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Assessment of the Effectiveness of Allergic Rhinitis Medications Using a Target Trial Emulation Approach Based on Mobile Health Data 基于移动健康数据的目标试验模拟方法评估过敏性鼻炎药物的有效性
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-11-09 DOI: 10.1111/cea.70173
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
随机对照试验(RCTs)是因果推理问题的范式,但由于其严格的资格标准,往往面临普遍性的挑战。在变应性鼻炎(AR)中,这一限制尤为重要,关于AR的随机对照试验显示,严重疾病患者的比例过高,并且没有提供足够详细的信息,说明合并症对治疗效果的影响[1-4]。移动医疗(mHealth)应用程序提供了收集大规模患者报告数据的机会,这些数据可以补充传统的试验证据,并扩大我们对常规护理治疗有效性的理解。然而,为了充分利用移动健康数据,必须采用适当处理混淆的方法。在这项研究中,我们旨在使用mHealth数据来比较三种常见AR药物类别的短期疗效:口服抗组胺药(OAH)、鼻内皮质类固醇(INCS)和鼻内抗组胺药加皮质类固醇喷雾剂(INAH+INCS)。特别是,我们的目的是比较这三种药物在24小时内的症状缓解,同时也探索治疗效果是否因自我报告的共病哮喘的存在而不同。为了处理混杂,我们采用了目标试验仿真方法[6]。这些方法的完整描述可在https://doi.org/10.5281/zenodo.17215607上获得。我们纳入了自我报告AR的MASK-air应用程序的成年用户。MASK-air是一款经过验证的应用程序,允许在视觉模拟量表(VAS)上每天报告AR症状以及药物使用情况。我们纳入了在服用上述药物之前和之后24小时内完成症状评估的用户。间隔小于60分钟的测量被排除在外。结果是全身、鼻、眼和哮喘相关症状的变化(VAS, 0-100)。为了消除混淆,我们使用了基于治疗前症状评分、年龄、性别、ARIA严重程度评分和哮喘状态的治疗加权逆概率。然后,我们使用贝叶斯混合效应回归模型估计平均治疗效果,将患者和月份作为随机效应[7,8]。有关结果的完整描述可在https://doi.org/10.5281/zenodo.17215607上获得。总共分析了648个治疗日,参与者的中位年龄为37岁;37.8%报告哮喘。用药前后记录的中位间隔为480 min (IQR = 568)。大多数治疗天数涉及OAH(64.2%),其次是INCS(25.5%)和INAH+INCS(10.3%)。与OAH相比,INCS和INAH+INCS均与整体症状的显著改善相关(平均VAS差异分别为- 4.25 [95% CrI = - 6.69, - 1.15]和- 7.27[- 10.30,- 4.07])(表1)。两者都能改善眼部症状,而INCS在鼻症状方面优于OAH(表1)。在哮喘患者中,INAH+INCS提供了比单独使用INCS更大的整体症状缓解(平均VAS差异= - 6.64,95% CrI = - 12.0, - 0.17),而在非哮喘患者中,联合使用比INCS更差(平均VAS差异= 5.09,95% CrI = - 5.39, 13.3)。本研究证明了将因果推理方法应用于移动健康数据以评估AR患者治疗效果的可行性。据我们所知,本研究首次使用患者生成的移动健康数据应用目标试验模拟方法。这种方法允许观测数据集模拟假设随机对照试验的关键组成部分,从而加强因果推理,同时利用所谓“现实世界”证据的包容性和生态有效性。我们的研究结果更倾向于鼻内治疗而不是OAH来控制症状。值得注意的是,我们观察到哮喘状态的差异反应。这表明潜在的炎症表型可能会改变治疗反应,在调整AR管理时应考虑哮喘合并症。然而,这一假设应该得到未来研究的证实。我们的发现应该考虑到一些局限性来解释。首先,国家层面的代表性不均衡,这反映了应用的使用模式。然而,我们的分析旨在通过关注针对关键混杂因素调整的个人水平效应来减轻这种影响。其次,我们承认不同的评估药物类别具有不同的药效学。例如,INCS的完全抗炎作用需要几天的时间。然而,(i)对于大多数参与者来说,评估的当天并不是他们第一次用药,(ii)我们检测到的短期改善与先前的证据一致,表明某些分子在7-12小时内出现临床作用(值得注意的是,在我们的研究中,我们检测到第一次和第二次观察之间的中位数间隔为8小时)。 最有趣的观察结果——基于哮喘状态的联合治疗(INAH+INCS)的差异反应——目前还没有明确的机制解释。因此,我们提出这是一个探索性的、产生假设的发现,值得进一步调查,因为它可能受到未测量的表型差异、依从模式或亚组内样本量限制的影响。最后,虽然任何有多重比较的研究都必须考虑偶然发现的可能性,但我们的贝叶斯框架通过提供治疗优势的概率来降低这种风险,提供比单独依赖p值更细致的解释。总之,这项研究表明,移动健康数据可以成功地用于模拟试验和评估现实世界条件下的增强现实治疗。鼻内治疗(INCS和INAH+INCS)在整体和眼部症状缓解方面比OAH更有效。观察到的与哮喘状态相关的影响,特别是对于INAH+INCS,是一个值得进一步调查的新发现,可以帮助完善指南建议。未来的研究应该将这种方法扩展到更长的随访期、更大的数据集和更多的治疗策略,以继续弥合RCT和观察证据之间的差距。、每分钟。和R.J.V.参与了研究设计、数据分析和撰写手稿初稿。a.b., D.B.和J.B.参与了研究设计方法,并撰写了手稿的初稿。m.m., m.o., G.P.和H.J.S.参与了手稿的方法论和批判性审查。所有剩余的作者都参与了数据收集和手稿的批判性审查。Jean Bousquet报告了Cipla, Menarini, Mylan, Novartis, Purina, Sanofi-Aventis, Teva, Noucor的个人费用,其他来自KYomed-Innov,其他来自Mask-air-SAS,提交的工作之外。