Francisca Castro Mendes, Vanessa Garcia-Larsen, André Moreira
Recognition of obesity as a treatable trait of asthma, impacting its development, clinical presentation and management, is gaining widespread acceptance. Obesity is a significant risk factor and disease modifier for asthma, complicating treatment. Epidemiological evidence highlights that obese asthma correlates with poorer disease control, increased severity and persistence, compromised lung function and reduced quality of life. Various mechanisms contribute to the physiological and clinical complexities observed in individuals with obesity and asthma. These encompass different immune responses, including Type IVb, where T helper 2 cells are pivotal and driven by cytokines like interleukins 4, 5, 9 and 13, and Type IVc, characterised by T helper 17 cells and Type 3 innate lymphoid cells producing interleukin 17, which recruits neutrophils. Additionally, Type V involves immune response dysregulation with significant activation of T helper 1, 2 and 17 responses. Finally, Type VI is recognised as metabolic-induced immune dysregulation associated with obesity. Body mass index (BMI) stands out as a biomarker of a treatable trait in asthma, readily identifiable and targetable, with significant implications for disease management. There exists a notable gap in treatment options for individuals with obese asthma, where asthma management guidelines lack specificity. For example, there is currently no evidence supporting the use of incretin mimetics to improve asthma outcomes in asthmatic individuals without Type 2 diabetes mellitus (T2DM). In this review, we advocate for integrating BMI into asthma care models by establishing clear target BMI goals, promoting sustainable weight loss via healthy dietary choices and physical activity and implementing regular reassessment and referral as necessary.
{"title":"Obesity and Asthma: Implementing a Treatable Trait Care Model","authors":"Francisca Castro Mendes, Vanessa Garcia-Larsen, André Moreira","doi":"10.1111/cea.14520","DOIUrl":"10.1111/cea.14520","url":null,"abstract":"<div>\u0000 \u0000 <p>Recognition of obesity as a treatable trait of asthma, impacting its development, clinical presentation and management, is gaining widespread acceptance. Obesity is a significant risk factor and disease modifier for asthma, complicating treatment. Epidemiological evidence highlights that obese asthma correlates with poorer disease control, increased severity and persistence, compromised lung function and reduced quality of life. Various mechanisms contribute to the physiological and clinical complexities observed in individuals with obesity and asthma. These encompass different immune responses, including Type IVb, where T helper 2 cells are pivotal and driven by cytokines like interleukins 4, 5, 9 and 13, and Type IVc, characterised by T helper 17 cells and Type 3 innate lymphoid cells producing interleukin 17, which recruits neutrophils. Additionally, Type V involves immune response dysregulation with significant activation of T helper 1, 2 and 17 responses. Finally, Type VI is recognised as metabolic-induced immune dysregulation associated with obesity. Body mass index (BMI) stands out as a biomarker of a treatable trait in asthma, readily identifiable and targetable, with significant implications for disease management. There exists a notable gap in treatment options for individuals with obese asthma, where asthma management guidelines lack specificity. For example, there is currently no evidence supporting the use of incretin mimetics to improve asthma outcomes in asthmatic individuals without Type 2 diabetes mellitus (T2DM). In this review, we advocate for integrating BMI into asthma care models by establishing clear target BMI goals, promoting sustainable weight loss via healthy dietary choices and physical activity and implementing regular reassessment and referral as necessary.</p>\u0000 </div>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 11","pages":"881-894"},"PeriodicalIF":6.3,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141466527","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}
Rola AbuJabal, Rakhee K. Ramakrishnan, Khuloud Bajbouj, Qutayba Hamid
Asthma is a common and burdensome chronic inflammatory airway disease that affects both children and adults. One of the main concerns with asthma is the manifestation of irreversible tissue remodelling of the airways due to the chronic inflammatory environment that eventually disrupts the whole structure of the airways. Most people with troublesome asthma are treated with inhaled corticosteroids. However, the development of steroid resistance is a commonly encountered issue, necessitating other treatment options for these patients. Biological therapies are a promising therapeutic approach for people with steroid-resistant asthma. Interleukin 5 is recently gaining a lot of attention as a biological target relevant to the tissue remodelling process. Since IL-5-neutralizing monoclonal antibodies (mepolizumab, reslizumab and benralizumab) are currently available for clinical use, this review aims to revisit the role of IL-5 in asthma pathogenesis at large and airway remodelling in particular, in addition to exploring its role as a target for biological treatments.
