Crisjana Bellamy, Kristin Chichester, Sarbjit Saini, Eric T. Oliver
{"title":"Low CCR3 Expression Is a Marker of Active Disease in Chronic Spontaneous Urticaria","authors":"Crisjana Bellamy, Kristin Chichester, Sarbjit Saini, Eric T. Oliver","doi":"10.1111/cea.14523","DOIUrl":"10.1111/cea.14523","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 9","pages":"703-705"},"PeriodicalIF":6.3,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418150","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}
Rory Chan, Chary Duraikannu, Mohamed Jaushal Thouseef, Brian Lipworth
<p>Fractional exhaled nitric oxide (FeNO) is a point-of-care breathing test that assesses IL13-mediated airway inflammation which is closely linked to severe asthma exacerbations [<span>1</span>]. Mucus plugging (MP) and bronchial wall thickening (BWT) have been identified as important asthma phenotypes [<span>2, 3</span>] and are, in turn, associated with elevated FeNO [<span>4</span>]. It is unknown, however, whether FeNO is a useful test when investigating asthma patients with MP or BWT.</p><p>We, therefore, performed a cross-sectional review of 55 consecutive patients with Global Initiative for Asthma (GINA) defined moderate-to-severe asthma who had a high-resolution computed tomography (HRCT) scan demonstrating the presence of MP or BWT between January 2019 and June 2023. Two senior thoracic radiologists interpreted all scans as previously described and were blinded to clinical information except for a diagnosis of persistent asthma. Briefly, MP was deemed present if any bronchopulmonary segments contained a fully obstructing plug, with a maximum score of 20 if all segments were obstructed [<span>2</span>]. BWT was considered evident if the wall area (WA) thickness exceeded 50% of the total airway area [<span>3</span>]. Patients were subsequently divided into tertiles according to FeNO.</p><p>FeNO (NIOX VERO, Circassia, UK) was performed according to American Thoracic Society (ATS) guidelines. Spirometry (Micromedical, Chatham, UK) values were obtained in triplicate as per ATS/European Respiratory Society (ERS) guidelines. A prednisolone prescription of 40 mg for at least 5 days in the preceding year constituted one severe asthma exacerbation. The Asthma Control Questionnaire (ACQ) was used to assess symptom control.</p><p>Statistical analysis was performed using SPSS v28 where differences in continuous variables were analysed using independent <i>T</i>-tests or Mann–Whitney <i>U</i>-tests. Categorical variables were analysed using chi-squared tests. A two-tailed alpha error of 0.05 was used to denote statistical significance. Caldicott Guardian approval (IGTCAL10360 and IGTCAL10810+) was obtained before any data collection.</p><p><i>N</i> = 38/55 (69%) and <i>n</i> = 34/55 (62%) patients exhibited a mucus plug score (MPS) ≥1 or WA ≥ 50%, respectively, whilst <i>n</i> = 17/55 (31%) patients exhibited both MPS ≥ 1 and WA ≥ 50%. Patient demographics are presented in Table 1.</p><p>The presence of elevated FeNO was associated with significantly worse forced expiratory volume in 1 s percentage predicted (FEV<sub>1</sub>%) in patients with MP (Table 1). In patients with BWT, more frequent severe exacerbations and worse symptom control was observed in those with higher FeNO (Table 1). Moreover, patients in both groups with raised FeNO exhibited higher blood eosinophils.</p><p>Previous studies have demonstrated greater FeNO levels and worse lung function in asthmatics with MP compared with those without [<span>2</span>]. The present study adds to t
{"title":"Fractional Exhaled Nitric Oxide Identifies Worse Outcomes in Asthmatics With Mucus Plugging and Bronchial Wall Thickening","authors":"Rory Chan, Chary Duraikannu, Mohamed Jaushal Thouseef, Brian Lipworth","doi":"10.1111/cea.14525","DOIUrl":"10.1111/cea.14525","url":null,"abstract":"<p>Fractional exhaled nitric oxide (FeNO) is a point-of-care breathing test that assesses IL13-mediated airway inflammation which is closely linked to severe asthma exacerbations [<span>1</span>]. Mucus plugging (MP) and bronchial wall thickening (BWT) have been identified as important asthma phenotypes [<span>2, 3</span>] and are, in turn, associated with elevated FeNO [<span>4</span>]. It is unknown, however, whether FeNO is a useful test when investigating asthma patients with MP or BWT.