and management of cow's milk allergy, the most commonly implicated food in non-IgE-mediated food allergy. These documents all help practitioners to distinguish between common manifestations in infancy that are not pathologic and non-IgE-mediated food allergy. Understanding diagnostic criteria is vital to prevent overdiagnosis, limit unnecessary elimination diets and preserve breastfeeding. Conversely, proper diagnosis may reduce symptoms in infants who are affected. Therefore, the first step in management of non-IgE-mediated food allergy is establishing a correct diagnosis, which requires understanding the clinical presentations and if needed, applying an appropriate short-term diagnostic elimination diet to observe for symptom resolution, followed by food reintroduction to assess for symptom recurrence. Once diagnosed, treatment requires removal of the trigger food, most commonly cow's milk, which is not without burden and nutrition risk. Non-IgE-mediated food allergies typically resolve early in childhood with some disorders resolving in infancy therefore early reassessment for tolerance is vital. Management of non-IgE-mediated food allergy entails following diagnostic algorithms, developing an individualised dietary plan, and timely assessment of tolerance development to reduce burden and nutrition risk.

Background: Wheat is a well-known elicitor of food allergy, but epidemiological data are limited. The aim of this study was to investigate the prevalence of wheat allergy in an unselected population of adults and adolescents and to characterise the clinical features of this cohort, as well as those of patients who experienced wheat-induced anaphylaxis.

Methods: A population-based cross-sectional study was conducted. Fifteen thousand individuals aged 12-80 years were randomly selected, and a standardised questionnaire was applied. If symptoms after wheat consumption were reported, telephone interviews were conducted. In the case of suspected type 1 wheat allergy, a skin prick test, specific immunoglobulin E (sIgE) and oral food challenge (OFC) were performed. The prevalence of self-reported wheat sensitivity and wheat allergy was determined after data extrapolation. For the assessment of severe wheat allergy-associated symptoms, a cohort from the European Anaphylaxis Registry was analysed.

Results: The questionnaire was answered by 1770 individuals, of whom 13.1% reported symptoms due to the consumption of foods containing wheat. Following telephone interviews (n = 105) and clinical diagnostics (n = 22), type 1 sensitisation to wheat was confirmed in 8 individuals, and 2 subjects were finally diagnosed with an IgE-mediated wheat allergy. After extrapolation, the prevalence of confirmed wheat allergy in the German population reached 0.25% [95% CI 0.08-0.9]. Self-reported wheat sensitivity was predominantly seen in females (71%), with local gastrointestinal and non-specific symptoms. This contrasted with wheat-induced anaphylaxis, where less than half occurred in females, and symptoms were mainly skin, cardiovascular or respiratory.

Conclusion: In a population with widespread wheat consumption, self-reported wheat sensitivity was common in adults and adolescents, but confirmed wheat allergy was rare. The distinct symptom profiles allow physicians to easily differentiate these entities. Dissemination of our findings may help to improve knowledge of the low prevalence of wheat allergy and may support the reduction of unnecessary dietary restrictions.

Background: Adherence to rhinitis treatment has been insufficiently assessed. We aimed to use data from the MASK-air mHealth app to assess adherence to oral antihistamines (OAH), intra-nasal corticosteroids (INCS) or azelastine-fluticasone in patients with allergic rhinitis.

Methods: We included regular European MASK-air users with self-reported allergic rhinitis and reporting at least 1 day of OAH, INCS or azelastine-fluticasone. We assessed weeks during which patients answered the MASK-air questionnaire on all days. We restricted our analyses to data provided between January and June, to encompass the pollen seasons across the different assessed countries. We analysed symptoms using visual analogue scales (VASs) and the combined symptom-medication score (CSMS), performing stratified analyses by weekly adherence levels. Medication adherence was computed as the proportion of days in which patients reported rhinitis medication use. Sensitivity analyses were performed considering all weeks with at most 1 day of missing data and all months with at most 4 days of missing data.

Results: We assessed 8212 complete weeks (1361 users). Adherence (use of medication > 80% days) to specific drug classes ranged from 31.7% weeks for azelastine-fluticasone to 38.5% weeks for OAH. Similar adherence to rhinitis medication was found in users with or without self-reported asthma, except for INCS (better adherence in asthma patients). VAS and CSMS levels increased from no adherence to full adherence, except for INCS. A higher proportion of days with uncontrolled symptoms was observed in weeks with higher adherence. In full adherence weeks, 41.2% days reported rhinitis co-medication. The sensitivity analyses displayed similar results.

Conclusions: A high adherence was found in patients reporting regular use of MASK-air. Different adherence patterns were found for INCS compared to OAH or azelastine-fluticasone that are likely to impact guidelines.