{"title":"Role of IL-5 in asthma and airway remodelling","authors":"Rola AbuJabal, Rakhee K. Ramakrishnan, Khuloud Bajbouj, Qutayba Hamid","doi":"10.1111/cea.14489","DOIUrl":"10.1111/cea.14489","url":null,"abstract":"<p>Asthma is a common and burdensome chronic inflammatory airway disease that affects both children and adults. One of the main concerns with asthma is the manifestation of irreversible tissue remodelling of the airways due to the chronic inflammatory environment that eventually disrupts the whole structure of the airways. Most people with troublesome asthma are treated with inhaled corticosteroids. However, the development of steroid resistance is a commonly encountered issue, necessitating other treatment options for these patients. Biological therapies are a promising therapeutic approach for people with steroid-resistant asthma. Interleukin 5 is recently gaining a lot of attention as a biological target relevant to the tissue remodelling process. Since IL-5-neutralizing monoclonal antibodies (mepolizumab, reslizumab and benralizumab) are currently available for clinical use, this review aims to revisit the role of IL-5 in asthma pathogenesis at large and airway remodelling in particular, in addition to exploring its role as a target for biological treatments.</p>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 8","pages":"538-549"},"PeriodicalIF":6.3,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14489","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141466581","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}
Si Hui Goh, Gaik Chin Yap, Hsin Yue Cheng, Wen Chin Chiang, Jian Yi Soh, Kok Wee Chong, Anne Goh, Elizabeth Huiwen Tham, Arif Tyebally, Sashikumar Ganapathy, Irwani Ibrahim, Bee Wah Lee
Background
There has been limited data regarding the incidence of anaphylaxis in Asia. We aim to describe patterns in patient characteristics, triggers and clinical presentation of childhood anaphylaxis in Singapore.
Methods
This was a retrospective review of emergency electronic medical records of children with anaphylaxis. Patients with the allergy-related diagnoses of anaphylaxis, angioedema, allergy and urticaria based on ICD-9 codes were screened. Cases fulfilling the World Allergy Organization criteria for anaphylaxis were included.
Results
A total of 1188 cases of anaphylaxis were identified with a median age of 6.3 years. Extrapolating data from the study sites, from 2015 to 2022, the incidence rate of childhood anaphylaxis emergency visits in Singapore doubled from 18.9 to 38.8 per 100,000 person-years, with an incidence rate ratio (IRR) of 2.06 (95% confidence interval [CI] 1.70–2.49). In 2022, the incidence rate of food anaphylaxis was 30.1 per 100,000 person-years, IRR 2.39 (95% CI 1.90–3.01) and drug anaphylaxis was 4.6 per 100,000 person-years, IRR 1.89 (95% CI 1.11–3.25). The incidence rate in children aged 0–4 years quadrupled during the study period. Common triggers were egg (10.4%), peanut (9.3%), tree nut (8.8%), milk (8%), shellfish (7.8%) and non-steroidal anti-inflammatory drug (4.4%). The majority (88.6%) of patients were treated with intramuscular adrenaline. Total number of allergy-related visits did not increase over time between 2015 and 2019. Rates of severe anaphylaxis, namely anaphylactic shock and admission to high-dependency and intensive care, did not increase over time, with a mean incidence of 1.6, IRR 0.85 (95% CI 0.40–1.83) and 0.7, IRR 1.77 (95% CI 0.54–5.76) per 100,000 person-years, respectively.
Conclusion
While the number of emergency visits due to childhood anaphylaxis has increased, the number of cases of allergy-related visits, anaphylactic shock and anaphylaxis requiring high-dependency and intensive care did not rise.