</p><p>We, therefore, performed a cross-sectional review of 55 consecutive patients with Global Initiative for Asthma (GINA) defined moderate-to-severe asthma who had a high-resolution computed tomography (HRCT) scan demonstrating the presence of MP or BWT between January 2019 and June 2023. Two senior thoracic radiologists interpreted all scans as previously described and were blinded to clinical information except for a diagnosis of persistent asthma. Briefly, MP was deemed present if any bronchopulmonary segments contained a fully obstructing plug, with a maximum score of 20 if all segments were obstructed [<span>2</span>]. BWT was considered evident if the wall area (WA) thickness exceeded 50% of the total airway area [<span>3</span>]. Patients were subsequently divided into tertiles according to FeNO.</p><p>FeNO (NIOX VERO, Circassia, UK) was performed according to American Thoracic Society (ATS) guidelines. Spirometry (Micromedical, Chatham, UK) values were obtained in triplicate as per ATS/European Respiratory Society (ERS) guidelines. A prednisolone prescription of 40 mg for at least 5 days in the preceding year constituted one severe asthma exacerbation. The Asthma Control Questionnaire (ACQ) was used to assess symptom control.</p><p>Statistical analysis was performed using SPSS v28 where differences in continuous variables were analysed using independent <i>T</i>-tests or Mann–Whitney <i>U</i>-tests. Categorical variables were analysed using chi-squared tests. A two-tailed alpha error of 0.05 was used to denote statistical significance. Caldicott Guardian approval (IGTCAL10360 and IGTCAL10810+) was obtained before any data collection.</p><p><i>N</i> = 38/55 (69%) and <i>n</i> = 34/55 (62%) patients exhibited a mucus plug score (MPS) ≥1 or WA ≥ 50%, respectively, whilst <i>n</i> = 17/55 (31%) patients exhibited both MPS ≥ 1 and WA ≥ 50%. Patient demographics are presented in Table 1.</p><p>The presence of elevated FeNO was associated with significantly worse forced expiratory volume in 1 s percentage predicted (FEV<sub>1</sub>%) in patients with MP (Table 1). In patients with BWT, more frequent severe exacerbations and worse symptom control was observed in those with higher FeNO (Table 1). Moreover, patients in both groups with raised FeNO exhibited higher blood eosinophils.</p><p>Previous studies have demonstrated greater FeNO levels and worse lung function in asthmatics with MP compared with those without [<span>2</span>]. The present study adds to t","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 9","pages":"706-708"},"PeriodicalIF":6.3,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14525","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418149","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}
Guillaume Pouessel, Timothy E. Dribin, Charles Tacquard, Luciana Kase Tanno, Victoria Cardona, Margitta Worm, Antoine Deschildre, Antonella Muraro, Lene H. Garvey, Paul J. Turner
In this review, we compare different refractory anaphylaxis (RA) management guidelines focusing on cardiovascular involvement and best practice recommendations, discuss postulated pathogenic mechanisms underlining RA and highlight knowledge gaps and research priorities. There is a paucity of data supporting existing management guidelines. Therapeutic recommendations include the need for the timely administration of appropriate doses of aggressive fluid resuscitation and intravenous (IV) adrenaline in RA. The preferred second-line vasopressor (noradrenaline, vasopressin, metaraminol and dopamine) is unknown. Most guidelines recommend IV glucagon for patients on beta-blockers, despite a lack of evidence. The use of methylene blue or extracorporeal life support (ECLS) is also suggested as rescue therapy. Despite recent advances in understanding the pathogenesis of anaphylaxis, the factors that lead to a lack of response to the initial adrenaline and thus RA are unclear. Genetic factors, such as deficiency in platelet activating factor-acetyl hydrolase or hereditary alpha-tryptasaemia, mastocytosis may modulate reaction severity or response to treatment. Further research into the underlying pathophysiology of RA may help define potential new therapeutic approaches and reduce the morbidity and mortality of anaphylaxis.