Oliver Pfaar报告ALK-Abelló的拨款和个人费用、Allergopharma的拨款和个人费用、Stallergenes Greer的拨款和个人费用、HAL Allergy Holding B.V./HAL Allergie GmbH的拨款和个人费用、ben卡德Allergie GmbH/Allergy Therapeutics的拨款和个人费用、Laboratorios LETI/LETI Pharma的拨款和个人费用、葛兰素史克的拨款和个人费用、ROXALL Medizin的个人费用、诺华的个人费用、葛兰素史克的拨款和个人费用。赛诺菲-安万特和赛诺菲-健赞的赠款和个人费用,Med Update Europe GmbH的个人费用,streamedup!来自Pohl-Boskamp的个人费用,来自Inmunotek s.l.的赠款,来自John Wiley and Sons, AS的个人费用,来自Paul-Martini-Stiftung (PMS)的个人费用,来自Regeneron Pharmaceuticals Inc.的个人费用,来自RG aerzteforbildung的个人费用,来自Institut fr Disease Management的个人费用,来自施普林格GmbH的个人费用,来自AstraZeneca的赠款和个人费用,来自IQVIA Commercial的个人费用,来自Ingress Health的个人费用,来自Wort&amp;Bild Verlag的个人费用,Verlag ME的个人费用、宝洁公司的个人费用
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Toppila-Salmi,&nbsp;Boleslaw Samolinski,&nbsp;Joaquin Sastre,&nbsp;Luís Taborda-Barata,&nbsp;Tuuli Thomander,&nbsp;Ilgım Vardaloğlu Koyuncu,&nbsp;Arunas Valiulis,&nbsp;Leticia de las Vecillas,&nbsp;Maria Teresa Ventura,&nbsp;Jolanta Walusiak-Skorupa,&nbsp;Yi-Kui Xiang,&nbsp;Oliver Pfaar,&nbsp;João A. Fonseca,&nbsp;Torsten Zuberbier,&nbsp;Holger J. Schünemann,&nbsp;Danilo di Bona,&nbsp;Jean Bousquet,&nbsp;Rafael José Vieira","doi":"10.1111/cea.70173","DOIUrl":"10.1111/cea.70173","url":null,"abstract":"&lt;p&gt;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 [&lt;span&gt;1-4&lt;/span&gt;]. 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 [&lt;span&gt;5&lt;/span&gt;]. However, to adequately use mHealth data for that purpose, approaches to adequately deal with confounding must be applied.&lt;/p&gt;&lt;p&gt;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 [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;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).&lt;/p&gt;&lt;p&gt;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 [&lt;span&gt;7, 8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;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%).&lt;/p&gt;&lt;p&gt;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}
引用次数: 0
Airway, Breathing or Circulation Failure in Fatal Food Anaphylaxis: A Nationally Representative Case Series. 致死性食物过敏的气道、呼吸或循环衰竭:全国代表性病例系列。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-11-07 DOI: 10.1111/cea.70175
John Coveney, Tom Roberts, Sylvia Stoianova, Nicholas Sargant
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引用次数: 0
Uncovering Mite Sensitisation: Epidemiological Insights From a General Population Study. 揭示螨致敏:来自一般人群研究的流行病学见解。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-11-05 DOI: 10.1111/cea.70174
Laura Romero-Sánchez, Francisco Gude, Arturo González-Quintela, Manuela Alonso-Sampedro, Óscar Lado-Baleato, Carmen Fernández-Merino, Flora Miranda-Pena, Carmen Vidal
