Nuno Lourenço-Silva, Bernardo Sousa-Pinto, Antonio Bognanni, Matteo Martini, Michal Ordak, Giovanni Paoletti, Sara Gil-Mata, Rita Amaral, Anna Bedbrook, Patrizia Bonadonna, Luisa Brussino, G. Walter Canonica, João Coutinho-Almeida, Alvaro A. Cruz, Wienczyslawa Czarlewski, Mark Dykewicz, Mattia Giovannini, Bilun Gemicioglu, Juan Carlos Ivancevich, Ludger Klimek, Violeta Kvedariene, Desiree E. Larenas-Linnemann, Manuel Marques-Cruz, André Moreira, Marek Niedoszytko, Ana Margarida Pereira, Nikolaos G. Papadopoulos, Nhân Pham-Thi, Frederico S. Regateiro, Sanna K. Toppila-Salmi, Boleslaw Samolinski, Joaquin Sastre, Luís Taborda-Barata, Tuuli Thomander, Ilgım Vardaloğlu Koyuncu, Arunas Valiulis, Leticia de las Vecillas, Maria Teresa Ventura, Jolanta Walusiak-Skorupa, Yi-Kui Xiang, Oliver Pfaar, João A. Fonseca, Torsten Zuberbier, Holger J. Schünemann, Danilo di Bona, Jean Bousquet, Rafael José Vieira
<p>Randomised controlled trials (RCTs) are the paradigm for questions on causal inference but often face challenges in generalisability due to strict eligibility criteria. In allergic rhinitis (AR), this limitation is particularly relevant, with RCTs on AR displaying an overrepresentation of patients with severe disease and not providing sufficiently detailed information on the impact of comorbidities on treatment effectiveness [<span>1-4</span>]. Mobile health (mHealth) applications provide an opportunity to collect large-scale patient-reported data that can complement traditional trial evidence and broaden our understanding of treatment effectiveness in routine care [<span>5</span>]. However, to adequately use mHealth data for that purpose, approaches to adequately deal with confounding must be applied.</p><p>In this study, we aimed to use mHealth data to compare the short-term effectiveness of three common AR medication classes: oral antihistamines (OAH), intranasal corticosteroids (INCS), and fixed-combination intranasal antihistamine plus corticosteroid sprays (INAH+INCS). In particular, we aimed to compare these three medication classes on symptom relief within 24 h, while also exploring whether treatment effects differed according to the presence of self-reported comorbid asthma. To deal with confounding, we applied a target trial emulation approach [<span>6</span>].</p><p>A full description of the Methods is available on https://doi.org/10.5281/zenodo.17215607. We included adult users of the MASK-air app with self-reported AR. MASK-air is a validated app that allows daily reporting of AR symptoms on visual analogue scales (VAS) together with medication use. We included users who completed symptom assessments before and after taking one of the aforementioned medication classes, within a 24-h interval. Measurements less than 60 min apart were excluded. Outcomes were changes in global, nasal, ocular, and asthma-related symptoms (VAS, 0–100).</p><p>To address confounding, we used inverse probability of treatment weighting based on pre-treatment symptom scores, age, sex, ARIA severity score, and asthma status. We then estimated average treatment effects using Bayesian mixed-effects regression models, with patient and month of the year as random effects [<span>7, 8</span>].</p><p>A full description of the Results is available on https://doi.org/10.5281/zenodo.17215607. A total of 648 treatment days were analysed, with a median participant age of 37 years; 37.8% reported asthma. The median interval between pre- and post-medication entries was 480 min (IQR = 568). Most treatment days involved OAH (64.2%), followed by INCS (25.5%) and INAH+INCS (10.3%).</p><p>Compared with OAH, both INCS and INAH+INCS were associated with significantly greater improvements in global symptoms (mean VAS difference = −4.25 [95% CrI = −6.69, −1.15] and −7.27 [−10.30, −4.07], respectively) (Table 1). Both also improved ocular symptoms, while INCS showed superiority ove