{"title":"Trends in Childhood Anaphylaxis in Singapore: 2015–2022","authors":"Si Hui Goh, Gaik Chin Yap, Hsin Yue Cheng, Wen Chin Chiang, Jian Yi Soh, Kok Wee Chong, Anne Goh, Elizabeth Huiwen Tham, Arif Tyebally, Sashikumar Ganapathy, Irwani Ibrahim, Bee Wah Lee","doi":"10.1111/cea.14528","DOIUrl":"10.1111/cea.14528","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There has been limited data regarding the incidence of anaphylaxis in Asia. We aim to describe patterns in patient characteristics, triggers and clinical presentation of childhood anaphylaxis in Singapore.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective review of emergency electronic medical records of children with anaphylaxis. Patients with the allergy-related diagnoses of anaphylaxis, angioedema, allergy and urticaria based on ICD-9 codes were screened. Cases fulfilling the World Allergy Organization criteria for anaphylaxis were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1188 cases of anaphylaxis were identified with a median age of 6.3 years. Extrapolating data from the study sites, from 2015 to 2022, the incidence rate of childhood anaphylaxis emergency visits in Singapore doubled from 18.9 to 38.8 per 100,000 person-years, with an incidence rate ratio (IRR) of 2.06 (95% confidence interval [CI] 1.70–2.49). In 2022, the incidence rate of food anaphylaxis was 30.1 per 100,000 person-years, IRR 2.39 (95% CI 1.90–3.01) and drug anaphylaxis was 4.6 per 100,000 person-years, IRR 1.89 (95% CI 1.11–3.25). The incidence rate in children aged 0–4 years quadrupled during the study period. Common triggers were egg (10.4%), peanut (9.3%), tree nut (8.8%), milk (8%), shellfish (7.8%) and non-steroidal anti-inflammatory drug (4.4%). The majority (88.6%) of patients were treated with intramuscular adrenaline. Total number of allergy-related visits did not increase over time between 2015 and 2019. Rates of severe anaphylaxis, namely anaphylactic shock and admission to high-dependency and intensive care, did not increase over time, with a mean incidence of 1.6, IRR 0.85 (95% CI 0.40–1.83) and 0.7, IRR 1.77 (95% CI 0.54–5.76) per 100,000 person-years, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While the number of emergency visits due to childhood anaphylaxis has increased, the number of cases of allergy-related visits, anaphylactic shock and anaphylaxis requiring high-dependency and intensive care did not rise.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 8","pages":"585-595"},"PeriodicalIF":6.3,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14528","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141455625","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}
Tom Marrs, Nandinee Patel, Sarah Burrell, Anjali Rampersad, Eleanor Minshall, Susan Leech, Dinusha Chandratilleke, Justine Dempsey, Sian Ludman, Graham Roberts, Louise Jane Michaelis, Helen A. Brough, Surendra Karanam, Rebecca Batt, Phoebe Moulsdale, Gary Steifel, Kiran Tiwana, Helen Smith, Katherine Knight, Marta Vazquez-Ortiz, Deepan Vyas, Paul J. Turner, Nick Makwana
<div> <section> <h3> Background</h3> <p>Palforzia® enables the safe and effective desensitisation of children with peanut allergy. The treatment pathway requires multiple visits for dose escalation, up-dosing, monitoring of patients taking maintenance therapy and conversion onto daily real-world peanut consumption. The demand for peanut immunotherapy outstrips current National Health Service (NHS) capacity and requires services to develop a national consensus on how best to offer Palforzia® in a safe and equitable manner. We undertook a Delphi consensus exercise to determine guidance statements for the implementation of Palforzia®-based immunotherapy in the NHS.</p> </section> <section> <h3> Methods</h3> <p>We undertook focus groups with children and young people who had received peanut immunotherapy to assess what was important for them and their carers. Common themes from patients formed the basis of creating draft statements. A panel of 18 multi-disciplinary professionals engaged in two rounds of anonymised voting to adapt the statements and score their importance. A final consensus workshop consolidated any variation in comments and scores to develop the final guidance statements.</p> </section> <section> <h3> Results</h3> <p>The panel achieved consensus on 91% (29/32) of guidance statements, demonstrating strong consensus around pragmatic principles for assuring the integrity of consent, safety and conversion from Palforzia® to real-world peanut products. The greatest amount of feedback was generated from three broad issues; (i) whether eligibility assessment should include compulsory peanut challenges and whether these should be designed to assess the threshold at which patients react to peanut, (ii) the governance processes to best ensure that patients' interests are prioritised and (iii) how to safely transition young people to other services, or discharge them, while they are taking daily peanut.