在这篇综述中，我们比较了不同的难治性过敏性休克（RA）管理指南，重点关注心血管参与和最佳实践建议，讨论了RA的假设致病机制，并强调了知识差距和研究重点。支持现有管理指南的数据很少。治疗建议包括：RA 患者需要及时给予适当剂量的积极液体复苏和静脉注射肾上腺素。首选的二线血管加压药（去甲肾上腺素、血管加压素、美他明醇和多巴胺）尚不明确。尽管缺乏证据，但大多数指南都建议使用β受体阻滞剂的患者静脉注射胰高血糖素。此外，还建议使用亚甲蓝或体外生命支持（ECLS）作为抢救疗法。尽管最近在了解过敏性休克的发病机制方面取得了进展，但导致对初始肾上腺素缺乏反应并进而导致 RA 的因素仍不清楚。遗传因素，如血小板活化因子乙酰水解酶缺乏或遗传性α-色氨酸血症、肥大细胞增多症可能会影响反应的严重程度或对治疗的反应。对 RA 潜在病理生理学的进一步研究可能有助于确定潜在的新治疗方法，降低过敏性休克的发病率和死亡率。
{"title":"Management of Refractory Anaphylaxis: An Overview of Current Guidelines","authors":"Guillaume Pouessel, Timothy E. Dribin, Charles Tacquard, Luciana Kase Tanno, Victoria Cardona, Margitta Worm, Antoine Deschildre, Antonella Muraro, Lene H. Garvey, Paul J. Turner","doi":"10.1111/cea.14514","DOIUrl":"10.1111/cea.14514","url":null,"abstract":"<p>In this review, we compare different refractory anaphylaxis (RA) management guidelines focusing on cardiovascular involvement and best practice recommendations, discuss postulated pathogenic mechanisms underlining RA and highlight knowledge gaps and research priorities. There is a paucity of data supporting existing management guidelines. Therapeutic recommendations include the need for the timely administration of appropriate doses of aggressive fluid resuscitation and intravenous (IV) adrenaline in RA. The preferred second-line vasopressor (noradrenaline, vasopressin, metaraminol and dopamine) is unknown. Most guidelines recommend IV glucagon for patients on beta-blockers, despite a lack of evidence. The use of methylene blue or extracorporeal life support (ECLS) is also suggested as rescue therapy. Despite recent advances in understanding the pathogenesis of anaphylaxis, the factors that lead to a lack of response to the initial adrenaline and thus RA are unclear. Genetic factors, such as deficiency in platelet activating factor-acetyl hydrolase or hereditary alpha-tryptasaemia, mastocytosis may modulate reaction severity or response to treatment. Further research into the underlying pathophysiology of RA may help define potential new therapeutic approaches and reduce the morbidity and mortality of anaphylaxis.</p>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 7","pages":"470-488"},"PeriodicalIF":6.3,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14514","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310202","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}
Early intervention and active management of infant atopic eczema may play a crucial role in limiting eczema severity and preventing the onset of immediate-type food allergy. Eczema management involves education, skincare and medications targeting skin inflammation and barrier repair. Topical corticosteroids are the mainstay of anti-inflammatory therapy, with nonsteroidal options available for some infants. Proactive therapy, addressing subclinical inflammation, is useful for preventing eczema flares, especially in infants with recurrent eczema flares despite reactive therapy. In clinical practice, holistic consideration of overall infant and family health is essential. Providing advice on maternal stress management, nutritional guidance and recommendations for proper sleep and lifestyle is crucial for the well-being of children and their families, not limited to eczema treatment alone.