{"title":"Assessment of the Effectiveness of Allergic Rhinitis Medications Using a Target Trial Emulation Approach Based on Mobile Health Data","authors":"Nuno Lourenço-Silva, Bernardo Sousa-Pinto, Antonio Bognanni, Matteo Martini, Michal Ordak, Giovanni Paoletti, Sara Gil-Mata, Rita Amaral, Anna Bedbrook, Patrizia Bonadonna, Luisa Brussino, G. Walter Canonica, João Coutinho-Almeida, Alvaro A. Cruz, Wienczyslawa Czarlewski, Mark Dykewicz, Mattia Giovannini, Bilun Gemicioglu, Juan Carlos Ivancevich, Ludger Klimek, Violeta Kvedariene, Desiree E. Larenas-Linnemann, Manuel Marques-Cruz, André Moreira, Marek Niedoszytko, Ana Margarida Pereira, Nikolaos G. Papadopoulos, Nhân Pham-Thi, Frederico S. Regateiro, Sanna K. Toppila-Salmi, Boleslaw Samolinski, Joaquin Sastre, Luís Taborda-Barata, Tuuli Thomander, Ilgım Vardaloğlu Koyuncu, Arunas Valiulis, Leticia de las Vecillas, Maria Teresa Ventura, Jolanta Walusiak-Skorupa, Yi-Kui Xiang, Oliver Pfaar, João A. Fonseca, Torsten Zuberbier, Holger J. Schünemann, Danilo di Bona, Jean Bousquet, Rafael José Vieira","doi":"10.1111/cea.70173","DOIUrl":"10.1111/cea.70173","url":null,"abstract":"<p>Randomised controlled trials (RCTs) are the paradigm for questions on causal inference but often face challenges in generalisability due to strict eligibility criteria. In allergic rhinitis (AR), this limitation is particularly relevant, with RCTs on AR displaying an overrepresentation of patients with severe disease and not providing sufficiently detailed information on the impact of comorbidities on treatment effectiveness [<span>1-4</span>]. Mobile health (mHealth) applications provide an opportunity to collect large-scale patient-reported data that can complement traditional trial evidence and broaden our understanding of treatment effectiveness in routine care [<span>5</span>]. However, to adequately use mHealth data for that purpose, approaches to adequately deal with confounding must be applied.</p><p>In this study, we aimed to use mHealth data to compare the short-term effectiveness of three common AR medication classes: oral antihistamines (OAH), intranasal corticosteroids (INCS), and fixed-combination intranasal antihistamine plus corticosteroid sprays (INAH+INCS). In particular, we aimed to compare these three medication classes on symptom relief within 24 h, while also exploring whether treatment effects differed according to the presence of self-reported comorbid asthma. To deal with confounding, we applied a target trial emulation approach [<span>6</span>].</p><p>A full description of the Methods is available on https://doi.org/10.5281/zenodo.17215607. We included adult users of the MASK-air app with self-reported AR. MASK-air is a validated app that allows daily reporting of AR symptoms on visual analogue scales (VAS) together with medication use. We included users who completed symptom assessments before and after taking one of the aforementioned medication classes, within a 24-h interval. Measurements less than 60 min apart were excluded. Outcomes were changes in global, nasal, ocular, and asthma-related symptoms (VAS, 0–100).</p><p>To address confounding, we used inverse probability of treatment weighting based on pre-treatment symptom scores, age, sex, ARIA severity score, and asthma status. We then estimated average treatment effects using Bayesian mixed-effects regression models, with patient and month of the year as random effects [<span>7, 8</span>].</p><p>A full description of the Results is available on https://doi.org/10.5281/zenodo.17215607. A total of 648 treatment days were analysed, with a median participant age of 37 years; 37.8% reported asthma. The median interval between pre- and post-medication entries was 480 min (IQR = 568). Most treatment days involved OAH (64.2%), followed by INCS (25.5%) and INAH+INCS (10.3%).</p><p>Compared with OAH, both INCS and INAH+INCS were associated with significantly greater improvements in global symptoms (mean VAS difference = −4.25 [95% CrI = −6.69, −1.15] and −7.27 [−10.30, −4.07], respectively) (Table 1). Both also improved ocular symptoms, while INCS showed superiority ove","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"56 2","pages":"176-179"},"PeriodicalIF":5.2,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12879269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145480981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John Coveney, Tom Roberts, Sylvia Stoianova, Nicholas Sargant
{"title":"Airway, Breathing or Circulation Failure in Fatal Food Anaphylaxis: A Nationally Representative Case Series.","authors":"John Coveney, Tom Roberts, Sylvia Stoianova, Nicholas Sargant","doi":"10.1111/cea.70175","DOIUrl":"https://doi.org/10.1111/cea.70175","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145457780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laura Romero-Sánchez, Francisco Gude, Arturo González-Quintela, Manuela Alonso-Sampedro, Óscar Lado-Baleato, Carmen Fernández-Merino, Flora Miranda-Pena, Carmen Vidal