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引用次数: 0
Adrenaline Auto-Injector Prescribing in Primary Care in England: An Analysis of Non-Standard Dosing 肾上腺素自动注射器处方在英国初级保健:非标准剂量的分析。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-11-02 DOI: 10.1111/cea.70163
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
简介:社区推荐的过敏反应一线治疗是肌肉注射肾上腺素。治疗是根据患者的体重使用150 μg或300 μg肾上腺素自动注射(AAI)装置的标准剂量。目前,尚无标准化机制使患者在体重达到25-30公斤时改用300 μg的较高剂量(取决于制造商)。方法:我们对英格兰社区分发的NHS处方数据进行分析,以确定非标准AAI剂量处方的比例。非标准处方被定义为可能超过25-30公斤阈值但仍接受150 μg剂量的患者。数据仅限于过去2年内(2022年12月至2024年12月)单个患者的最新AAI处方。使用年龄-体重相关模型来估计开药时患者的体重。AAI推荐的切换体重,基于设备元数据,与患者的近似体重进行比较,以识别非标准处方。使用Kendall's Tau相关系数计算非标准处方率与患者剥夺率的统计比较。还进行了一项补充分析,以确定接受300 μg剂量但可能低于25-30 kg阈值的患者。结果:总体而言,46,999例患者在其最近的AAI处方中接受了150 μg强度的注射器;其中,超过95%的人获得了符合国家指导的两个或更多设备。根据年龄对体重增长百分位数的估计表明,处方150 μg自动注射器的患者中有9480人(20.2%)至至少1747人(3.7%)可能超过该剂量的体重阈值。根据英国复苏委员会(Resuscitation Council UK)的6岁指南,将剂量改为300 μg,估计使用非标准AAI剂量的比例增加到23,059例(49.1%)。在英格兰最贫困的地区,非标准AAI处方的估计比率更高。保守估计发现,只有67名体重可能低于25公斤的儿童和330名体重可能低于30公斤的儿童接受了300微克的剂量。结论:对英格兰社区AAI处方的分析表明,儿童和成人的AAI处方剂量不足并不罕见。有过敏反应风险的患者的医疗保健专业人员应审查给患者开的AAI设备是否适合他们的体重。
{"title":"Adrenaline Auto-Injector Prescribing in Primary Care in England: An Analysis of Non-Standard Dosing","authors":"Louise J. Michaelis,&nbsp;Thomas Owen,&nbsp;Andrew D. Bright,&nbsp;Lucy Sherwin-Robson","doi":"10.1111/cea.70163","DOIUrl":"10.1111/cea.70163","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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}
引用次数: 0
Exploring the Disease Duration of Urticaria and Associated Determinants in Primary Care. 在初级保健中探讨荨麻疹的病程和相关决定因素。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-10-30 DOI: 10.1111/cea.70170
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}
引用次数: 0
Comparison Between a Rush and a Conventional Oral Immunotherapy Protocol to Treat Cow's Milk and Hen's Egg Allergy. CompITO Study Methodology. Rush与传统口服免疫治疗方案治疗牛奶和鸡蛋过敏的比较。编译研究方法。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-10-30 DOI: 10.1111/cea.70168
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}
引用次数: 0
Global Burden of Elderly Atopic Dermatitis (1990-2021) and Projections to 2030: A Socio-Demographic Index Analysis. 全球老年人特应性皮炎负担(1990-2021)和2030年预测:社会人口指数分析。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-10-29 DOI: 10.1111/cea.70169
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}
引用次数: 0
Early and Sustained Asthma Control and Remission in Real-World Patients With Severe Eosinophilic Asthma Treated With Benralizumab: XALOC-2. Benralizumab: XALOC-2治疗严重嗜酸性哮喘患者的早期和持续哮喘控制和缓解
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-10-29 DOI: 10.1111/cea.70162
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.