{"title":"Management of Infant Atopic Eczema to Prevent Severe Eczema and Food Allergy","authors":"Kiwako Yamamoto-Hanada, Yukihiro Ohya","doi":"10.1111/cea.14515","DOIUrl":"10.1111/cea.14515","url":null,"abstract":"<div>\u0000 \u0000 <p>Early intervention and active management of infant atopic eczema may play a crucial role in limiting eczema severity and preventing the onset of immediate-type food allergy. Eczema management involves education, skincare and medications targeting skin inflammation and barrier repair. Topical corticosteroids are the mainstay of anti-inflammatory therapy, with nonsteroidal options available for some infants. Proactive therapy, addressing subclinical inflammation, is useful for preventing eczema flares, especially in infants with recurrent eczema flares despite reactive therapy. In clinical practice, holistic consideration of overall infant and family health is essential. Providing advice on maternal stress management, nutritional guidance and recommendations for proper sleep and lifestyle is crucial for the well-being of children and their families, not limited to eczema treatment alone.</p>\u0000 </div>","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 9","pages":"669-681"},"PeriodicalIF":6.3,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310183","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}
<p>Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide [<span>1</span>]. It is a chronic noncurable condition, which is defined by progressive respiratory symptoms and airflow limitation. Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024's guidelines suggest a short-acting beta 2 agonist (SABA) or a long-acting beta 2 agonists (LABA) initially with the addition of a long-acting muscarinic antagonist as necessary. Inhaled corticosteroids (ICS) are considered if a patient falls into Group E. The criteria for Group E include if patients have ≥2 moderate exacerbations or ≥1 leading to hospitalisation and if their eosinophils ≥300 cells per microliter. If a patient has concomitant asthma, patients should be treated following the asthma treatment guideline, so the use of an ICS is mandatory [<span>2</span>].</p><p>Disclaimer: This is an abstract of a Cochrane review ‘Inhaled corticosteroids versus placebo for stable chronic obstructive pulmonary disease’ published in <i>Cochrane Database of Systematic Reviews</i> 2023 Issue 3 10.1002/14651858.cd002991.pub4. Accessed 9 May 2024 (see www.cochranelibrary.com for information). Cochrane reviews are regularly updated as new evidence emerges and in response to feedback, and the Cochrane Library should be consulted for the more recent version of the review.</p><p>Thirty-six primary studies with 23,139 participants met the inclusion criteria. Mean age ranged from 52 to 67 years, and females were 0%–46% of participants. Studies recruited across the severities of COPD. Seventeen studies were of duration longer than 3 months and up to 6 months and 19 studies were of duration longer than 6 months. We judged the overall risk of bias as low.</p><p>Long-term (more than 6 months) use of ICS as monotherapy reduced the mean rate of exacerbations in those studies where pooling of data was possible (generic inverse variance analysis: rate ratio 0.88 exacerbations per participant per year, 95% confidence interval (CI) 0.82–0.94; <i>I</i><sup>2</sup> = 48%, 5 studies, 10,097 participants; moderate-certainty evidence; pooled means analysis: mean difference (MD) −0.05 exacerbations per participant per year, 95% CI −0.07 to −0.02; <i>I</i><sup>2</sup> = 78%, 5 studies, 10,316 participants; moderate-certainty evidence). ICS slowed the rate of decline in quality of life, as measured by the St George's Respiratory Questionnaire (MD −1.22 units/year, 95% CI −1.83 to −0.60; <i>I</i><sup>2</sup> = 0%; 5 studies, 2507 participants; moderate-certainty evidence; minimal clinically importance difference 4 points). There was no evidence of a difference in all-cause mortality in people with COPD (odds ratio (OR) 0.94, 95% CI 0.84–1.07; <i>I</i><sup>2</sup> = 0%; 10 studies, 16,636 participants; moderate-certainty evidence). Long-term use of ICS reduced the rate of decline in FEV1 in people with COPD (generic inverse variance analysis: MD 6.31 mL/year benefit, 95% CI 1.76–10.85; <i>I</