{"title":"Uncovering Mite Sensitisation: Epidemiological Insights From a General Population Study.","authors":"Laura Romero-Sánchez, Francisco Gude, Arturo González-Quintela, Manuela Alonso-Sampedro, Óscar Lado-Baleato, Carmen Fernández-Merino, Flora Miranda-Pena, Carmen Vidal","doi":"10.1111/cea.70174","DOIUrl":"https://doi.org/10.1111/cea.70174","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Louise J. Michaelis, Thomas Owen, Andrew D. Bright, Lucy Sherwin-Robson
<div> <section> <h3> Introduction</h3> <p>The recommended first-line treatment for anaphylaxis in the community is intramuscular injection of adrenaline. The treatment is a standardised dose of either a 150 μg or a 300 μg adrenaline auto-injector (AAI) device depending upon the patient's weight. Currently, no standardised mechanisms exist to transition patients onto the higher 300 μg dose when they reach 25–30 kg (depending upon the manufacturer).</p> </section> <section> <h3> Methods</h3> <p>We undertook analysis of NHS prescriptions data dispensed in the community in England to identify rates of non-standard AAI dose prescribing. Non-standard prescribing is defined as patients who are likely to have exceeded the 25–30 kg threshold but still received a 150 μg dose. Data were limited to the most recent AAI prescription for an individual patient that occurred in the last 2 years (December 2022–2024). Patient weight at the time of prescribing was approximated using an age-to-weight correlation model. AAI recommended switching weights, based on device metadata, were compared to the patients' approximated weight to identify non-standard prescribing. Statistical comparison between rates of non-standard prescribing and patient deprivation was computed using Kendall's Tau correlation coefficient. A complementary analysis to identify patients who received a 300 μg dose but were likely under the 25–30 kg threshold was also carried out.</p> </section> <section> <h3> Results</h3> <p>Overall, 46,999 patients were identified as having received a 150 μg strength injector in their most recent AAI prescription; of these, over 95% received two or more devices in line with national guidance. Estimates based on age for weight growth centiles show that between 9480 (20.2%) and at least 1747 (3.7%) of those prescribed a 150 μg autoinjector were likely to exceed the weight threshold for this dose. Using a Resuscitation Council UK guideline of age 6 years for switching to a 300 μg dose, the estimated proportion prescribed a non-standard AAI dose increases to 23,059 patients (49.1%). Estimated rates of non-standard AAI prescribing were found to be higher in areas of England with the most deprivation. Conservative estimates found only 67 children likely under 25 kg and 330 children likely under 30 kg who received a 300 μg dose.</p> </section> <section> <h3> Conclusions</h3> <p>This analysis of community AAI prescriptions in England suggests that underdosing of AAI prescriptions in children and adults is not uncommon. Healthcare professionals with patients at risk of anaphy
{"title":"Adrenaline Auto-Injector Prescribing in Primary Care in England: An Analysis of Non-Standard Dosing","authors":"Louise J. Michaelis, Thomas Owen, Andrew D. Bright, Lucy Sherwin-Robson","doi":"10.1111/cea.70163","DOIUrl":"10.1111/cea.70163","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The recommended first-line treatment for anaphylaxis in the community is intramuscular injection of adrenaline. The treatment is a standardised dose of either a 150 μg or a 300 μg adrenaline auto-injector (AAI) device depending upon the patient's weight. Currently, no standardised mechanisms exist to transition patients onto the higher 300 μg dose when they reach 25–30 kg (depending upon the manufacturer).