</p> </section> <section> <h3> Conclusions</h3> <p>This consensus highlights the urgent need for the NHS to increase capacity for undertaking diagnostic food challenges as well as developing Palforzia® immunotherapy pathways. The voting panel agreed that families of peanut allergic children should be made aware of immunotherapy, that eligibility assessment should include how co-morbid conditions are managed and that services should monitor for adverse effects. The finalised statements are now published online for clinical practice in the UK. These guidance statements will be adapted in the coming years as more evidence is published and as the inter
{"title":"BSACI guidance for the implementation of Palforzia® peanut oral immunotherapy in the United Kingdom: A Delphi consensus study","authors":"Tom Marrs, Nandinee Patel, Sarah Burrell, Anjali Rampersad, Eleanor Minshall, Susan Leech, Dinusha Chandratilleke, Justine Dempsey, Sian Ludman, Graham Roberts, Louise Jane Michaelis, Helen A. Brough, Surendra Karanam, Rebecca Batt, Phoebe Moulsdale, Gary Steifel, Kiran Tiwana, Helen Smith, Katherine Knight, Marta Vazquez-Ortiz, Deepan Vyas, Paul J. Turner, Nick Makwana","doi":"10.1111/cea.14491","DOIUrl":"10.1111/cea.14491","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Palforzia® enables the safe and effective desensitisation of children with peanut allergy. The treatment pathway requires multiple visits for dose escalation, up-dosing, monitoring of patients taking maintenance therapy and conversion onto daily real-world peanut consumption. The demand for peanut immunotherapy outstrips current National Health Service (NHS) capacity and requires services to develop a national consensus on how best to offer Palforzia® in a safe and equitable manner. We undertook a Delphi consensus exercise to determine guidance statements for the implementation of Palforzia®-based immunotherapy in the NHS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We undertook focus groups with children and young people who had received peanut immunotherapy to assess what was important for them and their carers. Common themes from patients formed the basis of creating draft statements. A panel of 18 multi-disciplinary professionals engaged in two rounds of anonymised voting to adapt the statements and score their importance. A final consensus workshop consolidated any variation in comments and scores to develop the final guidance statements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The panel achieved consensus on 91% (29/32) of guidance statements, demonstrating strong consensus around pragmatic principles for assuring the integrity of consent, safety and conversion from Palforzia® to real-world peanut products. The greatest amount of feedback was generated from three broad issues; (i) whether eligibility assessment should include compulsory peanut challenges and whether these should be designed to assess the threshold at which patients react to peanut, (ii) the governance processes to best ensure that patients' interests are prioritised and (iii) how to safely transition young people to other services, or discharge them, while they are taking daily peanut.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This consensus highlights the urgent need for the NHS to increase capacity for undertaking diagnostic food challenges as well as developing Palforzia® immunotherapy pathways. The voting panel agreed that families of peanut allergic children should be made aware of immunotherapy, that eligibility assessment should include how co-morbid conditions are managed and that services should monitor for adverse effects. The finalised statements are now published online for clinical practice in the UK. These guidance statements will be adapted in the coming years as more evidence is published and as the inter","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 7","pages":"459-469"},"PeriodicalIF":6.3,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14491","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141516828","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}
Kristie Lao, Hugo W F Mak, Valerie Chiang, Mukesh Kumar, Billy K C Chow, Philip H Li
{"title":"Mas-Related G-Protein Coupled Receptor-X2 and Chemokine (C-C Motif) Ligand 2 Correlate With Disease Activity Among Treatment-Naïve Chinese Patients With Chronic Spontaneous Urticaria.","authors":"Kristie Lao, Hugo W F Mak, Valerie Chiang, Mukesh Kumar, Billy K C Chow, Philip H Li","doi":"10.1111/cea.14531","DOIUrl":"https://doi.org/10.1111/cea.14531","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141455622","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}