{"title":"Inhaled Corticosteroids Versus Placebo for Stable Chronic Obstructive Pulmonary Disease","authors":"Erin Kamalanathan, Sargam Sharma","doi":"10.1111/cea.14521","DOIUrl":"10.1111/cea.14521","url":null,"abstract":"<p>Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide [<span>1</span>]. It is a chronic noncurable condition, which is defined by progressive respiratory symptoms and airflow limitation. Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024's guidelines suggest a short-acting beta 2 agonist (SABA) or a long-acting beta 2 agonists (LABA) initially with the addition of a long-acting muscarinic antagonist as necessary. Inhaled corticosteroids (ICS) are considered if a patient falls into Group E. The criteria for Group E include if patients have ≥2 moderate exacerbations or ≥1 leading to hospitalisation and if their eosinophils ≥300 cells per microliter. If a patient has concomitant asthma, patients should be treated following the asthma treatment guideline, so the use of an ICS is mandatory [<span>2</span>].</p><p>Disclaimer: This is an abstract of a Cochrane review ‘Inhaled corticosteroids versus placebo for stable chronic obstructive pulmonary disease’ published in <i>Cochrane Database of Systematic Reviews</i> 2023 Issue 3 10.1002/14651858.cd002991.pub4. Accessed 9 May 2024 (see www.cochranelibrary.com for information). Cochrane reviews are regularly updated as new evidence emerges and in response to feedback, and the Cochrane Library should be consulted for the more recent version of the review.</p><p>Thirty-six primary studies with 23,139 participants met the inclusion criteria. Mean age ranged from 52 to 67 years, and females were 0%–46% of participants. Studies recruited across the severities of COPD. Seventeen studies were of duration longer than 3 months and up to 6 months and 19 studies were of duration longer than 6 months. We judged the overall risk of bias as low.</p><p>Long-term (more than 6 months) use of ICS as monotherapy reduced the mean rate of exacerbations in those studies where pooling of data was possible (generic inverse variance analysis: rate ratio 0.88 exacerbations per participant per year, 95% confidence interval (CI) 0.82–0.94; <i>I</i><sup>2</sup> = 48%, 5 studies, 10,097 participants; moderate-certainty evidence; pooled means analysis: mean difference (MD) −0.05 exacerbations per participant per year, 95% CI −0.07 to −0.02; <i>I</i><sup>2</sup> = 78%, 5 studies, 10,316 participants; moderate-certainty evidence). ICS slowed the rate of decline in quality of life, as measured by the St George's Respiratory Questionnaire (MD −1.22 units/year, 95% CI −1.83 to −0.60; <i>I</i><sup>2</sup> = 0%; 5 studies, 2507 participants; moderate-certainty evidence; minimal clinically importance difference 4 points). There was no evidence of a difference in all-cause mortality in people with COPD (odds ratio (OR) 0.94, 95% CI 0.84–1.07; <i>I</i><sup>2</sup> = 0%; 10 studies, 16,636 participants; moderate-certainty evidence). Long-term use of ICS reduced the rate of decline in FEV1 in people with COPD (generic inverse variance analysis: MD 6.31 mL/year benefit, 95% CI 1.76–10.85; <i>I</","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 7","pages":"455-458"},"PeriodicalIF":6.3,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14521","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310182","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}
George Doumat, Joumane El Zein, Geneva D. Mehta, Zhaozhong Zhu, Ying Shelly Qi, Janice A. Espinola, Ashley F. Sullivan, Kohei Hasegawa, Carlos A. Camargo Jr
{"title":"Prospective Study of Vitamin D Status and Risk of Developing Specific Immunoglobulin E During Mid-Childhood","authors":"George Doumat, Joumane El Zein, Geneva D. Mehta, Zhaozhong Zhu, Ying Shelly Qi, Janice A. Espinola, Ashley F. Sullivan, Kohei Hasegawa, Carlos A. Camargo Jr","doi":"10.1111/cea.14511","DOIUrl":"10.1111/cea.14511","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 8","pages":"627-630"},"PeriodicalIF":6.3,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283154","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}