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We undertook analysis of NHS prescriptions data dispensed in the community in England to identify rates of non-standard AAI dose prescribing. Non-standard prescribing is defined as patients who are likely to have exceeded the 25–30 kg threshold but still received a 150 μg dose. Data were limited to the most recent AAI prescription for an individual patient that occurred in the last 2 years (December 2022–2024). Patient weight at the time of prescribing was approximated using an age-to-weight correlation model. AAI recommended switching weights, based on device metadata, were compared to the patients' approximated weight to identify non-standard prescribing. Statistical comparison between rates of non-standard prescribing and patient deprivation was computed using Kendall's Tau correlation coefficient. A complementary analysis to identify patients who received a 300 μg dose but were likely under the 25–30 kg threshold was also carried out.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 46,999 patients were identified as having received a 150 μg strength injector in their most recent AAI prescription; of these, over 95% received two or more devices in line with national guidance. Estimates based on age for weight growth centiles show that between 9480 (20.2%) and at least 1747 (3.7%) of those prescribed a 150 μg autoinjector were likely to exceed the weight threshold for this dose. Using a Resuscitation Council UK guideline of age 6 years for switching to a 300 μg dose, the estimated proportion prescribed a non-standard AAI dose increases to 23,059 patients (49.1%). Estimated rates of non-standard AAI prescribing were found to be higher in areas of England with the most deprivation. Conservative estimates found only 67 children likely under 25 kg and 330 children likely under 30 kg who received a 300 μg dose.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This analysis of community AAI prescriptions in England suggests that underdosing of AAI prescriptions in children and adults is not uncommon. Healthcare professionals with patients at risk of anaphy","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"56 1","pages":"30-40"},"PeriodicalIF":5.2,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.70163","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145430496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R Soegiharto, B J Hengevelt, N Boekema-Bakker, I A M Groenewegen, A C Knulst, J M P A Van den Reek, H Röckmann
{"title":"Exploring the Disease Duration of Urticaria and Associated Determinants in Primary Care.","authors":"R Soegiharto, B J Hengevelt, N Boekema-Bakker, I A M Groenewegen, A C Knulst, J M P A Van den Reek, H Röckmann","doi":"10.1111/cea.70170","DOIUrl":"https://doi.org/10.1111/cea.70170","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145408493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Itziar Eusebio-Cartagena, Rodrigo Jiménez-Saiz, Vanesa Esteban, Emilio Nuñez-Borque, Alessandra Ruiz-Sánchez, Carmelo Escudero, Silvia Sánchez-García, Juan Trujillo, Audrey Dunn-Galvin, María Dolores P Ibáñez-Sandin, Pablo Rodríguez Del Río
{"title":"Comparison Between a Rush and a Conventional Oral Immunotherapy Protocol to Treat Cow's Milk and Hen's Egg Allergy. CompITO Study Methodology.","authors":"Itziar Eusebio-Cartagena, Rodrigo Jiménez-Saiz, Vanesa Esteban, Emilio Nuñez-Borque, Alessandra Ruiz-Sánchez, Carmelo Escudero, Silvia Sánchez-García, Juan Trujillo, Audrey Dunn-Galvin, María Dolores P Ibáñez-Sandin, Pablo Rodríguez Del Río","doi":"10.1111/cea.70168","DOIUrl":"10.1111/cea.70168","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145408448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ruiqian Yao, Lin Du, Haixia Zhao, Xiaoyan Yang, Erwen Kou, Bo Wang, Yuanjie Zhu
{"title":"Global Burden of Elderly Atopic Dermatitis (1990-2021) and Projections to 2030: A Socio-Demographic Index Analysis.","authors":"Ruiqian Yao, Lin Du, Haixia Zhao, Xiaoyan Yang, Erwen Kou, Bo Wang, Yuanjie Zhu","doi":"10.1111/cea.70169","DOIUrl":"https://doi.org/10.1111/cea.70169","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145400118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erika Penz, Thomas Rothe, Lieven Dupont, Trung N Tran, Andrew Menzies-Gow, Anat Shavit, David Cohen, Tanja Plate, Sheena Kayaniyil, An Herreman, Claudio Schuoler, Benjamin Emmanuel, Marek Lommatzsch
Background: Prospective real-world data concerning the early and sustained effects of benralizumab on asthma control in patients with severe eosinophilic asthma (SEA) is lacking.