背景:缺乏关于benralizumab对严重嗜酸性哮喘(SEA)患者哮喘控制的早期和持续影响的前瞻性现实数据。方法:XALOC-2是一项前瞻性、观察性、多国、真实世界的研究,在接受贝纳利珠单抗治疗的成人SEA患者中进行。该综合分析评估了哮喘控制问卷(ACQ)评分、三组分临床缓解(包括症状控制良好[ACQ评分≤0.75]、无恶化、不使用维持性口服皮质类固醇[mOCS])的实现情况,以及12个月基线期至第56周的其他临床结果。缓解状态和关键基线特征之间的关系也被评估。结果:共纳入535例患者。基线时ACQ评分中位数(四分位间距)为3.0(2.2-3.8)。在第1周,58.0%(283 /486)的患者ACQ评分降低≥0.5分(最小临床重要差异[MCID]), 35.0%(170/486)的患者ACQ评分降低≥1分(2× MCID)。到第56周,这两个数字分别上升到78.6%(276/351)和62.1%(218/351)。在贝纳利珠单抗开始使用后,哮喘控制的改善是相似的,与之前的生物使用状态无关。到第56周,26.7%(70/262)的患者达到了临床缓解标准,而基线时为0%(0/374)。未使用mOCS、较低的体重指数、较好的哮喘症状控制和较高的基线血嗜酸性粒细胞峰值计数与第56周满足3组分临床缓解标准相关。结论:现实世界中,接受贝纳利珠单抗治疗的患者哮喘症状出现了早期和持续的改善,无论之前是否使用过生物制剂。超过四分之一的患者在贝纳利珠单抗治疗1年后达到临床哮喘缓解。
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引用次数: 0
Validation of the PEN-FAST Penicillin Allergy Clinical Decision Rule in an Asian Cohort. PEN-FAST青霉素过敏临床决策规则在亚洲队列中的验证。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-10-25 DOI: 10.1111/cea.70164
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.

错误的青霉素过敏标签常常导致不必要地避免使用β -内酰胺类抗生素,导致抗菌素耐药性和次优临床结果。PEN-FAST临床决策规则是一种简单的,具有高阴性预测值(NPV)的即时护理工具,旨在识别可能不需要广泛过敏测试的低风险患者。本研究旨在验证PEN-FAST临床决策规则在亚洲人群中的表现。方法:回顾性分析我院过敏门诊2006年1月至2023年2月的病历。患者首先进行皮肤刺破和皮内试验,然后进行口服药物激发试验(DPT)或不事先进行皮肤试验(ST)的直接口服DPT。阳性结果定义为皮肤试验结果阳性或药物刺激后立即/延迟反应。将PEN-FAST评分与过敏测试结果进行比较。结果:共纳入357例患者,其中85例(23.8%)接受直接DPT治疗,既往无ST.;年龄中位数为49岁(四分位数间距[IQR]: 34-63),女性占61.9%。结果阳性47例(13.2%),其中DPT术后阳性反应26例。0-5分的PEN-FAST得分分布为:25分(7.0%)、159分(44.5%)、31分(8.7%)、96分(26.9%)、4分(1.1%)、42分(11.8%)。在PEN-FAST评分≤2的患者(n = 215)中,16例(7.4%)呈阳性。其中7例发展为荨麻疹,8例发展为轻度迟发性黄斑丘疹,1例皮肤试验阳性。如果PEN-FAST评分临界值≤2,则敏感性为66.0% (95% CI: 50.7%-79.1%),特异性为64.2% (95% CI: 58.6%-69.5%),阳性预测值(PPV)为21.8% (95% CI: 17.8%-26.5%), NPV为92.6% (95% CI: 89.2%-94.9%)。受试者工作特征曲线下面积为0.66 (95% CI: 0.58 ~ 0.75)。结论:PEN-FAST临床决策规则在亚洲人群中显示出较高的NPV,支持其在识别不太可能发生真正青霉素过敏的个体和对无st病史的低风险患者进行直接DPT方面的潜在效用。然而,0.66的中等曲线下面积(AUC)反映了有限的总体区分能力。
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引用次数: 0
Management and Research Progress of Severe Asthma in China 中国重症哮喘的管理与研究进展。
IF 5.2 2区 医学 Q1 ALLERGY Pub Date : 2025-10-25 DOI: 10.1111/cea.70166
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.

哮喘是最常见的慢性呼吸系统疾病之一,在整个生命过程中持续存在,影响全世界约3亿人。重度哮喘,定义为尽管坚持优化的高剂量吸入皮质类固醇/长效β2激动剂治疗和致病因素管理,哮喘仍未得到控制,但剂量减少后病情恶化。在中国,3.4%-8.3%的哮喘患者患有严重哮喘,其特点是异质性、频繁发作,以及相当大的医疗和经济负担。最近对其发病机制的理解取得了进展,特别是生物制剂的发展,使新的治疗策略成为可能。本文综述了中国在重症哮喘的流行病学、发病机制和生物治疗方面的最新进展。
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Clinical and Experimental Allergy
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