{"title":"Cross-Sensitisation Between Sesame and Other Seeds in Children","authors":"Francesca Mori, Giulia Trippella, Claudia Valleriani, Mattia Giovannini, Simona Barni, Silvia Ricci, Giulia Liccioli, Lucrezia Sarti, Leonardo Tomei, Benedetta Pessina, Erika Paladini, Riccardo Pertile, Elisabetta De Angelis, Linda Monaci","doi":"10.1111/cea.14510","DOIUrl":"10.1111/cea.14510","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 8","pages":"624-626"},"PeriodicalIF":6.3,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283174","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}
<p>Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the oesophagus first described in the 1970s.<span><sup>1</sup></span> All ages can be affected; however, it is more common in males and adults. Estimates of incidence in Europe and the United States range from 1.3 to 12.8 cases per 100,000.<span><sup>2</sup></span></p><p>Presenting symptoms vary widely between patients, including dysphagia, pain and food bolus impaction/obstruction.<span><sup>1-3</sup></span> EoE often coexists with other atopic diseases, and evidence supports an underlying mechanism of type-2 inflammatory response to food antigens.<span><sup>1, 2</sup></span> Diagnosis is made with a peak eosinophil count of ≥15 eosinophils/0.3 mm<sup>2</sup> on oesophageal histology.<span><sup>1, 3</sup></span> Recently, a group in France published on their automated, accurate and reproducible method to assess eosinophilic density and degree of degranulation, which poses time-saving advantages.<span><sup>4</sup></span></p><p>Treatment of EoE is lifelong, aiming to prevent fibrostenosis and strictures.<span><sup>3</sup></span> Elimination diets and corticosteroids have been used for many years, and biologics are now available for some patients. This Cochrane Corner will summarize the effectiveness and safety of medical interventions for people with EoE and put these in a useful, clinical context for the practising clinician.</p><p>This review comprised 41 RCTs involving 3253 participants with EoE. The primary interventions evaluated were corticosteroids versus placebo and biologics versus placebo; however, the review incorporated RCTs examining 19 intervention–comparisons of dietary modification or medication, including leukotriene receptor antagonists and transcutaneous patches. While children and adults were included, the authors felt the evidence had limited applicability to under 18 s.<span><sup>1</sup></span></p><p>For induction of remission, the authors concluded that corticosteroids improve histologic outcomes, and biologic anti-IL13 and anti-IL4r therapies may improve clinical outcomes (Figure 1). With no head-to-head trials, factors such as cost, acceptability and the burden of treatment are important to consider.</p><p>Budesonide respules (1 mg twice-daily) are estimated $2316/quarter, with fluticasone (440 mcg twice-daily) costing $691/quarter.<span><sup>5</sup></span> Comparatively, a quarterly supply of dupilumab (300 mg weekly), the only biologic currently licensed for EoE (US and EU, not UK, for over 12 s weighing >40 kg) would cost around $15,600.<span><sup>6</sup></span></p><p>A six-food elimination diet is estimated to cost around $710/quarter for a single male living alone, and patients need to visit multiple stores to purchase a nutritionally balanced grocery shop.<span><sup>7</sup></span> Hidden expenses affect patients on elimination diets as they require more endoscopies than those on corticosteroids, costing more in missed working hours and hospit