Methods: XALOC-2 is a prospective, observational, multi-national, real-world study in adults with SEA treated with benralizumab. This integrated analysis assessed Asthma Control Questionnaire (ACQ) scores, achievement of 3-component clinical remission (which included well-controlled symptoms [ACQ score ≤ 0.75], no exacerbations, and no use of maintenance oral corticosteroids [mOCS]), and other clinical outcomes, over a 12-month baseline period and up to Week 56. Associations between remission status and key baseline characteristics were also assessed.
Results: 535 patients were included. Median (interquartile range) ACQ score at baseline was 3.0 (2.2-3.8). At Week 1, 58.0% (282/486) of patients had ACQ score reductions of ≥ 0.5 points (minimal clinically important difference [MCID]) and 35.0% (170/486) had reductions of ≥ 1 point (2× MCID). By Week 56, these increased to 78.6% (276/351) and 62.1% (218/351), respectively. Improved asthma control after benralizumab initiation was similar irrespective of previous biologic use status. By Week 56, clinical remission criteria were achieved in 26.7% (70/262) of patients versus 0% (0/374) at baseline. No mOCS use, lower body mass index, better asthma symptom control and higher peak blood eosinophil count at baseline were associated with meeting 3-component clinical remission criteria at Week 56.
Conclusions: Real-world patients receiving benralizumab showed early and sustained improvements in asthma symptoms, regardless of previous biologic use. More than a quarter of patients achieved clinical asthma remission after 1 year of benralizumab treatment.
{"title":"Early and Sustained Asthma Control and Remission in Real-World Patients With Severe Eosinophilic Asthma Treated With Benralizumab: XALOC-2.","authors":"Erika Penz, Thomas Rothe, Lieven Dupont, Trung N Tran, Andrew Menzies-Gow, Anat Shavit, David Cohen, Tanja Plate, Sheena Kayaniyil, An Herreman, Claudio Schuoler, Benjamin Emmanuel, Marek Lommatzsch","doi":"10.1111/cea.70162","DOIUrl":"https://doi.org/10.1111/cea.70162","url":null,"abstract":"<p><strong>Background: </strong>Prospective real-world data concerning the early and sustained effects of benralizumab on asthma control in patients with severe eosinophilic asthma (SEA) is lacking.</p><p><strong>Methods: </strong>XALOC-2 is a prospective, observational, multi-national, real-world study in adults with SEA treated with benralizumab. This integrated analysis assessed Asthma Control Questionnaire (ACQ) scores, achievement of 3-component clinical remission (which included well-controlled symptoms [ACQ score ≤ 0.75], no exacerbations, and no use of maintenance oral corticosteroids [mOCS]), and other clinical outcomes, over a 12-month baseline period and up to Week 56. Associations between remission status and key baseline characteristics were also assessed.</p><p><strong>Results: </strong>535 patients were included. Median (interquartile range) ACQ score at baseline was 3.0 (2.2-3.8). At Week 1, 58.0% (282/486) of patients had ACQ score reductions of ≥ 0.5 points (minimal clinically important difference [MCID]) and 35.0% (170/486) had reductions of ≥ 1 point (2× MCID). By Week 56, these increased to 78.6% (276/351) and 62.1% (218/351), respectively. Improved asthma control after benralizumab initiation was similar irrespective of previous biologic use status. By Week 56, clinical remission criteria were achieved in 26.7% (70/262) of patients versus 0% (0/374) at baseline. No mOCS use, lower body mass index, better asthma symptom control and higher peak blood eosinophil count at baseline were associated with meeting 3-component clinical remission criteria at Week 56.</p><p><strong>Conclusions: </strong>Real-world patients receiving benralizumab showed early and sustained improvements in asthma symptoms, regardless of previous biologic use. More than a quarter of patients achieved clinical asthma remission after 1 year of benralizumab treatment.</p>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145400080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xin Rong Lim, Ryan Xuan Wei Teo, Justina Wei-Lyn Tan, Sze-Chin Tan, Khai-Pang Leong, Faith Li-Ann Chia, Samuel Shang-Ming Lee, Claire Min-Li Teo, Grace Yin-Lai Chan, Bernard Yu-Hor Thong
Introduction: A false penicillin allergy label often leads to the unnecessary avoidance of beta-lactam antibiotics, contributing to antimicrobial resistance and suboptimal clinical outcomes. The PEN-FAST clinical decision rule is a simple, point-of-care tool with a high negative predictive value (NPV) designed to identify low-risk patients who may not require extensive allergy testing. This study aims to validate the performance of the PEN-FAST clinical decision rule in an Asian population.