Shican Zhou, Ju Lai, Na Che, Kai Fan, Chuanliang Zhao, Bojin Long, Chunyan Yao, Yu Zeng, Shaoqing Yu
{"title":"Emerging Role of SAMSN1<sup>+</sup>Mast Cells: Insights From Mendelian Randomisation and Transcriptomic Analyses on Chronic Sinusitis and Obesity.","authors":"Shican Zhou, Ju Lai, Na Che, Kai Fan, Chuanliang Zhao, Bojin Long, Chunyan Yao, Yu Zeng, Shaoqing Yu","doi":"10.1111/cea.14529","DOIUrl":"https://doi.org/10.1111/cea.14529","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141455621","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}
Rhiannon Nancarrow-Lei, Joana Hiew de Sousa Magalhães
<p>Acute bronchiolitis, marked by inflammation of the bronchioles, is characterised by airway oedema and mucus plugging resulting in wheeze [<span>1, 2</span>]. It is the most common lower respiratory tract infection in children aged less than 2 years, with Respiratory Syncytial Virus (RSV) being the most frequent cause [<span>1</span>]. Nebulised hypertonic saline solution (≥3%) may reduce these pathological changes and decrease airway obstruction, although the current available evidence is conflicting. This Cochrane Corner aims to assess the effects of nebulised hypertonic (≥3%) saline solution in infants with acute bronchiolitis.</p><p>Zhang L, Mendoza-Sassi RA, Wainwright CE, Aregbesola A, Klassen TP. Nebulised hypertonic saline solution for acute bronchiolitis in infants. <i>Cochrane Database of Syst Rev 2023</i>, Issue 3: CD006458.</p><p>Bronchiolitis is the leading cause of infant hospitalisation, largely secondary to lower respiratory tract infections, typically RSV [<span>1</span>]. In the UK, RSV results in 467,000 GP visits and 34,000 hospitalisations annually, with an estimated cost of £80 million for children under 5 [<span>4</span>]. The Joint Committee of Vaccination and Immunisation (JCVI) have recommended an RSV immunisation programme for infants and older adults, which will likely reshape the landscape of bronchiolitis [<span>5</span>].</p><p>Acute bronchiolitis, marked by airway oedema and mucus plugging, may benefit from nebulised hypertonic saline to aid airway secretion clearance. ‘Bronchiolitis’ encompasses a diverse group of conditions with varying underlying pathologies, emphasising the necessity for a validated diagnostic criteria, as highlighted in this Cochrane review.</p><p>This 2023 Cochrane review update of 34 trials involving 5205 infants, 2727 of whom received nebulised hypertonic saline. It found that nebulised hypertonic saline may result in a modest reduction in hospital stay length compared to treatment with nebulised normal saline or standard treatment. However, its impact on symptom resolution such as wheezing, cough, or pulmonary moist crackles, remains inconclusive. Nebulised hypertonic saline was linked to a lower risk of hospitalisation, but did not demonstrate a discernible reduction in re-admission rates. While hospital length of stay and hospitalisation rates are clinically important endpoints, they are potentially prone to bias. We support the Cochrane reviewers' call for a robust and universally accepted core outcome measures for infants with acute bronchiolitis.</p><p>Though the observed difference in effect size was smaller than that in the 2013 update, a nearly 10-h reduction in hospital stay may still hold clinical significance, given the disease's short natural course of 3–5 days. Though cost-effectiveness was not analysed, this reduction may lead to substantial cost savings. Challenges in drug delivery to crying infants and the use of normal saline as a control might have influenced negative f
{"title":"Nebulised Hypertonic Saline Solution for Acute Bronchiolitis in Infants","authors":"Rhiannon Nancarrow-Lei, Joana Hiew de Sousa Magalhães","doi":"10.1111/cea.14530","DOIUrl":"10.1111/cea.14530","url":null,"abstract":"<p>Acute bronchiolitis, marked by inflammation of the bronchioles, is characterised by airway oedema and mucus plugging resulting in wheeze [<span>1, 2</span>]. It is the most common lower respiratory tract infection in children aged less than 2 years, with Respiratory Syncytial Virus (RSV) being the most frequent cause [<span>1</span>]. Nebulised hypertonic saline solution (≥3%) may reduce these pathological changes and decrease airway obstruction, although the current available evidence is conflicting. This Cochrane Corner aims to assess the effects of nebulised hypertonic (≥3%) saline solution in infants with acute bronchiolitis.</p><p>Zhang L, Mendoza-Sassi RA, Wainwright CE, Aregbesola A, Klassen TP. Nebulised hypertonic saline solution for acute bronchiolitis in infants. <i>Cochrane Database of Syst Rev 2023</i>, Issue 3: CD006458.