{"title":"Medical treatment of eosinophilic esophagitis","authors":"Hannah F. Marshall, Melvin Lee Qiyu","doi":"10.1111/cea.14509","DOIUrl":"10.1111/cea.14509","url":null,"abstract":"<p>Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the oesophagus first described in the 1970s.<span><sup>1</sup></span> All ages can be affected; however, it is more common in males and adults. Estimates of incidence in Europe and the United States range from 1.3 to 12.8 cases per 100,000.<span><sup>2</sup></span></p><p>Presenting symptoms vary widely between patients, including dysphagia, pain and food bolus impaction/obstruction.<span><sup>1-3</sup></span> EoE often coexists with other atopic diseases, and evidence supports an underlying mechanism of type-2 inflammatory response to food antigens.<span><sup>1, 2</sup></span> Diagnosis is made with a peak eosinophil count of ≥15 eosinophils/0.3 mm<sup>2</sup> on oesophageal histology.<span><sup>1, 3</sup></span> Recently, a group in France published on their automated, accurate and reproducible method to assess eosinophilic density and degree of degranulation, which poses time-saving advantages.<span><sup>4</sup></span></p><p>Treatment of EoE is lifelong, aiming to prevent fibrostenosis and strictures.<span><sup>3</sup></span> Elimination diets and corticosteroids have been used for many years, and biologics are now available for some patients. This Cochrane Corner will summarize the effectiveness and safety of medical interventions for people with EoE and put these in a useful, clinical context for the practising clinician.</p><p>This review comprised 41 RCTs involving 3253 participants with EoE. The primary interventions evaluated were corticosteroids versus placebo and biologics versus placebo; however, the review incorporated RCTs examining 19 intervention–comparisons of dietary modification or medication, including leukotriene receptor antagonists and transcutaneous patches. While children and adults were included, the authors felt the evidence had limited applicability to under 18 s.<span><sup>1</sup></span></p><p>For induction of remission, the authors concluded that corticosteroids improve histologic outcomes, and biologic anti-IL13 and anti-IL4r therapies may improve clinical outcomes (Figure 1). With no head-to-head trials, factors such as cost, acceptability and the burden of treatment are important to consider.</p><p>Budesonide respules (1 mg twice-daily) are estimated $2316/quarter, with fluticasone (440 mcg twice-daily) costing $691/quarter.<span><sup>5</sup></span> Comparatively, a quarterly supply of dupilumab (300 mg weekly), the only biologic currently licensed for EoE (US and EU, not UK, for over 12 s weighing >40 kg) would cost around $15,600.<span><sup>6</sup></span></p><p>A six-food elimination diet is estimated to cost around $710/quarter for a single male living alone, and patients need to visit multiple stores to purchase a nutritionally balanced grocery shop.<span><sup>7</sup></span> Hidden expenses affect patients on elimination diets as they require more endoscopies than those on corticosteroids, costing more in missed working hours and hospit","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 6","pages":"374-377"},"PeriodicalIF":6.1,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.14509","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080548","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}
Roberto Privato, Alessia Nucci, Simona Barni, Miriam Allegro, Mattia Giovannini, Lucrezia Sarti, Giulia Liccioli, Leonardo Tomei, Benedetta Pessina, Marco De Luca, Francesca Mori
{"title":"Association between educational interventions and anaphylaxis management over 20 years in a large paediatric emergency department","authors":"Roberto Privato, Alessia Nucci, Simona Barni, Miriam Allegro, Mattia Giovannini, Lucrezia Sarti, Giulia Liccioli, Leonardo Tomei, Benedetta Pessina, Marco De Luca, Francesca Mori","doi":"10.1111/cea.14508","DOIUrl":"10.1111/cea.14508","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 8","pages":"621-623"},"PeriodicalIF":6.3,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141070619","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}
{"title":"Nutritional disorders prevalence among adults with immunoglobin E-mediated food allergy","authors":"Vesna Vukičević Lazarević, Isabel J. Skypala","doi":"10.1111/cea.14507","DOIUrl":"10.1111/cea.14507","url":null,"abstract":"","PeriodicalId":10207,"journal":{"name":"Clinical and Experimental Allergy","volume":"54 11","pages":"930-932"},"PeriodicalIF":6.3,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141070621","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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