Methods: A retrospective review of medical records from January 2006 to February 2023 was conducted at our institution's outpatient allergy clinic. Patients underwent skin prick and intradermal testing, followed by oral drug provocation testing (DPT) or direct oral DPT without prior skin testing (ST). Positive results were defined as positive skin test outcomes or immediate/delayed reactions following drug challenge. PEN-FAST scores were compared to allergy testing results.
Results: A total of 357 patients were included, with 85 (23.8%) undergoing direct DPT without prior ST. None had a history of severe cutaneous allergic reaction as their index reaction. The median age was 49 years (interquartile range [IQR]: 34-63), and 61.9% were female. Forty-seven patients (13.2%) had positive test results, including 26 positive reactions following DPT. PEN-FAST scores of 0-5 were distributed as follows: 25 (7.0%), 159 (44.5%), 31 (8.7%), 96 (26.9%), 4 (1.1%) and 42 (11.8%). Among those with PEN-FAST scores ≤ 2 (n = 215), 16 (7.4%) had a positive test. Of these, 7 developed urticaria, 8 developed mild delayed maculopapular exanthem and 1 had a positive skin test. A PEN-FAST score cutoff of ≤ 2 yielded sensitivity of 66.0% (95% CI: 50.7%-79.1%), specificity of 64.2% (95% CI: 58.6%-69.5%), a positive predictive value (PPV) of 21.8% (95% CI: 17.8%-26.5%) and a NPV of 92.6% (95% CI: 89.2%-94.9%). The area under the receiver operating characteristic curve was 0.66 (95% CI: 0.58-0.75).
Conclusion: The PEN-FAST clinical decision rule demonstrates a high NPV in an Asian population, supporting its potential utility in identifying individuals unlikely to have true penicillin allergy and enabling direct DPT in low-risk patients without prior ST. However, the modest area under the curve (AUC) of 0.66 reflects limited overall discriminatory ability.