</p><p>Bronchiolitis is the leading cause of infant hospitalisation, largely secondary to lower respiratory tract infections, typically RSV [<span>1</span>]. In the UK, RSV results in 467,000 GP visits and 34,000 hospitalisations annually, with an estimated cost of £80 million for children under 5 [<span>4</span>]. The Joint Committee of Vaccination and Immunisation (JCVI) have recommended an RSV immunisation programme for infants and older adults, which will likely reshape the landscape of bronchiolitis [<span>5</span>].</p><p>Acute bronchiolitis, marked by airway oedema and mucus plugging, may benefit from nebulised hypertonic saline to aid airway secretion clearance. ‘Bronchiolitis’ encompasses a diverse group of conditions with varying underlying pathologies, emphasising the necessity for a validated diagnostic criteria, as highlighted in this Cochrane review.</p><p>This 2023 Cochrane review update of 34 trials involving 5205 infants, 2727 of whom received nebulised hypertonic saline. It found that nebulised hypertonic saline may result in a modest reduction in hospital stay length compared to treatment with nebulised normal saline or standard treatment. However, its impact on symptom resolution such as wheezing, cough, or pulmonary moist crackles, remains inconclusive. Nebulised hypertonic saline was linked to a lower risk of hospitalisation, but did not demonstrate a discernible reduction in re-admission rates. While hospital length of stay and hospitalisation rates are clinically important endpoints, they are potentially prone to bias. We support the Cochrane reviewers' call for a robust and universally accepted core outcome measures for infants with acute bronchiolitis.</p><p>Though the observed difference in effect size was smaller than that in the 2013 update, a nearly 10-h reduction in hospital stay may still hold clinical significance, given the disease's short natural course of 3–5 days. Though cost-effectiveness was not analysed, this reduction may lead to substantial cost savings. Challenges in drug delivery to crying infants and the use of normal saline as a control might have influenced negative f","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 8","pages":"534-537"},"PeriodicalIF":6.3,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14530","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141455623","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}
T. Buttgereit, F. Aulenbacher, A. Gutsche, P. Kolkhir, K. Weller, C. Vera Ayala, M. Magerl, H. Farkas, A. S. Grumach, E. Aygören-Pürsün, N. Bara, M. Ben-Shoshan, J. Bernstein, S. Betschel, L. Bouillet, T. Caballero, M. Cancian, A. J. Castaldo, S. Cimbollek, D. M. Cohn, T. Craig, D. Fomina, A. Gelincik, V. Grivcheva-Panovska, A. Jindal, C. Katelaris, A. Kessel, T. Kinaciyan, H. J. Longhurst, I. Martinez-Saguer, M. Riedl, C. Schöffl, P. Staubach, A. Zanichelli, Y. Zhi, H. Balle Boysen, J. S. Fok, P. H. Li, R. Hakl, M. Hide, J. Peter, M. Maurer
<p>Angioedema (AE) is a paroxysmal, localised and self-limiting swelling of the subcutaneous and/or submucosal tissue, because of a temporary increase in vascular permeability. Recurrent AE is a heterogeneous disease, which is categorised into different types [<span>1</span>]. Clinical and sociodemographic core factors in AE remain insufficiently investigated. A need exists for a large, comprehensive worldwide registry for all types of recurrent AE, applying modern methodologies and parameters from recent scientific knowledge.</p><p>Chronic Angioedema Registry (CARE) is an international, prospective, multicentre, observational (noninterventional), open-ended disease registry initiated in 2023 by the global network of Angioedema Centers of Reference and Excellence (ACARE) and the Urticaria Network e.V. (UNEV), which aims to enhance the understanding of recurrent AE of all aetiologies in worldwide clinical settings.</p><p>All physicians treating patients with AE, irrespective of location, medical specialty or setting, are invited to participate in CARE. The requirements for participation and the ‘Project Plan’ and ‘CARE Charter’ can be found on the CARE website (https://chronic-angioedema-registry.com). Participation in CARE incurs no costs, no financial compensation or support is provided, and no charges will be billed to health insurers. Data submission is voluntary and solely at the physician and patient's discretion.</p><p>The CARE questionnaires, developed by the CARE International Steering Committee (ISC), consist of basic multiple-choice or short-answer questions. Questions and variables are programmed in REDCap (Nashville, Tennessee), a secure, web-based software platform designed to support data capture for research studies (https://www.project-redcap.org; downloaded on 5 July 2023). After giving their written informed consent, participating patients receive a QR code linked to their participant identification (ID) number, allowing them to access the patient questionnaire via a smart device; the treating physician gets the patient's ID and completes the physician questionnaire (Figure 1).