{"title":"Validation of the PEN-FAST Penicillin Allergy Clinical Decision Rule in an Asian Cohort.","authors":"Xin Rong Lim, Ryan Xuan Wei Teo, Justina Wei-Lyn Tan, Sze-Chin Tan, Khai-Pang Leong, Faith Li-Ann Chia, Samuel Shang-Ming Lee, Claire Min-Li Teo, Grace Yin-Lai Chan, Bernard Yu-Hor Thong","doi":"10.1111/cea.70164","DOIUrl":"https://doi.org/10.1111/cea.70164","url":null,"abstract":"<p><strong>Introduction: </strong>A false penicillin allergy label often leads to the unnecessary avoidance of beta-lactam antibiotics, contributing to antimicrobial resistance and suboptimal clinical outcomes. The PEN-FAST clinical decision rule is a simple, point-of-care tool with a high negative predictive value (NPV) designed to identify low-risk patients who may not require extensive allergy testing. This study aims to validate the performance of the PEN-FAST clinical decision rule in an Asian population.</p><p><strong>Methods: </strong>A retrospective review of medical records from January 2006 to February 2023 was conducted at our institution's outpatient allergy clinic. Patients underwent skin prick and intradermal testing, followed by oral drug provocation testing (DPT) or direct oral DPT without prior skin testing (ST). Positive results were defined as positive skin test outcomes or immediate/delayed reactions following drug challenge. PEN-FAST scores were compared to allergy testing results.</p><p><strong>Results: </strong>A total of 357 patients were included, with 85 (23.8%) undergoing direct DPT without prior ST. None had a history of severe cutaneous allergic reaction as their index reaction. The median age was 49 years (interquartile range [IQR]: 34-63), and 61.9% were female. Forty-seven patients (13.2%) had positive test results, including 26 positive reactions following DPT. PEN-FAST scores of 0-5 were distributed as follows: 25 (7.0%), 159 (44.5%), 31 (8.7%), 96 (26.9%), 4 (1.1%) and 42 (11.8%). Among those with PEN-FAST scores ≤ 2 (n = 215), 16 (7.4%) had a positive test. Of these, 7 developed urticaria, 8 developed mild delayed maculopapular exanthem and 1 had a positive skin test. A PEN-FAST score cutoff of ≤ 2 yielded sensitivity of 66.0% (95% CI: 50.7%-79.1%), specificity of 64.2% (95% CI: 58.6%-69.5%), a positive predictive value (PPV) of 21.8% (95% CI: 17.8%-26.5%) and a NPV of 92.6% (95% CI: 89.2%-94.9%). The area under the receiver operating characteristic curve was 0.66 (95% CI: 0.58-0.75).</p><p><strong>Conclusion: </strong>The PEN-FAST clinical decision rule demonstrates a high NPV in an Asian population, supporting its potential utility in identifying individuals unlikely to have true penicillin allergy and enabling direct DPT in low-risk patients without prior ST. However, the modest area under the curve (AUC) of 0.66 reflects limited overall discriminatory ability.</p>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xiaoying Chen, Rui Feng, Xiaolong Ji, Bizhou Li, Tao Liu, Jing Li, Ruchong Chen
Asthma is one of the most common chronic respiratory diseases, persisting across the life course and affecting approximately 300 million people worldwide. Severe asthma, defined as asthma remaining uncontrolled despite adherence to optimised high-dose inhaled corticosteroids/long-acting β2-agonist therapy and management of contributory factors, worsens upon dose reduction. In China, 3.4%–8.3% of patients with asthma have severe asthma, characterised by heterogeneity, frequent exacerbations, and considerable medical and economic burdens. Recent advances in the understanding of its pathogenesis, especially the development of biologics, have enabled new treatment strategies. This review incorporates recent progress from China regarding the epidemiology, pathogenesis, and biologic therapy for severe asthma.
{"title":"Management and Research Progress of Severe Asthma in China","authors":"Xiaoying Chen, Rui Feng, Xiaolong Ji, Bizhou Li, Tao Liu, Jing Li, Ruchong Chen","doi":"10.1111/cea.70166","DOIUrl":"10.1111/cea.70166","url":null,"abstract":"<div>\u0000 \u0000 <p>Asthma is one of the most common chronic respiratory diseases, persisting across the life course and affecting approximately 300 million people worldwide. Severe asthma, defined as asthma remaining uncontrolled despite adherence to optimised high-dose inhaled corticosteroids/long-acting β2-agonist therapy and management of contributory factors, worsens upon dose reduction. In China, 3.4%–8.3% of patients with asthma have severe asthma, characterised by heterogeneity, frequent exacerbations, and considerable medical and economic burdens. Recent advances in the understanding of its pathogenesis, especially the development of biologics, have enabled new treatment strategies. This review incorporates recent progress from China regarding the epidemiology, pathogenesis, and biologic therapy for severe asthma.</p>\u0000 </div>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"56 2","pages":"147-166"},"PeriodicalIF":5.2,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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