</p><p>CARE data will be collected during routine patient consultation visits and examinations for AE treatment. CARE will continue to follow patients as long as the physician and patient are considered appropriate. Data will be transferred at regular periods from REDCap into an electronic case report form programme to process and monitor the data. Outlier and diagnostic plots are used to check for plausibility, consistency and integrity.</p><p>The registry database is owned, hosted and administered by UNEV. Participating physicians are responsible for retaining all source data, and the staff of the treating physician must monitor and manage the patient's data. If patients withdraw their consent, their data will not be further included. A patient's previous data will be deleted from the registry upon a patient's request.</p><p>Patient baseline and follow-u
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Rafael José Vieira, Lucas Leemann, Holger J. Schünemann, Luís Filipe Azevedo, João A. Fonseca, Jean Bousquet, Bernardo Sousa-Pinto
<p>The impact of allergic rhinitis (AR) on patients' quality of life (QoL) may vary with disease control and comorbidities [<span>1</span>]. Previously, we quantified utilities for different levels of AR control but did not assess the impact of specific symptoms on QoL [<span>2</span>]. In this study, we used EQ-5D-5L to assess the impact of uncontrolled individual symptoms on the QoL of patients with AR.</p><p>A full description of the Methods is available electronically (https://doi.org/10.6084/m9.figshare.25253323.v2). We assessed data from European users of the mHealth app MASK-air [<span>3</span>] between May 2015 and December 2022. These users had self-reported AR, were aged between 16 (or 15 in countries with a lower age of digital consent [<span>4</span>]) and 74 years and had filled-in the full EQ-5D-5L questionnaire and/or the EQ-5D visual analogue scale (VAS) alone.</p><p>MASK-air comprises a daily monitoring questionnaire consisting of (i) VASs assessing the daily impact of ocular, nasal, asthma and global allergy symptoms (0–100 scale, a higher score corresponds to a higher impact of symptoms) and (ii) the EQ-5D VAS (0–100 scale, the higher the value the better the patient is feeling on that day). Additionally, users may opt to respond to the EQ-5D-5L questionnaire, which allows for the computation of utilities [<span>5</span>].</p><p>We computed Spearman correlation coefficients between the EQ-5D utility index score or the EQ-5D VAS and symptom VASs (VASs on eye, nose and asthma symptoms).</p><p>We then categorised each symptom VAS into ‘good’, ‘partial’ and ‘poor’ control [<span>6</span>]. We first studied the association between each symptom VAS and QoL by building mixed-effects linear regression models for each symptom individually. Additionally, to measure which isolated symptoms have the greatest impact on QoL (removing the effect of the remaining symptoms), we performed similar regression analyses restricted to observations with ‘good’ control of the two remaining symptom VASs (e.g., to assess the impact of poor versus good control on VAS Eye, we considered only the observations in which there was a simultaneously good control of VAS Nose and VAS Asthma). We performed this stratified analysis (instead of adjusting for the remaining symptoms in regression models) due to multicollinearity between allergy symptoms and the need to account for interactions in multivariable models (which would render regression coefficients difficult to interpret). Separate analyses were performed considering observations from all patients with AR, patients with AR only or patients with AR+asthma [<span>7</span>].</p><p>We analysed 4008 days (reported by 2424 users) with information on utilities and 82,737 days (reported by 7905 users) with information on the EQ-5D VAS (Table S1).</p><p>We found moderate correlations between utilities and symptom VASs (coefficients from −0.38 to −0.41) or between the EQ-5D VAS and symptom VAS (coefficients from −0.3
尽管如此，我们还是观察到了效用和 EQ-5D VAS 的一致模式，即当 AR 症状控制恶化时，效用和 EQ-5D VAS 都会下降。这项研究的局限性包括移动医疗用户可能无法代表普通患者群体。另一个局限性是 AR 在不同个体之间以及同一个体内部的控制水平各不相同。为了最大限度地减少 AR 控制的潜在影响，我们根据症状控制水平进行了分层分析。最后，根据 EQ-5D-5L 健康档案而非标准赌博法估算了效用。在AR+哮喘患者中，哮喘症状是导致QoL下降幅度最大的症状。在单纯哮喘或哮喘+哮喘患者中，眼部和鼻部症状控制不佳对QoL的影响类似（表明哮喘不会影响眼部和鼻部症状对QoL的影响）。Lucas Leemann：数据分析、撰写-审阅和编辑。Holger J. Schünemann、Luís Filipe Azevedo、João A. Fonseca 和 Jean Bousquet：构思、撰写-审阅和编辑。Bernardo Sousa-Pinto：构思、数据分析、撰写-审阅和编辑。J.B.报告的个人酬金来自 Cipla、Menarini、Mylan、Novartis、Purina、Sanofi-Aventis、Teva、Uriach，其他酬金来自 KYomed-Innov，其他酬金来自 MASK-air SAS。H.S. 报告并制定了过敏性鼻炎及其对哮喘的影响（ARIA）指南，他所在的学术机构为此获得了研究经费。
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